Objective:
To develop and validate a predictive model to estimate the probability of being nonadherent to topical glaucoma medications.
Design:
Prospective cohort study.
Participants:
Patients being treated with once-daily prostaglandin eye drops…
Objective:
To develop and validate a predictive model to estimate the probability of being nonadherent to topical glaucoma medications.
Design:
Prospective cohort study.
Participants:
Patients being treated with once-daily prostaglandin eye drops…
Objective:
To examine the anatomic features and function of the macula in achiasma and to compare visual acuity, eye movements, foveation, and eye velocity before and after tenotomy and reattachment (T&R) surgery.
Design:
Case series.
Participants:
Two children with isolated achiasma.
Methods:
Ophthalmologic examinations, brain magnetic resonance imaging, full-field and multifocal electroretinography (ERG), visual evoked potentials (VEPs), spectral-domain optical coherence tomography (OCT), eye-movement recordings, and unilateral T&R in 1 patient.
Main Outcome Measures:
Visual acuity before and after surgery, macular anatomic features and function, and eye velocity before and after T&R surgery in 1 patient.
Results:
Magnetic resonance imaging and VEP confirmed absence of decussation of retinofugal fibers in both patients. Visual acuity was 20/100 and 20/200. The anatomic features and function of the fovea and macula were normal by OCT and multifocal ERG. After T&R, there was a marked reduction in horizontal eye velocity and monocular visual acuity improved to 20/80.
Conclusions:
The finding that the macula is normal in achiasma suggests that reduced acuity is the result of retinal image motion from nystagmus. Two-muscle T&R reduces horizontal retinal image motion and can improve visual acuity in achiasma or patients with infantile nystagmus.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Purpose: To compare the optical quality of implantable Collamer lens (ICL) with and without central hole (Hole ICL and conventional ICL) at different degrees of decentering.Design: Experimental laboratory investigation.Methods: Wavefront aberrations of the −3, −6, and −12 diopter (D) V4b and −3, −6, and −12 D V4c ICLs were measured in 3 conditions—centered and decentered 0.3 and 0.6 mm—at 3-mm and 4.5-mm pupils. The root mean square of total higher order aberrations, trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were evaluated. In addition, point spread function and simulated retinal images of ICLs were calculated from the wavefront aberrations for each ICL and all conditions of decentering at 4.5-mm pupil.Results: No statistically significant differences in any Zernike coefficient terms evaluated were found between conventional and Hole ICLs for any ICL powers and pupils evaluated (P > .05). We could not appreciate differences in the point spread function images and in simulated retinal images. Regarding the effect of the ICL decentration, coma aberration increased significantly with ICL decentration (P < .05), although these differences were not visible in the point spread function images and simulated retinal images. The ICL decentration was affected in the same manner on the conventional and Hole ICLs.Conclusions: The outcomes showed good and comparable optical quality of the conventional and Hole ICLs for all ICL powers evaluated. Despite that coma aberration increased with ICL decentering, these values were clinically negligible and did not have a significant effect on the simulated visual performance.
Purpose: To investigate the spectrum of organisms causing culture-proven endophthalmitis and their susceptibilities to commonly used antimicrobial agents over 10 years.Design: Retrospective, noncomparative, consecutive case series.Methods: Medical reco…
Purpose: To describe the clinical characteristics of ciliary body tumors, surgical outcomes, and factors associated with poor visual outcome and metastasis.Design: Retrospective case series.Methods: Medical records of 27 patients with ciliary body tumors who underwent partial lamellar sclerouvectomy in a single-center setting (Seoul, South Korea) were reviewed. Surgical outcomes were reviewed, and clinical characteristics were analyzed with respect to visual prognosis and globe retention rate.Results: Tumors were diagnosed histopathologically as benign in 8 (30%) cases and as melanoma in 19 (70%) cases. Patients had a median age of 48 years. The median follow-up was 3.5 years (range, 0.5 to 6 years). The tumors had a median diameter of 11 mm and a median thickness of 9 mm. The globe was retained in 20 (74%) eyes, with visual acuity of 20/400 or better in 13 (48%) eyes and 20/40 or better in 6 (22%) eyes. Choroidal involvement of tumor (P = .003), larger diameter of tumor (P < .001), and thicker tumor (P < .001) were associated with poor visual outcome. Local recurrence (P = .003) and presence of epithelioid cells (P = .040) were predictive factors for metastasis in melanoma patients. Kaplan-Meier estimates of metastasis-free survival at 3 and 5 years for melanoma patients were 82% and 55%, respectively.Conclusions: Partial lamellar sclerouvectomy is a reasonable primary therapeutic option in ciliary body tumors, and good visual prognosis is expected in selected cases.
