Publisher: Elsevier   (Total: 3161 journals)

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Showing 1 - 200 of 3161 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 106, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 44, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 446, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 30, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 323, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 13, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 188, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 13, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 1, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 35, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 14)
Advances in Digestive Medicine     Open Access   (Followers: 13)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 45, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 30, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 9)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 68, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 8, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 26)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 6, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 11)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 69)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 430, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 56, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 394, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 487, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 46, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 55, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 67, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 48, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 15, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 39, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 37, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 263, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 67, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 30, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 6, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 214, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 236, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)
Annales d'Endocrinologie     Full-text available via subscription   (Followers: 3, SJR: 0.451, CiteScore: 1)

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Similar Journals
Journal Cover
American Journal of Ophthalmology
Journal Prestige (SJR): 3.184
Citation Impact (citeScore): 4
Number of Followers: 67  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9394
Published by Elsevier Homepage  [3161 journals]
  • Addendum to: Validation of a Prognostic Staging for Metastatic Uveal
    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of OphthalmologyAuthor(s): Tero Kivelä, Sophie Piperno-Neumann, Laurence Desjardins, Alexander Schmittel, Nikolaos Bechrakis, Edoardo Midena, Serge Leyvraz, Leonidas Zografos, Jean-Daniel Grange, Guillaume Ract-Madoux, Ernest Marshall, Bertil Damato, Sebastian Eskelin
  • OCT Angiography Features of Neovascularization as Predictive Factors for
           Frequent Recurrence in Age-Related Macular Degeneration
    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of OphthalmologyAuthor(s): Mihyun Choi, Seong-Woo Kim, Cheolmin Yun, Jaeryung OhAbstractPurposeTo investigate the features of neovascularization (NV) in eyes with neovascular age-related macular degeneration (NVAMD) using optical coherence tomography angiography (OCTA) according to the treatment interval of intravitreal aflibercept injection (IVI).DesignRetrospective, interventional, comparative case series.MethodsPatients with type 1 NV treated with the “pro-re-nata” regimen after three loading IVI were classified into two groups based on the numbers of treatments during 12 months, specifically a stable group who required less than two injections and an unstable group who required more than three injections. Quantitative features of OCTA including NV area, NV length, NV density, endpoint density (open-ended vessels per unit length), junction density (vessel junction per unit length), lacunarity, and largest vessel caliber were compared between the two groups.ResultsAmong 71 eyes, 38 and 33 eyes were classified into the stable and unstable groups, respectively. The unstable group had higher endpoint densities (stable vs. unstable: 2.74 vs. 3.08; p = 0.03) and higher levels of lacunarity (0.177 vs. 0.211; p = 0.028). The area, density, length of NV and junction density and largest vessel caliber were not different between the two groups (p= 0.057, p = 0.184, p = 0.062, p = 0.160, and p = 0.473). Endpoint density was correlated with the unstable group in both univariate and multivariate analyses (p = 0.004, p = 0.002, respectively). A predictive model with an endpoint index demonstrated a sensitivity of 93.75% and a negative predictive value of 89.47% for the unstable group.ConclusionsThe characteristics of NV in eyes of exudative AMD with type 1 NV were different according to treatment requirements. Identifying the features of NV on OCTA might be helpful for predicting clinical outcomes and optimal treatment intervals.
  • Morning myopic shift and glare in advanced Fuchs endothelial corneal
    • Abstract: Publication date: Available online 16 January 2020Source: American Journal of OphthalmologyAuthor(s): Niklas Loreck, Werner Adler, Sebastian Siebelmann, Alexander C. Rokohl, Ludwig M. Heindl, Claus Cursiefen, Björn O. Bachmann, Mario MatthaeiAbstractPurposeImpaired subjective morning visual acuity with improvement of symptoms during the day is pathognomonic for corneal endothelial dysfunction in advanced Fuchs endothelial corneal dystrophy (FECD). This study aimed to analyze the daily fluctuations of corneal thickness, refraction, and (glare) visual acuity in advanced FECD.DesignProspective cohort study.MethodsPatients with advanced FECD (FECD group) and patients with normal cornea (control group) were enrolled. Routine clinical examination was performed using slitlamp biomicroscopy, funduscopy, macular OCT. In addition, assessment using corneal Scheimpflug tomography (Pentacam), refraction, corrected distance visual acuity (CDVA) and glare CDVA was performed at 4pm (afternoon) and the following day at 8am (morning).ResultsA total of 29 FECD eyes and 22 control eyes were included. Diurnal variations from afternoon to morning were Δcorneal thickness (apex) ± standard deviation (SD) 41.45±34.1μm (p
  • Localization in glaucomatous visual field loss vulnerable to
           posture-induced intraocular pressure changes in open angle glaucoma
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): Yusuke Manabe, Akira Sawada, Tetsuya YamamotoAbstractPurposeTo investigate localization in glaucomatous visual field defect vulnerable to posture-induced intraocular pressure (IOP) changes.DesignProspective cross-sectional studyMethodsNinety-three eyes of 93 newly-diagnosed cases with normal tension glaucoma were examined. The IOP was measured in both the sitting and lateral decubitus positions with an Icare rebound tonometer. Visual field tests were performed with a Humphrey Field Analyzer with the Central 30-2 program using Swedish Interactive Threshold Algorithm standard strategies. The total deviation (TD) map values of 51 tested points were used for the analysis. A regression analysis was conducted to investigate relationships between TD in each point or cluster and posture-induced IOP changes. A linear mixed-effects model was used to identify factors associated with TD changes in each visual field cluster.Main Ootcome MeasuresRelationship between posture-induced IOP changes and localization of visual field defect.ResultsThere were 54 women and 39 men (mean age, 53.4 ± 12.5 years). The mean IOP per Icare rebound tonometer was 15.5 ± 3.2 mmHg in the sitting position and 18.8 ± 3.1 mmHg in the lateral decubitus position. The postural IOP difference was +3.3 ± 1.8 mmHg (P < .001; range, -1.0 to 7.7 mmHg). There was a significant negative correlation between TD and posture-induced IOP changes in four contiguous central points located just above the horizontal meridian. A linear mixed-effects model revealed a significant association between the difference in postural IOP change and decreased TD in the superior paracentral visual field according to multivariate analysis (P = .010).ConclusionsPosture-induced IOP variation have been shown to be associated with glaucomatous superior paracentral visual field defect.
  • Comparison of techniques for correction of chin-down vertical abnormal
           head position associated with infantile nystagmus syndrome
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): James J. Law, Yuxi Zheng, Derick G. Holt, David G. Morrison, Sean P. DonahueAbstractPurposeWe evaluated the relative effectiveness of combined recession-resection of vertical rectus muscles versus superior rectus recession with inferior oblique weakening for patients who underwent surgical correction of chin-down abnormal head position (AHP) associated with infantile nystagmus syndrome (INS).DesignRetrospective interventional case series.MethodsReview of 22 patients who underwent surgical correction of chin-down vertical AHP associated with INS at an academic institution. The primary outcome was collapse of AHP. Unfavorable outcomes included repeat surgery, induced strabismus, in addition to failure of collapse of AHP.ResultsTwenty-two patients had chin-down AHP. Recession-resection (BSRc 6-9 mm; BIRs 5-9 mm) was performed in 11 cases; weakening of both elevators (BSRc 5-8 mm, BIOc or myectomy) in 11 cases. Unfavorable outcome rates were 64% (7/11) compared with 18% (2/11), respectively (P = 0.03). Re-operation was performed for 6/22 patients. Five were from the recession-resection group, namely three for induced V-pattern esotropia, one for alternating esotropia, and one to correct recurrent AHP. The last of the 6 who requied reoperation was in the elevator weakening group, and required correction of a recurrent AHP (P = 0.06).ConclusionsWhile recession-resection of the vertical recti and weakening of both elevators each produce acceptable collapse of chin-down AHP, the former frequently induces a V-pattern esotropia requiring re-operation.
