Objective: To compare spectacle independence in patients randomized to receive bilateral multifocal intraocular lenses (IOLs) or monofocal IOLs with the powers adjusted to produce monovision.Design: Randomized, multicenter clinical trial.Participants: A total of 212 patients with bilateral, visually significant cataract.Methods: Before bilateral sequential cataract surgery, patients were randomized (allocation ratio 1:1) to receive bilateral Tecnis ZM900 diffractive multifocal lenses (Abbott Medical Optics, Santa Ana, CA) or Akreos AO monofocal lenses (Bausch & Lomb, Rochester, NY) with the powers adjusted to target −1.25 diopters (D) monovision. Outcomes were assessed 4 months after the second eye underwent operation.Main Outcome Measures: The primary outcome was spectacle independence. Secondary outcomes included questionnaires (VF-11R, dysphotopsia symptoms, and satisfaction) and visual function measures (near, intermediate, and distance logarithm of minimum angle of resolution [logMAR] visual acuity, stereoacuity, contrast sensitivity, and forward light scatter).Results: A total of 212 patients were randomized, and 187 patients (88%) returned for assessment 4 months after surgery. Uniocular distance refractions in the monovision arm showed a mean spherical equivalent of +0.075 D in the distance eye and −0.923 in the near eye. In the multifocal arm, the mean distance spherical equivalents were −0.279 D and −0.174 D in the right and left eyes, respectively. A total of 24 of 93 patients (25.8%) in the monovision arm and 67 of 94 patients (71.3%) in the multifocal arm reported never wearing glasses (P < 0.001, Fisher exact test). The adjusted odds ratio of being spectacle free was 7.51 (95% confidence interval, 3.89–14.47). Binocular uncorrected acuities did not differ significantly for distance (0.058 logMAR for monovision vs. 0.076 for multifocal, P = 0.3774) but were significantly worse in the multifocal arm for intermediate acuity (0.149 vs. 0.221, P = 0.0001) and in the monovision arm for near acuity (0.013 vs. −0.025, P = 0.037). In the first postoperative year, 6 patients (5.7%) in the multifocal arm underwent IOL exchange (4 had a bilateral and 2 had a unilateral exchange). No patients in the monovision arm underwent IOL exchange.Conclusions: Patients randomized to bilateral implantation with the diffractive multifocal Tecnis ZM900 were more likely to report being spectacle independent but also more likely to undergo IOL exchange than those randomized to receive monofocal implants (Akreos AO) with the powers adjusted to give low monovision.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Category: Peer-reviewed
Trabeculectomy in the 21st Century: A Multicenter Analysis – Corrected Proof
Objective: To evaluate the efficacy and safety of current trabeculectomy surgery in the United Kingdom.Design: Cross-sectional, multicenter, retrospective follow-up.Participants: A total of 428 eyes of 395 patients.Methods: Consecutive trabeculectomy cases with open-angle glaucoma and no previous incisional glaucoma surgery from 9 glaucoma units were evaluated retrospectively. Follow-up was a minimum of 2 years.Main Outcome Measures: Surgical success, intraocular pressure (IOP), visual acuity, complications, and interventions. Success was stratified according to IOP, use of hypotensive medications, bleb needling, and resuturing/revision for hypotony. Reoperation for glaucoma and loss of perception of light were classified as failures.Results: Antifibrotics were used in 400 cases (93%): mitomycin C (MMC) in 271 (63%), 5-fluorouracil (5-FU) in 129 (30%), and no antifibrotic in 28 (7%). At 2 years, IOP (mean ± standard deviation) was 12.4±4 mmHg, and 342 patients (80%) achieved an IOP ≤21 mmHg and 20% reduction of preoperative IOP without IOP-lowering medication, whereas 374 patients (87%) achieved an IOP ≤21 mmHg and 20% reduction of preoperative IOP overall. An IOP ≤18 mmHg and 20% reduction of preoperative IOP were achieved by 337 trabeculectomies (78%) without IOP-lowering treatment and by 367 trabeculectomies (86%) including hypotensive medication. Postoperative treatments included suture manipulation in 184 patients (43%), resuturing or revision for hypotony in 30 patients (7%), bleb needling in 71 patients (17%), and cataract extraction in 111 of 363 patients (31%). Subconjunctival 5-FU injection was performed postoperatively in 119 patients (28%). Visual loss of >2 Snellen lines occurred in 24 of 428 patients (5.6%). A total of 31 of the 428 patients (7.2%) had late-onset hypotony (IOP <6 mmHg after 6 months). In 3 of these, visual acuity decreased by >2 Snellen lines. Bleb leaks were observed in 59 cases (14%), 56 (95%) of which occurred within 3 months. Two patients developed blebitis. Bleb-related endophthalmitis developed in 1 patient within 1 month postoperatively and in 1 patient at 3 years. There was an endophthalmitis associated with subsequent cataract surgery.Conclusions: This survey shows that good trabeculectomy outcomes with low rates of surgical complications can be achieved, but intensive proactive postoperative care is required.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
