Category: Peer-reviewed

Erratum

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With apologies from the editorial office, the Correspondence entitled, “Gene Expression Profiling vs. TNM Classification,” which printed in the May 2013 issue (Ophthalmology 2013;120:1109) erroneously included a statement that the authors of the or…

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Author reply

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We thank Sherwin et al for highlighting the importance of nonrefractive error as a cause of blindness and visual impairment in older Africans and the possibility that reporting refractive error as the leading cause of correctible vision loss could resu…

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Examining Absolute Risk of AMD in Relation to Cataract Surgery

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Cataract surgery is a common procedure in older adults. It is becoming more common not only by virtue of increasing age of the population, but also because of trends in ophthalmic practice and higher prevalence and incidence of late age-related macular degeneration (AMD) in persons who have had cataract surgery as has previously been reported. In the study by Klein et al, the maximally adjusted odds ratio (OR) for incidence of late AMD after cataract surgery compared with eyes with ≥1 type of cataract was 1.96 (95% confidence interval, 1.28–3.02). Including the presence and severity of early AMD lesions in the model somewhat attenuated the overall OR; however, the effect of surgery remained significant (P<0.05). Knowledge of the approximate doubling of the odds of late AMD is of limited use when making recommendations or decisions in clinical practice because this does not place the increased odds in the context of the actual risk. In the current report, we have described the adjusted attributable risk (AR) estimate and number needed to harm (NNH) to provide a measure of absolute risk when evaluating the effect of cataract surgery on incidence of late AMD.

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We are grateful to Dr Sangtam for the interest in our article, and for raising 2 interesting issues for further discussion. Based on previously available data, we find it hard to draw a simple conclusion that advanced and medically uncontrolled chron…

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Choroidal Thickness Changes After Intravitreal Ranibizumab and Photodynamic Therapy in Recurrent Polypoidal Choroidal Vasculopathy – Corrected Proof

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Purpose: To evaluate subfoveal choroidal thickness changes in cases with recurrent polypoidal choroidal vasculopathy (PCV) after combination therapy with intravitreal ranibizumab and photodynamic therapy (PDT).Design: Retrospective observational case series study.Methods: We measured subfoveal choroidal thickness in PCV using optical coherence tomography (OCT) before and after PDT. In recurrent cases, the choroidal thickness was measured at the time of the recurrence. In nonrecurrent cases, choroidal thickness was measured 1 year after PDT.Results: Combination therapy was performed in 27 eyes (27 patients). Polypoidal lesions regressed within 3 months after initial treatment in all eyes. Retreatment was needed in 10 of 27 eyes (37.0%) after more than 3 months of follow-up. In recurrent cases, subfoveal choroid decreased from 188 μm at baseline to 157 μm 3 months after PDT (P < .01); however, choroidal thickness increased to 179 μm with recurrence (P = .54 compared to baseline; average, 8.0 months). In nonrecurrent cases, subfoveal choroid decreased from 257 μm at baseline to 210 μm 3 months after PDT and 212 μm 1 year after PDT (P < .01, respectively).Conclusion: Subfoveal choroidal thickness in PCV at the time of recurrence returned to the baseline level after choroidal thinning as a result of PDT treatment. Choroidal thickness changes after PDT examined using OCT may reflect disease activity in PCV.

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Accuracy of Matching Optic Discs with Visual Fields: The European Structure and Function Assessment Trial (ESAFAT) – Corrected Proof

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Purpose: To determine the ability of ophthalmologists across Europe to match stereoscopic optic disc photographs to visual fields of varying severity.Design: Evaluation and comparison of 2 diagnostic tests.Participants: A total of 109 of 260 invited ophthalmologists in 11 European countries. These had participated in the previous European Optic Disc Assessment Trial (EODAT), a trial on glaucoma diagnostic accuracy based on optic discs only.Methods: Each participant matched stereo optic disc photographs of 40 healthy and 48 glaucomatous eyes to a visual field chosen from 4 options per disc. The 4 presented visual fields included the corresponding one and 3 other visual fields, varying in severity. The matching accuracy and any inaccuracy per disease severity were calculated. Classification accuracy (as glaucomatous or healthy) was compared with EODAT data. Duplicate slides allowed for the assessment of intraobserver agreement.Main Outcome Measures: Accuracy of matching optic discs with their corresponding visual field and of classifying them as healthy or glaucomatous; intraobserver agreement (κ).Results: The overall accuracy of ophthalmologists for correctly matching stereoscopic optic disc photographs to their visual fields was 58.7%. When incorrectly matched, the observers generally overestimated the visual field severity (P < 0.001), notably in eyes with early glaucoma. The intraobserver agreement was, on average, moderate (0.52).Conclusions: European ophthalmologists correctly matched stereoscopic optic disc photographs to their corresponding visual field in only approximately 59% of cases. In most mismatches, the clinicians overestimated the visual field damage.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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Mitochondrial Retinal Dystrophy Associated with the m.3243A>G Mutation – Corrected Proof

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Objective: To describe the spectrum of retinal abnormalities associated with the m.3243A>G mutation in the mitochondrial MTTL1 gene and to analyze putative correlations among the severity of retinal abnormalities, disease severity in other organ systems, and heteroplasmy levels.Design: Observational, cohort-based, cross-sectional study.Participants: Twenty-nine patients carrying the m.3243A>G mutation.Methods: Extensive clinical examinations, including visual acuity testing, indirect ophthalmoscopy, color fundus photography, fundus autofluorescence (FAF), high-resolution optical coherence tomography (OCT), and central visual field analysis. In selected patients, Goldmann perimetry, fluorescein angiography, full-field electroretinography (ERG) and electro-oculography (EOG), and color vision testing were performed. Heteroplasmy levels of the m.3243A>G mutation were measured in leukocytes, urinary epithelial cells (UECs), and buccal mucosa. The Newcastle Mitochondrial Disease Adult Scale (NMDAS) score was measured for all patients.Main Outcome Measures: Age at onset, visual acuity, fundus appearance, FAF, OCT findings, systemic disease features, heteroplasmy levels, and NMDAS scores.Results: Twenty-five of the 29 mutation carriers (86%) had retinal abnormalities that could be classified into 4 grades. Six patients (21%) had grade 1 retinal dystrophy with fine pigment abnormalities that were clearly visible with FAF and fluorescein angiography. Eleven patients (38%) had grade 2 abnormalities that were characterized by yellowish or mildly pigmented deposits in the early stage; in advanced grade 2, these pigment changes encompassed the entire macula and often encircled the optic disc. Six patients (21%) had grade 3 disease in which profound chorioretinal atrophy was present outside the fovea. Two patients (7%) with retinal abnormalities had grade 4 disease, in which the fovea was affected by atrophy, with marked loss of visual acuity. The grade of mitochondrial retinal dystrophy correlated significantly with both age (r = −0.483, P = 0.008) and visual acuity (r = −0.614, P  G mutation has specific characteristics that can be classified into 4 grades based on the findings on ophthalmoscopy, FAF, and OCT. However, because the maternal inheritance pattern can be masked and the systemic disease associations can be variable or even absent, the disease may be misdiagnosed.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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