  • Determining and comparing the effective lens position and refractive
           outcome of a novel rhexis-fixated lens to established lens designs
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): Mehdi Shajari, Ruven Sonntag, Theresa Niermann, Detlef Holland, Thomas Kohnen, Siegfried Priglinger, Wolfgang J. MayerabstractPurposeTo evaluate differences in effective lens position (ELP) based on the lens design. Intraocular lenses (IOL) with plate-haptic, c-loop haptic and a rhexis fixated lens were compared.SettingDepartment of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. Department of Ophthalmology, Goethe-University, Frankfurt, Germany. nordBlick Eye Clinic, Kiel, Germany.DesignRetrospective, multicenter, comparative case series.MethodsThe study included patients having age-related cataract surgery with implantation of either a plate-haptic, c-loop haptic or a novel rhexis fixated IOL. Biometry and refraction measurements were conducted pre- and three months postoperatively. Lens constant optimization was performed.ResultsSeventy eyes of 56 subjects were included. ELP for rhexis fixated IOL was shortest (4.29 ± 0.24 mm), followed by c-loop haptic (4.41 ± 0.42 mm) and plate-haptic (4.51 ± 0.26 mm) IOL. Difference in ELP was significant between rhexis fixated IOL and both plate-haptic (P=0.001) and c-loop haptic IOL (P=0.000). ACD adjustment based on lens design showed a significant effect on refraction and IOL power predictions for all formulas and lenses (P
  • Reply to Correspondence: Trends in Retina Specialist Imaging Utilization
           From 2012 to 2016 in the United States Medicare Fee-for-Service Population
    • Abstract: Publication date: Available online 15 January 2020Source: American Journal of OphthalmologyAuthor(s): Turner D. Wibbelsman, Ravi R. Pandit, David Xu, Thomas L. Jenkins, Phoebe L. Mellen, Rebecca R. Soares, Anthony Obeid, Hannah Levin, Jason Hsu, Allen C. Ho
  • Near-Infrared Reflectance Imaging for Quantification of Atrophy associated
           with Age-related Macular Degeneration
    • Abstract: Publication date: Available online 14 January 2020Source: American Journal of OphthalmologyAuthor(s): Nizar Saleh Abdelfattah, Jaya Sadda, Ziyuan Wang, Zhihong Hu, Srinivas SaddaAbstractPurposeTo compare measurements of area of geographic atrophy (GA) in dry age-related macular degeneration (AMD) obtained by fundus autofluorescence (FAF) to those obtained by near infrared reflectance (NIR).DesignInter-rater reliability analysis.MethodsNinety-seven confocal NIR images (Heidelberg HRA + Spectralis) and FAF images from 97 patients/eyes with GA with dry AMD were collected retrospectively from existing anonymized Doheny Image Reading Center datasets. Two masked reading center graders (NS and JS) independently and blindly performed manual segmentation of the GA lesions on each NIR and FAF image using GNU Image Manipulation Program (GIMP, ver 2.8.22) software. GA on NIR/FAF images was defined in accordance to recently published Classification of Atrophy Meeting criteria as sharply-demarcated hyper-reflective regions of at least 250 microns in diameter. The difference and point-to-point correspondence between gradings in GA area measurements between NIR and FAF were assessed by mean difference, overlap ratio and Dice similarity coefficient.ResultsAmong the 97 eyes with dry AMD, mean GA area was 7.62 ± 7.77 mm2 from FAF images and 7.65 ± 7.83 mm2 from NIR, with a mean nonsignificant difference of 0.31 ± 0.55 mm2 (two-tailed t-test, p = 0.65). The overlap ratio in the segmented GA lesion between modalities was 0.84 ± 0.28 with a Dice similarity coefficient of 0.87 ± 0.27. Intermodal reliability was high (intra-class correlation coefficient/ICC = 0.998, p
  • Changes in choroidal thickness varied by age and refraction in children
           and adolescents: a one-year longitudinal study
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Shuyu Xiong, Xiangui He, Bo Zhang, Junjie Deng, Jingjing Wang, Minzhi Lv, Jianfeng Zhu, Haidong Zou, Xun XuAbstractPurposeTo clarify the changing characteristics of choroidal thickness over time within different age ranges and among different refractive statuses of children aged 6 to 18 years.DesignProspective cohort study.MethodsData of axial length, cycloplegic refraction, and choroidal thickness (using swept-source optical coherence tomography) were collected at baseline and at a one-year follow-up for 756 participants. One-year change in choroidal thickness and its association with age and refraction were analyzed.ResultsSignificantly greater attenuation of choroidal thickness was observed in younger children aged 6 to 9 years for all participants (-9±25μm) and for those with a myopic shift (-12±25μm), while there was a larger increase in adolescents aged 10 to 13 years for those without a myopic shift (9±23μm). There was a marked decrease in the choroidal thickness for newly developed myopes compared with persistent nonmyopes and persistent myopes (p
  • Accelerated corneal cross-linking: Efficacy, risk of progression, and
           characteristics affecting outcomes. A large single-centre prospective
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Wendy Hatch, Sherif El-Defrawy, Stephan Ong Tone, Raymond Stein, Allan R. Slomovic, David S. Rootman, Theodore Rabinovitch, Christoph Kranemann, Hall F. Chew, Clara C. Chan, Matthew C. Bujak, Ashley Cohen, Gerald Lebovic, Yaping Jin, Neera SingalAbstractPurposeWe examined the efficacy and preoperative characteristics that affect outcomes of accelerated (9 mW/cm2 for 10 minutes) corneal cross-linking (CXL).DesignProspective single-centre observational cohort studyMethodsWe enrolled 612 eyes of 391 subjects with progressive keratoconus (n=589), pellucid marginal degeneration (PMD) (n=11) and laser in situ keratomileusis (LASIK)-induced ectasia (n=12). We evaluated best spectacle corrected visual acuity (BSCVA), topography, refraction, endothelial cell density, corneal thickness, haze, intraocular pressure and visual function before and 12 months after the CXL procedure. We tabulated the proportion of those with progression of maximum keratometry (Kmax). We included race, age, gender and the presence of preoperative apical scarring and environmental allergies in a multivariable linear regression model to determine the effect of these characteristics on outcomes.ResultsAt one year there was no significant change in mean Kmax (n=569). Progression of KMax was higher in subgroups with baseline Kmax>58D (n=191) and 14-18 years of age (n=53). Preoperative BSCVA, Kmax, refraction, corneal cylinder, coma, central corneal thickness (CCT) and vision function were statistically and clinically significant predictors of outcomes. (p
  • Medication Adherence in Patients with Glaucoma After Cancer Diagnosis
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Chiun-Ho Hou, Ken-Kuo Lin, Jiahn-Shing Lee, Christy PuAbstractPurposeTo determine the association between cancer diagnosis on medication adherence in patients with glaucoma.DesignCohort studyMethodsSetting: Population-based.Study Population: All patients with confirmed glaucoma in one or both eyes. All patients were aged 20 years or older. Patients who developed cancer within one year of a confirmed glaucoma diagnosis or who were dead within one year after a confirmed cancer diagnosis were excluded. Intervention or Observation Procedure(s): Individuals without cancer but with a confirmed glaucoma diagnosis were followed until they received a confirmed cancer diagnosis. They were then matched with a group of patients with confirmed glaucoma who did not develop cancer during the study period.Main Outcome Measure(s): Secondary adherence measured using medication possession ratio (MPR) at 1-year, 2-year, and 2-year-average intervals.ResultsFor both patients with cancer and their matches, MPR was the highest when measured at 1-year intervals. MPR was 0.379 (95% CI: 0.370–0.388) for the cancer group and 0.313 (95% CI: 0.308–0.319) for the cancer-free group. MPR measured using 1-year intervals decreased by 17.4% (p < 0.001). MPR measured using 2-year and 2-year-average intervals decreased by 10.4% (p < 0.001) and 9.21% (p < 0.001), respectively.ConclusionsCancer diagnosis leads to lower medication adherence in patients with glaucoma. To improve medication adherence in patients with glaucoma who also have cancer, policies should directly target the burden associated with having cancer that tends to create barriers for medication refills, rather than targeting risk factors that are also applicable to patients with glaucoma but without cancer.
  • Visual Impairment and Major Eye Diseases in Chronic Kidney Disease: The
           National Health and Nutrition Examination Survey 2005 to 2008
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Zhuoting Zhu, Huan Liao, Wei Wang, Jane Scheetz, Jian Zhang, Mingguang HeAbstractPurposeTo investigate the prevalence and associations of visual impairment (VI), major eye diseases with chronic kidney disease (CKD) in the US.DesignCross-sectional study.MethodsWe investigated the prevalence and associations of VI, major eye diseases with CKD among 5,518 participants aged 40 years or older in the 2005-2008 National Health and Nutrition Examination Survey. An estimated glomerular filtration rate of lower than 60 ml/min/1.73m2 was defined as CKD. Corrected visual acuity of worse than 20/40 in the better-seeing eye was defined as VI. Major eye diseases, including any ocular disease, any objectively-determined ocular disease, cataract surgery, any retinopathy, diabetic retinopathy (DR), age-related macular degeneration (AMD) and glaucoma were evaluated from questionnaire or retinal photographs using standardized grading protocols.ResultsThe prevalence of VI and major eye diseases were approximately two to seven-fold higher in participants with CKD than in those without (all P
  • Anterior Chamber Angles in Different Types of Mucopolysaccharidoses
    • Abstract: Publication date: Available online 13 January 2020Source: American Journal of OphthalmologyAuthor(s): Jia-Rong Zhang, Jen-Hung Wang, Hong-Zin Lin, Yuan-Chieh LeeAbstractPurposeTo evaluate the anterior chamber angle status and estimate the intraocular pressure (IOP) in patients with mucopolysaccharidoses (MPS) type I, II, IV, and VI.DesignProspective cross-sectional studyMethodsThis study enrolled 27 consecutive MPS patients (8 patients with MPS I, 4 patients with MPS II, 9 patients with MPS IV, and 6 patients with MPS VI) and 20 normal controls. Anterior chamber angle status was evaluated by swept-source optical coherence tomography, and intraocular pressure (IOP) was estimated by the new-generation tonometer Corvis ST.Results12 eyes (6 patients) out of the 15 eyes (8 patients) with MPS I had very narrow angles or peripheral iridocorneal touches together with elevated IOP (80%). 6 eyes (3 patients) out of the 8 eyes (4 patients) with MPS II had plateau iris configuration, but all the 8 eyes had normal IOP. All the 18 eyes (9 patients) with MPS IV had normal angle structures, but 8 eyes (4 patients) had elevated IOP (44.4%). 9 eyes (5 patients) out of the 11 eyes (6 patients) with MPS VI had shallow but not closed angles (81.8%). Among these 9 eyes, 5 eyes had elevated IOP, and 4 out of these 5 eyes had IOP above 30 mmHg. The trabecular iris angles of MPS type I, II, VI were smaller than those of MPS type IV and control group. The angle recess areas of MPS type I and VI were smaller than those of MPS type IV and control group.ConclusionsMPS type I patients are prone to have glaucoma with narrow or closed angle; MPS type II patients tend to have plateau iris; MPS type IV patients are vulnerable to open-angle glaucoma; MPS type VI patients have narrow angles not as close as those of MPS type I. MPS type I, IV, and VI had higher IOP estimates than the control group, but only MPS I and IV had higher corrected IOP estimates than the control group. The ordinary IOP estimates in MPS VI patients may be falsely high due to clouded corneas and increased corneal rigidity. The swept-source optical coherence tomography helps ophthalmologist to investigate the angle structure and the pathophysiology of glaucoma caused by MPS.
  • Ophthalmological findings in fetal alcohol spectrum disorders – a cohort
           study from childhood to adulthood
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of OphthalmologyAuthor(s): Emelie Gyllencreutz, Eva Aring, Valdemar Landgren, Leif Svensson, Magnus Landgren, Marita Andersson GrönlundAbstractPurposeTo investigate whether ophthalmological findings in children with fetal alcohol spectrum disorders (FASD) persist into young adulthood.DesignProspective cohort study.MethodsThirty children (13 female) adopted from eastern Europe to Sweden in the 1990s and diagnosed with FASD by a multidisciplinary team at the median age of 7.9 years were followed up by the same team 13–18 years later. Visual acuity (VA), refraction, stereoacuity, strabismus, ocular media and fundus were investigated.ResultsMedian VA right/left eye (RE/LE) was 20/32/20/32 (0.2/0.2 logMAR) in childhood and 20/22/20/20 (0.05/0.0 logMAR) in adulthood. Median (range) refraction RE/LE was +0.88/+1.25 (-8.75 to +4.75/-9.38 to +5.25) spherical equivalent diopter (D) in childhood and -0.25/-0.25 (-12 to +2.75/-13.25 to +2.63) in adulthood. Astigmatism (≥1D) was the most common refractive error;13 (40%) and 14 (47%), respectively. Defective stereoacuity (>60”) was noted in 20 (67%) in childhood and 22 (73%) in adulthood. Heterotropia occurred in 12 (40%) in childhood and 13 (43%) in adulthood. Increased tortuosity of the retinal vessels was found in eight (27%) participants in childhood versus eleven (37%) in adulthood. Optic nerve hypoplasia was recorded in three children and in four young adults.ConclusionsOphthalmological findings such as refractive errors, strabismus and fundus abnormalities are frequent in children with FASD and persist into early adulthood. The facial features characteristic of FAS diminish with age, making a dysmorphology evaluation in adulthood less reliable. An ophthalmological examination is an important part of the evaluation of FASD in childhood as well as in young adulthood.