The Association between Scholarly Impact and National Institutes of Health Funding in Ophthalmology – Corrected Proof
Objective: To examine whether there is an association between scholarly impact, as measured by the h-index, academic rank, and National Institutes of Health (NIH) awards in academic ophthalmology.Design: Retrospective analysis of NIH RePORTER and Scopus databases.Participants: Not applicable.Methods: Five hundred seventy-three NIH awards to 391 primary investigators (PIs) in ophthalmology departments were examined. Grant recipients were organized by academic rank, obtained from online listings, and h-index, calculated using the Scopus database. Non–NIH-funded faculty from 20 randomly chosen academic ophthalmology departments also were organized by rank and h-index for comparison with their NIH-funded colleagues.Main Outcome Measures: Scholarly impact, as measured by the h-index, and NIH funding.Results: The h-index increased with successive academic rank among non–NIH-funded and NIH-funded faculty, as did NIH funding among the latter group. The NIH-funded faculty had higher scholarly impact, as measured by the h-index, than their non–NIH-funded PIs (h = 18.3 vs. 7.8; P < 0.0001), even when considering publications only in the prior 5 years; h-index increased with increasing NIH funding ranges. The h-indices of those holding an MD degree (21.4±1.6 standard error of mean) were not statistically higher than those of PhD holders (17.9±0.6) and those with both an MD and PhD degree (18.1±1.7; P = 0.14).Conclusions: The h-index increases with increasing academic rank among NIH-funded and non–NIH-funded faculty in ophthalmology departments. This bibliometric is associated strongly with NIH funding because NIH-funded PIs had higher scholarly impact than their non–NIH-funded colleagues, and increasing impact was noted with higher funding. The h-index is an objective and easily calculable measure that may be valuable as an adjunct in assessing research productivity, a significant factor for academic promotion in academic ophthalmology.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Pharmacogenetic Associations with Vascular Endothelial Growth Factor Inhibition in Participants with Neovascular Age-Related Macular Degeneration in the IVAN Study – Corrected Proof
Purpose: To determine if prespecified genetic polymorphisms influence responsiveness to vascular endothelial growth factor (VEGF) inhibition in neovascular age-related macular degeneration (nAMD). The objectives were to replicate 3 reported pharmacogen…
What is the Value of Incorporating Tear Osmolarity Measurement in Assessing Patient Response to Therapy in Dry Eye Disease? – Corrected Proof
Purpose: To evaluate the correlation between changes in tear osmolarity, symptoms, and corneal fluorescein staining in patients with dry eye disease (DED).Design: Retrospective, clinic-based cohort study.Methods: In this single-institution study, we reviewed the charts of 186 patients with DED from whom we had data on tear osmolarity, symptoms, and corneal fluorescein staining from 2 separate visits. Main outcomes included the correlation of the changes between the 2 visits for tear osmolarity (TearLab system), symptoms (Ocular Surface Disease Index), and corneal fluorescein staining (modified Oxford scheme). For tear osmolarity and corneal fluorescein staining the scores from the eye with highest readings were analyzed. The correlations were repeated on subgroups based on proposed cutoffs for DED severity and on patients’ treatment.Results: We found a modest, though statistically significant, correlation between changes in corneal fluorescein staining and symptoms of DED (R = 0.31; P < .001). However, there was no correlation between the recorded change in tear osmolarity and symptoms (R = −0.091; P = .38) or between changes in tear osmolarity and corneal fluorescein staining (R = −0.02; P = .80). This lack of correlation was consistent in all the subgroups studied. A multivariate analysis revealed that changes in corneal fluorescein staining had predictive value on symptom changes, whereas tear osmolarity changes did not.Conclusions: Changes in tear osmolarity do not correlate significantly with changes in patient symptoms or corneal fluorescein staining in dry eye disease.
