Objective: To report the 2-year incidence of raised intraocular pressure (IOP) and glaucomatous optic nerve damage in patients with uveitis randomized to either fluocinolone acetonide (FA) implants or systemic therapy. Secondarily, we sought to explore patient and eye characteristics associated with IOP elevation or nerve damage.Design: A randomized, partially masked trial in which patients were randomized to either FA implants or systemic therapy.Participants: Patients aged ≥13 years with noninfectious intermediate, posterior, or panuveitis active within the prior 60 days for which systemic corticosteroids were indicated were eligible.Methods: Visual fields were obtained at baseline and every 12 months using the Humphrey 24-2 Swedish interactive threshold algorithm fast protocol. Stereoscopic optic nerve photos were taken at baseline and at 3-, 6-, 12-, and 24-month follow-up visits. Masked examiners measured IOP at every study visit.Main Outcome Measures: Glaucoma was diagnosed based on an increase in optic nerve cup-to-disc ratio with visual field worsening or increased cup-to-disc ratio alone, for cases where visual field change was not evaluable, because of missing data or severe visual field loss at baseline.Results: Most patients were treated as assigned; among those evaluated for glaucoma, 97% and 10% of patients assigned to implant and systemic treatment, respectively, received implants. More patients (65%) assigned to implants experienced an IOP elevation of ≥10 mmHg versus 24% assigned to systemic treatment (P<0.001). Similarly, 69% of patients assigned to the implant required IOP-lowering therapy versus 26% in the systemic group (P<0.001). Glaucomatous optic nerve damage developed in 23% versus 6% (P<0.001) of implant and systemic patients, respectively. In addition to treatment assignment, black race, use of IOP-lowering medications, and uveitis activity at baseline were associated with incident glaucoma (P<0.05).Conclusions: Implant-assigned eyes had about a 4-fold risk of developing IOP elevation of ≥10 mmHg and incident glaucomatous optic neuropathy over the first 2 years compared with those assigned to systemic therapy. Central visual acuity was unaffected. Aggressive IOP monitoring with early treatment (often including early filtration surgery) is needed to avoid glaucoma when vision-threatening inflammation requires implant therapy.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Author: Ophthalmology
Analysis of a Novel Protocol of Pulsed Intravenous Cyclophosphamide for Recalcitrant or Severe Ocular Inflammatory Disease – Corrected Proof
Purpose: To analyze the success rate of pulsed intravenous (IV) cyclophosphamide (CyP) for noninfectious ocular inflammatory disease and to identify risk factors for failure of therapy.Design: Retrospective, interventional, noncomparative cohort study.Participants: One hundred ten eyes of 65 patients.Methods: Through a computer search of the Massachusetts Eye Research and Surgery Institution’s database, we identified patients who were treated with IV CyP between May 2005 and April 2012. We obtained demographic and clinical information through review of the electronic health record of each patient.Main Outcomes Measures: Clinical response, corticosteroid-sparing effect, recurrence rate, calculated “risk factors” for failure, visual acuity, and adverse reactions.Results: Pulsed IV CyP achieved complete remission of inflammation (for ≥2 visits) in 54 patients (84.4%). Sustained remission of inflammation occurred in 70% of patients within 3 months, 86.6% of patients within 6 months, and 91.7% within 9 months. The mean time to achieving quiescence was 3.5 months. The success rate in reducing corticosteroid to prednisone ≤10 mg/d within 6 months, while maintaining control of ocular inflammation, was 89.7% (95% confidence interval [CI], 81.1–93.5%). The mean duration of clinical remission for those patients who had a positive response to CyP was 32.67 months (95% CI, 25.91–39.43). Relapse of vasculitis was observed in 1 patient (1.5%) after completing the course of therapy. Early initiation of therapy during the course of the disease was correlated with a lesser rate of recurrence (P = 0.028). The most common adverse effects were nausea (29%) and transient lymphopenia (26%). The mean best-corrected visual acuity (BCVA) improved from 0.59±0.66 at baseline to 0.30±0.54 at 6 months of follow-up (P<0.001). The mean follow-up period was 31.61±20.47 months.Conclusions: Pulsed IV CyP employing our protocol results in an extremely high rate of sustained complete remission in patients with recalcitrant and fulminant, vision-threatening ocular inflammatory disorders, with an excellent safety profile in the hands of physicians trained and skilled in the art of this therapy. It also allows tapering and discontinuing corticosteroids in most patients. Early initiation of therapy may decrease the risk of relapses.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
Strategy for the Management of Uncomplicated Retinal Detachments: The European Vitreo-Retinal Society Retinal Detachment Study Report 1 – Corrected Proof
Objective: To study success and failure in the treatment of uncomplicated rhegmatogenous retinal detachments (RRDs).Design: Nonrandomized, multicenter retrospective study.Participants: One hundred seventy-six surgeons from 48 countries spanning 5 conti…
Strategy for the Management of Complex Retinal Detachments: The European Vitreo-Retinal Society Retinal Detachment Study Report 2 – Corrected Proof
Objective: To study the outcome of the treatment of complex rhegmatogenous retinal detachments (RRDs).Design: Nonrandomized, multicenter, retrospective study.Participants: One hundred seventy-six surgeons from 48 countries spanning 5 continents reporte…
Actinic Granuloma of the Conjunctiva in Young Women – Corrected Proof
Objective: To report the occurrence of actinic granuloma of the conjunctiva in young women.Design: Retrospective case series.Participants: Three eyes of 3 young women with a unilateral conjunctival mass of recent onset.Methods: Three young women (21, 2…
Proximal Tarsal Attachments of the Levator Aponeurosis: Implications for Blepharoptosis Repair – Corrected Proof
Purpose: To examine the tarsal attachments of the levator aponeurosis.Design: Experimental anatomic study.Participants: Sixteen orbits from 12 fresh frozen white cadavers.Methods: Eight specimens served as controls. In the remaining 8 specimens from 4 …
Ocular Manifestations of Xeroderma Pigmentosum: Long-Term Follow-up Highlights the Role of DNA Repair in Protection from Sun Damage – Corrected Proof
Objective: Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by mutations in DNA repair genes. Clinical manifestations of XP include mild to extreme sensitivity to ultraviolet radiation resulting in inflammation and neoplasia in s…
Corneal Collagen Cross-linking with Riboflavin and Ultraviolet A Irradiation for Keratoconus: Long-term Results – Corrected Proof
Purpose:
To evaluate the long-term results of corneal collagen cross-linking (CXL) in patients with progressive keratoconus.
Design:
Prospective case series.
Participants:
This study was conducted on 40 eyes of 32 patients with progressive kerato…
Screening for Diabetic Retinopathy with or without a Copayment in a Randomized Controlled Trial: Influence of the Inverse Care Law – Corrected Proof
Objective:
To examine whether the inverse care law operates in a screening program for diabetic retinopathy (DR) based on fee for service in Hong Kong.
Design:
Randomized controlled trial.
Participants:
All those with type 1 or 2 diabetes from 2 clinics were recruited.
Intervention:
Diabetic retinopathy screening with a small copayment versus free access in a publicly funded family medicine service.
Main Outcome Measures:
Uptake of screening and severity of DR detected. Association between these outcome variables and independent variables were determined using multivariate logistic regression models and reported as odds ratios (ORs).
Results:
After randomization, 1387 subjects in the free group and 1379 subjects in the pay group were eligible for screening, and 94.9% (1316/1387) and 92.6% (1277/1379), respectively, agreed to participate in the study. The offer of screening was accepted by 94.8% (1247/1316) in the free group and 91.2% (1164/1277) in the pay group, and the final uptake ratios were 88.5% (1165/1316) and 82.4% (1052/1277), respectively (Pearson chi = 19.74, P<0.001). Being in the pay group was associated with a lower uptake of screening than being in the free group (OR, 0.59; confidence interval [CI], 0.47–0.74) and a lower detection rate of DR (OR, 0.73; CI, 0.60–0.90) after adjustment for potential confounding factors. Subjects with higher socioeconomic status were more likely to attend screening and had a lower prevalence of DR detected.
Conclusions:
The inverse care law seems to operate in a preventive intervention when a relatively small copayment is applied. There is a case for making effective preventive services free of charge.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Conjunctivochalasis Interferes with Tear Flow from Fornix to Tear Meniscus – Corrected Proof
Purpose:
To determine whether conjunctivochalasis (CCh) interferes with tear flow from the fornix to the tear meniscus and depletes the fornix tear reservoir.
Design:
Comparative case series.
Participants:
The study group of 24 CCh patients (8 as…
Long-Term Effects of Vitamins C and E, β-Carotene, and Zinc on Age-Related Macular Degeneration: AREDS Report No. 35 – Corrected Proof
Objective: To describe the long-term effects (10 years) of the Age-Related Eye Disease Study (AREDS) formulation of high-dose antioxidants and zinc supplement on progression of age-related macular degeneration (AMD).Design: Multicenter, randomized, controlled, clinical trial followed by an epidemiologic follow-up study.Participants: We enrolled 4757 participants with varying severity of AMD in the clinical trial; 3549 surviving participants consented to the follow-up study.Methods: Participants were randomly assigned to antioxidants C, E, and β-carotene and/or zinc versus placebo during the clinical trial. For participants with intermediate or advanced AMD in 1 eye, the AREDS formulation delayed the progression to advanced AMD. Participants were then enrolled in a follow-up study. Eye examinations were conducted with annual fundus photographs and best-corrected visual acuity assessments. Medical histories and mortality were obtained for safety monitoring. Repeated measures logistic regression was used in the primary analyses.Main Outcome Measures: Photographic assessment of progression to, or history of treatment for, advanced AMD (neovascular [NV] or central geographic atrophy [CGA]), and moderate visual acuity loss from baseline (≥15 letters).Results: Comparison of the participants originally assigned to placebo in AREDS categories 3 and 4 at baseline with those originally assigned to AREDS formulation at 10 years demonstrated a significant (P<0.001) odds reduction in the risk of developing advanced AMD or the development of NV AMD (odds ratio [OR], 0.66, 99% confidence interval [CI], 0.53–0.83 and OR, 0.60; 99% CI, 0.47–0. 78, respectively). No significant reduction (P = 0.93) was seen for the CGA (OR, 1.02; 99% CI, 0.71–1.45). A significant reduction (P = 0.002) for the development of moderate vision loss was seen (OR 0.71; 99% CI, 0.57–0.88). No adverse effects were associated with the AREDS formulation. Mortality was reduced in participants assigned to zinc, especially death from circulatory diseases.Conclusions: Five years after the clinical trial ended, the beneficial effects of the AREDS formulation persisted for development of NV AMD but not for CGA. These results are consistent with the original recommendations that persons with intermediate or advanced AMD in 1 eye should consider taking the AREDS formulation.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Corneal Collagen Cross-Linking for Ectasia after LASIK and Photorefractive Keratectomy: Long-Term Results – Corrected Proof
Purpose:
To report the long-term results of corneal collagen cross-linking (CXL) in ectasia after LASIK and photorefractive keratectomy (PRK).
Design:
Retrospective, interventional cases series.
Participants:
Twenty-six eyes of 26 patients (18 male, 8 female) with postoperative ectasia after LASIK (23 eyes) and PRK (3 eyes) were included with a mean age of 35±9 years at the time of treatment and a mean follow-up of 25 months (range, 12–62 months).
Methods:
All consecutive patients treated with CXL for progressive ectasia after LASIK or PRK at the Institute for Refractive and Ophthalmic Surgery, Zurich, Switzerland between 2004 and 2010 were included.
Main Outcome Measures:
Corrected distance visual acuity (CDVA), maximum keratometry readings (Kmax), minimum radius of curvature (Rmin), and 6 corneal topography indices were assessed in this study.
Results:
Mean CDVA before CXL was 0.5 logarithm of the minimum angle of resolution (logMAR) units, which improved to a mean of 0.3 logMAR units (P<0.001). Corrected distance visual acuity improved 1 line or more in 19 cases and remained unchanged in 7 patients. Mean Kmax after CXL of 50.9±4.9 diopters (D) was significantly lower (P<0.001) than mean pre-CXL Kmax of 52.8±5 D. The Rmin after CXL was increased significantly (P = 0.006), whereas the index of surface variance (P = 0.03), the index of vertical asymmetry (P = 0.04), the keratoconus index (P = 0.03), and the central keratoconus index (P = 0.016) were reduced significantly.
Conclusions:
Ectasia after LASIK and PRK was arrested by CXL with stabilization or improvement of CDVA and Kmax after a mean follow-up of 25 months. There were improvements in 4 topography indices, suggesting a more regular corneal surface.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Long-Term Outcomes of Neoadjuvant Intra-arterial Cytoreductive Chemotherapy for Lacrimal Gland Adenoid Cystic Carcinoma – Corrected Proof
Purpose: To compare the long-term outcomes after intra-arterial cytoreductive chemotherapy (IACC) with conventional treatment for lacrimal gland adenoid cystic carcinoma (ACC).Design: Retrospective case series.Participants: Nineteen consecutive patients treated with IACC, followed by orbital exenteration, chemoradiotherapy, and intravenous chemotherapy.Interventions: Analyses of the histologic characteristics of biopsy specimens, extent of disease at the time of diagnosis, diagnostic surgical procedures, incidence of locoregional recurrences or distant metastases, disease-free survival time, response to IACC, tumor margins at definitive surgery, and toxicity and complications.Main Outcome Measures: Disease relapse, disease-free survival, and chemotherapeutic complications.Results: Eight patients with an intact lacrimal artery had significantly better outcomes for survival (100% vs. 28.6% at 10 years), cause-specific mortality, and recurrences (all P = 0.002, log-rank test) than conventionally treated patients from the University of Miami Miller School of Medicine. These 8 patients (group 1) had cumulative 10-year disease-free survival of 100% compared with 50% for 11 patients (group 2) who had an absence of the lacrimal artery or deviated from the treatment protocol (P = 0.035) and 14.3% for conventionally treated patients (P<0.001). Likewise, group 2 was associated with lower cause-specific mortality than the institutional comparator group (P = 0.038). Prior tumor resection with lateral wall osteotomy, delay in IACC implementation or exenteration, and failure to adhere to protocol are risk factors for suboptimal outcomes.Conclusions: Neoadjuvant IACC seems to improve overall survival and decrease disease recurrence. An intact lacrimal artery, no disruption of bone barrier or tumor manipulation other than incisional biopsy, and protocol compliance are factors responsible for favorable outcomes. The chemotoxicity complication rate is limited and manageable.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Genetic Influences on the Outcome of Anti-Vascular Endothelial Growth Factor Treatment in Neovascular Age-related Macular Degeneration – Corrected Proof
Purpose: To determine the association of genetic variants in known age-related macular degeneration (AMD) risk-associated genes with outcome of anti-vascular endothelial growth factor (VEGF) treatment in neovascular AMD.Design: Prospective cohort study.Participants: We enrolled 224 consecutive patients with neovascular AMD at the Royal Victorian Eye and Ear Hospital, Australia.Methods: Patients were treated with 3 initial monthly ranibizumab or bevacizumab injections followed by 9 months of “as required” injections based on clinician’s decision at each follow-up visit according to retreatment criteria. Seventeen single nucleotide polymorphisms (SNPs) in known AMD risk-associated genes including CFH (rs800292, rs3766404, rs1061170, rs2274700 and rs393955), HTRA1 (rs11200638), CFHR1-5 (rs10922153, rs16840639, rs6667243, and rs1853883), LOC387715/ARMS2 (rs3793917 and rs10490924), C3 (rs2230199 and rs1047286), C2 (rs547154), CFB (rs641153) and F13B (rs6003) were examined. Multivariate analysis was used to determine the role of each SNP in treatment outcome.Main Outcome Measures: The influence of selected SNPs on mean change in visual acuity (VA) at 12 months.Results: Mean baseline VA was 51±16.8 Early Treatment Diabetic Retinopathy Study letters. Overall, the mean change in VA from baseline was +3.2±14.9 letters at 12 months. The AA (homozygote risk) genotype at rs11200638 – HTRA1 promoter SNP (P = 0.001) and GG (homozygote risk) genotype at rs10490924 (A69S) in LOC387715/ARMS2 (P = 0.002) were each significantly associated with poorer VA outcome at 12 months after multiple correction. Mean ± standard deviation change in VA from baseline in patients with AA genotype at rs11200638 was –2.9±15.2 letters after 12 months compared with +5.1±14.1 letters in patients with AG or GG genotypes at this SNP. Patients with either of these genotypes were also significantly more likely to lose >15 letters after 12 months. SNPs rs11200638 and rs10490924 were in high linkage disequilibrium (r2 = 0.92). None of the other examined SNPs was associated with outcome.Conclusions: The HTRA1 promoter SNP (rs11200638) and A69S at LOC387715/ARMS2 were associated with a poorer visual outcome for ranibizumab or bevacizumab treatment in neovascular AMD, suggesting strong pharmacogenetic associations with anti-VEGF treatment. This finding could aid in applying more individualized treatment regimens based on patients’ genotype to achieve optimal treatment response in AMD.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
Investigation of Genetic Variation in Scavenger Receptor Class B, Member 1 (SCARB1) and Association with Serum Carotenoids – Corrected Proof
Objective:
To investigate association of scavenger receptor class B, member 1 (SCARB1) genetic variants with serum carotenoid levels of lutein (L) and zeaxanthin (Z) and macular pigment optical density (MPOD).
Design:
A cross-sectional study of healthy adults aged 20 to 70.
Participants:
We recruited 302 participants after local advertisement.
Methods:
We measured MPOD by customized heterochromatic flicker photometry. Fasting blood samples were taken for serum L and Z measurement by high-performance liquid chromatography and lipoprotein analysis by spectrophotometric assay. Forty-seven single nucleotide polymorphisms (SNPs) across SCARB1 were genotyped using Sequenom technology. Association analyses were performed using PLINK to compare allele and haplotype means, with adjustment for potential confounding and correction for multiple comparisons by permutation testing. Replication analysis was performed in the TwinsUK and Carotenoids in Age-Related Eye Disease Study (CAREDS) cohorts.
Main Outcome Measures:
Odds ratios for MPOD area, serum L and Z concentrations associated with genetic variations in SCARB1 and interactions between SCARB1 and gender.
Results:
After multiple regression analysis with adjustment for age, body mass index, gender, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, smoking, and dietary L and Z levels, 5 SNPs were significantly associated with serum L concentration and 1 SNP with MPOD (P<0.01). Only the association between rs11057841 and serum L withstood correction for multiple comparisons by permutation testing (P<0.01) and replicated in the TwinsUK cohort (P = 0.014). Independent replication was also observed in the CAREDS cohort with rs10846744 (P = 2×10−4), an SNP in high linkage disequilibrium with rs11057841 (r2 = 0.93). No interactions by gender were found. Haplotype analysis revealed no stronger association than obtained with single SNP analyses.
Conclusions:
Our study has identified association between rs11057841 and serum L concentration (24% increase per T allele) in healthy subjects, independent of potential confounding factors. Our data supports further evaluation of the role for SCARB1 in the transport of macular pigment and the possible modulation of age-related macular degeneration risk through combating the effects of oxidative stress within the retina.
Financial Disclosure(s):
Proprietary or commercial disclosures may be found after the references.
Macular Hole Surgery in Patients with End-stage Choroideremia – Corrected Proof
Objective: To assess macular hole surgery in patients with end-stage choroideremia with regard to anatomic closure and visual outcome.Design: Retrospective, interventional case series.Participants: Thirty adult male patients with a diagnosis of advance…
Macular Hole Surgery in Patients with End-stage Choroideremia – Corrected Proof
Objective: To assess macular hole surgery in patients with end-stage choroideremia with regard to anatomic closure and visual outcome.Design: Retrospective, interventional case series.Participants: Thirty adult male patients with a diagnosis of advance…
Age-related Macular Degeneration and Modification of Systemic Complement Factor H Production Through Liver Transplantation – Corrected Proof
Purpose: To investigate whether modification of liver complement factor H (CFH) production, by alteration of liver CFH Y402H genotype through liver transplantation (LT), influences the development of age-related macular degeneration (AMD).Design: Multicenter, cross-sectional study.Participants: We recruited 223 Western European patients ≥55 years old who had undergone LT ≥5 years previously.Methods: We determined AMD status using a standard grading system. Recipient CFH Y402H genotype was obtained from DNA extracted from recipient blood samples. Donor CFH Y402H genotype was inferred from recipient plasma CFH Y402H protein allotype, measured using enzyme-linked immunosorbent assays. This approach was verified by genotyping donor tissue from a subgroup of patients. Systemic complement activity was ascertained by measuring levels of plasma complement proteins using an enzyme-linked immunosorbent assay, including substrates (C3, C4), activation products (C3a, C4a, and terminal complement complex), and regulators (total CFH, C1 inhibitor).Main Outcome Measures: We evaluated AMD status and recipient and donor CFH Y402H genotype.Results: In LT patients, AMD was associated with recipient CFH Y402H genotype (P = 0.036; odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0–2.4) but not with donor CFH Y402H genotype (P = 0.626), after controlling for age, sex, smoking status, and body mass index. Recipient plasma CFH Y402H protein allotype predicted donor CFH Y402H genotype with 100% accuracy (n = 49). Plasma complement protein or activation product levels were similar in LT patients with and without AMD. Compared with previously reported prevalence figures (Rotterdam Study), LT patients demonstrated a high prevalence of both AMD (64.6% vs 37.1%; OR, 3.09; P<0.001) and the CFH Y402H sequence variation (41.9% vs 36.2%; OR, 1.27; P = 0.014).Conclusions: Presence of AMD is not associated with modification of hepatic CFH production. In addition, AMD is not associated with systemic complement activity in LT patients. These findings suggest that local intraocular complement activity is of greater importance in AMD pathogenesis. The high AMD prevalence observed in LT patients may be associated with the increased frequency of the CFH Y402H sequence variation.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
Age-related Macular Degeneration and Modification of Systemic Complement Factor H Production Through Liver Transplantation – Corrected Proof
Purpose: To investigate whether modification of liver complement factor H (CFH) production, by alteration of liver CFH Y402H genotype through liver transplantation (LT), influences the development of age-related macular degeneration (AMD).Design: Multicenter, cross-sectional study.Participants: We recruited 223 Western European patients ≥55 years old who had undergone LT ≥5 years previously.Methods: We determined AMD status using a standard grading system. Recipient CFH Y402H genotype was obtained from DNA extracted from recipient blood samples. Donor CFH Y402H genotype was inferred from recipient plasma CFH Y402H protein allotype, measured using enzyme-linked immunosorbent assays. This approach was verified by genotyping donor tissue from a subgroup of patients. Systemic complement activity was ascertained by measuring levels of plasma complement proteins using an enzyme-linked immunosorbent assay, including substrates (C3, C4), activation products (C3a, C4a, and terminal complement complex), and regulators (total CFH, C1 inhibitor).Main Outcome Measures: We evaluated AMD status and recipient and donor CFH Y402H genotype.Results: In LT patients, AMD was associated with recipient CFH Y402H genotype (P = 0.036; odds ratio [OR], 1.6; 95% confidence interval [CI], 1.0–2.4) but not with donor CFH Y402H genotype (P = 0.626), after controlling for age, sex, smoking status, and body mass index. Recipient plasma CFH Y402H protein allotype predicted donor CFH Y402H genotype with 100% accuracy (n = 49). Plasma complement protein or activation product levels were similar in LT patients with and without AMD. Compared with previously reported prevalence figures (Rotterdam Study), LT patients demonstrated a high prevalence of both AMD (64.6% vs 37.1%; OR, 3.09; P<0.001) and the CFH Y402H sequence variation (41.9% vs 36.2%; OR, 1.27; P = 0.014).Conclusions: Presence of AMD is not associated with modification of hepatic CFH production. In addition, AMD is not associated with systemic complement activity in LT patients. These findings suggest that local intraocular complement activity is of greater importance in AMD pathogenesis. The high AMD prevalence observed in LT patients may be associated with the increased frequency of the CFH Y402H sequence variation.Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
Prevalence and Causes of Visual Impairment in Asian and Non-Hispanic White Preschool Children: Multi-Ethnic Pediatric Eye Disease Study – Corrected Proof
Purpose:
To determine the prevalence and causes of decreased visual acuity (VA).
Design:
Population-based cross-sectional study.
Participants:
Multi-ethnic sample of children 30 to 72 months of age identified in Los Angeles.
Methods:
All eligib…