Purpose

To determine if the accuracy of the baseline prediction model for the development of primary open-angle glaucoma (POAG) in ocular hypertension patients can be improved by correcting intraocular pressure (IOP) for central corneal thickness (CCT).

Design

Re-analysis of the baseline prediction model for the development of POAG from the Ocular Hypertension Treatment Study (OHTS) substituting IOP adjusted for CCT using 5 different correction formulae for unadjusted IOP.

Participants

1,433 of 1,636 participants randomized to OHTS who had complete baseline data for factors in the prediction model – age, IOP, CCT, vertical cup-to-disc ratio (VCDR) and pattern standard deviation (PSD).

Methods

Re-analysis of the prediction model for the risk of developing POAG using the same baseline variables (age, IOP, CCT, VCDR and PSD) except that IOP was adjusted for CCT using correction formulae. A separate Cox proportional hazards model was run using IOP adjusted for CCT by each of the five formulae published to date. Models were run including and excluding CCT.

Main Outcome Measures

Predictive accuracy of each Cox proportional hazards model was assessed using the c-statistic and calibration chi-square.

Results

C-statistics for prediction models that used IOP adjusted for CCT by various formulas ranged from 0.75 to 0.77, no better than the original prediction model (0.77) that did not adjust IOP for CCT. Calibration chi-square was acceptable for all models. Baseline IOP, whether adjusted for CCT or not, was statistically significant in all models including those with CCT in the same model. CCT was statistically significant in all models including those with IOP adjusted for CCT in the same model.

Conclusion

The calculation of individual risk for developing POAG in ocular hypertensive individuals is simpler and equally accurate using IOP and CCT as measured, rather than applying an adjustment formula to correct IOP for CCT.

Purpose

To identify socio-demographic and biological risk factors associated with having cortical, nuclear, posterior sub-capsular (PSC), and mixed lens opacities.

Design

Population-based, cross-sectional study

Participants

Five thousand nine hundred forty-five Latinos 40 years and older from 6 census tracts in Los Angeles, California.

Methods

Participants underwent an interview and detailed eye examination, including best-corrected visual acuity and slit-lamp assessment of lens opacities using the Lens Opacities Classification System II. Univariate and stepwise logistic regression analyses were used to identify independent risk factors associated with each type of lens opacity.

Main Outcome Measures

Odds ratios for socio-demographic and biological risk factors associated with cortical only, nuclear only, PSC only, and mixed lens opacities.

Results

Of the 5945 participants with gradable lenses, 468 had cortical only lens opacities, 217 had nuclear only lens opacities, 27 had PSC only opacities, and 364 had mixed lens opacities. Older age, higher hemoglobin A1c, and history of diabetes mellitus were independent risk factors for cortical only lens opacities. Older age, smoking, and myopic refractive error were independent risk factors for nuclear only lens opacities. Higher systolic blood pressure and history of diabetes were independent risk factors for posterior sub-capsular lens opacities. Older age, myopic refractive error, history of diabetes, higher systolic blood pressure, female gender, and presence of large drusen were independent risk factors for mixed lens opacities.

Conclusions

The modifiable and non-modifiable risk factors identified in this study provide insight into the mechanisms related to the development of lens opacification. Improved glycemic control, smoking cessation and prevention, and blood pressure control may help to reduce the risk of having lens opacities and their associated vision loss.

Objective

Non-mydriatic fundus photography by non-ophthalmic trained personnel has recently been shown to be a potential alternative to direct ophthalmoscopy in the emergency department (ED). We evaluated the reliability of a novel quality rating scale and applied this scale to non-mydriatic fundus photographs taken during routine ED patient encounters to determine factors associated with diminished photograph quality.

Design

Prospective, cross-sectional

Participants

350 patients enrolled in the Fundus photography vs. Ophthalmoscopy Trials Outcomes in the Emergency Department (FOTO-ED) study were photographed by nurse practitioners after <30 minutes of training followed by supervision.

Methods

Photographs of both eyes were graded for quality on two occasions by two neuro-ophthalmologists. Four regions were independently evaluated for quality: optic disc, macula, superior and inferior vascular arcades. Quality as a function of the number of photographs taken was evaluated by Kaplan-Meier analysis. Mixed effects ordinal logistic regression was used to evaluate for predictors of image quality while accounting for the repeated measures design.

Main Outcome Measure

Overall photographic quality (1–5 scale, 5 best).

Results

We evaluated 1734 photographs. Inter- and intra-observer agreements between neuro-ophthalmologists were very good (weighted kappa:0.84–0.87). Quality of the optic disc area was better than those of other retinal areas (p<0.002). Kaplan-Meier analysis showed that if a high-quality photograph of an eye was not obtained by the third attempt it was unlikely that one would be obtained at all. A 10 second increase in the inter-photograph interval before a total of forty seconds increased the odds of a one unit higher quality rating by 1.81 times (95%CI: 1.68–1.98), and a ten year increase in age decreased the odds by 0.76 times (95%CI: 0.69–0.85). Black patients had 0.42 times (95%CI: 0.28–0.63) the odds of a one unit higher quality rating compared to whites.

Conclusions

Our 5-point scale is a reliable measure of non-mydriatic photograph quality. The region of interest, interphotograph interval, age, and race are significant predictors of image quality for non-mydriatic photographs taken by nurse practitioners in the ED. Addressing these factors may have a direct impact on the successful implementation of non-mydriatic fundus photography into the ED.