The Vast Complexity of Primary Open Angle Glaucoma: Disease Genes, Risks, Molecular Mechanisms and Pathobiology
Publication date: Available online 19 September 2013
Source:Progress in Retinal and Eye Research
Author(s): Sarah F. Janssen , Theo G.M.F. Gorgels , Wishal D. Ramdas , Caroline C.W. Klaver , Cornelia M. van Duijn , Nomdo M. Jansonius , Arthur A.B. Bergen
Primary open angle glaucoma (POAG) is a complex progressive optic nerve neuropathy triggered by both environmental and genetic risk factors. Several ocular tissues, including the ciliary body, trabecular meshwork and optic nerve head, and perhaps even brain tissues, are involved in a chain of pathological events leading to POAG.Genetic risk evidence for POAG came from family linkage-studies implicating a small number of disease genes (MYOC, OPTN, WDR36). Recent Genome Wide Association Studies (GWAS) identified a large number of new POAG loci and disease genes, such as CAV1, CDKN2B and GAS7. In the current study, we reviewed over 120 family and GWA studies. We selected in total 65 (candidate) POAG disease genes and proceeded to assess their function, mRNA expression in POAG relevant eye tissues and possible changes in disease state. We found that the proteins corresponding to these 65 (candidate) POAG disease genes take part in as few as four common functional molecular networks. Functions attributed to these 4 networks were developmental (dys)function, lipid metabolism, and inflammatory processes. For the 65 POAG disease genes, we reviewed the available (transgenic) mouse models of POAG, which may be useful for future functional studies. Finally, we showed that the 65 (candidate) POAG genes substantially increased the specificity and sensitivity of a discriminative POAG risk test. This suggests that personal risk assessment and personalized medicine for POAG are on the horizon. Taken together, the data presented are essential to comprehend the role of genetic variation in POAG, and may provide leads to understand the pathophysiology of POAG as well as other neurodegenerative disorders, such as Alzheimer’s disease.
