With apologies from the publishers, the final authorship in the article entitled, “Prevalence of Glaucoma in a Rural Northern China Adult Population: A Population- based Survey in Kailu County, Inner Mongolia” by Wulian Song, MD, Li Shan, MD, Fang …
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We appreciate the comments of Dr. Mamalis. We were unaware of the disagreements that the American Society of Cataract and Refractive Surgery (ASCRS) TASS force had with the Food and Drug Administration’s.
Bacterial Keratitis in Shanghai
The recent report by Lichtinger et al describing the clinical characteristics of bacterial keratitis isolates over a 11-year period within a Toronto institution raised our interest. Although we found several previous studies about the distribution, cur…
“Salt and Pepper” Corneal Endothelium
We report a symptomatic patient who resembles the “salt and pepper endothelium” described by Hillenaar et al his “How Normal Is the Transparent Cornea? Effects of Ageing on Corneal Morphology.”
Characterization of Ischemic Index Using Ultra-widefield Fluorescein Angiography in Patients With Focal and Diffuse Recalcitrant Diabetic Macular Edema – Corrected Proof
Purpose: To explore the association of angiographic nonperfusion in focal and diffuse recalcitrant diabetic macular edema (DME) in diabetic retinopathy (DR).Design: A retrospective, observational case series of patients with the diagnosis of recalcitra…
Racial Variations in the Prevalence of Refractive Errors in the United States: The Multi-Ethnic Study of Atherosclerosis – Corrected Proof
Purpose: To describe racial variations in the prevalence of refractive errors among adult white, Chinese, Hispanic, and black subjects in the United States.Design: Cross-sectional data from a prospective cohort study—the Multi-Ethnic Study of Atheros…
Topical Linezolid 0.2% for the Treatment of Vancomycin-Resistant or Vancomycin-Intolerant Gram-Positive Bacterial Keratitis – Corrected Proof
Purpose: To report the successful use of topical linezolid 0.2% in the treatment of gram-positive bacterial keratitis.Study Design: Retrospective, interventional case series.Methods: All cases of bacterial keratitis treated at the University of Illinoi…
Visual Outcomes in Children With Neurofibromatosis Type 1 and Orbitotemporal Plexiform Neurofibromas – Corrected Proof
Purpose: To describe the visual outcomes and volumetric magnetic resonance imaging (3D MRI) in children with neurofibromatosis type 1 (NF1) and orbitotemporal plexiform neurofibromas.Design: Multicenter retrospective case series.Methods: Two institutio…
Toward Zero Effective Phacoemulsification Time Using Femtosecond Laser Pretreatment – Corrected Proof
Objective:
To compare effective phacoemulsification time after femtosecond laser pretreatment with conventional phacoemulsification and the associated effect on visual outcomes and endothelial cell loss.
Design:
Prospective, consecutive, single-surgeon case-control study.
Controls:
Controls underwent phacoemulsification cataract extraction plus insertion of an intraocular lens (IOL). Cases underwent pretreatment with the femtosecond laser followed by phacoemulsification cataract extraction and IOL insertion.
Methods:
Two hundred one eyes underwent cataract surgery between April 2012 and July 2012. Data collected included patient demographics, preoperative characteristics, femtosecond lens fragmentation method, effective phacoemulsification time (EPT), intraoperative complications, and postoperative outcomes.
Main Outcome Measures:
Effective phacoemulsification time, intraoperative complications, corneal endothelial cell loss, as well as postoperative best-corrected visual acuity, intraocular pressure, and refractive outcomes.
Results:
Patient demographics were similar between groups. There was no difference between baseline cataract grades (2.59±0.71 vs. 2.52±0.72, not significant). One hundred percent of cases pretreated with the femtosecond laser had complete capsulotomy. Mean EPT was reduced by 83.6% in the femtosecond pretreatment group (P<0.0001) when compared with controls, with 30% having 0 EPT (P<0.0001). Effective phacoemulsification time was reduced 28.6% within the femtosecond group using improved lens fragmentation algorithms, and a further 72.8% reduction was achieved with a 20-gauge phacoemulsification tip. Overall, there was a 96.2% reduction in EPT between controls and the optimized femtosecond pretreatment group. This was associated with a 36.1% reduction in endothelial cell loss in the femtosecond group. Visual and refractive outcomes were similar to those of conventional cataract surgery.