Purpose: To assess the repeatability and comparability of corneal power and central corneal thickness (CCT) measurements obtained using Orbscan II (Bausch & Lomb), Pentacam (Oculus), and Galilei (Ziemer) tomographers.Design: Prospective, comparative study.Methods: setting: Departments of Ophthalmology, University of Auckland and Auckland District Health Board, Auckland, New Zealand. study population: Thirty eyes of 30 healthy participants. observations. CCT and corneal power measured using Orbscan II, Pentacam, and Galilei tomography. main outcome measures: Degree of agreement in and repeatability of CCT and corneal power measures.Results: Orbscan II measured significantly lower CCT compared with Pentacam (20 μm; P < .0005) and Galilei (18 μm; P < .0005). The Orbscan II had wide limits of agreement when compared with both the Galilei (−11 to 47 μm) and Pentacam (−88 to 47 μm). For each device, the intraclass correlation coefficient for CCT was higher than 0.9. The coefficient of variation ranged from 0.33% to 0.93%. There was no significant difference in mean steep keratometry or mean flat keratometry between instrument pairs. However, there was poor agreement in flat keratometry and steep keratometry obtained by Orbscan II compared with those obtained by the Galilei and Pentacam.Conclusions: The keratometry and pachymetry measurements obtained by Orbscan II, Pentcam, and Galilei tomographers were sufficiently disparate that the 3 devices could not be considered equivalent. All 3 devices demonstrated a high level of repeatability, although the Galilei exhibited the best repeatability.
Purpose: To compare the morphologic parameters of ophthalmoscopically and tomographically normal foveae of the fellow eyes of patients with a unilateral macular hole (MH), other unilateral retinal diseases, and healthy eyes.Design: Observational, cross-sectional study.Methods: Of the 849 subjects studied, 183 eyes were excluded because they had an abnormal vitreofoveal interface that might have affected the foveal thickness. The average regional retinal thicknesses of the Early Treatment Diabetic Retinopathy Study sectors determined by spectral-domain optical coherence tomography were compared among 160 patients with MH, 175 patients with epiretinal membrane, 145 patients with retinal vein occlusion, and 186 healthy subjects. The foveal depression was quantified as the foveal pit depth divided by the foveal pit diameter.Results: The fovea (1 mm) and central fovea were significantly thinner in the MH group (243 and 192 μm) than in the other groups (P < .0001). There were no significant differences in the thickness of the fovea and central fovea among the eyes with epiretinal membrane (254 and 203 μm) or retinal vein occlusion (251 and 202 μm) or in the healthy group (254 and 201 μm). The foveal depression was significantly greater in the MH group (0.063) than in the retinal vein occlusion group (0.059) or in the healthy group (0.058; P = .014 and P = .0014, respectively). Multiple regression analyses showed that a thinner fovea and a deeper foveal depression were associated significantly with the presence of MH (P = .0054 to P < .0001).Conclusions: These results suggest that patients with MH have unique foveal morphologic features that predispose them to MH development.
Purpose: To report the clinical success and incidence of adverse events of repetitive botulinum toxin treatment of 15 years or greater.Design: Retrospective cohort study.Methods: The study sample consisted of 37 patients from a clinical practice, 11 ma…
Objective: To evaluate the delivery characteristics of the AcrySof IQ SN60WS intraocular lens (IOL) injected via a preloaded AcrySert delivery system.Design: Prospective observational case series.Methods: setting: This study was carried out in the cata…
Available online 27 March 2013 Publication year: 2013Source:Progress in Retinal and Eye Research Glaucoma is a chronic neurodegenerative disease and one of the leading causes of blindness. Several risk factors have been described, e.g. an …
Objective:
To assess the structure of central optic disc pits (ODPs) using enhanced-depth imaging optical coherence tomography (EDI OCT) and to ascertain their clinical significance.
Design:
Prospective, cross-sectional study.
Participants:
Patie…
Purpose:
To identify common perceptions and ideas about preparation and planning for retirement of chairs of academic departments of ophthalmology, determining areas of particular stress and proposing ways to better prepare for retirement.
Design:
…
Objective:
To investigate the use of swept-source optical coherence tomography (OCT) for measuring the area and degree of peripheral anterior synechia (PAS) involvement in patients with angle-closure glaucoma.
