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1.  Estimating Minimally Important Differences for Two Vision-Specific Quality of Life Measures 
To estimate minimally important differences (MIDs) for the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ).
A total of 607 subjects with newly-diagnosed open-angle glaucoma (OAG) was enrolled in the Collaborative Initial Glaucoma Treatment Study (CIGTS) and randomized to initial treatment with medications or surgery. Subjects underwent an ophthalmic examination and telephone-administered quality of life (QOL) interview before randomization and every six months thereafter. The VAQ and NEI-VFQ were used to assess participants' perceptions of their visual function. Clinical measures included the mean deviation (MD) from Humphrey 24-2 full threshold visual field (VF) testing, and best-corrected visual acuity (VA) measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol. Anchor-based (using MD and VA) and distribution-based methods were used to estimate MIDs.
Anchor-based cross-sectional analyses at 66 months follow-up found a 10-letter increment in better eye VA corresponded to MIDs of 5.2 units for VAQ and 3.8 units for NEI-VFQ total scores. A 3-dB increment in the better eye MD yielded MIDs of 2.6 and 2.3 units for the same two questionnaires. In longitudinal analyses, MIDs for the VAQ were 3.2 units for a 10-letter change of VA and 3.4 units for a 3-dB change in the MD. Distribution-based MIDs were larger.
A range of MIDs for the VAQ (2.6–6.5 units) and NEI-VFQ (2.3–3.8 units) was found. Although similar in magnitude, MIDs were sensitive to the MID estimation method, the anchor chosen, and differences between questionnaires. ( number, NCT00000149.)
Minimally important differences (MIDs) were estimated for two vision-specific quality of life measures, VAQ and NEI-VFQ, using anchor-based cross-sectional, anchor-based longitudinal, and distribution-based methods. Subscale MIDs for VAQ (2.6–6.5 units) and NEI-VFQ (2.3–3.8 units) were found.
PMCID: PMC4095718  PMID: 24906863
MID; glaucoma; CIGTS; NEI-VFQ; VAQ
2.  Regression Rate of Posterior Uveal Melanomas Following Iodine-125 Plaque Radiotherapy 
To characterize the regression rate of posterior uveal melanoma following radioactive iodine-125 (I-125) plaque.
Materials and Methods:
We retrospectively analyzed 95 patients with posterior uveal melanoma who were treated with only radioactive I-125 plaque and had more than 3 years follow-up. All patients were treated with plaque radiotherapy using tumor dose of 85 Gy at the tumor apex, following COMS protocol. Regression rate was assessed with standardized A-scan ultrasonography. Associations with tumor regression were evaluated by means of mixed linear regression modeling.
Mean decrease in the tumor thickness (% original thickness) at 12, 24, and 36 months after radiotherapy for melanomas <3 mm in thickness was 29%, 38%, and 45%, for melanoma 3-8 mm in thickness was 32%, 44%, and 59%, and for melanoma more than 8 mm in thickness was 52%, 62%, and 68%, respectively. With a doubling of follow-up time (0.5-1 year, or 1-2 years of follow-up from treatment), tumors <3 mm in thickness at treatment showed a 0.5 mm decrease in tumor thickness, whereas melanomas 3-8 mm showed a 1 mm decrease, and melanomas >8 mm showed a 1.7 mm decrease. Uveal melanomas that developed systemic metastasis showed an additional 0.4 mm decrease with a doubling of follow-up time from treatment, compared with those that did not develop metastasis (P = 0.050).
Posterior uveal melanomas with higher initial thickness show steeper and more reduction in tumor thickness following radioactive I-125 plaque. After the initial phases, the regression curve became similar for tumors with different thicknesses.
PMCID: PMC4302463  PMID: 25624683
Uveal Melanoma; Plaque Radiotherapy; Tumor Regression
3.  Can topical ketorolac 0.5% improve the function of Ahmed glaucoma drainage devices? 
Background and Objective
To determine whether postoperative use of topical ketorolac tromethamine 0.5% affects intraocular pressure (IOP) following Ahmed glaucoma drainage device implantation.