  • Long-term results of trimethoprim–sulfamethoxazole versus placebo to
           reduce the risk of recurrent Toxoplasma gondii retinochoroiditis
    • Abstract: Publication date: Available online 9 January 2020Source: American Journal of OphthalmologyAuthor(s): João Paulo Fernandes Felix, Rodrigo Pessoa Cavalcanti Lira, Alex Treiger Grupenmacher, Hermano Lucio Gomes de Assis Filho, Alexandre Brito Cosimo, Mauricio Abujamra Nascimento, Carlos Eduardo Leite ArietaAbstractPurposeTo compare the effects of one year of treatment with trimethoprim–sulfamethoxazole (TMP-SMZ) versus placebo in reducing the risk of recurrence of toxoplasmic retinochoroiditis during a six-year follow-up period.DesignRandomized, double-masked clinical trial.MethodsThis cohort included 141 subjects recruited in Campinas, Brazil. The inclusion criterion was unilateral active recurrent toxoplasmic retinochoroiditis. All subjects were treated with one dose of TMP-SMZ (160 mg/800 mg) twice daily for 45 days, and all lesions healed after this treatment. After this initial treatment, subjects were randomly assigned to Group 1 (1 TMP-SMZ dose every other day for 311 days) or Group 2 (one identical placebo tablet containing starch with no active ingredients every other day for 311 days). Between the second and sixth years of follow-up appointments, none of the subjects received treatment unless a new recurrence episode had occurred. The primary outcomes were recurrent toxoplasmic retinochoroiditis within the first year of follow up and recurrent toxoplasmic retinochoroiditis in the six years of follow up.ResultsThe cumulative probability of recurrence 1, 2, 3, 4, 5, and 6 years after the initial infection was, respectively, 13.0% (9/69), 17.4% (12/69), 20.3% (14/69), 23.2% (16/69), 26.1% (18/69), and 27.5% (19/69) in the placebo group and 0%, 0%, 0%, 0%, 0%, and 1.4% (1/72) in the TMP-SMZ group (p
  • Radiation-Induced Optic Neuropathy: Observation versus Intravitreal
    • Abstract: Publication date: December 2019Source: American Journal of Ophthalmology, Volume 208Author(s): Daniela Eckstein, Aline I. Riechardt, Jens Heufelder, Oliver Zeitz, Alexander Böker, Claudia Brockmann, Antonia M. Joussen, Ira SeibelPurposeTo compare intravitreal therapy with the natural course of radiation optic neuropathy after primary proton beam therapy for choroidal melanoma with respect to long-term visual acuity and development of optic atrophy.DesignRetrospective comparative case series.MethodsInclusion criteria: patients treated with primary proton beam therapy for choroidal melanoma with a minimum follow-up of 24 months after the occurrence of radiation optic neuropathy and optic disc imaging during follow-up. Exclusion criteria: pathologic condition of the optic disc before irradiation and intravitreal therapy to treat cystoid macular edema not originating from the optic disc.ResultsOf 93 patients, 48 were observed only after radiation optic neuropathy, and 45 were treated with intravitreal therapy (triamcinolone, bevacizumab, and/or dexamethasone). Median follow-up was 55 months (29-187 months); median interval between onset of radiation optic neuropathy and the last patient visit was 34 months (24-125 months). Of 48 observed patients, 41 (85.4%) developed an optic atrophy after a median of 14 months (3-86 months) after radiation optic neuropathy; and of 45 intravitreally treated patients, 34 (75.5%) presented with an optic atrophy after a median of 12.5 months (1-55 months) following optic neuropathy, indicating no statistically significant differences between the groups. Comparing the change in visual acuity from occurrence of optic neuropathy to final visual acuity, no statistically significant differences were found between either group (P = 0.579).ConclusionsPatients treated with intravitreal therapy for radiation optic neuropathy showed no statistically significant differences related to visual acuity or optic atrophy development from patients who underwent only observation.
  • Population-Based Cataract Surgery Complications and Their Impact on Visual
           Status in the Brazilian Amazon Region
    • Abstract: Publication date: December 2019Source: American Journal of Ophthalmology, Volume 208Author(s): Sung Eun Song Watanabe, Adriana Berezovsky, João Marcello Furtado, Márcia Regina Kimie Higashi Mitsuhiro, Marcela Cypel, Marcos Jacob Cohen, Jacob Moysés Cohen, Cristina Coimbra Cunha, Paula Yuri Sacai, Nívea Nunes Ferraz, Galton Carvalho Vasconcelos, Paulo Henrique Morales, Mauro Campos, Arthur Gustavo Fernandes, Sergio Muñoz, Rubens Belfort, Solange Rios SalomãoPurposeTo investigate cataract surgery prevalence, complications, visual outcomes, and coverage in a population of older adults from the Brazilian Amazon region.DesignPopulation-based cross-sectional study.MethodsIndividuals ≥45 years of age from urban and rural areas of Parintins City, Brazil, were identified by cluster random sampling. Participants underwent ophthalmic examination, including uncorrected visual acuity, acuity with presenting correction (APC), and best-corrected visual acuity (BCVA) from each eye. In those with previous cataract surgery, surgical technique and complications including its contribution to vision impairment were noted. The association of surgical complications and surgical coverage with sociodemographic variables was assessed by multiple logistic regression.ResultsA total of 2,384 persons were determined to be eligible, and 2,041 (85.6%) were examined. Overall, prevalence of cataract surgery was 8.6%, with 11.3% urban and 5.0% rural. Surgical complications were associated with males, older age, and urban residency and were found in 60.4%, with posterior capsule opacification in 29.6% and posterior capsule rupture in 16.3%. Among the 270 eyes having cataract surgery, APC ≥20/32 was found in 44.4%, APC 20/40 to 20/63 in 20.8%, APC
  • Visual Function and Disability are Associated with Increased Retinal
           Volumetric Vessel Density in Patients with Multiple Sclerosis.
    • Abstract: Publication date: Available online 8 January 2020Source: American Journal of OphthalmologyAuthor(s): Hong Jiang, Giovana Rosa Gameiro, Yi Liu, Ying Lin, Hernandez Jeffrey, Yuqing Deng, Giovanni Gregori, Silvia Delgado, Jianhua WangAbstractPurposeThe goal of this study was to determine the volumetric vessel density (VVD) in the intraretinal layers, and its relations with visual function and disability in patients with multiple sclerosis (MS).DesignCross-sectional studyMethodsEighty patients with relapsing-remitting MS (RRMS) and 99 age- and gender-matched healthy controls (HC) were recruited. The retinal microvascular network in the macular area was imaged using optical coherence tomography angiography in 123 eyes without a history of optic neuritis (MSNON) and 36 eyes with a history of ON (MSON). The VVD was calculated as the vessel densities in the retinal vascular network (RVN), superficial vascular plexus (SVP) or deep vascular plexus (DVP) of an annulus (0.6 – 2.5 mm diameter), divided by the corresponding tissue volume of the intraretinal layers respectively.ResultsThe VVD of RVN and DVP in MSNON were significantly higher than in HC (P < .05). The VVD of RVN, SVP, and DVP in MSON were significantly higher than in MSNON and HC (P < .05). The VVD in both RVN and SVP were positively related to EDSS and disease duration, but negatively related to low contrast letter acuity (P < .05). The VVD measurements were also negatively and strongly related to the corresponding tissue volumes (P < .05).ConclusionsThis is the first study to reveal increased retinal VVD in patients with RRMS. The measurements of VVD in the RVN and SVP are related to disability and visual function, which may be developed as image markers for tracking disease progression.
  • Characterization of Progressive Cicatrizing Conjunctivitis With Negative
           Immunofluorescence Staining
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Jae Young You, Charles G. Eberhart, Sezen Karakus, Esen K. AkpekPurposeTo characterize the clinical features of patients with direct immunofluorescence (DIF)-negative mucous membrane pemphigoid (MMP).DesignRetrospective case series.MethodsThirty-six patients who underwent a conjunctival biopsy for suspected MMP were included. Demographic and clinical information was collected. Main outcome measures included visual acuity, Foster stages, presence of extraocular involvement, history of autoimmune disease, and durations of follow-up.ResultsThirty-two patients had a negative DIF. Of those, 2 had a positive DIF on repeat biopsy. Eleven showed progression of conjunctival scarring during a median follow-up of 42 months (range, 8-100 months) and were diagnosed with biopsy-negative MMP. Another 11 patients with a median follow-up of 54 months (range, 15-138 months) were diagnosed with cicatrizing conjunctivitis of other causes. The median visual acuity of patients with biopsy-negative MMP at presentation was significantly lower compared to patients with cicatrizing conjunctivitis of other causes (20/400 vs 20/40, P = .02). Conjunctival scarring score at presentation in both biopsy-positive and biopsy-negative MMP groups was significantly higher compared to patients with cicatrizing conjunctivitis of other causes (median Foster stage, 3 vs 1, P = .009; and 3 vs 1, P = .01, respectively).ConclusionsPatients with progressive cicatrizing conjunctivitis likely have MMP in the absence of alternate diagnoses. Our findings emphasize that suspicion for MMP must remain high for patients who have Foster stage 3 conjunctival scarring on presentation or worsening of scarring during follow-up, even in the setting of negative DIF.
  • Reply to Kumawat and associates
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Andrew Rong, Swarup Swaminathan, Elizabeth Vanner, Richard Parrish
  • Comment on: Conbercept for Treatment of Neovascular Age-related Macular
           Degeneration: Results of the Randomized Phase 3 PHOENIX Study
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Andrzej Grzybowski, Piotr Kanclerz
  • Reply to Correspondence
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Atalie C. Thompson, Daniel M. Vu, Eric Postel, Pratap Challa
  • Comment on: Factors Impacting Outcomes and the Time to Recovery from
           Malignant Glaucoma
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Andrzej Grzybowski, Piotr Kanclerz
  • Reply to Correspondence
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Jong Chul Han, Jae Hwan Choi, Do Young Park, Eun Jung Lee, Changwon Kee
  • Comment on: Border Tissue Morphology Is Spatially Associated With Focal
           Lamina Cribrosa Defect and Deep-Layer Microvasculature Dropout in
           Open-Angle Glaucoma
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Pooja Gupta, Prafulla Sarma, Harsha Bhattacharjee, Susmita Paul, Mayuri Borgohain, Shahinur Tayab, Chengchira A. Sangma
  • Detection of Reduced Retinal Vessel Density in Eyes with Geographic
           Atrophy Secondary to Age-Related Macular Degeneration Using
           Projection-Resolved Optical Coherence Tomography Angiography
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Qi Sheng You, Jie Wang, Yukun Guo, Christina J. Flaxel, Thomas S. Hwang, David Huang, Yali Jia, Steven T. BaileyPurposeTo compare retinal vessel density in eyes with geographic atrophy (GA) secondary to age-related macular degeneration (AMD) to age-matched healthy eyes by using projection-resolved optical coherence tomography angiography (PR-OCTA).DesignProspective cross-sectional study.MethodsStudy participants underwent macular 3- × 3-mm OCTA scans with spectral domain OCTA. Reflectance-compensated retinal vessel densities were calculated on projection-resolved superficial vascular complex (SVC), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). Quantitative analysis using normalized deviation compared the retinal vessel density in GA regions, 500-μm GA rim regions, and non-GA regions to similar macular locations in control eyes.ResultsTen eyes with GA and 10 control eyes were studied. Eyes with GA had significantly lower vessel density in the SVC (54.8 ± 2.4% vs. 60.8 ± 3.1%; P 
  • Retinal and Corneal Neurodegeneration and Their Association with Systemic
           Signs of Peripheral Neuropathy in Type 2 Diabetes
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Julia Hafner, Markus Zadrazil, Anna Grisold, Gerda Ricken, Martin Krenn, Daniela Kitzmantl, Andreas Pollreisz, Andreas Gleiss, Ursula Schmidt-ErfurthPurposeTo determine the extent of retinal and corneal neurodegeneration and investigate the association with intraepidermal neuronal loss and diabetic peripheral neuropathy (DPN) in type 2 diabetes.DesignProspective, cross-sectional study.MethodsSingle-center study of 94 patients with type 2 diabetes patients (157 eyes), divided into groups: the groups without diabetic retinopathy (DR) (n = 68); the nonproliferative DR (NPDR) group (n = 48); and the proliferative DR (PDR) group (n = 41). Patients were imaged with optical coherence tomography and confocal microscopy for macular and peripapillary neuroretinal layer thicknesses and corneal nerve length/density, respectively. Distal leg skin punch biopsies and 2 neurological scores were used to depict intraepidermal nerve fiber density (IENFD) and clinical DPN.ResultsAmong neuroretinal layers, solely the peripapillary retinal nerve fiber layer was decreased in PDR (96 μm; 95% confidence interval [CI], 92-100 μm) versus no DR (103 μm; 95% CI, 100-106 μm) eyes and only after exclusion of outliers (P = .01). Corneal nerve fiber length and density were statistically significantly reduced in the NPDR group (23.0 mm/mm2; 95% CI, 20.0-26.00 mm/mm2 and 14.3 mm; 95% CI, 14.5-16.63 mm, respectively) and the PDR group (18.6 mm/mm2; 95% CI, 14.9-22.30 mm/mm2 and 11.7 mm; 95% CI, 10.2-13-3 mm, respectively) versus the no DR group (25.5 mm/mm2; 95% CI, 23.3-27.70 mm/mm2 and 15.6 mm; 95% CI, 14.5-16.6 mm, respectively), and in the PDR versus the NPDR group. IENFD was statistically significantly reduced in the NPDR (2.0/mm; 95% CI, 1.4-2.7/mm) and PDR stage (1.4/mm; 95% CI, 0.9-2.1/mm) versus in eyes without DR (3.6/mm; 95% CI, 2.9-4.6/mm). A low correlation between intraepidermal and corneal fiber loss was found with both neurological scores (P < .05).ConclusionsRetinal neurodegenerative changes may develop independently of the microvascular alterations defining DR. Corneal and intraepidermal neuronal loss is more pronounced in advanced stages of DR, indicating a positive severity correlation between DR and DPN.