Diagnosis of Occult Melanoma Using Transient Receptor Potential Melastatin 1 (TRPM1) Autoantibody Testing: A Novel Approach – Corrected Proof
Purpose: To report the first case of melanoma-associated retinopathy (MAR) and underlying occult melanoma diagnosed based on the presence of serum transient receptor potential melastatin 1 (TRPM1) autoantibodies.Design: Interventional case report with …
The International Vitreomacular Traction Study Group Classification of Vitreomacular Adhesion, Traction, and Macular Hole – Corrected Proof
Objective: The International Vitreomacular Traction Study (IVTS) Group was convened to develop an optical coherence tomography (OCT)-based anatomic classification system for diseases of the vitreomacular interface (VMI).Design: The IVTS applied their c…
The Ocular Consequences and Applicability of Minimally Invasive 25-Gauge Transvitreal Retinochoroidal Biopsy – Corrected Proof
Objective: To determine the applicability and ocular morbidity of the 25-gauge transvitreal retinochoroidal biopsy technique in the management of intraocular tumors.Design: Retrospective, consecutive, observational, single-surgeon case series.Participa…
Visual Impairment and Blindness in Spanish Adults: Geographic Inequalities Are Not Explained by Age or Education – Corrected Proof
Objectives: The objectives of this study were to examine for the first time the prevalence of visual impairment and blindness among adults in Spain, to explore regional differences, and to assess whether they may vary as a function of sex or be explain…
Retinal Nerve Fiber Layer Progression in Glaucoma: A Comparison between Retinal Nerve Fiber Layer Thickness and Retardance – Corrected Proof
Objective: To investigate the performance of spectral-domain optical coherence tomography (OCT) and scanning laser polarimetry to detect progressive retinal nerve fiber layer (RNFL) changes and to determine whether reduction of the RNFL retardance occu…
Mortality in Patients with Central Retinal Vein Occlusion – Corrected Proof
Purpose: To assess mortality in patients with central retinal vein occlusion (CRVO).Design: Registry-based cohort study.Participants and Controls: Four hundred thirty-nine photographically verified CRVO patients and a control cohort of 2195 unexposed s…
Teaching Ophthalmoscopy to Medical Students (the TOTeMS Study) – Corrected Proof
Purpose: To determine medical student preferences for learning the ocular fundus examination and to assess their accuracy using different examination modalities.Design: Prospective, randomized study of medical student education approaches.Methods: First-year medical students received training in direct ophthalmoscopy using simulators and human volunteers. Students were randomized to receive vs not receive specific training on interpreting fundus photographs prior to accuracy assessments. Students’ preferences for each of the 3 methods (direct ophthalmoscopy on simulators or human volunteers, or use of fundus photographs) and recognition of normal and abnormal fundus features were assessed.Results: Of 138 first-year medical students, 119 (86%) completed all required elements. For learning ophthalmoscopy, 85 (71%) preferred humans to simulators. For learning relevant features of the ocular fundus, 92 (77%) preferred photographs to ophthalmoscopy on simulators or humans. Accuracy of answers was better when interpreting fundus photographs than when performing ophthalmoscopy on simulators (P < .001). Performance improved after specific teaching about assessing fundus photographs before testing (P = .02). Examination of the ocular fundus was found easier and less frustrating when using photographs than when using ophthalmoscopy on simulators or humans. Eighty-four students (70%) said they would prefer to have fundus photographs instead of using the ophthalmoscope during upcoming clinical rotations.Conclusions: Students preferred fundus photographs for both learning and examining the ocular fundus. Identification of ocular fundus features was more accurate on photographs compared to examination by direct ophthalmoscopy. In the future, the increasing availability of nonmydriatic ocular fundus photography may allow replacement of direct ophthalmoscopy in many clinical settings for non-ophthalmologists.