Design:
Cross-sectional study.
Partic…
Purpose:
We sought to determine the prevalence, incidence, and change in refractive errors for Australian schoolchildren and examine the impact of ethnicity and sex.
Design:
Population-based cohort study.
Participants:
The Sydney Adolescent Vascular and Eye Study, a 5- to 6-year follow-up of the Sydney Myopia Study, examined 2760 children in 2 age cohorts, 12 and 17 years. Longitudinal data were available for 870 and 1202 children in the younger and older cohorts, respectively.
Methods:
Children completed a comprehensive examination, including cycloplegic autorefraction (cyclopentolate 1%; Canon RK-F1). Myopia was defined as ≤−0.50 diopters (D) and hyperopia as ≥+2.00 D right eye spherical equivalent refraction.
Main Outcome Measures:
Baseline and follow-up refraction.
Results:
Prevalence of myopia increased between baseline and follow-up for both the younger (1.4%–14.4%; P<0.0001) and older cohorts (13.0%–29.6%; P<0.0001). The annual incidence of myopia was 2.2% in the younger cohort and 4.1% in the older. Children of East Asian ethnicity had a higher annual incidence of myopia (younger 6.9%, older 7.3%) than European Caucasian children (younger 1.3%, older 2.9%; all P<0.0001). The prevalence of myopia in European Caucasian children almost doubled between the older (4.4%; 95% confidence interval [CI], 3.0–5.8) and younger samples (8.6%; 95% CI, 6.7–10.6) when both were aged 12 years. Children with ametropia at baseline were more likely to have a significant shift in refraction (hyperopia: odds ratio [OR], 3.4 [95% CI, 1.2–9.8]; myopia: OR, 6.3 [95% CI, 3.7–10.8]) compared with children with no refractive error. There was no significant difference in myopia progression between children of European Caucasian and East Asian ethnicity (P = 0.7).
Conclusions:
In Sydney, myopia prevalence (14.4%, 29.6%) and incidence (2.2%, 4.1%) was low for both age cohorts, compared with other locations. However, in European Caucasian children at age 12, the significantly higher prevalence of myopia in the younger sample suggests a rise in prevalence, consistent with international trends. Progression of myopia was similar for children of East Asian and European Caucasian ethnicity, but lower than reported in children of East Asian ethnicity in East Asia, suggesting that environmental differences may have some impact on progression.
Financial Disclosure(s):
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Purpose:
To determine the rate of metastasis resulting from uveal melanoma associated with congenital ocular melanocytosis (COM) and to compare it with the rate of metastasis resulting from uveal melanoma not associated with COM.
Design:
Matched re…
Purpose:
To report a diplopia questionnaire (DQ) with a data-driven scoring algorithm.
Design:
Cross-sectional study.
Participants:
To optimize questionnaire scoring, 147 adults with diplopic strabismus completed both the DQ and the Adult Strabismus-20 (AS-20) health-related quality-of-life (HRQOL) questionnaire. To assess test–retest reliability, 117 adults with diplopic strabismus. To assess responsiveness to surgery, 42 adults (46 surgeries).
Methods:
The 10-item AS-20 function subscale score (scored 0–100) was defined as the gold standard for severity. A range of weights was assigned to the responses and the gaze positions (from equal weighting to greater weighting of primary and reading). Combining all response option weights with all gaze position weights yielded 382848 scoring algorithms. We then calculated 382848 Spearman rank correlation coefficients comparing each algorithm with the AS-20 function subscale score.
Main Outcome Measures:
To optimize scoring, Spearman rank correlation coefficients (measuring agreement) between DQ scores and AS-20 function subscale scores. For test–retest reliability, 95% limits of agreement and intraclass correlation coefficient (ICC). For responsiveness, change in DQ score.
Results:
For the 382 848 possible scoring algorithms, correlations with AS-20 function subscale score ranged from −0.64 (best correlated) to −0.55. The best-correlated algorithm had response option weights of 5 for rarely, 50 for sometimes, and 75 for often, and gaze position weights of 40 for straight ahead in the distance, 40 for reading, 1 for up, 8 for down, 4 for right, 4 for left, and 3 for other, totaling 100. There was excellent test–retest reliability with an ICC of 0.89 (95% confidence interval, 0.84–0.92), and 95% limits of agreement were 30.9 points. The DQ score was responsive to surgery with a mean change of 51±34 (P<0.001).