  • Telemetric Measurement of Intraocular Pressure via an Implantable Pressure
           Sensor—12-Month Results from the ARGOS-02 Trial
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Lars Choritz, Kaweh Mansouri, Jacqueline van den Bosch, Melanie Weigel, H. Burkhard Dick, Markus Wagner, Hagen Thieme, Hagen Thieme, Florian Rüfer, Peter Szurmann, Wolfram Wehner, Martin Spitzer, Lutz Hesse, Anselm Jünemann, Niklas Plange, Stefanie Schmickler, Burkhard Dick, Kaymak HakanPurposeThe aim of this study was to investigate the safety and performance of the second generation of an implantable intraocular pressure (IOP) sensor in patients with primary open angle glaucoma (POAG).Designprospective, noncomparative, open-label, multicenter clinical investigation.MethodsIn this study, patients with POAG, regularly scheduled for cataract surgery, were implanted with a ring-shaped, sulcus-placed, foldable IOP sensor in a single procedure after intraocular lens implantation. Surgical complications as well as adverse events (AEs) during 12 months of follow-up were recorded. At each follow-up visit, a complete ophthalmic examination, including visual acuity, IOP, slit lamp examination, and dilated funduscopy as well as comparative measurements between Goldmann applanation tonometry and the EYEMATE-IO implant were performed.ResultsThe EYEMATE-IO implant was successfully implanted in 22 patients with few surgical complications and no unexpected device-related AEs. All ocular AEs resolved quickly under appropriate treatment. Comparative measurements showed good agreement between EYEMATE-IO and Goldmann applanation tonometry (GAT) with an intraclass correlation coefficient (ICC(3,k)) of 0.783 (95% confidence interval [CI]: 0.743, 0.817). EYEMATE-IO measurements were higher than GAT, with a mean difference of 3.2 mm Hg (95% CI: 2.8, 3.5 mm Hg).ConclusionsThe EYEMATE-IO sensor was safely implanted in 22 patients and performed reliably until the end of follow-up. This device allows for continual and long-term measurements of IOP.
  • Trabeculotomy Ab Interno With the Trab360 Device for Childhood Glaucomas
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Raymond G. Areaux, Alana L. Grajewski, Saranya Balasubramaniam, James D. Brandt, Amber Jun, Beth Edmunds, Michael T. Shyne, Elena BitrianPurposeTo report outcomes and complications of trabeculotomy ab interno using the Trab360 device (Trab360; Sight Sciences, Menlo Park, California, USA) in eyes with childhood glaucomas.DesignMulticenter retrospective interventional case series.MethodsEyes with childhood glaucomas that underwent Trab360 with at least 3 months follow-up were evaluated. Postoperative intraocular pressure (IOP) less than or equal to 24 mm Hg with or without medications and no additional surgery defined success.ResultsForty-six eyes of 41 patients were included. Median age at surgery was 12 months (range 1-325 months, mean 71 months); 54% prior to 20 months. A total of 48% were right eyes; 48% were male. Mean treatment was 290°. Median follow-up was 14.5 months (range 6-34 months, mean 16.2 months). Median preoperative IOP was 30 mm Hg (range 18-49 mm Hg, mean 30.9 mm Hg); median postoperative IOP was 18 mm Hg (range 5-40 mm Hg, mean 20.3 mm Hg]. Median number of preoperative glaucoma medications was 2.5 (range 0-5, mean 2.6); median number postoperatively was 1 (range 0-4, mean 1.6). Success was achieved in 67.4% (95% CI: 51.9%-80.0%) of eyes. Among 40 eyes for which Trab360 was the first glaucoma surgery, success rate was 70% (95% CI 53.3%-82.9%). Success was achieved in 81% (95% CI 57.4%-93.7%) of primary congenital glaucoma (PCG) eyes. Among 18 PCG eyes for which Trab360 was the first glaucoma surgery, success rate was 83.3% (95% CI 57.7%-95.6%). Two eyes (4.3%) suffered cyclodialysis. There were no other significant complications.ConclusionsTrab360 success resembles literature on other angle surgeries for childhood glaucomas. Good surgical technique and caution in high-risk angles is imperative to avoid cyclodialysis. Our study is limited by the imperfections inherent in any retrospective analysis. Single-incision ab interno trabeculotomy with the Trab360 device is effective and safe for treating childhood glaucomas, especially PCG.
  • Large Field of View Corneal Epithelium and Bowman's Layer Thickness Maps
           in Keratoconic and Healthy Eyes
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Niklas Pircher, Florian Beer, Stephan Holzer, Andreas Gschließer, Ruth Donner, Michael Pircher, Christoph K. Hitzenberger, Gerald Schmidinger, Jan LammerPurposeTo assess differences between epithelium thickness (ET) and Bowman's layer thickness (BLT) maps in keratoconic eyes and healthy eyes.DesignCross-sectional study.MethodsSetting: institutional. Study population: 47 patients (1 eye) with keratoconus (KC) and 20 healthy subjects (1 eye). Observation procedure: epithelium and Bowman's layer measurements were performed by using custom-designed polarization-sensitive optical coherence tomography (PS-OCT) with a conical scanning optics design. En face corneal ET and BLT maps with a diameter of 11 mm were computed. Main outcome measurements were mean ET and BLT of 25 sectors; the thinnest (minET, minBLT) and thickest sectors (maxET, maxBLT) were assessed. Ratios between thinnest/thickest sectors (R1) and between mean ET and BLT of the inferior temporal quadrant/superior nasal quadrant (R2) were calculated (R1ET, R1BLT; R2ET, R2BLT). Receiver operator characteristic (ROC) curve analysis was used to assess the diagnostic power of statistically different parameters.ResultsIn healthy eyes, smooth ET maps were observed. KC eyes showed a “doughnut pattern.” The BLT maps of healthy eyes had a smooth appearance, but highly irregular “moth”-like damage pattern could be observed in keratoconic eyes. Highest area under the curve values were found for the thinnest sector of the BLT map, the R1ET, and the thinnest sector of the ET map.ConclusionsPS-OCT imaging enables the visualization of significant differences of the corneal epithelium and the Bowman's layer in en face maps covering almost the entire cornea. ET and BLT profiles could clearly show their diagnostic importance for the distinguishing of keratoconic eyes and healthy eyes.
  • Functional and Morphological Evaluation of Meibomian Glands in the
           Assessment of Meibomian Gland Dysfunction Subtype and Severity
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Jiaxin Xiao, Muhammed Yasin Adil, Xiangjun Chen, Øygunn A. Utheim, Sten Ræder, Kim Alexander Tønseth, Neil S. Lagali, Darlene A. Dartt, Tor P. UtheimPurposeTo classify subtypes of meibomian gland dysfunction (MGD) and evaluate the dependency of dry eye signs, symptoms, and parameters on MGD subtype.DesignCross-sectional study. Study Population: the right eyes of 447 patients with MGD of various subtypes and 20 healthy volunteers.MethodsPatients were divided into 4 subtypes of MGD based on meibum expression, meibum quality, and MG loss on meibography images (meibograde of 0–6). Subtypes were patients with high meibum delivery (hypersecretory and nonobvious MGD) and those with low meibum delivery (hyposecretory and obstructive MGD). Additional clinical tests included tear film break-up time (TFBUT), ocular staining, osmolarity, Schirmer I, blink interval timing and the Ocular Surface Disease Index (OSDI) questionnaire.ResultsA total of 78 eyes had hypersecretory MGD; 49 eyes had nonobvious MGD; 66 eyes had hyposecretory MGD; and 254 eyes had obstructive MGD. Increased tear film osmolarity and lower TFBUT were found in the low-delivery groups; hyposecretory (P = 0.006, P = 0.016) and obstructive MGD (P = 0.008, P = 0.006) relative to high-delivery MGD (hypersecretory and nonobvious groups, respectively). Worse ocular symptoms and ocular staining were also found in low-delivery MGD groups than the high delivery MGD groups (P
  • Effects of Immersive Virtual Reality Headset Viewing on Young Children:
           Visuomotor Function, Postural Stability, and Motion Sickness
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Lawrence Tychsen, Paul FoellerPurposeTo assess the safety of VR 3D headset (virtual reality 3-dimensional binocular-stereoscopic near-eye display) use in young children. Product safety warnings that accompany VR headsets ban their use in children under age 13 years.DesignProspective, interventional, before-and-after study.MethodsRecordings were obtained in 50 children (29 boys) aged 4-10 years (mean 7.2 ± 1.8 years). Minimum binocular corrected distance visual acuity (CDVA) was 20/50 (logarithm of the minimum angle of resolution [logMAR] 0.4) and stereoacuity 800 seconds of an arc or better. A Sony PlayStation VR headset was worn for 2 sequential play sessions (of 30 minutes each) of a first-person 3D flying game (Eagle Flight) requiring head movement to control flight direction (pitch, yaw, and roll axes). Baseline testing preceded VR exposure, and each VR session was followed by post-VR testing of binocular CDVA, refractive error, binocular eye alignment (strabismus), stereoacuity, and postural stability (imbalance). Visually induced motion sickness was probed using the Simulator Sickness Questionnaire modified for pediatric use (Peds SSQ). Visual-vestibulo-ocular reflex (V-VOR) adaptation was also tested pre- vs post-trial in 5 of the children. Safety was gauged as a decline or change from baseline in any visuomotor measure.ResultsForty-six of 50 children (94%) completed both VR play sessions with no significant change from baseline in measures of binocular CDVA (P = .89), refractive error (P = .36), binocular eye alignment (P = .90), or stereoacuity (P = .45). Postural stability degraded an average 9% from baseline after 60 minutes of VR exposure (P = .06). Peds SSQ scores increased a mean 4.7%—comparing pretrial to post-trial—for each of 4 symptom categories: eye discomfort (P = .02), head/neck discomfort (P = .03), fatigue (P = .03), and motion sickness (P = .01). None of the children who finished both trial sessions (94%) asked to end the play, and the majority were disappointed when play was halted. V-VOR gain remained unaltered in the 5 children tested. Three children (6% of participants) discontinued the trial during the first 10 minutes of the first session of VR play, 2 girls (aged 5 and 6 years) and 1 boy (aged 7 years). The girls reported discomfort consistent with mild motion sickness; the boy said he was bored and the headset was uncomfortable. No child manifested aftereffects (“flashbacks”) in the days following the VR exposure.ConclusionYoung children tolerate fully immersive 3D virtual reality game play without noteworthy effects on visuomotor functions. VR play did not induce significant post-VR postural instability or maladaption of the vestibulo-ocular reflex. The prevalence of discomfort and aftereffects may be less than that reported for adults.