Purpose

To report the clinical and histopathological findings associated with congenital fibrovascular pupillary membranes.

Design

Case series.

Participants

Seven infants; six with a unilateral congenital pupillary membrane and one with classic persistent fetal vasculature (PFV).

Methods

Patients underwent a membranectomy, pupilloplasty and/or a lensectomy. Histopathological examination was performed on the excised membranes.

Main Outcome Measures

Visual acuity and pupil size.

Results

Four of the 6 patients with a unilateral congenital pupillary membrane had one or more recurrences after a membranectomy and pupilloplasty. The most recent pupil size ranged from 2 to 5 mm in the affected eye. When last tested, the vision in the affected eye was excellent in 4 of the 6 patients. The two patients without recurrences of the pupillary membranes underwent multiple iris spincterotomies at the time of the initial surgery. Histopathological examination of two primary pupillary membranes showed fibrovascular tissue that did not stain for neuron specific enolase. Smooth muscle actin was only present in vascular walls. In contrast, histopathology of a recurrent pupillary membrane revealed collagenized fibrovascular tissue that was immunoreactive for smooth muscle actin. Finally, histopathology of the retrolenticular membrane excised from an infant with classic PFV was similar to the latter aside from hypercellularity.

Conclusions

Congenital fibrovascular pupillary membranes in infants are likely a variant of PFV that may recur if incompletely excised. The risk of these membranes recurring may be reduced by excising as much as the membrane as possible and enlarging the pupil with iris spincterotomies. A lensectomy should be avoided if possible.

Purpose

To validate measurement scales for rating ocular chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation. Candidate scales were recommended for use in clinical trials by the National Institutes of Health (NIH) Chronic GVHD Consensus Conference or have been previously validated in dry eye syndromes.

Design

Prospective follow-up study.

Participants

Between August 2007 and June 2010, the study enrolled 387 patients with chronic GVHD in a multicenter, prospective, observational cohort.

Methods

Using anchor-based methods, we compared clinician or patient-reported changes in eye symptoms (8-point scale) with calculated changes in 5 candidate scales: The NIH eye score, patient-reported global rating of eye symptoms, Lee eye subscale, Ocular Surface Disease Index, and Schirmer test. Change was examined for 333 follow-up visits where both clinician and patient reported eye involvement at the previous visit. Linear mixed models were used to account for within-patient correlation.

Main Outcome Measures

An 8-point scale of clinician or patient-reported symptom change was used as an anchor to measure symptom changes at the follow-up visits.

Results

In serial evaluations, agreement regarding improvement, stability, or worsening between the clinician and patient was fair (weighted kappa = 0.34). Despite only fair agreement between evaluators, all scales except the Schirmer test correlated with both clinician-reported and patient-reported changes in ocular GVHD activity. Among all scales, changes in the NIH eye scores showed the greatest sensitivity to symptom change reported by clinicians or patients.

Conclusions

Our results support the use of the NIH eye score as a sensitive measure of eye symptom changes in clinical trials assessing treatment of chronic GVHD.

Purpose

To compare the results of Glaucoma Progression Analysis (GPA, Carl Zeiss Meditec, Dublin, CA) to subjective expert consensus in the detection of glaucomatous visual field progression.

Design

Retrospective, observational case series.

Participants

100 eyes of 83 glaucoma patients.

Methods

Five serial Humphrey visual fields from 100 eyes of 83 glaucoma patients were evaluated by five masked glaucoma subspecialists for determination of progression. Four months later, with a randomly reordered patient sequence, the same visual field series were re-evaluated by the same graders, at which time they had access to the Glaucoma Progression Analysis (GPA) printout.

Main Outcome Measures

The level of agreement between majority expert consensus and GPA, both before and after access to GPA data, was assessed using kappa statistics.

Results

On initial review and on re-evaluation with access to the GPA printout, the level of agreement between majority expert consensus and GPA was fair (kappa = 0.52, 95% confidence interval [CI] = 0.35 – 0.69 and 0.62, 95% CI = 0.46 – 0.78, respectively). Expert consensus was more likely to classify a series of fields as showing progression than was GPA (p ≤ 0.002). There was good agreement between expert consensus on initial review and reevaluation 4 months later (kappa = 0.77, 95% CI = 0.65 – 0.90).

Conclusions

The level of agreement between majority expert consensus of subjective determination of visual field progression and GPA is fair. In cases of disagreement with GPA, the expert consensus classification was usually progression. Access to the results of GPA did not significantly change the level of agreement between expert consensus and the GPA result; however, expert consensus did change in 11 of 100 cases.

Purpose

To determine longitudinal rates of postoperative adverse outcomes after incisional glaucoma surgery in a nationally representative longitudinal sample.

Design

Retrospective, longitudinal cohort analysis.

Participants

Medicare beneficiaries ≥68 years who underwent a primary trabeculectomy (PT), trabeculectomy with scarring (TS), or glaucoma drainage device (GDD) implantation from 1994 to 2003 with follow-up through 2005.

Intervention

Primary trabeculectomy, TS, and GDD were identified from International Classification of Diseases (ICD-9-CM) and Current Procedural Terminology (CPT) procedure codes. Change in rates of postoperative adverse outcomes associated with these 3 surgical interventions was analyzed by cumulative incidence rates and Cox proportional hazards model regression; regression analysis controlled for prior adverse outcome measures (3-year run-up) and demographic variables.