Study Design
Patients undergoing Ahmed implantation at the University of Michigan from January 2002-June 2008 were reviewed. Fourteen eyes received ketorolac after surgery; 50 eyes did not. Preoperative and postoperative IOP and glaucoma medications were recorded for both groups; the two-sided Student t-test was used to compare these parameters.
Mean preoperative IOP was similar in the two groups (35.1 ± 11.9 mmHg versus 37.0 ± 12.2 mmHg; p=0.60). At postoperative month 6, the ketorolac eyes following Ahmed implantation had significantly lower IOP compared with the no ketorolac group (13.1 ± 3.7 mmHg versus 19.5 ± 9.3 mmHg respectively; p= 0.0003). There was no difference in the number of glaucoma medications postoperatively between the two groups.
Ketorolac may lead to lower postoperative IOP following Ahmed implantation.
PMCID: PMC3343136  PMID: 21449531
4.  The Effect of Early Post-trabeculectomy Intraocular Pressure Spike in the Collaborative Initial Glaucoma Treatment Study 
Journal of glaucoma  2011;20(4):211-214.
To examine effects of early postoperative intraocular pressure (IOP) spike in patients undergoing primary trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
Patients and Methods
We identified patients with IOP spike ≥ 5 mmHg above the baseline IOP on postoperative day 1, as well as those without IOP increase. The Mean Deviation (MD), Pattern Standard Deviation (PSD), and Corrected PSD (CPSD) of the visual field (VF) were compared at 6 months and years 1, 2, 3, and 5 after surgery, as was the IOP.
Seventeen of 300 patients (5.7%) had IOP spike. After controlling for baseline VF severity in a generalized linear regression model that addressed change in MD, PSD, and CPSD, or in a logistic regression model for ≥ 3 dB of MD change, comparison between the groups revealed no significant difference at all time points examined (P > .05). Patients with IOP spike had significantly higher mean IOP at years 3 and 5 of follow-up (P ≤ .04).
Among CIGTS patients, early post-trabeculectomy IOP spike ≥ 5 mmHg above baseline IOP was not associated with subsequent VF loss, but was associated with significantly higher IOP during long-term follow-up.
PMCID: PMC2978773  PMID: 20577103
trabeculectomy; intraocular pressure; spike; visual field; glaucoma
5.  Risk of Endophthalmitis and Other Long-Term Complications of Trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS) 
American journal of ophthalmology  2012;155(4):674-680.e1.
To report the risk of endophthalmitis and other long-term complications in patients randomized to trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
A longitudinal cohort study using data collected from a multicenter, randomized clinical trial.
Long-term post-operative complications in the 300 patients randomized to trabeculectomy in CIGTS were tabulated. Kaplan-Meier analyses were used to estimate the time-related probability of blebitis, hypotony, and endophthalmitis.
285 patients were included in the final trabeculectomy cohort after accounting for assignment refusal and other early events. Patients were followed for an average of 7.2 years. 163 patients (57%) received 5-fluorouracil (5-FU) intraoperatively. Of the 247 patients with at least 5 years of follow-up, 50 required further treatment for glaucoma. Cataract extraction was performed in 57 patients (20%). Forty patients (14%) required bleb revision at least once. Bleb-related complications included bleb leak (N = 15), blebitis (N = 8), and hypotony (N = 4). Three patients were noted to have endophthalmitis, although the diagnosis in two patients was presumptive. The occurrences of blebitis, hypotony, or endophthalmitis were not significantly associated with 5-FU use. The Kaplan-Meier calculated risks of blebitis and hypotony at 5 years were both 1.5%, while the risk of endophthalmitis was 1.1%.
The potential efficacy of trabeculectomy must be weighed against the long-term risk of complications, especially endophthalmitis, when selecting treatments for patients with open-angle glaucoma. We report a low 5-year risk of endophthalmitis (1.1%) and other bleb-related complications in the trabeculectomy cohort of the CIGTS.
PMCID: PMC3608803  PMID: 23246272
6.  Longitudinal Trends in Resource Utilization in an Incident Cohort of Open Angle Glaucoma Patients 
American journal of ophthalmology  2012;154(3):452-459.e2.