  • Factors Impacting Outcomes and the Time to Recovery From Malignant
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Atalie C. Thompson, Daniel M. Vu, Eric A. Postel, Pratap ChallaPurposeTo identify factors associated with the successful treatment of malignant glaucoma (MG).DesignRetrospective case series.MethodsSetting: single institution; study population: 64 eyes (55 subjects) with MG; observation procedure(s): chart review; main outcome measures: anatomy, intraocular pressure (IOP), best visual acuity (BVA).Results87.5% (n=56/64) of eyes with MG required surgical intervention. Vitrectomy was more likely to be successful in eyes with a history of
  • Modeling Changes in Corneal Parameters With Age: Implications for Corneal
           Disease Detection
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Janelle Tong, Jack Phu, Michael Kalloniatis, Barbara ZangerlPurposeTo apply computational methods to model normal age-related changes in corneal parameters and to establish their association with demographic factors, thereby providing a framework for improved detection of subclinical corneal ectasia (SCE).DesignCross-sectional study.MethodsOne hundred seventeen healthy participants were enrolled from Centre for Eye Health (Sydney, Australia). Corneal thickness (CT), front surface sagittal curvature (FSSC), and back surface sagittal curvature (BSSC) measurements were extracted from 57 corneal locations from 1 eye per participant using the Pentacam HR. Cluster analyses were performed to identify locations demonstrating similar variations with age. Age-related changes were modeled using polynomial regression with sliding window methods, and model accuracy was verified with Bland–Altman comparisons. Pearson correlations were applied to examine the impacts of demographic factors.ResultsConcentric cluster patterns were observed for CT and FSSC but not for BSSC. Sliding window analyses were best fit with quartic and cubic regression models for CT and FSSC/BSSC, respectively. CT and FSSC sliding window models had narrower 95% limits of agreement compared with decade-based models (0.015 mm vs 0.017 mm and 0.14 mm vs 0.27 mm, respectively), but were wider for BSSC than decade-based models (0.73 mm vs 0.54 mm). Significant correlations were observed between CT and astigmatism (P = .02-.049) and FSSC and BSSC and gender (P = 
  • Age-dependent Deformation of the Optic Nerve Head and Peripapillary Retina
           by Horizontal Duction
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Alan Le, Jessica Chen, Michael Lesgart, Bola A. Gawargious, Soh Youn Suh, Joseph L. DemerPurposeTo study effects of age and horizontal duction on deformation of the optic nerve head (ONH) and peripapillary retina (PPR), as reflected by displacement of vascular landmarks, to explore the influence of adduction tethering.DesignCross-sectional study.MethodsSetting: University. Study Population: Single eyes of 20 healthy young adults (average age 23.9 ± 3.9 [SD] years) were compared to 20 older subjects (average age 61.4 ± 9.3 years). Observational Procedure: The disc and PPR were imaged by scanning laser ophthalmoscopy in central gaze and at 35 degrees abduction and adduction. Main Outcome Measure: Deformations of the disc and adjacent PPR were measured by comparing positions of epipapillary and epiretinal blood vessels.ResultsVessels within the ONH of younger subjects shifted temporally during adduction and nasally during abduction. Displacement of the nasal hemi-disc in adduction was greater at 38.5 ± 1.7 μm (standard error of mean) than the temporal half at 4.1 ± 2.1 μm (P < .001). PPR within 1 radius of the disc margin underwent 7.6 ± 1.6 μm average temporal displacement in adduction in young subjects. In abduction, the young temporal hemi-disc shifted 4.4 ± 0.6 μm nasally without significant displacement in the nasal half. Older subjects' ONH showed less temporal shift and less displacement in the PPR within 1 disc radius (P < .0001) in adduction; the nasal hemi-disc shifted 24.5 ± 1.3 μm compared with 4.4 ± 2.1 μm in the temporal half. There were no significant deformations of the disc during abduction by older subjects.ConclusionLarge horizontal duction, particularly adduction, deforms the disc and peripapillary vasculature. This deformation, which is larger in younger than older subjects, may be due to optic nerve tethering in adduction.
  • Relationship Between Retinal Fractal Dimension and Nonperfusion in
           Diabetic Retinopathy on Ultrawide-Field Fluorescein Angiography
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Wenying Fan, Muneeswar Gupta Nittala, Alan Fleming, Gavin Robertson, Akihito Uji, Charles C. Wykoff, David M. Brown, Jano van Hemert, Michael Ip, Kang Wang, Khalil Ghasemi Falavarjani, Michael Singer, Min Sagong, SriniVas R. SaddaPurposeTo correlate fractal dimension (FD) of the retinal vasculature with the extent of retinal nonperfusion area in diabetic retinopathy (DR) on ultrawide-field fluorescein angiography (FA).DesignCross-sectional study.MethodsBaseline Optos 200Tx ultrawide-field FA images of 80 eyes with DR from the DAVE (NCT01552408) and RECOVERY (NCT02863354) studies were stereographically projected at the Doheny Image Reading Center. The retinal vasculature was extracted from an early-phase FA frame by exploiting the elongated nature of the vessels and then skeletonized for calculation of FD using a box-counting method. The nonperfusion area was delineated by 2 independent, reading center–certified graders who were masked to the study groups and who were using a standardized protocol and then computed in millimeters squared.ResultsWhile no difference in FD was observed for the entire retina in DR compared with normal control subjects, a significantly smaller FD was found in the far-periphery of the DR eyes (P < .001). FD for the entire retina was negatively associated with global nonperfusion area (R = −0.44; P < .001), and this relationship was also present within the 3 concentric retinal zones (posterior: R = −0.31, P = .016; midperiphery: R = −0.35, P = .007; and far periphery: R = −0.31, P = .015).ConclusionsPeripheral FD on ultrawide-field FA is reduced in DR eyes compared with normal eyes and is correlated with severity of retinal nonperfusion. FD can be calculated automatically without the need for correction of peripheral distortion, and therefore it may prove to be a useful surrogate biomarker when precise quantification of nonperfusion is not feasible.
  • Clinical Course and Risk Factors for Visual Field Progression in
           Normal-Tension Glaucoma With Myopia Without Glaucoma Medications
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Jong Chul Han, Sun Hyup Han, Do Young Park, Eun Jung Lee, Changwon KeePurposeTo investigate the natural clinical course and the risk factors of visual field (VF) progression in untreated normal-tension glaucoma (NTG) with myopia with a minimum 3-year follow-up.DesignRetrospective cohort study.MethodsKaplan-Meier survival analysis and log-rank test were used to compare survival experiences between the groups. The hazard ratios (HRs) for the associations between potential risk factors and glaucomatous progression were determined using Cox proportional hazards model.ResultsThe average follow-up period for the included 97 patients was 71.1 ± 29.7 months and 32 eyes showed progression during the observation period. In NTG with myopia, Kaplan-Meier survival curve showed progression cases in 10.3% at 36 months and 24.8% at 60 months. When age and disc tilt direction were classified into 2 groups, a higher cumulative probability of progression was observed in those aged ≤50 years than>50 years (P = .001) and in those with disc tilt direction
  • Residency Program Directors of United States Ophthalmology Programs: A
           Descriptive Analysis
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Amy Kloosterboer, Nicolas A. Yannuzzi, Steven J. Gedde, Jayanth SridharPurposeTo analyze the academic background, scholarly achievements, and demographic characteristics of all US ophthalmology residency program directors (PDs).DesignCross-sectional study.MethodsOnline search of publicly available resources conducted from February 16, 2019, to February 26, 2019. Study population: 116 ophthalmology residency PDs. Main outcome measurements were demographic and academic data.ResultsA total of 116 program directors were analyzed. Eighty-four of 116 (72%) PDs were male. The average age was 50.0 years old. The mean age at appointment was 42.9 years old. Ninety-three percent graduated from an American medical school, and 97% received an MD degree. Twenty percent of PDs completed an additional graduate degree, most commonly a master's degree (7 of 23) and doctor of philosophy (7 of 23). Seventy-eight percent completed a fellowship, with the most frequent in glaucoma (24%), cornea and external diseases (22%), and neuroophthalmology (21%). The mean number of publications according to PubMed was 17.6 (range, 0–92). There were no significant differences between the average number of publications by male PDs and those by female PDs (19.2 ± 20.5 vs. 13.5 ± 23.1, respectively; P = 0.21). On average, the H-index was 8.7 (range, 0–35) and was higher in male than in female PDs (9.8 ± 8.3 vs. 5.4 ± 4.0, respectively; P = 0.01).ConclusionsOphthalmology PDs are predominantly male with fellowship training in glaucoma, cornea, or neuro-ophthalmology. Women remain underrepresented, and future efforts should be aimed at addressing this disparity.
  • Beyond Intraocular Pressure: Visual Functioning and Quality of Life in
           Primary Congenital Glaucoma and Secondary Childhood Glaucoma
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Vijaya K. Gothwal, Sujata Sharma, Anil K. MandalPurposeTo compare the visual functioning (VF) and vision-related QoL (VRQoL) of children 8–18 years old treated for primary congenital glaucoma (PCG) and secondary childhood glaucoma.DesignCross-sectional study.MethodsA total of 309 children 8–18 years old treated for PCG and secondary childhood glaucoma between 2000 and 2010 by a single pediatric glaucoma specialist were prospectively enrolled at LV Prasad Eye Institute, Hyderabad, India. Children completed 2 questionnaires, the LV Prasad Functional Vision Questionnaire–II (LVP-FVQ-II), and the Impact of Vision Impairment-Children (IVI-C) questionnaire. Rasch-calibrated scores from both these questionnaires were used to compare the VF and VFQoL between the 2 groups.ResultsMean ages of the children were 12.2 and 12.6 years in the PCG (53%, median age at diagnosis = 5 months) and secondary glaucoma groups (47%, median age at diagnosis = 3 years), respectively. A majority (80%) of children had bilateral glaucoma and underwent filtering surgery (83%). Mean better eye logMAR visual acuity (VA) was comparable between PCG and secondary childhood glaucoma groups (0.49 vs 0.52, respectively; P = 0.59). Children with PCG reported significantly better VF and VRQoL than secondary childhood glaucoma patients. Unadjusted and adjusted childhood glaucoma group comparisons revealed secondary childhood glaucoma to be associated with worse VF and VRQoL compared to PCG (difference for VF, −0.83; 95% confidence interval [CI], −1.34 to 0.31; P = 0.002; 0.39; 95% CI, 0.16–0.62; P = 0.001 for VRQoL).ConclusionsResults show that children with treated PCG experience significantly better VF and VRQoL than those with secondary childhood glaucoma, despite comparable VA and IOP.