Conclusions:
Femtosecond laser pretreatment results in a significant reduction in effective phacoemulsification time, including the possibility of 0 EPT. Further reductions may be achieved using optimization of lens fragmentation patterns and surgical technique.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Management of Submacular Hemorrhage Secondary to Neovascular Age-Related Macular Degeneration With Anti–Vascular Endothelial Growth Factor Monotherapy – Corrected Proof
Purpose: To report the visual and anatomic outcomes of anti–vascular endothelial growth factor (VEGF) monotherapy in the management of marked submacular hemorrhage secondary to neovascular age-related macular degeneration (AMD).Design: Retrospective,…
Correlation Between Quantitative Measurements of Tear Film Lipid Layer Thickness and Meibomian Gland Loss in Patients With Obstructive Meibomian Gland Dysfunction and Normal Controls – Corrected Proof
Purpose: To evaluate the correlation between tear film lipid layer thickness and other objective measurements such as tear film break-up time (TBUT), upper and lower meibomian gland losses, and Schirmer 1 test in patients with obstructive meibomian gland dysfunction (MGD) and normal controls.Design: Cross-sectional study.Methods: Thirty eyes of 30 patients with obstructive MGD and 25 eyes of 25 normal controls were enrolled. Lipid layer thickness was measured using an interferometer. Tear film stability and tear production were evaluated by TBUT and Schirmer 1 test. Upper and lower meibomian gland losses were evaluated using noncontact meibography. The correlations among variables were evaluated in the obstructive MGD group and the control group.Results: TBUT was significantly shorter in the obstructive MGD group than in the control group (P < .001). Upper and lower meibomian gland losses were higher in the obstructive MGD group than in the control group (P < .001 and P < .001, respectively), and lipid layer thickness was significantly thicker in the control group than in the obstructive MGD group (P = .028). Lipid layer thickness was significantly negatively correlated with upper and lower meibomian gland losses in both groups.Conclusions: Lipid layer thickness objectively measured with the interferometer was significantly thicker in the control group than in the obstructive MGD group. Lipid layer thickness was negatively correlated with upper and lower meibomian gland losses in the control group as well as in the obstructive MGD group.
Comparison of Cone Pathologic Changes in Idiopathic Macular Telangiectasia Types 1 and 2 Using Adaptive Optics Scanning Laser Ophthalmoscopy – Corrected Proof
Purpose: To compare pathologic changes in the photoreceptors of eyes with idiopathic macular telangiectasia types 1 and 2 using adaptive optics scanning laser ophthalmoscopy (AO-SLO).Design: Prospective cross-sectional study.Methods: Eleven eyes with idiopathic macular telangiectasia type 1, 14 eyes with type 2, and 10 normal eyes underwent a full ophthalmologic examination, spectral-domain optical coherence tomography (SD-OCT), and imaging with an original prototype AO-SLO system. All eyes with idiopathic macular telangiectasia were examined with fluorescein angiography (FA), confocal blue reflectance, and microperimetry.Results: Compared with normal eyes (29 017 ± 5507 cones/mm2), those with idiopathic macular telangiectasia type 1 had significantly lower cone density on the temporal side (18 427 ± 4908 cones/mm2, P = .010). The FA leakage area (5.90 ± 3.23 mm2) was larger than the dark regions (2.45 ± 2.40 mm2) on AO-SLO (P = .003)—which were observed only in the FA leakage area. Compared with normal eyes, those with idiopathic macular telangiectasia type 2 had significantly lower cone density in all areas (P < .05 for all). Patchy dark regions were also seen in areas without FA abnormalities in 12 eyes. Higher mean retinal sensitivity correlated with greater mean cone density 0.5 mm from the center of the fovea (type 1: P = .010; type 2: P < .001).Conclusions: Idiopathic macular telangiectasia type-specific differences in the distribution of photoreceptor abnormalities were shown in the AO-SLO images. For both idiopathic macular telangiectasia types 1 and 2, visual impairment was associated with cone damage.
Imaging Retinal Pigment Epithelial Proliferation Secondary to PASCAL Photocoagulation In Vivo by Polarization-sensitive Optical Coherence Tomography – Corrected Proof
Purpose: To image the retinal pigment epithelium (RPE) after macular laser and to monitor healing responses over time in vivo in patients with diabetic maculopathy using polarization-sensitive optical coherence tomography (OCT).Design: Prospective, no…
Agreement of Flicker Chronoscopy for Structural Glaucomatous Progression Detection and Factors Associated With Progression – Corrected Proof
Purpose: To evaluate agreement of flicker chronoscopy for structural glaucomatous progression detection and factors associated with progression.Design: Retrospective cohort study.Methods: Two glaucoma fellowship–trained ophthalmologists, masked to temporal sequence, independently graded serial flicker chronoscopy images from 1 eye of a cohort of glaucoma patients for features of structural progression. Agreement between graders was determined, as was accuracy for determining the temporal order of images. After adjudication, simple and multiple logistic models were constructed to determine baseline variables associated with increased odds of progression.Results: Fifty of 103 included eyes/patients (48.5%) had at least 1 sign of structural progression. Temporal sequence was incorrectly determined in 14 of 206 cases (6.4%). Interobserver agreements for identifying baseline photographs (κ = 0.9), global progression (κ = 0.7), parapapillary atrophy (PPA) progression (κ = 0.7), disc hemorrhages (κ = 0.7), neuroretinal rim loss (κ = 0.5), and retinal nerve fiber layer (RNFL) loss (κ = 0.2) were calculated. Age was significantly associated with global (1.8; 1.3-2.6, P < .001) (odds ratio; 95% confidence interval, significance) and PPA progression (1.7; 1.2-2.4, P = .002). Lower corneal hysteresis was associated with global progression (0.78; 0.56-0.99, P = .049) and RNFL loss (0.5; 0.3-0.9, P = .02). Goldmann-correlated intraocular pressure (1.0, 0.7-1.4, P = .9), visual field mean deviation (1.0, 0.9-1.0, P = .2), and central corneal thickness (0.9, 0.8-1.0, P = .1) were not significantly associated with progression. On multivariable analysis, only age was associated with global progression (1.8; 1.2-2.5, P = .002).Conclusion: Flicker chronoscopy demonstrated acceptable interobserver agreement in structural progression detection. Corneal hysteresis and age were both associated with progression, but age was the only significant factor on multivariable analysis.
Features of Recurrence after Excimer Laser Phototherapeutic Keratectomy for Anterior Corneal Pathologies in North China – Corrected Proof
Purpose:
To study long-term clinical patterns of recurrence of anterior corneal pathologies after excimer laser phototherapeutic keratectomy (PTK).
Design:
Retrospective, noncomparative, interventional case series.
Participants:
Thirty patients (…
Outdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children – Corrected Proof
Purpose:
The aim of this study was to investigate the effect of outdoor activity during class recess on myopia changes among elementary school students in a suburban area of Taiwan.
Design:
Prospective, comparative, consecutive, interventional study.
Participants:
Elementary school students 7 to 11 years of age recruited from 2 nearby schools located in a suburban area of southern Taiwan.
Intervention:
The children of one school participated in the interventions, whereas those from the other school served as the control group. The interventions consisted of performing a recess outside the classroom (ROC) program that encouraged children to go outside for outdoor activities during recess. The control school did not have any special programs during recess.
Main Outcome Measures:
Data were obtained by means of a parent questionnaire and ocular evaluations that included axial length and cycloplegic autorefraction at the beginning and after 1 year.
Results:
Five hundred seventy-one students were recruited for this study, of whom 333 students participated in the interventional program, and 238 students were in the control school. At the beginning of the study, there were no significant differences between these 2 schools with regard to age, gender, baseline refraction, and myopia prevalence (47.75% vs. 49.16%). After 1 year, new onset of myopia was significantly lower in the ROC group than in the control group (8.41% vs. 17.65%; P<0.001). There was also significantly lower myopic shift in the ROC group compared with the control group (−0.25 diopter [D]/year vs. −0.38 D/year; P = 0.029). The multivariate analysis demonstrated that the variables of intervention of the ROC program and higher school year proved to be a protective factor against myopia shift in nonmyopic subjects (P = 0.020 and P = 0.017, respectively). For myopic subjects, school year was the only variable significantly associated with myopia progression (P = 0.006).
Conclusions:
Outdoor activities during class recess in school have a significant effect on myopia onset and myopic shift. Such activities have a prominent effect on the control of myopia shift, especially in nonmyopic children.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Reading Performance in Infantile Nystagmus – Corrected Proof
Objective:
To characterize reading deficits in infantile nystagmus (IN), to determine optimal font sizes for reading in IN, and to investigate whether visual acuity (VA) and severity of nystagmus are good indicators of reading performance in IN.
Design:
Prospective cross-sectional study.
Participants and Controls:
Seventy-one participants with IN (37 idiopathic, 34 with albinism) and 20 age-matched controls.
Methods:
Reading performance was assessed using Radner reading charts and was compared with near logarithm of the minimum angle of resolution (logMAR) VA, nystagmus intensity, and foveation characteristics as quantified using eye movement recordings.
Main Outcome Measures:
Reading acuity (smallest readable font size), maximum reading speed, critical print size (font size below which reading is suboptimal), near logMAR VA, nystagmus intensity, and foveation characteristics (using the eXpanded Nystagmus Acuity Function).
Results:
Using optimal reading conditions, maximum reading speeds were 18.8% slower in albinism and 14.7% slower in idiopathic IN patients compared with controls. Reading acuities were significantly worse (P<0.001) in IN patients compared with controls. Also, the range of font sizes over which reading speeds were less than the optimum were much larger in IN patients compared with controls (P<0.001). Reading acuity was correlated strongly to near VA (r2 = 0.74 albinism, r2 = 0.55 idiopathic), but was better than near VA in participants with poor VA. Near VA was a poor predictor of maximum reading speed. Nystagmus intensity and foveation were poor indicators of both reading acuity and maximum reading speed.
Conclusions:
Maximum reading speeds can be near normal in IN when optimal font sizes are provided, even in individuals with poor VA or intense nystagmus. However, reading performance in IN is acutely sensitive to font size limitations. Font sizes for optimal reading speeds in IN may be as much as 6 logMAR lines worse than the near VA.
Financial Disclosure(s):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Peripheral Autofluorescence and Clinical Findings in Neovascular and Non-neovascular Age-related Macular Degeneration – Corrected Proof
Purpose:
To characterize peripheral fundus autofluorescence (FAF) abnormalities in patients with age-related macular degeneration (AMD), correlate these with clinical findings, and identify risk factors associated with these FAF abnormalities.
Design:
Clinic-based, cross-sectional study.
Participants:
A total of 119 consecutive patients: 100 patients with AMD (200 eyes) and 19 patients without AMD (38 eyes).
Methods:
In a prospective study performed at the Doheny Eye Institute, University of Southern California, widefield 200-degree FAF and color images were obtained by the Optos 200Tx Ultra-Widefield device (Optos, Dunfermline, Scotland) using a standardized imaging protocol. The FAF images were captured centered on the fovea, and additional images were captured after steering the field of view inferiorly and superiorly. All FAF and color images were graded independently by 2 masked ophthalmologists with respect to the presence, location, extent, and type of peripheral (defined as outside the central 30 degrees) FAF abnormality.
Main Outcome Measures:
Presence and type of peripheral FAF abnormalities.
Results:
Peripheral FAF abnormalities were evident in 164 eyes (68.9%), with several distinct FAF patterns identified: granular (46.2%), mottled (34.0%), and nummular (18.1%). A 90% concordance of FAF patterns was observed between both eyes. Abnormal FAF occurred more frequently in neovascular compared with non-neovascular AMD or normal eyes (86% vs. 72.8% vs. 18.4%, respectively, P<0.001). Significant risk factors for peripheral FAF abnormalities were AMD type (neovascular AMD odds ratio [OR], 12.7 and non-neovascular AMD OR, 6.2 compared with normal eyes, P<0.001), older age (OR, 6.5; 95% confidence interval [CI], 2.4–17.8; P<0.001 for the oldest quartile compared with the youngest), and female sex (OR, 4.1; 95% CI, 1.9–8.9; P<0.001). Clinical features on color photography were detected in 174 eyes (73.1%): peripheral drusen (51.7%), retinal pigment epithelium (RPE) depigmentation (34.9%), RPE hyperpigmentation (branching reticular pigmentation) (22.7%), and atrophic patches (16.8%). There was a high correlation between specific FAF and clinical findings: granular FAF with peripheral drusen (P<0.001) and mottled FAF with RPE depigmentation (P<0.001).
Conclusions:
Several distinct patterns of peripheral FAF abnormalities were observed in 68.9% of patients, with AMD type, female sex, and age being independent risk factors. The peripheral FAF patterns correlate strongly with specific clinical features seen in eyes with AMD.
Financial Disclosure(s):
Proprietary or commercial disclosure may be found after the references.
Peripapillary Scleral Deformation and Retinal Nerve Fiber Damage in High Myopia Assessed With Swept-Source Optical Coherence Tomography – Corrected Proof
Purpose: To study peripapillary morphologic changes in highly myopic eyes using swept-source optical coherence tomography at a longer wavelength.Design: Prospective cross-sectional study.Methods: Peripapillary regions of 196 eyes of 107 patients with h…