To characterize the costs of caring for patients with open-angle glaucoma (OAG) in the United States (US) over time and to identify factors that influence these costs.
Longitudinal cohort study.
Claims data from 19,927 newly-diagnosed OAG patients enrolled in a large US managed care network were reviewed to identify glaucoma-related charges for all incident OAG patients from 2001–2009. Average glaucoma-related charges for enrollees with OAG were characterized in six month blocks from the date of initial OAG diagnosis through the following 5 years. Factors associated with being an enrollee in the costliest 5% for glaucoma-related charges (accruing ≥$5810 in charges in the first 2 years) were identified using logistic regression.
The costliest 5% of enrollees were responsible for $10,202,871 (24%) of all glaucoma-related charges. By comparison, those whose costs fell within the lower 50% of the cost distribution collectively amassed only $7,986,582 (19%) of all glaucoma-related charges. A spike in glaucoma-related charges occurred in the 6 month period around the time of OAG diagnosis, stabilized by 1 year following diagnosis, and remained relatively constant over time. Risk factors associated with being in the costliest 5% for glaucoma-related care included younger age, Northeastern US state residence, undergoing cataract surgery, and possessing ocular co-morbidities.(p<0.006 for all comparisons).
A small subset of enrollees account for a large proportion of all glaucoma-related charges. Understanding the characteristics of these individuals and finding ways to reduce disease burden and costs associated with their care can result in substantial cost savings.
PMCID: PMC3422396  PMID: 22789564
7.  Factors Associated with Intraocular Pressure Prior to and during Nine Years of Treatment in the Collaborative Initial Glaucoma Treatment Study 
Ophthalmology  2007;115(6):927-933.
To evaluate, both at initial glaucoma diagnosis and during treatment, the role of demographic and clinical factors on intraocular pressure (IOP).
Cohort study of patients enrolled in a randomized clinical trial.
607 patients with newly diagnosed, open-angle glaucoma (OAG) were enrolled at 14 U.S. centers.
After randomization to initial surgery or medications, patients were followed at six-month intervals. IOP was measured by Goldmann applanation tonometry. Predictive factors for IOP at baseline and during follow-up were analyzed using linear mixed models.
Main Outcome Measure
IOP at baseline and during follow-up.
The mean baseline IOP was 27.5 mmHg (standard deviation, 5.6 mmHg). Predictive factors for higher baseline IOP included younger age (0.7 mmHg per 10 years), male sex (2.4 mmHg higher than females), pseudoexfoliative glaucoma (5.4 mmHg higher than primary OAG), and pupillary defect (2.2 mmHg higher than those without a defect). During nine years of follow-up, both surgery and medications dramatically reduced IOP from baseline levels, but the extent of IOP reduction was consistently greater in the surgery group. Over follow-up years 2–9, mean IOP was 15.0 vs. 17.2 mmHg for surgery vs. medicine, respectively. Predictive associations with higher IOP during follow-up included higher baseline IOP (P<0.0001), worse baseline visual field (mean deviation; P<0.0001), and lower level of education (P=0.0019). Treatment effect was modified by smoking status: non-smokers treated surgically had lower IOP than smokers treated surgically (14.6 vs. 16.7 mmHg, respectively; P=0.0013). Clinical center effects were significant (P<0.0001) in both the baseline and follow-up models.
In this large cohort of newly diagnosed glaucoma patients, predictors of pre-treatment IOP and IOP measurements over nine years of follow-up were identified. Our findings lend credence to the postulate that sociodemographic, economic, compliance, or other environmental influences play a role in IOP control during treatment.
PMCID: PMC2758572  PMID: 17964655
8.  Diffuse lamellar keratitis after laser in situ keratomileusis with femtosecond laser flap creation 
To identify possible associations with the development of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) with femtosecond laser flap creation.
University-based academic practice, Ann Arbor, Michigan, USA.
Case-control study.