Main Outcome Measures

First-, second-, and sixth-year cumulative rates and probability of experiencing serious adverse outcomes (retinal detachment, endophthalmitis, suprachoroidal hemorrhage), less serious adverse outcomes (choroidal detachment, corneal edema, hypotony), and receipt of additional glaucoma surgery were identified through Medicare claims for each treatment group.

Results

At the 1-year follow-up, rates of severe adverse outcomes were higher among beneficiaries in the GDD group (2.0%) relative to the PT (0.6%) and TS groups (1.3%). Controlling for prior adverse outcomes to the surgery and demographic factors in Cox proportional analysis, differences were often reduced, but generally remained statistically and clinically significant. Rates of severe outcomes, less severe outcomes, corneal edema, and low vision/blindness were higher for persons undergoing GDD than PT or TS. However, rates of reoperation were higher for TS than GDD.

Conclusions

The risk for adverse outcomes was higher in GDD than in PT surgery or TS, controlling for a number of important case mix and demographic factors.

Purpose

To determine the immediate changes in intraocular pressure (IOP) after laser peripheral iridotomy in primary angle-closure suspects.

Design

Prospective, randomized controlled trial (split-body design).

Participants

Seven hundred thirty-four Chinese people 50 to 70 years of age.

Methods

Primary angle-closure suspects underwent iridotomy using a neodymium:yttrium–aluminum–garnet laser in 1 randomly selected eye, with the fellow eye serving as a control. Intraocular pressure was measured using Goldmann applanation tonometry before treatment and 1 hour and 2 weeks after treatment. Total energy used and complications were recorded. Risk factors for IOP rise after laser peripheral iridotomy were investigated.

Main Outcome Measures

Intraocular pressure.

Results

The proportion of treated eyes with an IOP spike (an elevation of ≥8 mmHg more than baseline) at 1 hour and 2 weeks after treatment was 9.8% (95% confidence interval [CI], 7.7–12.0) and 0.82% (95% CI, 0.2–1.5), respectively. Only 4 (0.54%) of 734 eyes (95% CI, 0.01–1.08) had an immediate posttreatment IOP of 30 mmHg or more and needed medical intervention. The average IOP 1 hour after treatment was 17.5±4.7 mmHg in the treated eyes, as compared with 15.2±2.6 mmHg in controls. At 2 weeks after treatment, these values were 15.6±3.4 mmHg in treated eyes and 15.1±2.7 mmHg in controls (P<0.001). No significant difference was detected in the baseline IOP of the treated and untreated eyes. Logistic regression showed that the incidence of IOP spike was associated with greater laser energy used and shallower central anterior chamber.

Conclusions

Laser peripheral iridotomy in primary angle-closure suspects resulted in significant IOP rise in 9.8% and 0.82% of cases at 1 hour and 2 weeks, respectively. Eyes in which more laser energy and a higher number of laser pulses were used and those with shallower central anterior chambers were at increased risk for IOP spikes at 1 hour after laser peripheral iridotomy.

Objective

To assess whether outcomes of strabismus surgery are improved by using the adjustable suture technique and to determine which subgroups of strabismus patients benefit most from the adjustable suture technique.

Design

A retrospective chart review.

Participants

Five hundred thirty-five adults who had strabismus surgery between 1989–2010.

Methods

Success was defined as ≤10 prism diopters (PD) for horizontal deviations and ≤2 PD for vertical deviations. Differences in the proportion of successful strabismus surgery were analyzed using a chi-square test with an alpha of 0.05.

Main outcome measures

Ocular alignment in primary position at a 7-day to 12-week follow-up examination.

Results

491 patients met the inclusion criteria (adjustable suture, n=305; non-adjustable, n=186). The success rates for non-adjustable and adjustable groups were 61.3% and 74.8% respectively (χ2=9.91, p=0.0016). Adjustable suture use was particularly beneficial for patients undergoing a reoperation for childhood strabismus (success rate: non-adjustable, 42.4%; adjustable, 65.7% p=0.0268; n=100). The differences in outcomes were not statistically significant for patients with childhood strabismus undergoing a primary surgery (non-adjustable, 65.0%; adjustable, 81.4% p=0.1354; n=90) or with thyroid orbitopathy (non-adjustable, 76.7%; adjustable, 74.1% p=0.8204; n=57).

Conclusions

Strabismus surgery using adjustable sutures was associated with improved short-term ocular alignment compared to strabismus surgery without the use of adjustable sutures. Adjustable sutures were most beneficial for patients undergoing reoperations for childhood strabismus.

Purpose

To report spontaneous corneal clearing with improved visual acuity and central endothelial cell repopulation after Descemet’s stripping without endothelial replacement.

Design

Interventional case report.

Methods

A 34 year-old female with bilateral decreased vision secondary to corneal edema from endothelial dysfunction underwent Descemet’s stripping endothelial keratoplasty (DSEK) in the right eye and Descemet’s stripping (DS) only in her contralateral eye. Histopathologic evaluation confirmed a dual diagnosis of Fuchs endothelial dystrophy (Fuchs) and posterior polymorphous membrane dystrophy (PPMD) from Descemet’s membrane specimens removed from each eye. Following primary graft failure with regraft in the right eye, the second posterior corneal lenticule detached, was removed and was not replaced. The cornea cleared and central endothelial cell repopulation was documented by confocal microscopy. Therefore, Descemet’s stripping without endothelial replacement was performed in the left eye. The left cornea also cleared with central endothelial cell repopulation.

Main Outcome Measures

Postoperative visual acuity and central endothelial cell repopulation

Results

Endothelial migration after Descemet’s stripping alone in the second eye, with probably host endothelial cell repopulation in the right eye.

Conclusions

Endothelial cell migration after Descemet’s stripping procedure without insertion of endothelial graft can occur, resulting in host endothelial cell repopulation with corneal clearing and improved visual acuity.

Purpose

To determine the impact of chemotherapy or external beam radiotherapy (EBRT) on pediatric anophthalmic sockets.

Design

A retrospective, nonrandomized, interventional cohort study.

Participants

A total of 135 sockets of 133 children undergoing enucleation from late 1999 to early 2009 at the St. Jude Children’s Research Hospital were included.

Methods

A retrospective chart review of outcomes after enucleation in patients treated with systemic chemotherapy or orbital EBRT either before or after removal of the eye compared with patients who received no other treatment.

Main Outcome Measures

Incidence of implant exposure, migration, extrusion, socket contracture, and pyogenic granuloma formation.

Results

Retinoblastoma was the primary diagnosis in 128 eyes (95%). Median follow-up was 3.6 years (range, 0.1–9.3 years). Event-free course was observed in 94 sockets (69.6%). Complications included implant exposure (n = 28, 20.7%), socket contracture (n = 16, 11.9%), pyogenic granuloma (n = 9, 6.7%), implant extrusion (n = 3, 2.2%), and migration (n = 2, 1.5%). Exposure resolved in 21 sockets (77.8%) and improved in 2 sockets (11.1%); 1 patient with exposure died. Use of prior, adjuvant, or subsequent chemotherapy increased the long-term risk of exposure (odds ratio [OR] = 3.7; 95% confidence interval [CI], 1.4–9.4), and contracture (OR could not be calculated, P<0.0001). External beam radiotherapy greatly increased the risk of contracture (OR 24.0; 95% CI, 6.9–82.8) and exposure (OR 2.89; 95% CI, 1.1–7.9).

Conclusions

In this unique pediatric population with cancer, chemotherapy and EBRT had an additive effect, significantly increasing the incidence of exposure and socket contracture.

Objective

To determine visual acuity improvement in children with strabismic and combined strabismic-anisometropic (combined-mechanism) amblyopia treated with optical correction alone and to explore factors associated with improvement.

Design

Prospective multi-center cohort study

Participants

146 children 3 to <7 years old with previously untreated strabismic amblyopia (N=52) or combined-mechanism amblyopia (N=94).

Methods

Optical treatment was provided as spectacles (prescription based on a cycloplegic refraction) that were worn for the first time at the baseline visit. Visual acuity with spectacles was measured using the Amblyopia Treatment Study HOTV© visual acuity protocol at baseline and every 9 weeks thereafter until no further improvement in visual acuity. Ocular alignment was assessed at each visit.

Main outcome measure

Visual acuity 18 weeks after baseline.

Results

Overall, amblyopic eye visual acuity improved a mean of 2.6 lines (95% confidence interval: 2.3 to 3.0), with 75% of children improving ≥2 lines and 54% improving ≥3 lines. Resolution of amblyopia occurred in 32% (95% confidence interval: 24% to 41%) of the children. The treatment effect was greater for strabismic amblyopia than for combined-mechanism amblyopia (3.2 versus 2.3 lines, adjusted P=0.003). Visual acuity improved regardless of whether eye alignment improved.

Conclusions

Optical treatment alone of strabismic and combined-mechanism amblyopia results in clinically meaningful improvement in amblyopic eye visual acuity for most 3 to <7-year-old children, resolving in at least one quarter without the need for additional treatment. Consideration should be given to prescribing refractive correction as the sole initial treatment for children with strabismic or combined-mechanism amblyopia before initiating other therapies.

Purpose

To prospectively examine the association between demographic and geographic factors in relation to exfoliation glaucoma or exfoliation glaucoma suspect (EG/EGS).

Design

Prospective cohort study.

Participants

We included 78,955 women in the Nurses’ Health Study and 41,191 men in the Health Professionals Follow-up Study.

Methods

Female and male health professionals were prospectively followed during the periods 1980–2008 and 1986–2008, respectively. Eligible participants were 40+ years old, did not have EG/EGS at baseline and reported receiving eye examinations during follow-up. Information regarding demographic features, lifetime geographic residence and potential confounders was collected. During follow-up, 348 EG/EGS cases were confirmed with medical record review. We estimated the relative risk of EG/EGS in each cohort separately and pooled the results with meta-analysis.

Main outcome measures

Multivariable rate ratios (MVRR) of EG/EGS and their 95% confidence intervals (95% CI).

Results

EG/EGS was strongly age-related with subjects ≥ 75 years old at 46.22-fold (95% CI, 22.77 – 93.80) increased risk compared to those between aged 40–55 years. While men were 68% less likely to develop EG/EGS than women (MVRR = 0.32; 95% CI, 0.23 – 0.46), no predisposition to EG/EGS by ancestry, particularly Scandinavian ancestry, emerged. Compared to a lifetime of living in the Northern tier of the continental US, lifetime residence in the middle geographical tier (MVRR = 0.53; 95% CI, 0.40 – 0.71) and in the southern geographical tier (MVRR = 0.25; 95% CI, 0.09 – 0.71) was associated with markedly reduced risks of EG/EGS.

Conclusions

In this mainly Caucasian cohort from the United States (US), increasing age and female gender were significant risk factors for EG/EGS; however, Scandinavian heritage was not. Living in the middle or southern regions of the US relative to living in the northern region was associated with a reduced risk of EG/EGS.

Purpose

To evaluate the effect of dopaminergic medication and deep brain stimulation on ocular function in Parkinson disease (PD) and to measure vision-related quality of life in subjects with PD.

Design

Prospective comparative case series.

Participants and Controls

Twenty-seven PD and 16 control subjects were recruited.

Methods

We measured visual acuity, ocular motor function, convergence, and vision-related quality of life using the Visual Function Questionnaire–25 (VFQ-25). Visual sensory and motor measurements were made during the “on” and “off” states of PD dopaminergic treatment.

Main Outcome Measures

Convergence ability and vision related quality of life.

Results

The PD subjects had a mean age of 58.8 years; 30% were female. Their mean duration of PD was 10.9 ± 6.8 years. The control subjects had a mean age of 61.6 years; 56% were female. There was no difference in visual acuity, contrast sensitivity or color vision of the PD subjects in their “on” state compared with controls. Convergence amplitudes measured with base-out prism were significantly poorer in PD subjects compared with controls (24.1 ± 8 Δ vs 14.8 ±10.3 Δ; P=0.003). The mean composite VFQ-25 score was significantly worse in the PD subjects compared with the controls (87.1 ± 8.69 vs 96.6 ± 3.05; P=0.0001).

Comparing the PD subjects in their “on” with their “off” states, there was no difference in distance exodeviation, near exodeviation or ocular ductions. Mean convergence amplitudes and near point of convergence were better in the “on” state compared with the “off” state, 14.8±10.3 Δ vs 10.7±9.0 Δ, (P=0.0006), and 13.1±9.1 cm vs 18.1±12.2, (P=0.002), respectively.

Conclusions

Convergence ability is significantly poorer in PD subjects in both their “on” and “off” states compared with controls, but significantly improves with systemic dopaminergic treatment. Ocular motor function in PD subjects fluctuates in response to treatment, which complicates ophthalmic management. PD subjects have a significant reduction in vision-related quality of life, especially near activities, that is not associated with visual acuity.

Purpose

To investigate the reproducibility of choroidal thickness measurements in normal subjects on three Spectral Domain Optical Coherence Tomography (SDOCT) instruments, Zeiss Cirrus HD-OCT (Carl Zeiss Meditec Inc, Dublin, California, USA), Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany) and Optovue RTVue (Optovue Inc., Fremont, CA).

Design

Cross-sectional non-interventional study

Participants

Images were obtained in 28 eyes of 28 healthy undilated volunteers without ocular pathology in a clinical setting.

Methods

All subjects were imaged on the fovea using Cirrus HD 1-line raster, Spectralis enhanced depth imaging and RTVue retina-cross.

Main Outcome Measures

The choroid was measured subfoveally, 750 μm temporal and 750 μm nasal to the fovea. All measurements were performed by 2 independent observers. Two way analysis of variance (ANOVA) with Bonferroni's post-test, Pearson correlation and the Bland-Altman analysis were used to compare measurements.

Results

The group of 28 subjects consisted of 7 men and 21 women, with an average age of 35.2 years (range, 23 to 64 years). A two way ANOVA with Bonferroni's post-test revealed no significant difference in the average subfoveal choroidal thickness (P >0.05) between systems for any location: subfoveally, 750μm temporal and 750 μm nasal to the fovea. The measurements of choroidal thickness from any pair of three instruments (Cirrus vs. Spectralis, Cirrus vs. RTVue, Spectralis vs. RTVue) were also strongly correlated. The Pearson correlation between all two system pairs of the three systems was greater than 0.9 p <0.0001. The 95% limits of agreement between four choroidal thickness measurements between Cirrus and RTVue were +11.21% to -13.57% (Bias -1.17), between Spectralis and RTVue +10.85% to -12.45% (Bias -0.80) and between Cirrus and Spectralis +12.81% to -13.33% (Bias -0.25).

Conclusions

In our population of young healthy adults with normal vision, there was good reproducibility between choroidal thickness measurements of images acquired with Cirrus, Spectralis and RTVue.

Purpose

To examine the association between self-rated vision and distance visual acuity by race and other factors.

Design

Cross-sectional analysis within a longitudinal, population-based cohort study.

Participants and Controls

Two thousand five hundred and twenty individuals, aged 65 to 84, including 666 Black participants and 1854 White participants.

Methods

All participants reported their self-rated vision score. Binocular distance visual acuity was assessed. Based on the level of visual acuity and the self-reported vision score, participants were placed into concordant and discrepant groups.

Main Outcome Measures

Multinomial logistic regression models were used to examine the characteristics associated with concordant and discrepant groups.

Results

Black participants were more likely to be represented in the discordant group that reported good vision but had acuity worse than 20/40. In the multivariate analysis, a per year decrement in years of education received increased the odds of being in both discrepant groups, one that reported good vision but had a visual acuity worse than 20/40 (odds ratio, 1.21; P<0.0001) and the other discrepant group that reported bad vision but had a visual acuity of 20/40 or better (odds ratio, 1.04; P<0.0001). A per year decrement in years of education received also appeared to explain the excess risk of Black race in the discrepant group that reported good vision but had a visual acuity worse than 20/40.

Conclusions

Given the socioeconomically driven discrepancies in self-reported vision status, self-reported vision status should be used cautiously in surveillance surveys especially when assessing vision inequalities between socioeconomic groups.

Purpose

To compare stereoacuity thresholds before and after visual acuity testing in patients with intermittent strabismus and in controls.

Design

Prospective cohort study.

Participants and controls

We prospectively enrolled 88 patients (41 with intermittent strabismus and 47 controls) with measurable stereoacuity on their initial stereoacuity test.

Methods

Stereoacuity was measured prior to and immediately following visual acuity testing using the near Preschool Randot and Distance Randot stereotests. Stereoacuity was transformed to log units for analysis.

Main Outcome Measures

Change in stereoacuity thresholds (log arcsec).

Results

There was no overall deterioration in distance stereoacuity or near stereoacuity thresholds in either the intermittent strabismus or control groups. The mean change for patients with intermittent strabismus was 0.02 log arcsec (95% confidence interval (CI): -0.02 to 0.06) for near stereoacuity and 0.04 log arcsec (95% CI: -0.01 to 0.09) for distance stereoacuity. Control patients demonstrated a mean change of 0.03 log arcsec (95% CI: -0.01 to 0.06) for near stereoacuity and 0.01 log arcsec (95% CI: -0.06 to 0.08) for distance stereoacuity. These mean changes correspond to less than approximately one eighth of an octave. For individual patients, deterioration in stereoacuity beyond previously reported test-retest variability (0.6 log arcsec or greater) was not observed in patients with intermittent strabismus or controls using either test.

Conclusions

Stereoacuity thresholds do not deteriorate following visual acuity testing and therefore measurements of stereoacuity do not need to precede visual acuity measurement or other tests that involve short periods of dissociation.

Objective

The purpose of this study is to investigate whether children with congenital esotropia are more likely than controls to develop mental illness by early adulthood.

Design

Retrospective, population-based cohort.

Participants

Children (<19 years) diagnosed with congenital esotropia while residing in Olmsted County, Minnesota, from January 1, 1965, through December 31, 1994, and their one-to-one non-strabismic birth- and gender-matched controls.

Methods

The medical records of patients with esotropia and their controls were retrospectively reviewed for the subsequent development of psychiatric disease.

Main Outcome Measures

The development of mental illness and associated co-morbidities among patients with congenital esotropia and their controls.

Results

A mental health disorder was diagnosed in 42 (33%) of the 127 patients with congenital esotropia followed to a mean age of 20.4 years compared to 16% of controls (p=0.002). Congenital esotropia increased the odds of developing a psychiatric illness 2.6 times (Confidence interval: 1.5- 4.8) compared to controls. The number of mental health diagnoses (p=0.019) and the use of psychotropic medications (p= 0.015) were significantly more common among esotropic patients compared to non-strabismic controls.

Conclusions

Congenital esotropia, similar to those with intermittent exotropia or convergence insufficiency, increases the odds of devloping mental illness by early adulthood 2.6 times compared to controls. The etiology of this association does not appear to be associated with premature birth.

Purpose

To elucidate the subclinical anatomy of retinopathy of prematurity (ROP) using spectral domain optical coherence tomography (SD OCT).

Design

Prospective, observational case series.

Participants

Three low-birth-weight, severely premature infants.

Methods

Clinical examination was performed using a portable slit lamp and indirect ophthalmoscope. Imaging was performed by using a handheld SD OCT device and Retcam (Clarity Medical Systems, Pleasanton, CA) or video-indirect recording. Spectral domain optical coherence tomography imaging was conducted without sedation at the bedside in the neonatal intensive care unit on 1 patient. The other 2 patients had an examination under anesthesia with SD OCT imaging in the operating room.

Main Outcome Measures

In vivo determination of vitreoretinal morphology, anatomy, and pathology by clinical examination, imaging, and SD OCT.

Results

Linear and volumetric imaging was achieved with the handheld system in infant eyes despite tunica vasculosa lentis and vitreous bands. Imaging was not possible in eyes with notable vitreous hemorrhage. Analysis of SD OCT images revealed preretinal structures (ranging from 409 to 2700 μm in width and 212 to 440 μm in height), retinoschisis, and retinal detachment in the posterior pole of patients with advanced ROP. Both the retinoschisis and the preretinal structures were not identified on conventional examination or imaging by expert pediatric ophthalmologists. The preretinal structures varied in location and size, and may represent preretinal fibrovascular proliferation. Some were found in close proximity to blood vessels, whereas others were near the optic nerve.

Conclusions

Handheld SD OCT imaging can be performed on the sedated or nonsedated neonate and provides valuable subclinical anatomic information. This novel imaging modality can reveal the location and extent of posterior ROP pathology not evident on standard examination. This could affect future clinical decision-making if studies validate a management strategy based on findings from this imaging technique.

Purpose

To characterize the natural history of drusen using spectral-domain optical coherence tomography (SDOCT) imaging of eyes from patients with non-exudative age-related macular degeneration (AMD).

Design

Prospective longitudinal natural history study

Participants

One hundred forty three eyes of 100 patients with at least 6 months follow-up.

Methods

Patients with drusen secondary to non-exudative AMD were scanned using the Cirrus SDOCT instrument (Carl Zeiss Meditec, Dublin, CA). Eyes were imaged using the 200×200 A-scan raster pattern contained within a 6×6mm area. Custom software was used to quantify volumetric changes in drusen over a period of at least 6 months and for as long as 24 months. Drusen volume and drusen area were measured within circular regions centered at the fovea having diameters of 3mm and 5mm. The measurements were analyzed using a suitable scale transformation. For drusen volume, a cube root transformation strategy was used.

Main Outcome Measures

The change in drusen volume and area over time.

Results

One hundred forty three eyes of 100 patients were analyzed with 69 eyes followed for 6 months, 106 eyes followed for 12 months, 48 eyes followed for 18 months, and 48 eyes followed for 24 months. The 3mm circle baseline drusen volume ranged from 0.0009mm3 to 0.7479mm3 or 0.10mm to 0.91mm using the cube root scale. On average, drusen volume and drusen area increased over time with the magnitude of the increase dependent on the length of follow-up (p=0.001, 3mm circle). In the eyes with a decrease in drusen volume, the magnitude of this decrease was dependent on the baseline drusen volume (p=0.001, 3mm circle) and independent of the follow-up interval.

Conclusions

SDOCT imaging revealed a dynamic, undulating growth pattern for drusen with a tendency for drusen to increase in volume and area over time. An appreciation of the quantitative changes in drusen volume over time using SDOCT imaging provides a novel strategy for following normal disease progression and for identifying novel clinical trial endpoints to be used when investigating therapies for the treatment of non-exudative AMD.

Objective

To describe the prevalence of choroidal nevi in four racial/ethnic groups (white, black, Hispanic, and Chinese) in the United States (US).

Design

Cross-sectional study.

Participants

Participants of the second examination of the Multi-Ethnic Study of Atherosclerosis (MESA), involving 6176 persons aged 45–85 years without clinical cardiovascular disease at baseline selected from 6 US communities.

Methods

Fundus images were taken using a 45° digital camera through dark-adapted pupils and were graded for choroidal nevi using the modified Wisconsin Age-Related Maculopathy Grading System and the Blue Mountains Eye Study protocol.

Main Outcome Measure

Choroidal nevi.

Results

The overall prevalence of choroidal nevi in the whole cohort was 2.1%, with prevalences higher in whites (4.1%) than blacks (0.7%), Hispanics (1.2%) and Chinese (0.4%, P < 0.001 for any differences among groups). The lowest prevalence of choroidal nevi occurred in those 75–84 years old. The nevi were subfoveal in 4% of eyes with nevi and were not associated with a decrease in visual acuity. Characteristics of the nevi (size, shape, location, color, drusen on surface) did not differ among racial/ethnic groups. With the exception of associations with higher C-reactive protein levels (odds ratio [OR] per mg/dL on the logarithmic scale 1.23; 95% confidence interval [CI] 1.06–1.43; P = 0.01) and lower systolic blood pressure (OR per 10 mmHg 0.90; 95% CI 0.82–0.99; P = 0.04), choroidal nevi were not associated with other potential risk factors (e.g., sex, smoking status, alcohol consumption, lipid levels, coagulation factors or kidney disease).

Conclusions

Low prevalences of choroidal nevi were found in the four groups participating in MESA cohort, with whites having higher prevalence than the other racial/ethnic groups. The higher prevalence in whites than in other groups was not explained by any of the factors studied. When choroidal nevi were present, their characteristics did not differ among racial/ethnic groups.

Objective

The purpose of the study was to examine: (a) how patient adherence and eye drop technique were associated with visual field defect severity and (b) how general glaucoma adherence self-efficacy and eye drop technique self-efficacy were related to visual field defect severity.

Design

Cross-sectional study conducted at a single private practice site.

Participants

Patients on eye drops for their glaucoma.

Methods

We measured subjects’ adherence to glaucoma medications through Medication Events Monitoring System (MEMS) devices and assessed eye drop instillation technique by video-recording. We measured general glaucoma medication adherence self-efficacy using a 10-item scale and eye drop technique self-efficacy using a 6-item scale. Multivariable logistic regression was used to analyze the data.

Main outcome measures

Visual field defect severity.

Results

Patients who were less than 80% adherent according to the MEMS caps were significantly more likely to have worse defect severity. Patients with lower scores on the general glaucoma medication adherence self-efficacy scale were also significantly more likely to have worse defect severity. Eye drop technique and eye drop technique self-efficacy were not significantly related to visual field defect severity.

Conclusions

Eye care providers need to assess patient adherence and work with those patients with poor adherence to find ways to improve their ability and self-efficacy in using their glaucoma medications.

Purpose

We previously identified a genetic copy number polymorphism (CNP147) that was statistically associated with age-related macular degeneration (AMD), and which resides downstream of the complement factor H (CFH) gene. Factor H protein is polymorphic at amino acid 402 in which the resulting histidine containing moiety has been established to impart significant risk of AMD. Here we present a method to precisely determine the exact copy number of CNP147 and examine in more detail the association with AMD.

Design

Case-control Study

Participants

421 AREDS (Age-related Eye Disease cohort Study) subjects of whom approximately 35% were diagnosed with neovascular disease, 19% with geographic atrophy, 16% with both, 30% with large drusen and 215 controls.

Methods

Using copy number assays available from Applied Biosystems Inc., we examined four loci spanning CNP147 and neighboring CNP148 in an AREDS matched case-control sample set. We analyzed these data by copy number while controlling for two high-risk CFH variants, rs1061170 (Y402H) and rs1410996. We phased the high risk CFH variants with CNP147 and analyzed haplotype frequencies in cases and controls. To further validate copy numbers, six Utah CEPH families (Centre D’etude du Polymorphism Humaine) were typed for CNP147 and the segregation assessed.

Main Outcome Measures

Increased or decreased risk of AMD from genetic loci.

Results

Having fewer than 2 copies of CNP147 is associated with an estimated 43% reduction in odds of having AMD in this sample set (adjusted odds ratio=0.57, P=0.006). CNP148 variation is rare in Caucasians and it was not statistically significant. Common haplotypes reveal that the risk alleles for rs1061170 and rs1410996 most frequently segregate with higher copy numbers for CNP147; but not exclusively, and that one haplotype that carried a deletion of CNP147 was highly protective (odds ratio=0.25 P=1.3×10−13) when compared to the reference.

Conclusions

In this matched subset of AREDS subjects, after adjusting for two known risk variants in CFH, CNP147 deletion statistically associates with diminished risk for AMD.

Purpose

To examine the prevalence of astigmatism (≥1.00 diopter (D)) and high astigmatism (≥2.00 D) from 6 months post term due date to 6 years postnatal, in preterm children with birth weight ≤ 1251g who developed high-risk prethreshold retinopathy of prematurity (ROP) and participated in the Early Treatment for ROP (ETROP) Study.

Design

Observational Cohort Study

Participants

401 infants who developed high-risk prethreshold ROP in one or both eyes and were randomized to early treatment (ET) versus conventional management (CM). Refractive error was measured by cycloplegic retinoscopy. Eyes were excluded if they received additional retinal, glaucoma, or cataract surgery.

Intervention

Eyes were randomized to receive laser photocoagulation at high-risk prethreshold ROP or to receive treatment only if threshold ROP developed.

Main Outcome Measures

Astigmatism and high astigmatism at each study visit.

Results

For both ET and CM eyes, there was a consistent increase in prevalence of astigmatism over time, increasing from 42% at 4 years to 52% by 6 years for the group of ET eyes and from 47% to 54% in the CM eyes. There was no statistically significant difference between the slopes (rate of change per month) of the ET and CM eyes for both astigmatism and high astigmatism. (P=0.75)

Conclusions

By 6 years of age, over 50% of eyes with high-risk prethreshold ROP developed astigmatism ≥ 1.00 D, and nearly 25% of such eyes had high astigmatism (≥ 2.00 D). Presence of astigmatism was not influenced by timing of treatment, zone of acute-phase ROP, or presence of plus disease. However, there was a trend toward higher prevalence of astigmatism and high astigmatism in eyes with ROP residua. Most astigmatism was with-the-rule (75º –105º). More eyes with Type 2 than Type 1 had astigmatism by 6 years. These findings reinforce the need for follow-up eye examinations through early grade school years in infants with high risk prethreshold ROP.

Objective

Trichothiodystrophy (TTD) is a rare autosomal recessive disorder characterized by sulfur-deficient brittle hair and multisystem abnormalities. Many TTD patients have a defect in known DNA repair genes. This report systematically evaluates the ocular manifestations of the largest-to-date cohort of TTD patients and xeroderma pigmentosum (XP)/TTD patients.

Design

Case Series

Participants

Thirty-two participants, ages 1 to 30 years, referred to the National Eye Institute for examination from 2001 to 2010: Twenty-five had TTD, and 7 had XP/TTD.

Methods

Complete, age- and developmental stage-appropriate ophthalmic examination.

Main Outcome Measures

Visual acuity (VA), best corrected VA, ocular motility, state of the ocular surface and corneal endothelial cell density, corneal diameter, lens assessment.

Results

Developmental abnormalities included microcornea (44% TTD), microphthalmia (8% TTD, 14% XP/TTD), nystagmus (40% TTD), and infantile cataracts (56% TTD and 86% XP/TTD). Corrective lenses were required by 65% of the participants, and decreased best-corrected VA was present in 28% of TTD patients and 71% of XP/TTD patients. Degenerative changes included dry eye (32% TTD, 57% XP/TTD) and ocular surface disease identified by ocular surface staining with fluorescein (32% TTD), that usually are exhibited by much older patients in the general population. The two oldest TTD patients exhibited clinical signs of retinal/macular degeneration. Four XP/TTD patients presented with corneal neovascularization.

Conclusions

TTD and XP/TTD study participants had a wide variety of ocular findings including refractive error, infantile cataracts, microcornea, nystagmus, and dry eye/ocular surface disease. While many of these can be ascribed to abnormal development—likely due to abnormalities in basal transcription of critical genes—patients may also have a degenerative course.