  • Age- and Gender-Related Characteristics of Corneal Refractive Parameters
           in a Large Cohort Study
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Igor Vainer, Michael Mimouni, Gilad Rabina, Oriel Spierer, Arie Y. Nemet, Yinon Shapira, Tzahi Sela, Igor KaisermanPurposeTo characterize age- and sex-related changes in corneal refractive parameters in myopic and hyperopic patients undergoing refractive surgery.DesignA retrospective cross-sectional study.MethodsAnalysis of demographic and refractive parameters of myopic and hyperopic patients who underwent laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between January 2000 and December 2014 at the Care-Vision Laser Centers, Tel-Aviv, Israel.ResultsA total of 62,422 eyes of 31,211 patients were included. With advancing age, refractive surgery was performed for lower magnitudes of myopia and hyperopia. The magnitude of cylinder was higher in men than in women in both myopic and hyperopic patients. In comparison, women were significantly more myopic than men (spherical equivalent of −3.73 diopter [D] versus −4.07 D; P < 0.01). The myopic group sphere (r = 0.044; P < 0.001) had a positive correlation with age, whereas other parameters had a negative correlation with age: astigmatism (r = −0.09; P < 0.001), best-correct visual acuity (BCVA) (r = −0.04; P < 0.001), flat K (r = −0.09; P < 0.001), steep K (r = −0.06; P < 0.001), average K (r = −0.07; P < 0.001), and J0 (r = −0.05; P < 0.001). For hyperopic patients, astigmatism (r = 0.35; P < 0.001), BCVA (r = 0.11; P < 0.001), flat K (r = 0.30; P < 0.001), average K (0.14; P < 0.001), and central corneal thickness (r = 0.10; P < 0.001) correlated positively with age, whereas sphere (r = −0.23; P < 0.001), J0 (r = −0.31; P < 0.001), and overall blurring strength (r = −0.31; P < 0.001) had negative correlations with age.ConclusionsThis large cohort study shows age- and sex-related refractive parameters among myopic and hyperopic patients seeking refractive surgery. These parameters can explain and predict trends in patients attending refractive surgery.
  • Evaluation of Hydroxychloroquine Retinopathy Using Ultra-Widefield Fundus
           Autofluorescence: Peripheral Findings in the Retinopathy
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Seong Joon Ahn, Jooyoung Joung, Byung Ro LeeObjectivesTo investigate the application of ultra-widefield fundus autofluorescence (UWF-FAF) imaging in evaluating hydroxychloroquine (HCQ) retinopathy and to report peripheral autofluorescence findings in Asian patients with this condition.DesignRetrospective case series.MethodsSetting: institutional. Patient population: 58 eyes of 29 patients with HCQ retinopathy. Observation procedures: UWF-FAF imaging was performed, and the images were compared to conventional FAF images obtained using a confocal digital ophthalmoscope. The sensitivities of detecting retinopathy using the 2 modalities were compared. Peripheral autofluorescence findings in the eyes with HCQ retinopathy were assessed, and their association with the Humphrey visual field test results obtained using the 30-2 and full-field 120 (FF-120) protocols was analyzed. Main outcome measurements were abnormal FAF findings.ResultsIn 41 of 58 eyes (70.7%) with HCQ retinopathy, abnormal FAF findings were noted in the retinal periphery outside the field of view of conventional FAF as hypoautofluorescent (23 eyes, 39.7%) and hyperautofluorescent (38 eyes, 65.5%) lesions. In 5 eyes (8.6%), differences were revealed between conventional FAF and UWF-FAF in detecting retinopathy. Most of the eyes with severe retinopathy showed the most extensive hypoautofluorescence in the nasal peripheral retina. The areas with abnormal FAF findings were significantly correlated with the number of unseen spots on FF-120 results and mean deviation and pattern standard deviation of the 30-2 test results (all P < .001).ConclusionsPeripheral autofluorescence findings varied in eyes with HCQ retinopathy according to the severity of the retinopathy. The retinal findings with UWF-FAF were functionally correlated to visual field results. UWF-FAF may be useful for evaluating HCQ retinopathy, particularly in Asian patients.
  • Macular Vascularity in Ischemic Optic Neuropathy Compared to Glaucoma by
           Projection-Resolved Optical Coherence Tomography Angiography
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Masoud Aghsaei Fard, Ghasem Fakhraee, Hossein Ghahvechian, Alireza Sahraian, Sasan Moghimi, Robert RitchPurposeTo compare macular vasculature in patients with primary open-angle glaucoma (POAG) and atrophic nonarteritic anterior ischemic optic neuropathy (NAION).DesignProspective, cross-sectional study.MethodsThirty-seven eyes with moderate and advanced POAG, 19 eyes with atrophic NAION, and 40 eyes of normal subjects were imaged using optical coherence tomography angiography (OCT-A). Macular ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thicknesses were measured in addition to macular superficial and deep vasculature after projection removal using custom software.ResultsLinear models showed that while averaged peripapillary RNFL and macular GCC were not different between NAION and POAG eyes, both were significantly thinner than control eyes. Whole image macular superficial vessel density was significantly lower in NAION and glaucoma eyes (P = .003 and
  • Correlations Between Different Choriocapillaris Flow Deficit Parameters in
           Normal Eyes Using Swept Source OCT Angiography
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Yingying Shi, Qinqin Zhang, Fang Zheng, Jonathan F. Russell, Elie H. Motulsky, James T. Banta, Zhongdi Chu, Hao Zhou, Nimesh A. Patel, Luis de Sisternes, Mary K. Durbin, William Feuer, Giovanni Gregori, Ruikang K. Wang, Philip J. RosenfeldPurposeChoriocapillaris (CC) imaging of normal eyes with swept-source optical coherence tomographic angiography (SS-OCTA) was performed, and the percentage of CC flow deficits (FD%) and the average area of CC flow deficits (FDa) were compared within the given macular regions.DesignA prospective, cross-sectional study.MethodsSubjects with normal eyes ranging in age from their 20s through their 80s were imaged with SS-OCTA (PLEX Elite 9000; Carl Zeiss Meditec, Dublin, California, USA) using both 3×3-mm and 6×6-mm macular scan patterns. The CC images were generated using a previously published and validated algorithm. In both 3×3-mm and 6×6-mm scans, the CC FD% and FDa were measured in circular regions centered on the fovea with diameters as 1 mm and 2.5 mm (C1 and C2.5). In 6×6-mm scans, the FD% and FDa were measured within an additional circular region with diameter as 5 mm (C5). The correlations between FD% and FDa from each region were analyzed with Pearson correlation coefficients.ResultsA total of 164 eyes were analyzed. There was excellent correlation between CC FDa and FD% measurements from each region. In the 3×3-mm scans, the correlations in the C1 and C2.5 regions were 0.83 and 0.90, respectively. In the 6×6-mm scans, the correlations in C1, C2.5, and C5 regions were 0.90, 0.89, and 0.89, respectively.ConclusionsWhen measuring CC FDs, we found excellent correlations between FDa and FD% in regions from 3×3-mm and 6×6-mm scans. Further studies are needed to determine if one parameter is more useful when studying diseased eyes.
  • Comment on Cataract Surgery and Rate of Visual Field Progression in
           Primary Open-Angle Glaucoma
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Shuichiro Aoki, Hiroshi Murata, Shunsuke Nakakura, Yoshitaka Nakao, Masato Matsuura, Kazunori Hirasawa, Kana Tokumo, Yoshiaki Kiuchi, Ryo Asaoka
  • Ophthalmic Clinical Trials: We've Come a Long Way, Baby
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s): Alfred Sommer
  • Editorial board page MYK Red
    • Abstract: Publication date: January 2020Source: American Journal of Ophthalmology, Volume 209Author(s):
  • OCT Structural Abnormality Detection in Glaucoma using Topographically
           Correspondent Rim and Retinal Nerve Fiber Layer Criteria
    • Abstract: Publication date: Available online 30 December 2019Source: American Journal of OphthalmologyAuthor(s): Hongli Yang, Haomin Luo, Christy Hardin, Ya Xing Wang, Jin Wook Jeoung, Cindy Albert, Jayme R. Vianna, Glen P. Sharpe, Juan Reynaud, Shaban Demirel, Steven L. Mansberger, Brad Fortune, Marcelo Nicolela, Stuart K. Gardiner, Balwantray C. Chauhan, Claude F. BurgoyneAbstractPurposeTo evaluate the ability of topographically correspondent (TC) minimum rim width (MRW) and peripapillary retinal nerve fiber layer thickness (pRNFLT) criteria to detect optical coherence tomography (OCT) structural abnormality in glaucoma (GL) and glaucoma suspect (GLS) eyes.DesignRetrospective cross-sectional study.Methods196 GL, 150 GLS eyes and 303 Heathy eyes underwent PRNFL and 24 radial optic nerve head OCT imaging and manual correction of the internal limiting membrane, Bruch’s membrane opening (BMO) and outer pRNFL segmentations. MRW and pRNFLT were quantified in six Garway-Heath (GH) or twelve 30° (clock-hour) sectors. OCT abnormality for each parameter was defined to be < the 5th percentile of the Healthy eye distribution. OCT abnormality for individual eyes was defined using global, sectoral and combined-parameter criteria that achieved ≥ 95% specificity in the Healthy eyes. TC combination criteria required the sectoral location of MRW and pRNFLT abnormality to be topographically aligned and included comMR (MRW + pRNFLT x (Average MRW Healthy eyes / Average pRNFLT Healthy eyes).ResultsTC sectoral criteria (1 GH MRW + corresponding GH RNFLT), (1 30° MRW + any 1 corresponding or adjacent 30° pRNFLT), 30⁰ and GH comMR and global comMR were the best performing criteria, demonstrating: (96-99% specificity); 86-91% sensitivity for GL; 80-84% sensitivity for early GL (MD ≥ -4.0 dB) and 93-96% sensitivity for moderate-to-advanced GL (MD < -4.0 dB).ConclusionsClinically intuitive TC MRW and pRNFLT combination criteria identified the sectoral location of OCT abnormality in GL eyes with high diagnostic precision.
  • Validation of a Comprehensive Clinical Algorithm for the Assessment and
           Treatment of Microbial Keratitis
    • Abstract: Publication date: Available online 30 December 2019Source: American Journal of OphthalmologyAuthor(s): Lawson Ung, Yvonne Wang, Mark Vangel, Emma C. Davies, Matthew Gardiner, Paulo J.M. Bispo, Michael S. Gilmore, James ChodoshAbstractPurposeTo validate a comprehensive clinical algorithm for the assessment and treatment of MK.DesignRetrospective cohort study.MethodsThe 1,2,3-Rule for the initial management of MK was conceived by Vital et al. (2007) to inform the decision as to when to perform corneal cultures. The rule is invoked when any one of three clinical parameters is met: >1+ anterior chamber cells, >2mm infiltrate, or infiltrate
  • Automated Diagnosis and Measurement of Strabismus in Children
    • Abstract: Publication date: Available online 27 December 2019Source: American Journal of OphthalmologyAuthor(s): Oren Yehezkel, Michael Belkin, Tamara Wygnanski–JaffeAbstractPurposeManual measurements of strabismus are subjective, time consuming, difficult to perform in babies, toddlers, and young children, and rely on the examiner’s skill and experience. An automated system, based on eye tracking and dedicated full occlusion glasses, was developed to provide a fast, objective, and easy-to-use alternative to the manual measurements of strabismus. The objective of this study was to test the efficacy of the system in determining the presence of strabismus in children, as well as its type and the amount of deviation, in addition to differentiating between phorias and tropias.DesignProspective, masked, inter-rater reliability study.MethodsA prospective, masked, cross-sectional study included 69 children, aged 3-15 years. A cover uncover test (CUT) and a prism alternating cover test (PACT) for the primary gaze, at a distance of 50 cm, were performed by two independent, masked examiners and by the automated system.ResultsA high correlation was found between the automated and the manual tests, R=0.9, P
  • Comparison of Perioperative Parameters in Femtosecond Laser-assisted
           Cataract Surgery using Three Nuclear Fragmentation Patterns
    • Abstract: Publication date: Available online 27 December 2019Source: American Journal of OphthalmologyAuthor(s): Danni Lyu, Zeren Shen, Lifang Zhang, Zhenwei Qin, Shuang Ni, Wei Wang, Yanan Zhu, Ke YaoAbstractPurposeTo compare the perioperative parameters of quadrant, sextant, and grid lens fragmentation patterns in femtosecond laser-assisted cataract surgery (FLACS).DesignProspective randomized clinical trial.Methods.SettingEye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.Patient or Study PopulationA total of 894 eyes in 661 patients with cataracts were enrolled.Intervention or Observation ProceduresThe nuclear density was graded according to the Emery-Little classification. Patients received lens fragmentation using a quadrant, sextant, or grid pattern after random allocation. Evaluations included intraoperative parameters, complications, and postoperative outcomes.Main Outcome Measure(s)Effective phacoemulsification time (EPT), intraoperative complications, visual acuity and intraocular pressure (IOP) at one day postoperatively, as well as endothelial cell density (ECD), endothelial cell loss (ECL) and central corneal thickness (CCT) at one week postoperatively.ResultsIn grade 1 nuclei, the mean EPT in the grid group was the shortest compared to those in the quadrant (P = 0.011) and sextant (P = 0.001) groups. In grade 2 nuclei, all three patterns showed no significant difference in the mean EPT (p> 0.05). In grade 3 nuclei, the sextant group revealed shorter mean EPT compared to the grid (P = 0.017) and quadrant (P> 0.05) groups. In grade 4 & 5 nuclei, the quadrant pattern had the shortest mean EPT among all three patterns (P < 0.05). The grid pattern is associated with higher IOP in hard nuclei (grade 4 & 5) than the other two patterns (P < 0.05).ConclusionsThe grid and quadrant patterns allow for shorter EPT in soft (grade 1) and hard (grade 4 & 5) nuclei, respectively. All three patterns can be selected for treating grade 2 nuclei. The sextant pattern may be the best option when treating grade 3 nuclei. The grid pattern should be avoided in hard nuclei combined with glaucoma or glaucoma suspect.
  • Imbalance of Matrix Metalloproteinases and Their Inhibitors is Correlated
           with Trabeculectomy Outcomes in Acute Primary Angle Closure
    • Abstract: Publication date: Available online 27 December 2019Source: American Journal of OphthalmologyAuthor(s): Tianwei Qian, Mingshui Fu, Chunling Hu, Zhihua Zhang, Xun Xu, Haidong ZouAbstractPurposeTo analyze matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), and their molar ratios in the aqueous humor in previous APAC patients and their correlations with trabeculectomy outcomes.DesignProspective cohort study.MethodsAqueous humor samples were collected from a total of 78 eyes including 52 previous APAC eyes and 26 cataract eyes. TIMP-1, 2, 3, and 4 and MMP-1, 2, 3, 7, 8, 9, 12 and 13 analyte concentrations were measured using multiplexed immunoassays kits. Patient follow-up occurred at 1 week and 1, 3, 6, 12, and 18 months.ResultsIn the previous APAC group, eleven MMP/TIMP molar ratios were significantly lower. APAC eyes were then followed for up to 18 months after trabeculectomy and divided into success (37 eyes) and failure (15 eyes) groups. Five out of the eleven molar ratios were significantly lower in the failure group than the success group. In multiple logistic regression analysis, failed filtration surgery was more likely in APAC eyes with lower MMP-2/TIMP-2 (P = 0.040, OR = 44.499) and MMP-13/TIMP-1 (P = 0.034, OR = 37.947) ratios. Previous APAC eyes were divided according to MMP-2/TIMP-2 and MMP-13/TIMP-1 ratios. Compared to eyes with high ratios, eyes with low MMP-2/TIMP-2 and MMP-13/TIMP-1 ratios had significantly higher failure rates.ConclusionsIn previous APAC eyes, changes in MMP and TIMP levels resulted in MMP and TIMP imbalance. Lower MMP-2/TIMP-2 and MMP-13/TIMP-1 ratios in aqueous humor are risk factors for trabeculectomy failure. Modulating specific MMP/TIMP ratios may have potential clinical applications for filtration surgery.
  • Morphological and functional assessment of photoreceptors after macula-off
           retinal detachment with adaptive-optics OCT and microperimetry
    • Abstract: Publication date: Available online 25 December 2019Source: American Journal of OphthalmologyAuthor(s): Adrian Reumueller, Lorenz Wassermann, Matthias Salas, Maria Georgia Karantonis, Stefan Sacu, Michael Georgopoulos, Wolfgang Drexler, Michael Pircher, Andreas Pollreisz, Ursula Schmidt-ErfurthAbstractPurposeLimited information is available on morphological and functional regeneration of photoreceptors after retinal detachment (RD) surgery. This observational clinical study compared morphological and functional changes of cones after vitrectomy for macula-off retinal detachment.Design Prospectivefellow-eye comparative case seriesMethods Study PopulationFive eyes after vitrectomy with gas for macula-off retinal detachment (retinal detachment eyes, RDE) and five healthy fellow-eyes (HFE) of five patients (mean age 59.8 years, macula-off duration 0.5 days to 5.5 days)Observation ProceduresEyes were examined with AO-OCT, spectral domain OCT (SD-OCT) and microperimetry (MP) at 6 (baseline, BL) and 56 weeks (follow-up, FUP) after 23 gauge pars-plana vitrectomy and SF6 gas tamponade. Eight corresponding regions at foveal eccentricities of 2.5° (ecc 2.5) and 6.5° (ecc 6.5) were analysed in every eye. AO-OCT en-face images and SD-OCT B-Scans were graded regarding irregularity and loss of photoreceptor signals ranging from none to severe changes. The number of detectable cones at height of the inner-outer segment junction (IS/OS) and cone outer segment tips (COST) was counted manually in AO-OCT images. MP with a custom grid was used to assess retinal sensitivity at these locations.Main Outcome MeasuresCone density, cone pattern regularity and signal attenuation, retinal sensitivity.ResultsIn comparison to HFE, RDE showed highly irregular cone patterns in AO-OCT and irregular outer retinal bands in SD-OCT. Despite significant improvement of cone pattern regularity compared to BL (p
  • Primary Pediatric Keratoplasty: Etiology, Graft Survival, And Visual
    • Abstract: Publication date: Available online 25 December 2019Source: American Journal of OphthalmologyAuthor(s): Maria Emilia Xavier dos Santos Araújo, Namir Clementino Santos, Luciene Barbosa Souza, Elcio Hideo Sato, Denise de FreitasAbstractPurposeInterventional study to evaluate the etiology, visual outcome and survival of corneal transplantation in children and to identify the risk factors associated with graft failure.DesignRetrospective, interventional consecutive case series.MethodsMedical records of every child 7 years of age or younger who underwent primary penetrating keratoplasty at Department of Ophthalmology, Federal University of São Paulo were reviewed. The parameters evaluated were indications for keratoplasty, graft survival and post-operative visual acuity (VA) improvement. Children underwent ophthalmologic examination before and after corneal graft including visual acuity, assessed by the preferential looking test and visual evoked potential. The analysis of transplant survival was performed using the Kaplan-Meier method.ResultsFifty-six penetrating transplants were performed in 51 eyes of 43 children. The patients were divided into two groups: congenital (72.5%) and acquired (17.5%) corneal opacity. The main indication was congenital glaucoma (29.4%). The overall Kaplan-Meier graft survival rates were 64.7% in the postoperative average follow-up period of 24 months. There was no significant difference in graft survival between the groups congenital and acquired (Mantel-Cox p = 0.1031). There was significant improvement in visual acuity in both groups (p = 0.0022 for congenital and p
  • Predictors of Bubble Formation and Type Obtained with Pneumatic Dissection
           During Deep Anterior Lamellar Keratoplasty in Keratoconus
    • Abstract: Publication date: Available online 25 December 2019Source: American Journal of OphthalmologyAuthor(s): Vincenzo Scorcia, Giuseppe Giannaccare, Andrea Lucisano, Mauro Soda, Giovanna Carnovale Scalzo, James Myerscough, Marco Pellegrini, Francesco Verdoliva, Gabriele Piccoli, Cristina Bovone, Massimo BusinAbstractPurposeTo identify predictors of bubble formation and type during big-bubble deep anterior lamellar keratoplasty (BB-DALK) performed in keratoconus at different stages of severity.DesignRetrospective Cohort Study.MethodsSetting: University Magna Græcia (Catanzaro, Italy); Study Population: Consecutive keratoconus patients undergoing BB-DALK from September 2014 to February 2019; Observation Procedure: Keratometric astigmatism, mean keratometry value (K-mean), highest keratometry value (K-max), thinnest point, anterior segment Optical Coherence Tomography (AS-OCT)-based stage of ectasia. Main Outcome Measures: Rate of bubble formation and type; number and fate of micro/macro-perforation; conversion to mushroom keratoplasty (MK); comparison of parameters in patients with bubble formation vs failure and in type 1 vs type 2 bubble; areas under the curves (AUC) of preoperative parameters for distinguishing between bubble types.ResultsPneumatic dissection succeeded in 113/155 eyes (72.9%), with 100 type 1 bubbles (88.4%), 11 type 2 (9.8%) and 2 mixed-type (1.8%). Micro-perforations were managed conservatively in type-1 bubbles; macro-perforations occurring in both types of bubbles required conversion to MK. Preoperative K-mean and K-max values were significantly higher in eyes in which bubble formation succeeded (respectively, P=0.006 and P
  • Effect of surgical indication and preoperative lens status on Descemet
           membrane endothelial keratoplasty outcomes
    • Abstract: Publication date: Available online 18 December 2019Source: American Journal of OphthalmologyAuthor(s): Rénuka S. Birbal, Lamis Baydoun, Lisanne Ham, Alina Miron, Korine van Dijk, Isabel Dapena, Martine J. Jager, Stefan Böhringer, Silke Oellerich, Gerrit R.J. MellesAbstractPurposeTo analyze 6-month results of 1000 consecutive DMEK cases, and to evaluate if outcomes are influenced by surgical indication and preoperative lens status.DesignRetrospective, interventional case series.MethodsA series of 1000 eyes (738 patients) underwent DMEK mainly for Fuchs endothelial corneal dystrophy (FECD; 85.3%) or bullous keratopathy (BK; 10.5%). Main outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (ECD), postoperative complications and re-transplantations.ResultsAt 6 months after DMEK, there was no difference in BCVA outcome between FECD and BK eyes (P=0.170), or between phakic and pseudophakic FECD eyes (P=0.066) after correcting for patient age and preoperative BCVA. Endothelial cell loss at 6 months postoperatively was similar for phakic and pseudophakic FECD eyes (39%; P=0.852), but higher for BK eyes than for FECD eyes (46% versus 39%, P=0.001). Primary and secondary graft failure occurred in 3 (0.3%) and 2 eyes (0.2%), respectively, and 7 eyes developed allograft rejection (0.7%). Eighty-two eyes (8.2%) received re-bubbling for graft detachment and re-transplantation was performed in 20 eyes (2.0%). Re-bubbling was more often required in eyes treated for BK versus FECD eyes (12.4% versus 7.4%, P=0.022).Conclusionand Relevance: DMEK consistently provides excellent short-term results, with similar high visual acuity levels for both FECD and BK eyes. As preoperative lens status did not influence DMEK outcomes, for phakic FECD eyes with a still relatively clear crystalline lens, lens preservation may be preferable in a selected group of younger patients, who may still benefit from their residual accommodative capacity.
  • The Relationship of Age and Other Baseline Factors to Outcome of Initial
           Surgery for Intermittent Exotropia
    • Abstract: Publication date: Available online 17 December 2019Source: American Journal of OphthalmologyAuthor(s): Michael X. Repka, Danielle L. Chandler, Jonathan M. Holmes, Sean P. Donahue, Darren L. Hoover, Brian G. Mohney, Paul H. Phillips, Ann U. Stout, Benjamin H. Ticho, David K. Wallace, The Pediatric Eye Disease Investigator GroupAbstractPurposeTo determine whether age at surgery is associated with surgical outcome of intermittent exotropia (IXT) at 3 years.DesignSecondary analysis of pooled data from a randomized trialMethods197 children 3 to 2 octaves, at any masked examination; or reoperation without meeting any of these criteria.ResultsThe cumulative probability of a suboptimal surgical outcome by 3 years was 28% (19 of 72) for children 3 to
  • Editorial board page MYK Red
    • Abstract: Publication date: December 2019Source: American Journal of Ophthalmology, Volume 208Author(s):
  • Comment on: Predictors of Neovascular Glaucoma in Central Retinal Vein
    • Abstract: Publication date: Available online 13 November 2019Source: American Journal of OphthalmologyAuthor(s): Devesh Kumawat, Pranita Sahay, Pooja Shah
  • OCT-Detected Optic Nerve Head Neural Canal Direction, Obliqueness, and
           Minimum Cross-Sectional Area in Healthy Eyes
    • Abstract: Publication date: December 2019Source: American Journal of Ophthalmology, Volume 208Author(s): Seungwoo Hong, Hongli Yang, Stuart K. Gardiner, Haomin Luo, Christy Hardin, Glen P. Sharpe, Joseph Caprioli, Shaban Demirel, Christopher A. Girkin, Jeffrey M. Liebmann, Christian Y. Mardin, Harry A. Quigley, Alexander F. Scheuerle, Brad Fortune, Balwantray C. Chauhan, Claude F. BurgoynePurposeTo assess anterior scleral canal opening (ASCO) offset relative to Bruch's membrane opening (BMO) (ASCO/BMO offset) so as to determine neural canal direction, obliqueness, and minimum cross-sectional area (NCMCA) in 362 healthy eyes.DesignCross-sectional study.MethodsAfter optical coherence tomography optic nerve head and retinal nerve fiber layer thickness (RNFLT) imaging, BMO and ASCO were manually segmented. Planes, centroids, size, and shape were calculated. Neural canal direction was defined by projecting the neural canal axis vector (connecting BMO and ASCO centroids) onto the BMO plane. Neural canal obliqueness was defined by the angle between the neural canal axis and the BMO plane perpendicular vector. NCMCA was defined by projecting BMO and ASCO points onto a neural canal axis perpendicular plane and measuring the area of overlap. The angular distance between superior and inferior peak RNFLT was measured, and correlations between RFNLT, BMO, ASCO, ASCO/BMO offset, and NCMCA were assessed.ResultsMean (SD) NCMCA was significantly smaller than either the BMO or ASCO area (1.33 (0.42), 1.82 (0.38), 2.22 (0.43) mm2, respectively), and most closely correlated to RNFLT (P < .001, R2 = 0.158). Neural canal direction was most commonly superior-nasal (55%). Mean neural canal obliqueness was 39.4° (17.3°). The angular distance between superior and inferior peak RNFLT correlated to neural canal direction (P ≤ .008, R2 = 0.093).ConclusionsASCO/BMO offset underlies neural canal direction, obliqueness, and NCMCA. RNFLT is more strongly correlated to NCMCA than to BMO or ASCO, and its peripapillary distribution is influenced by neural canal direction.
  • Development of a Spatial Model of Age-Related Change in the Macular
           Ganglion Cell Layer to Predict Function From Structural Changes
    • Abstract: Publication date: December 2019Source: American Journal of Ophthalmology, Volume 208Author(s): Janelle Tong, Jack Phu, Sieu K. Khuu, Nayuta Yoshioka, Agnes Y. Choi, Lisa Nivison-Smith, Robert E. Marc, Bryan W. Jones, Rebecca L. Pfeiffer, Michael Kalloniatis, Barbara ZangerlPurposeTo develop location-specific models of normal, age-related changes in the macular ganglion cell layer (GCL) from optical coherence tomography (OCT). Using these OCT-derived models, we predicted visual field (VF) sensitivities and compared these results to actual VF sensitivities.DesignRetrospective cohort study.MethodsSingle eyes of 254 normal participants were retrospectively enrolled from the Centre for Eye Health (Sydney, Australia). Macular GCL measurements were obtained using Spectralis OCT. Cluster algorithms were performed to identify spatial patterns demonstrating similar age-related change. Quadratic and linear regression models were subsequently used to characterize age-related GCL decline. Forty participants underwent additional testing with Humphrey VFs, and 95% prediction intervals were calculated to measure the predictive ability of structure-function models incorporating cluster-based pooling, age correction, and consideration of spatial summation.ResultsQuadratic GCL regression models provided a superior fit (P value
  • A Randomized Clinical Trial of Immediate Versus Delayed Glasses for
           Moderate Hyperopia in Children 3 to 5 Years of Age
    • Abstract: Publication date: December 2019Source: American Journal of Ophthalmology, Volume 208Author(s): Jonathan M. Holmes, Marjean T. Kulp, Trevano W. Dean, Donny W. Suh, Raymond T. Kraker, David K. Wallace, David B. Petersen, Susan A. Cotter, Earl R. Crouch, Ingryd J. Lorenzana, Benjamin H. Ticho, Lisa C. Verderber, Katherine K. Weise, Pediatric Eye Disease Investigator GroupPurposeTo compare visual acuity (VA) and binocularity outcomes in moderately hyperopic children with normal VA and binocularity assigned to glasses versus observation.DesignProspective randomized clinical trial (RCT).MethodsOne hundred nineteen 3- to 5-year-old children with hyperopia between +3.00D and +6.00D spherical equivalent were randomly assigned to glasses versus observation (with glasses prescribed if deteriorated for subnormal distance VA or near stereoacuity, or manifest strabismus). Follow-up occurred every 6 months. At 3 years, the treatment strategy was classified as “failed” if any of the following were met, both with and without correction: subnormal distance VA or stereoacuity; manifest strabismus; or strabismus surgery during follow-up.ResultsOf 84 (71%) children who completed the primary outcome examination, failure occurred in five (12%; 95% confidence interval [CI]: 4%–26%) of 41 assigned to glasses and four (9%; 95% CI: 3%–22%) of 43 assigned to observation (difference = 3%; 95% CI: -12%–18%; P = .72). Deterioration prior to 3 years (requiring glasses per protocol) occurred in 29% (95% CI: 19%–43%) assigned to glasses and 27% (95% CI: 17%–42%) assigned to observation.ConclusionsIn an RCT comparing glasses to observation for moderately hyperopic 3- to 5-year-old children with normal VA and binocularity, failure for VA or binocularity was not common. With insufficient enrollment and retention, our study was unable to determine whether immediate glasses prescription reduces failure rate, but low failure rates suggest that immediate glasses prescription for these children may not be needed to prevent failure for VA and/or binocularity.
  • Near vision impairment and Frailty: Evidence of an association
    • Abstract: Publication date: Available online 26 August 2019Source: American Journal of OphthalmologyAuthor(s): Varshini Varadaraj, Moon Jeong Lee, Jing Tian, Pradeep Y. Ramulu, Karen Bandeen-Roche, Bonnielin K. SwenorAbstractPurposeTo examine associations between near vision impairment (NVI) and frailtyDesignCross-sectional studyMethodsSettingNationally representative sample of non-institutionalized United States civiliansStudy Population2,705 older adults ≥60 years from National Health and Nutrition Examination Survey (1999-2002)ObservationPresenting NVI (PNVI)-near acuity worse than 20/40. Self-reported NVI (SNVI)-self-reported difficulty with near vision tasksMain Outcome Measure(s)5-item physical frailty; participants classified as frail (≥3 criteria) and pre-frail (1 or 2 criteria). Propensity score adjusted, and probability-weighted multinomial multivariable logistic regression was used to examine associations of PNVI and SNVI with frailty.ResultsOf 2,705 participants, 10%, 5%, and 3% had PNVI only, SNVI only, and PNVI+SNVI, respectively. In fully adjusted models, as compared to those without PNVI, participants with PNVI were more likely to be prefrail (OR=1.6; 95% CI=1.1,2.3) and frail (OR=2.5; 95% CI=1.4,4.3). As compared to those without SNVI, participants with SNVI were more likely to be prefrail (OR=2.9; 95% CI=1.8,4.7) and frail (OR=4.3; 95% CI=2.2,8.3). As compared to those without PNVI or SNVI, participants with PNVI+SNVI were more likely to be prefrail and frail (prefrail: OR=4.0; 95% CI=2.2,7.2 and frail: OR=4.5; 95% CI=1.7,12.7).ConclusionsOlder adults with PNVI and SNVI were more likely to be pre-frail and frail than those without respective NVI, suggesting that NVI is associated with frailty.
  • Incidence and Risk Factors for Glaucoma development after Bilateral
           Congenital Cataract Surgery in Microphthalmic eyes
    • Abstract: Publication date: Available online 23 August 2019Source: American Journal of OphthalmologyAuthor(s): Jeong-Ah Kim, Sang-yoon Lee, Ki Ho Park, Young Suk Yu, