Author: Ophthalmology

Wide-Field Fundus Autofluorescence Imaging of Retinitis Pigmentosa – Corrected Proof

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Purpose: To evaluate the clinical usefulness of wide-field fundus autofluorescence (FAF) imaging in patients with retinitis pigmentosa (RP).Design: Cross-sectional case series.Participants: Seventy-five eyes of 75 patients with RP.Methods: We examined the eyes of the RP patients using the Optos 200Tx imaging system (Optos PLC, Dunfermline, United Kingdom) and identified abnormal FAF patterns such as ring hyperautofluorescence and patchy hypoautofluorescent areas. Patients with hyperautofluorescent rings or foveal hyperautofluorescence were compared with those without such findings. We determined the percentage area occupied by the FAF abnormalities within a defined region of the eye and examined the relationship between the percentage area of these abnormalities and the visual field area. Moreover, we categorized the patients into 3 different groups based on the presence of a patchy hypoautofluorescent lesion larger than 1 disc diameter: Group A consisted of those with patchy lesions smaller than 1 disc diameter, group B consisted of those with patchy lesions larger than 1 disc diameter but present in only 1 quadrant, and group C consisted of those with patchy lesions larger than 1 disc diameter and present in more than 1 quadrant. In addition, various clinical characteristics were compared among these 3 groups.Main Outcome Measures: Predicting the visual field size and duration of the disease in RP patients based on FAF patterns.Results: Patients without hyperautofluorescent rings or foveal hyperautofluorescence had better visual acuity or mean deviation measured with a Humphrey perimeter. The total area of the abnormal FAF image correlated with the visual field area measured with a Goldmann perimeter (R = −0.64, P<0.001). The individuals with the large patchy hypofluorescent areas (i.e., larger than 1 disc diameter) were older than those with small patchy hypofluorescent areas (group A vs. groups B and C, P = 0.002 and P<0.001, respectively) and had experienced the symptoms for longer durations (group A vs. groups B and C, P<0.05 and P<0.001, respectively).Conclusions: We can estimate the visual field in patients with RP using the objective measurements from wide-field FAF. The presence of patchy hypofluorescent lesions can be used an indicator of the duration of RP.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Characterization of a Clinician–Scientist Cohort in Ophthalmology: A Demographic Analysis of K Grant Awardees in Ophthalmology – Corrected Proof

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Objective: To analyze ophthalmologists who are National Institutes of Health (NIH) K grant awardees to characterize clinician–scientists in ophthalmology.Design: Cohort study.Participants: Ophthalmologists who have received a K award from 1996 through 2010.Methods: K08 and K23 grant awardees were identified through the NIH Research Portfolio Online Reporter database. Information including gender, institution, educational degrees, and success in obtaining an R01 grant was analyzed.Main Outcome Measures: Receipt of an R01 grant.Results: One hundred five ophthalmologists were identified who received K08 or K23 grants from the National Eye Institute from 1996 through 2010. Overall, 75% of these were male, although 43% of K awardees were women from 2006 through 2010. Sixty-five percent (68/105) of individuals came from ophthalmology departments that ranked in the top 20 of NIH funding in 2010. The most predominant subspecialties represented were retina (32%), cornea (22%), and glaucoma (15%). Among the K awardees, 40% (42/105) had a doctor of philosophy (PhD) degree in addition to their medical doctor degree. From 1996 through 2000, 61% (23/38) were successful in obtaining an R01 grant, whereas only 13% (5/39) from 2001 through 2005 obtained R01 grants (P<0.001).Conclusions: Gender disparities exist among K awardees in ophthalmology, but these seem to be improving over time. None of the other variables studied—gender, PhD degree, specialty, or funding tier—was associated with obtaining R01 funding. This study helps to characterize the clinician–scientist cohort in ophthalmology and to identify areas to improve the recruitment of these individuals.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Characteristics of Incident Geographic Atrophy in the Complications of Age-Related Macular Degeneration Prevention Trial – Corrected Proof

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Objective: To characterize the size, location, conformation, and features of incident geographic atrophy (GA) as detected by annual stereoscopic color photographs and fluorescein angiograms (FAs).Design: Retrospective cohort study within a larger clinical trial.Participants: Patients with bilateral large drusen in whom GA developed during the course of the Complications of Age-related Macular Degeneration Prevention Trial (CAPT).Methods: Annual stereoscopic color photographs and FAs were reviewed from 114 CAPT patients in whom GA developed in the untreated eye during 5 to 6 years of follow-up. Geographic atrophy was defined according to the Revised GA Criteria for identifying early GA.23 Color-optimized fundus photographs were viewed concurrently with the FAs during grading.Main Outcome Measures: Size and distance from the fovea of individual GA lesions, number of areas of atrophy, and change in visual acuity (VA) when GA first developed in an eye.Results: At presentation, the median total GA area was 0.26 mm2 (0.1 disc area). Geographic atrophy presented as a single lesion in 89 (78%) eyes. The median distance from the fovea was 395 μm. Twenty percent of incident GA lesions were subfoveal and an additional 18% were within 250 μm of the foveal center. Development of GA was associated with a mean decrease of 7 letters from the baseline VA level compared with 1 letter among matched early age-related macular degeneration eyes without GA. Geographic atrophy that formed in areas previously occupied by drusenoid pigment epithelial detachments on average were larger (0.53 vs. 0.20 mm2; P = 0.0001), were more central (50 vs. 500 μm from the center of the fovea; P<0.0001), and were associated with significantly worse visual outcome (20/50 vs. 20/25; P = 0.0003) than GA with other drusen types as precursors.Conclusions: Incident GA most often appears on color fundus photographs and FAs as a small, singular, parafoveal lesion, although a large minority of lesions are subfoveal or multifocal at initial detection. The characteristics of incident GA vary with precursor drusen types. These data can facilitate design of future clinical trials of therapies for GA.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Evaluation of Lamina Cribrosa in Pseudoexfoliation Syndrome Using Spectral-Domain Optical Coherence Tomography Enhanced Depth Imaging – Corrected Proof

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Purpose:
To evaluate the features of the lamina cribrosa (LC) in pseudoexfoliation glaucoma (PXG) patients using enhanced depth imaging (EDI) of spectral-domain optical coherence tomography (SD OCT). The results were compared with those of patients with primary open-angle glaucoma (POAG).

Design:
Cross-sectional study.

Participants:
Patients with PXG (n = 21) and POAG (n = 35) matched for age and visual field mean deviation (VF MD).

Methods:
Participants were imaged using SD OCT. Lamina cribrosa thickness (LT) and anterior lamina cribrosa depth (ALD) were determined at 3 areas (mid superior, center, and mid inferior) by 2 examiners using an EDI mode of the optic nerve head.

Main Outcome Measures:
The LT and ALD were compared between PXG and POAG eyes.

Results:
Mean ± standard deviation baseline untreated intraocular pressure was not significantly different between the 2 groups (PXG, 18.3±8.2 mmHg; POAG, 15.3±3.4 mmHg; P = 0.310). The mean VF MD was −12.7±9.0 dB in the PXG group versus −11.6±9.1 dB in the POAG group (P = 0.643). When compared with the POAG group, the PXG group demonstrated a significantly thinner LT in all 3 areas and a thinner mean LT (133.4±14.5 μm in the POAG group vs. 121.3±13.0 μm in the PXG group; P<0.001). Anterior lamina cribrosa depth did not demonstrate a significant difference in any of the 3 areas between both groups (mean ALD, 324.3±91.9 μm in the POAG group vs. 358.7±142.7 μm in the PXG group; P = 0.470). Of 21 eyes in the PXG group, 9 eyes demonstrated a unilateral clinical presentation. When we compared the PXG eyes and the apparently normal-looking fellow eyes of those 9 eyes, neither the LT nor ALD demonstrated a significant difference (P = 0.223 and P = 0.079, respectively).

Conclusions:
Eyes with PXG demonstrate a thinner LC compared with POAG eyes at similar levels of glaucoma severity.

Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Pseudoexfoliation: Normative Data and Associations: The Beijing Eye Study 2011 – Corrected Proof

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Objective: To assess the prevalence of pseudoexfoliation syndrome (PEX) and its associations in a population-based setting.Design: Population-based, cross-sectional cohort study.Participants: Of 4403 eligible subjects with an age of ≥50 years, 3468 individuals (78.8%) participated in the Beijing Eye Study 2011 (mean age, 64.6±9.8 years; range, 50–93 years).Methods: All study participants underwent a detailed ophthalmologic examination. After medical pupil dilation, PEX was assessed by an experienced ophthalmologist using slit-lamp-based biomicroscopy.Main Outcome Measures: Prevalence and associations of PEX.Results: Slit-lamp examination results were available for 3022 study participants (87.1%). Definite pseudoexfoliation was observed in 72 of the 3022 subjects, with a prevalence of 2.38% (95% confidence interval [CI], 1.84–2.93). Suspected PEX was detected in 104 of the subjects (3.44%; 95% CI, 2.8–4.1). The overall prevalence of PEX (definite and suspected) was 176 of 3022 or 5.82% (95% CI, 4.99–6.66). In 80 subjects (45.5%), PEX was detected in both eyes, whereas it was detected only in the right eye in 42 subjects (23.9%) and only in the left eye in 54 (30.7%). The prevalence of PEX increased from 1.1% in among those 50 to 54 years old, to 3.5%, 5.7%, and 11.8% among those 60 to 64 years, 70 to 74 years, and ≥80 years, respectively. In multivariate analysis, presence of PEX was significantly associated with older age (P<0.001; odds ratio [OR], 1.08; 95% CI, 1.04–1.10), shorter axial length (P = 0.03; OR, 0.82; 95% CI, 0.68,0.98), and shallower anterior chamber (P = 0.03; OR, 0.59; 95% CI, 0.36–0.95). We found that PEX was not associated (all P>0.05) with sex, diabetes mellitus, blood pressure, psychological depression, smoking, dyslipidemia, body mass index, central corneal thickness, corneal diameter, optic nerve head measurements, choroidal thickness, retinal vessel diameters, early age-related macular degeneration, or retinal vein occlusion.Conclusions: In a North Chinese population aged ≥50 years, the prevalence of definite PEX was 2.38% (95% CI, 1.84–2.93), suspect PEX was 3.4% (95% CI, 2.8–4.1) and overall PEX was 5.82% (95% CI, 4.99–6.66). We found PEX to be associated with older age, shorter axial length, and shallower anterior chamber. The relationship between PEX and glaucomatous optic neuropathy remained inconclusive among our population.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

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A National Survey of Practice Patterns: Temporal Artery Biopsy – Corrected Proof

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Objective: To assess current clinical practice patterns for temporal artery biopsy (TAB) among clinicians in establishing the diagnosis of giant cell arteritis.Design: A survey was sent via e-mail using the Survey Monkey website (www.surveymonkey.com; accessed January 24, 2013). The survey initially was sent in July 2010 and continued through October 2010.Participants: The survey was sent via e-mail to the members and affiliates of the American Society of Ophthalmic Plastic and Reconstructive Surgery, the North American Neuro-Ophthalmology Society, and the American College of Rheumatology.Methods: Data from the survey were collected via Survey Monkey and data analysis was performed using the Fisher exact test and Wilcoxon rank-sum test.Main Outcome Measures: Response to the survey questions on primary unilateral versus bilateral biopsy, performing second-side biopsy if first side results were negative, and the duration for which biopsy findings are reliable after initiating immunosuppressive therapy.Results: The self-described primary subspecialty of the 1074 respondents was as follows: oculoplastic surgery (n = 127), neuro-ophthalmology (n = 119), rheumatology (n = 799), and other (n = 28). Overall, 66% of respondents advocated initial unilateral TAB, 18% advocated bilateral biopsy in all cases, and 16% recommended either unilateral or bilateral TAB depending on the degree of clinical suspicion. Rheumatologists were 4.5 times more likely to advocate initial bilateral biopsy than neuro-ophthalmologists or oculoplastic surgeons (P<0.0001, Fisher exact test). Most respondents believed that biopsy results were accurate for more than 14 days. These results were not affected by stratification of years in practice by the Kruskal-Wallis rank-sum test.Conclusions: Temporal artery biopsy practices vary greatly among treating physicians. This lack of consensus underscores the need for a systematic assessment of varying practice patterns.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Publication Times, Impact Factors, and Advance Online Publication in Ophthalmology Journals – Corrected Proof

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Objective: Publication speed of peer-reviewed journals may play a major role in early dissemination of knowledge and may raise the citation index. In this study, we evaluated the publication speed of ophthalmology journals.Design: Observational study.Participants: Observational study of bibliometric data in published ophthalmology journals.Methods: A list of ophthalmic journals featured in the 2010 Journal Citation Report was obtained on September 1, 2011. A total of 12 articles were chosen randomly from each of these journals published between January and December 2010. Median publication time and interquartile range (IQR) were obtained from the full texts of the published articles.Main Outcome Measures: Time lag between submission and revision, acceptance, and publication of the manuscripts was calculated. Correlation between publication time lag and journal impact factor as well as advance online publication was analyzed.Results: A total of 51 ophthalmic journals were included. There was no statistically significant difference in the impact factors of journals based on their reporting of submission, revision, or acceptance times of the manuscripts (both P>0.05, Wilcoxon test). The median peer review and publication time of all ophthalmology journals was 133 days (IQR, 100.5–171.5) and 100 days (IQR, 62.9–166.3), respectively. There was no correlation between the journal impact factors and publication time lag (Spearman correlation). Approximately half of the ophthalmology journals (n = 26; 50.98%) published online in advance. Journals with advance online publication had higher impact factors compared with those without this feature (median, 1.692 [IQR, 1.05–2.80] vs. 1.02 [0.39–1.53]; P = 0.015, Mann–Whitney U test). For journals with advance online publication, the median time from acceptance to advance online publication (74.3 days [IQR, 48.3–115 days]) was significantly shorter than the median time between acceptance and print publication (170.75 days [IQR, 101.4–217 days]; P<0.001, Wilcoxon test).Conclusions: Publication time lag in ophthalmology journals was not correlated with journal impact factors. Advance online publication facility was provided by only half of the ophthalmology journals published in 2010. Journals with advance online publication had a higher impact factor compared with those without this feature.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Visual Outcomes after Blunt Ocular Trauma – Corrected Proof

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Objective: To describe the prognosis and retinal location in patients presenting with acute traumatic maculopathy and extramacular retinal injuries.Design: Retrospective, noninterventional case series.Participants and Controls: All patients presenting with commotio retinae or sclopetaria retinae to the Birmingham Midland Eye Centre Eye Casualty from October 1, 2007, to February 23, 2011.Methods: The notes of all patients presenting with ocular trauma in the specified time period were examined to identify suitable patients and demographic and injury data were extracted.Main Outcome Measures: Outcome was assessed by visual acuity (VA).Results: For macular commotio retinae, 53 patients were identified, of whom 34 had adequate follow-up to determine final VA. The median presenting VA was 20/40; 25 patients (74%) recovered to ≥20/30. The median extent of visual recovery was 0.18 logarithm of the minimum angle of resolution (logMAR). For extramacular commotio retinae, 117 patients were identified, of whom 58 had adequate follow-up to determine final VA. The median presenting VA retinae was 20/30; 55 patients (95%) recovered to ≥20/30. The median extent of visual recovery was logMAR 0.076. There was 1 case of extramacular sclopetaria retinae. The 3 most common retinal locations of extramacular commotio retinae, in order of frequency, were inferotemporal (37%), temporal (17%), and superotemporal (17%); <5% of cases were in a nasal location.Conclusions: This is the first report on the prognosis of acute traumatic maculopathy and extramacular commotio retinae. After macular injury, 26% of patients were left with a VA of ≤20/30, although the proportion with visual impairment is higher than this because (1) a deterioration from 20/15 to 20/30 is significant to many patients; and (2) additional patients are visually impaired by symptomatic paracentral visual field defects despite a normal VA. Reduced VA after extramacular commotio retinae may represent occult macular injury or previously undiagnosed visual impairment in the affected eye. Extramacular commotio occurs mostly in an inferotemporal to temporal location, consistent with direct trauma to the sclera overlying the injured retina.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

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