Myopic LASIK was performed between October 2006 and December 2010 using an Intralase 60 kHz femtosecond laser for flap creation. Preoperative clinical characteristics, treatment parameters, and intraoperative and postoperative complications were recorded. Statistical comparisons were made using t, chi-square, and Fisher exact tests and repeated-measures logistic regression to adjust for inter-eye dependency.
The study enrolled 801 eyes (419 patients). Ninety-nine eyes (12.4%) of 70 patients developed DLK; most cases comprised mild flap interface inflammation and were treated with a routine postoperative antiinflammatory regimen. Twenty-two eyes (2.7%) required more than 1 week of antiinflammatory treatment. There was a statistically significant increase in the incidence of DLK with larger flap diameter (P = .0171), higher side-cut energy (P = .0037), and higher raster energy (P = .0033). Patients with DLK were less likely to achieve corrected distance visual acuity of 20/20 or better 1 day postoperatively (P = .0453). The difference in acuity was no longer present at 1 week. There were no significant associations between the incidence of DLK and preoperative refractive error, flap thickness, ablation depth, or other treatment parameters.
Diffuse lamellar keratitis after LASIK with femtosecond laser flap creation tended to be mild with little effect on visual acuity. Higher energy level for flap creation and larger flap diameter were associated with an increased risk for DLK.
PMCID: PMC3360807  PMID: 22487775
9.  Clinical Characteristics of Newly Diagnosed Primary, Pigmentary, and Pseudoexfoliative Open-Angle Glaucoma in the Collaborative Initial Glaucoma Treatment Study 
The British journal of ophthalmology  2012;96(9):1180-1184.
Three types of open-angle glaucoma (OAG) – primary, pigmentary, and pseudoexfoliative – are frequently encountered. The aim of this study was to compare demographic, ocular, and systemic medical information collected on people with these three OAG types at diagnosis, and determine if the OAG type affected prognosis.
Information on 607 participants of the Collaborative Initial Glaucoma Treatment Study was accessed. Descriptive statistics characterized their demographic, ocular, and medical status at diagnosis. Comparisons were made using analysis of variance (ANOVA), and chi-square or Fisher exact tests. Multinomial, mixed, and logistic regression analyses were also performed.
Relative to people with primary OAG, those with pigmentary OAG were younger, more likely to be white, less likely to have a family history of glaucoma, and were more myopic. Those with pseudoexfoliative OAG were older, more likely to be white, more likely to be female, less likely to have bilateral disease, and presented with higher IOP and better VA. The type of glaucoma was not associated with intraocular pressure or visual field progression during follow-up.
Characteristics of newly-diagnosed enrollees differed by the type of OAG. While some of these differences relate to the pathogenesis of OAG type, other differences are noteworthy for further evaluation within population-based samples of subjects with newly-diagnosed OAG.
PMCID: PMC3480313  PMID: 22773091
Glaucoma; Epidemiology
10.  Evaluating clinical change and visual function concerns in drivers and non-drivers with glaucoma 
To compare drivers and non-drivers, and describe the specific concerns of drivers, among individuals with glaucoma.
607 newly-diagnosed glaucoma patients from 14 clinical centers of the Collaborative Initial Glaucoma Treatment Study were randomly assigned to initial medicine or surgery and followed every six months for < 5 years. Driving status (drivers vs. non-drivers) as well as patient-reported visual function was determined by the Visual Activities Questionnaire and the National Eye Institute Visual Function Questionnaire. Clinical evaluation included visual field mean deviation (MD) and visual acuity. Statistical comparisons were made using t, Chi-square, and exact tests, regression, and Rasch analyses.
Drivers were more likely than non-drivers to be male, white, married, employed, and have more education, higher income, and fewer co-morbidities. Over 50% of drivers reported at least “some” difficulty performing tasks involving glare, whereas 22% reported at least “some” difficulty with tasks requiring peripheral vision. At 54 months, drivers with moderate/severe bilateral visual field loss (VFL) reported greater difficulty with night driving and tasks involving visual search and visual processing speed than drivers with less bilateral VFL (all p-values <0.05). While those who remained drivers over follow-up had better MD in both eyes than those who became non-drivers due to eyesight, a number of drivers had marked VFL.