Cuticular Drusen: Stars in the sky
Publication date: Available online 9 September 2013 Source:Progress in Retinal and Eye Research Author(s): Camiel J.F. Boon , Johannes P.H. van de Ven , Carel B. Hoyng , Anneke I. den Hollander , B. Jeroen Klevering Cuticular drus…
Assessment of Choroidal Thickness and Volume during the Water Drinking Test by Swept-Source Optical Coherence Tomography – Corrected Proof
Objective: To evaluate changes in peripapillary and macular choroidal thickness and volume after the water-drinking test (WDT) using swept-source optical coherence tomography (SS OCT).Design: Prospective, cross-sectional, observational study.Participants: Fifty-six eyes of 28 healthy volunteers.Methods: Participants underwent a 3-dimensional optic disc and macula scanning protocol with a prototype SS OCT (Topcon, Inc., Tokyo, Japan) at baseline and 15, 30, 45, and 120 minutes after the start of the WDT. The WDT consisted of drinking 1000 ml of water within 5 minutes. Objective measurements of the choroid were obtained with automated segmentation of the choroidal boundaries.Main Outcome Measures: Choroidal thickness and volume.Results: Mean age±standard deviation of participants was 35.6±9.1 years. Intraocular pressure (IOP) increased from 14.9±2.7 mmHg at baseline to a peak of 16.8±3.0 mmHg 15 minutes after the WDT (P < 0.001). Mean baseline choroidal thickness and volume were 181.3±50.8 μm and 6.19±1.80 mm3, respectively, at the optic disc and 217.4±43.6 μm and 7.83±1.55 mm3, respectively, at the macula. After the WDT, peripapillary and macular choroidal thickness increased by a maximum of 5.7% (P < 0.001) and 4.3% (P < 0.001), respectively. Choroidal volumes increased by 6.4% (P < 0.001) and 3.9% (P < 0.001), respectively. There was no association between change in IOP and peripapillary (P = 0.27) or macular (P = 0.09) choroidal thickness.Conclusions: Using automated segmentation of SS OCT measurements, significant increases in choroidal thickness and volume are observed after the WDT in healthy subjects.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Risk of Pseudophakic Retinal Detachment in 202 226 Patients Using the Fellow Nonoperated Eye as Reference – Corrected Proof
Purpose: To study the risk of pseudophakic retinal detachment (PRD) after first-eye phacoemulsification cataract surgery in Denmark relative to the risk of retinal detachment (RD) in the patients’ fellow nonoperated eyes.Design: Register-based cohort s…
Bromfenac Ophthalmic Solution 0.07% (Prolensa) Dosed Once Daily for Cataract Surgery: Results of 2 Randomized Controlled Trials – Corrected Proof
Purpose: To evaluate the efficacy and ocular safety of bromfenac ophthalmic solution 0.07% dosed once daily for the treatment of ocular inflammation and pain in subjects who underwent cataract surgery with posterior chamber intraocular lens implantation.Design: Two phase 3, randomized, double-masked, placebo-controlled, multicenter clinical trials.Participants: Four hundred forty subjects (440 study eyes: 222 in the bromfenac group and 218 in the placebo group).Methods: Two phase 3, prospective, randomized, double-masked, placebo-controlled clinical trials were conducted at 39 ophthalmology clinics in the United States. Subjects 18 years of age or older were randomized to receive either bromfenac 0.07% or placebo dosed once daily beginning 1 day before cataract surgery, on the day of surgery, and continuing for 14 days after surgery (for a total of 16 days). Subjects were evaluated on days 1, 3, 8, 15, and 22 after surgery. The primary efficacy end point was cleared ocular inflammation, as measured by the summed ocular inflammation score of zero (anterior chamber cell count = 0 and absence of flare) by day 15. Secondary end points included cleared ocular inflammation at day 15 and the number of subjects who were pain free at day 1. The data from the 2 clinical trials were integrated for analyses.Main Outcome Measures: Summed ocular inflammation score and ocular pain.Results: A significantly higher proportion of subjects treated with bromfenac 0.07% achieved complete clearance of ocular inflammation by day 15 and at day 15 compared with placebo (P < 0.0001). A statistically significantly higher proportion of subjects in the bromfenac 0.07% group were pain free at all study visits compared with those in the placebo group (P < 0.0001). Fewer subjects in the bromfenac group (3.2%) discontinued investigational product early because of a lack of efficacy than in the placebo group (23.9%; P < 0.0001). The incidence of adverse events was significantly lower in the bromfenac 0.07% group compared with the placebo group (P = 0.0041).Conclusions: Bromfenac ophthalmic solution 0.07% dosed once daily was clinically safe and effective compared with placebo for the treatment of ocular inflammation and pain in subjects who had undergone cataract surgery and may be a beneficial addition to the current standard of care, which commonly includes ophthalmic antibiotics and corticosteroids.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Retinal Connectomics: Towards Complete, Accurate Networks
Publication date: Available online 7 September 2013 Source:Progress in Retinal and Eye Research Author(s): Robert E. Marc , Bryan W. Jones , Carl B. Watt , James R. Anderson , Crystal Sigulinsky , Scott Lauritzen Connectomics is …
Systemic Diagnostic Testing in Patients With Apparently Isolated Uveal Coloboma – Corrected Proof
Purpose: To investigate the frequency and types of systemic findings in patients with apparently isolated uveal coloboma.Design: Cross-sectional observational study.Methods: setting: Single-center ophthalmic genetics clinic. study population: Ninety-nine patients with uveal coloboma seen at the National Eye Institute. observational procedure: Results of audiology testing, echocardiogram, brain magnetic resonance imaging, renal ultrasound, and total spine radiographs. main outcome measure: Prevalence of abnormal findings on systemic testing.Results: Uveal coloboma affected only the anterior segment in 8 patients, only the posterior segment in 23 patients, and both anterior and posterior segments in 68 patients. Best-corrected visual acuity (BCVA) of eyes with coloboma was ≥20/40 in 45% of eyes; 23% of eyes had BCVA of ≤20/400. The majority of patients (74%) had good vision (>20/60) in at least 1 eye. Ten of the 19 patients (53%) who underwent echocardiography had abnormalities, with ventral septal defects being the most prevalent. Abnormal findings were observed in 5 of 72 patients (7%) who had a renal ultrasound and in 5 of 29 patients (17%) who underwent a brain MRI. Audiology testing revealed abnormalities in 13 of 75 patients (17%), and spine radiographs showed anomalies in 10 of 77 patients (13%). Most findings required no acute intervention.Conclusions: Although some patients with coloboma had evidence of extraocular abnormalities, the majority of findings on routine clinical examination did not require acute intervention, but some warranted follow-up. Results from the systemic evaluation of patients with coloboma should be interpreted with caution and in view of their clinical context.
Infliximab for the Treatment of Refractory Noninfectious Uveitis: A Study of 88 Patients with Long-term Follow-up – Corrected Proof
Objective: To establish the safety and efficacy of infliximab for the treatment of refractory noninfectious uveitis.Design: Retrospective, interventional, noncomparative cohort study.Participants: Eighty-eight patients from a single-center private practice.Methods: Patients with chronic, recalcitrant uveitis treated with infliximab (Remicade; Janssen Biotech, Inc., Titusville, NJ) were identified through an electronic medical record database. All charts were reviewed for sex, diagnosis, location of inflammation, presence of vasculitis, prior immunomodulatory treatments, duration of infliximab treatment, dose received, secondary side effects, and other medications continued while receiving treatment with infliximab.Main Outcome Measures: The primary outcome measures were the rate of remission, time to remission, relapse rate, failure rate, and patient tolerance. Additional analysis aimed to identity risk factors that would predict a higher success rate of infliximab to treat various types of noninfectious uveitis.Results: Of the 72 patients (81.8%) who achieved clinical remission while being treated with infliximab, 42 (58.3%) required additional immunomodulatory medications. At 7, 18.1, and 44.7 weeks, 25%, 50%, and 75% of patients, respectively, achieved clinical remission off all corticosteroids. Thirty-two patients (36.4%) experienced at least 1 side effect while on infliximab therapy, and 17 patients (19.3%) discontinued treatment secondary to 1 or more intolerable side effects. The most common adverse effects were skin rash (9.1%) and fatigue (8%). Factors associated with a higher chance to achieve clinical remission were nonidiopathic uveitis (P < 0.001), intermediate or panuveitis (P < 0.001), absence of vasculitis (P < 0.001), and a starting dose ≥5 mg/kg (P < 0.011).Conclusions: Infliximab induces a high rate of complete clinical remission in recalcitrant uveitis and is well tolerated by most patients.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.