Category: Peer-reviewed

Glaucoma Severity and Medication Adherence in a County Hospital Population – Corrected Proof

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Objective:
To assess the association between disease severity and adherence with glaucoma medications in a county hospital population.

Design:
Cross-sectional study.

Participants:
A total of 126 patients diagnosed with glaucoma receiving intraocular pressure (IOP)–lowering medication were recruited from the San Francisco General Hospital Ophthalmology Clinic.

Methods:
Subjects completed an oral questionnaire to assess demographic information, knowledge of glaucoma, and perceptions of glaucoma medication adherence. Glaucoma disease severity was classified according to the American Academy of Ophthalmology’s Preferred Practice Pattern guidelines. Medication adherence was measured for each patient by obtaining pharmacy refill data and calculating medication possession ratio (MPR), that is, the ratio of total days’ supply of medication during a 365-day period. Adherence was measured retrospectively over the 18-month period before study entry. Subjects with an MPR >80% were considered adherent.

Main Outcome Measure:
Medication adherence.

Results:
Subjects with mild or moderate glaucoma were more likely to be nonadherent to their prescribed glaucoma medications than those with severe disease (adjusted odds ratio [OR], 1.54; 95% confidence interval [CI], 1.03–2.31; P = 0.04). Age, gender, race, education level, years of glaucoma, number of medications, and glaucoma diagnosis were not found to be statistically significantly associated with adherence.

Conclusion:
Patients with severe glaucoma were more likely to adhere to their topical IOP-lowering medication regimen than those with milder glaucomatous disease.

Financial Disclosure(s):
Proprietary or commercial disclosure may be found after the references.

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Toward Zero Effective Phacoemulsification Time Using Femtosecond Laser Pretreatment – Corrected Proof

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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.

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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

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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.

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Comparison of Cone Pathologic Changes in Idiopathic Macular Telangiectasia Types 1 and 2 Using Adaptive Optics Scanning Laser Ophthalmoscopy – Corrected Proof

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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.

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Outdoor Activity during Class Recess Reduces Myopia Onset and Progression in School Children – Corrected Proof

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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.

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Reading Performance in Infantile Nystagmus – Corrected Proof

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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.

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Peripheral Autofluorescence and Clinical Findings in Neovascular and Non-neovascular Age-related Macular Degeneration – Corrected Proof

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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.

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