Inquiring about specific difficulties with tasks related to glare, visual processing speed, visual search and peripheral vision in driving, especially among patients with substantial bilateral VF damage, will enable physicians to more effectively counsel patients regarding driving.
PMCID: PMC3395081  PMID: 19060263
11.  Differences in Rates of Glaucoma Among Asian Americans Compared With Other Races and Among Individuals of Different Asian Ethnicities 
Ophthalmology  2011;118(6):1031-1037.
To determine the incidence and prevalence rates of different glaucoma types among Asian Americans, contrast glaucoma incidence and prevalence rates for Asian Americans with other races, and evaluate the hazard of developing glaucoma among different Asian ethnicities and other races.
Retrospective longitudinal cohort study
2,259,061 beneficiaries aged ≥40 enrolled in a large, national managed-care network in the United States (US) in 2001–2007
Incidence and prevalence rates of open-angle glaucoma (OAG), narrow-angle glaucoma (NAG), and normal-tension glaucoma (NTG) were determined for the beneficiaries and stratified by race and Asian ethnicity. Cox regression analyses determined the hazard of developing OAG, NAG, and NTG for Asian Americans compared with other races and among different Asian ethnicities, with adjustment for confounding factors.
Main Outcome Measures
Multivariable hazard of OAG, NAG, and NTG among different races and Asian ethnicities.
The OAG prevalence rate for Asian Americans of 6.52% was similar to that of Latinos (6.40%) and higher than that of non-Hispanic whites (5.59%). The NAG and NTG prevalence rates (3.01% and 0.73%, respectively) were considerably higher among Asian Americans compared with each of the other races. After adjustment for confounding factors, Asian Americans had a 51% increased hazard of OAG (Hazard ratio (HR)=1.51 (95% confidence interval (CI) 1.42–1.60), a 123% increased hazard of NAG (HR=2.23 (95% CI 2.07–2.41), and a 159% increased hazard of NTG (HR=2.59 (95% CI 2.22–3.02) compared with non-Hispanic whites. Vietnamese Americans (HR=3.78, (95% CI 3.19–4.48), Pakistani Americans (HR=2.45, 95% CI 1.50–4.01) and Chinese Americans (HR=2.31, 95% CI 2.06–2.59) had considerably higher hazards of NAG while Japanese Americans (HR=4.37, 95% CI 3.24–5.89) had a substantially higher hazard of NTG, compared with non–Asian Americans.
Given the rapid rise in the number of Asian Americans in the US population, resources need to be devoted to identifying and treating glaucoma among these individuals. Eye-care providers should be aware of the increased hazard of developing OAG, NAG, and NTG among Asian Americans relative to other races. When evaluating Asian Americans, inquiring about ethnicity can provide additional information on risk of specific glaucoma types.
Financial Disclosures
The authors have no proprietary or commercial interest in any materials discussed in this article.
PMCID: PMC3109193  PMID: 21310489
12.  The Effect of Trabeculectomy on Intraocular Pressure of the Untreated Fellow Eye in the Collaborative Initial Glaucoma Treatment Study 
Ophthalmology  2010;117(11):2055-2060.
To describe the intraocular pressure (IOP) of the untreated fellow eye following unilateral trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
Data collected from a prospective, multicenter, randomized clinical trial
Three hundred patients with newly diagnosed open-angle glaucoma enrolled at 14 centers in the United States who were randomized to initial trabeculectomy.
After baseline evaluation and randomization to initial trabeculectomy in the study eye, patients were evaluated at 3 and 6 months, and at 6-month intervals thereafter. The IOP was measured by Goldmann applanation tonometry. All eyes included in the analysis were untreated fellow eyes, and the data were censored for potential IOP lowering events in the fellow eye including trabeculectomy, argon laser trabeculoplasty or cataract extraction. Predictive factors for IOP response in the fellow eye to initial trabeculectomy in the study eye were analyzed using a linear mixed model.
Main Outcome Measure
IOP in the untreated fellow eye during follow up.
While the IOP in the fellow eye was lower than baseline at 3, 6, 12, 18 and 24 months after trabeculectomy in the study eye, this decrease was statistically significant only at month 12 (mean decrease from baseline, 0.73±3.37 mm Hg; P=0.0134). Predictive associations with higher IOP in the fellow eye during follow-up included higher baseline IOP (P<0.0001), lower level of education (P=0.0129), time (p=0.0005) and the presence of other vascular disease (p=0.0069). Patients who ultimately required fellow eye trabeculectomy (p<0.0001) or argon laser trabeculoplasty (p<0.0001) but not cataract extraction (p=0.4597) in the fellow eye had lower IOPs during follow-up after these procedures.
There was no evidence of a substantial effect of trabeculectomy on the untreated fellow eye IOP during follow up. Trabeculectomy does not appear to decrease the mean IOP of the fellow eye, as suggested by some previous studies.
PMCID: PMC3334525  PMID: 20570363
glaucoma; intraocular pressure; trabeculectomy; fellow eye; contralateral eye
13.  Visual Field Progression in the Collaborative Initial Glaucoma Treatment Study: The Impact of Treatment and other Baseline Factors 
Ophthalmology  2008;116(2):200-207.
To evaluate factors associated with visual field (VF) progression, using all available follow-up through nine years after treatment initiation, in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
Longitudinal follow-up of participants enrolled in a randomized clinical trial.
607 newly diagnosed glaucoma patients.
In a randomized clinical trial, 607 subjects with newly diagnosed open-angle glaucoma were initially treated with either medication or trabeculectomy. After treatment initiation and early follow-up, subjects were evaluated clinically at 6-month intervals. Study participants in both arms of the CIGTS were treated aggressively in an effort to reduce intraocular pressure (IOP) to a level at or below a predetermined, eye-specific target pressure. VF progression was analyzed using repeated measures models.
Main outcome measures
VF progression, measured by Humphrey 24-2 full threshold testing and assessed by the change in the mean deviation (MD), and an indicator of substantial worsening of the VF (MD decrease of ≥3 dB from baseline), assessed at each follow-up visit.
Follow-up indicates minimal change from baseline in each initial treatment group’s average MD. However, at the eight year follow-up examination, substantial worsening (≥3 dB) of MD from baseline was found in 21.3% and 25.5% of the initial surgery and initial medicine groups, respectively. The effect of initial treatment on subsequent VF loss was modified by time (P<0.0001), baseline MD (P=0.03), and diabetes (P=0.01). Initial surgery led to less VF progression than initial medicine in subjects with advanced VF loss at baseline, whereas subjects with diabetes had more VF loss over time if treated initially with surgery.
The CIGTS intervention protocol led to a lowering of IOP that persisted over time in both treatment groups. Progression in VF loss was seen in a subset increasing to over 20% of the subjects. Our findings regarding initial surgery being beneficial for subjects who present at diagnosis with more advanced VF loss, but detrimental for patients with diabetes, are noteworthy and warrant independent confirmation.
PMCID: PMC3316491  PMID: 19019444
14.  Prevalence of Corneal Dystrophies in the United States: Estimates from Claims Data 
Knowledge of the prevalence of corneal dystrophies is limited. This report provides prevalence estimates based on claims data obtained from a large U.S. managed-care network. It gives insight to the age, sex, and race distribution of specific corneal dystrophies.
To estimate the prevalence of corneal dystrophies.
Records of almost 8 million enrollees in a national managed-care network throughout the United States who had an eye care visit in 2001 to 2009 were searched for a recording of corneal dystrophy on a claim submitted by an ophthalmologist or optometrist from January 1, 2001, through December 31, 2007.
Unique individuals (n = 27,372) received two or more diagnoses of any type of corneal dystrophy, for an overall corneal dystrophy prevalence rate of 897 per million (106) covered lives. Endothelial and anterior corneal dystrophies accounted for most of the reported dystrophies, and granular corneal dystrophy was the least common, being reported in 167 enrollees. Age, sex, and race variations among the various corneal dystrophies were observed. The mean age of those with macular corneal dystrophy (47.3 years) was 15 years younger than the age of those with endothelial dystrophy (62.9 years), and females were most highly represented (68.5%) among those with lattice corneal dystrophy. Hispanics and blacks were underrepresented relative to enrollees undergoing eye care for reasons other than corneal dystrophy. Keratoplasty was most frequently coded among those with lattice dystrophy.
Although caveats must be considered in using claims data to estimate prevalence in a population, these data provide an indication of corneal dystrophy's prevalence within insured subjects across the United States. Variations in age, sex, and race, within and between the different types of corneal dystrophies, raise questions that warrant further study.
PMCID: PMC3175990  PMID: 21791583
15.  Incidence of Diffuse Lamellar Keratitis After LASIK with 15 KHz, 30 KHz and 60 KHz IntraLase Femtosecond Laser Flap Creation 
To compare the incidence of diffuse lamellar keratitis (DLK) after laser in situ keratomileusis (LASIK) with flap creation using the IntraLase® 15 kHz (FS15), 30 kHz (FS30), or 60 kHz (FS60) femtosecond laser.
University-based academic practice, Ann Arbor, Michigan, USA
We retrospectively reviewed 520 consecutive myopic LASIK surgeries performed using the IntraLase FS15, FS30, or FS60 femtosecond laser for flap creation from January 1, 2005 to June 1, 2007. Preoperative clinical characteristics, treatment parameters, intraoperative and postoperative complications were recorded. Statistical comparisons were made using repeated measures analysis, analysis of variance, chi-square, and Fisher’s exact tests.
Five hundred twenty eyes of 274 patients were included in the study. One hundred seventy-six eyes (93 patients) were treated using the FS15 laser, 180 eyes (93 patients) with the FS30 laser, and 164 eyes (89 patients) with the FS60 laser. Seventeen eyes (10%) in the FS15 laser group, 24 eyes (13%) in the FS30 laser group, and 23 eyes (14%) in the FS60 laser group developed DLK. There was no statistically significant difference in the incidence of DLK among the three groups (p=0.68).
This study found no significant difference in the incidence of DLK among the FS15, FS30, and FS60 groups.
PMCID: PMC2966847  PMID: 21029900
16.  Contrasting the Use of Two Vision-Specific Quality of Life Questionnaires in Subjects with Open-Angle Glaucoma 
Journal of glaucoma  2009;18(5):403-411.
To compare two vision-specific functional status measures to each other and to clinical parameters in the Collaborative Initial Glaucoma Treatment Study (CIGTS).
CIGTS participants completed the Visual Activities Questionnaire (VAQ) and the National Eye Institute-Visual Function Questionnaire (NEI-VFQ) and were tested for visual field (VF) and visual acuity (VA). 426 subjects contributed VAQ and NEI-VFQ scores at 54 months. Pearson correlations were used to assess associations.
The VAQ subscales (range 0–100) that assessed light-dark adaptation (mean=66.1), glare disability (66.4), and acuity/spatial vision (67.7) indicated vision-related functions that CIGTS participants found most difficult. On the NEI-VFQ, subjects reported high levels of visual functioning, with mean ≥90 (out of 100) on the total score and in 9 of 12 subscales. General vision (mean=82.6) received the lowest subscale score. Two subscales common to both questionnaires were highly correlated: VA (r=0.68) and peripheral vision (r=0.77) (both p<.0001). Correlations between participants’ perceptions and clinical measures of visual function were in the expected direction, but weaker. Stronger associations were found between clinical measures and the NEI-VFQ than the VAQ. Better eye VF and worse eye VA had the highest number of significant correlations with subjects’ perceptions of their visual function. Increasing VF loss was associated with a significant decrease in the overall and peripheral vision subscale scores from both questionnaires, as well as several other subscales.
These findings will help researchers interested in assessing patients’ perceptions of their visual function make an informed selection when choosing between the VAQ and the NEI-VFQ.
PMCID: PMC3060041  PMID: 19525733
Glaucoma; quality of life; visual field; visual acuity

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