Conclusions:
We have developed a data-driven scoring algorithm for the DQ, rating diplopia symptoms from 0 to 100. On the basis of correlations with HRQOL, straight-ahead and reading positions should be highly weighted. The DQ has excellent test–retest reliability and responsiveness, and may be useful in both clinical and research settings.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Objective:
To assess the value of enhanced depth imaging optical coherence tomography (EDI OCT) in diagnosing and evaluating optic nerve head drusen (ONHD) compared with conventional diagnostic methods.
Design:
Prospective, comparative, cross-sectional study.
Participants:
Thirty-four patients with clinically visible or suspected ONHD in either eye based on dilated optic disc examination or optic disc stereophotography and without ocular comorbidity.
Methods:
Spectral-domain OCT of the optic nerve head in both conventional (non-EDI) and EDI modes, ultrasound B-scan, and standard automated perimetry were performed on both eyes of all participants.
Main Outcome Measures:
Detection and findings of ONHD between EDI OCT and conventional diagnostic methods.
Results:
Sixty-eight eyes were clinically classified into 3 groups: 32 eyes with definite ONHD, 25 eyes with suspected ONHD, and 11 normal-appearing fellow eyes. In the definite ONHD group, EDI OCT, non–EDI OCT, and ultrasound B-scan were positive for ONHD in all eyes and visual field (VF) was abnormal in 24 eyes. In the suspected ONHD group, EDI OCT, non–EDI OCT, ultrasound B-scan, and VF were positive in 17, 14, 7, and 3 eyes, respectively; 8 eyes had no evidence of ONHD in any of the tests. In normal-appearing fellow eyes, EDI OCT, non–EDI OCT, ultrasound B-scan, and VF were positive in 3, 1, 1, and 0 eyes, respectively; 4 eyes had no evidence of ONHD in any of the tests. Enhanced depth imaging OCT had a significantly higher ONHD detection rate than ultrasound B-scan in all eyes (52/68 eyes vs. 40/68 eyes; P<0.001), in eyes with clinically suspected ONHD or normal-appearing fellow eyes (20/36 eyes vs. 8/36 eyes; P<0.001), and in eyes with clinically suspected ONHD (17/25 eyes vs. 7/25 eyes; P = 0.002). Enhanced depth imaging OCT–detected ONHD appeared as signal-poor regions surrounded by short, hyper-reflective bands or isolated/clustered hyper-reflective bands without a signal-poor core. In non–EDI OCT, posterior surfaces of the ONHD and deep-seated hyper-reflective bands were invisible or less clear than in EDI OCT.
Conclusions:
Enhanced depth imaging OCT detects lesions likely representing ONHD more often and better assesses their shape and structure than conventional tests.
Financial Disclosure(s):
Proprietary or commercial disclosure may be found after the references.
Clinical relevance:
Systematic reviews and meta-analyses serve as a basis for decision-making and clinical practice guidelines and should be carried out using appropriate methodology to avoid incorrect inferences.
Topic:
We describe the characteris…
Objective:
To evaluate and compare the cumulative incidence and risk factors for first-episode immunologic graft rejection in Descemet’s stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) and to identify potential risk factors for rejection.
Design:
Retrospective chart review.
Participants:
All patients who underwent PK or DSAEK for endothelial disease at the Department of Ophthalmology, North Shore LIJ, between January 2004 and June 2010.
Methods:
One hundred sixty-nine PK cases and 122 DSAEK cases were reviewed. All patients had a minimum of 3 months of follow-up, with median follow-up of 36 months in the PK group and 29 months in the DSAEK group.
Main Outcome Measures:
Cumulative incidence of first-episode immunologic graft rejection in PK and DSAEK cohorts. Risk factors for graft rejection were reviewed.
Results:
Cumulative incidence of rejection was not significantly different between the DSAEK and PK cohorts (P<0.1324). However, among patients without glaucoma, the risk of rejection in PK was higher than that in DSAEK (hazard ratio [HR], 5.56). Prior incisional glaucoma surgery imparted a 3.15 times greater risk of rejection regardless of transplant type. Phakic patients were more likely to experience rejection than patients with a posterior chamber intraocular lens (HR, 3.23; P<0.0266), but not more likely than those with an anterior chamber intraocular lens or who were aphakic. Graft failure occurred within 6 months in 31% of PK rejections and none of the DSAEK rejections.
Conclusions:
Descemet’s stripping automated endothelial keratoplasty and PK did not show a statistically significant difference in the incidence of rejection; however, among nonglaucomatous eyes, there were significantly fewer rejections in those that underwent DSAEK.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.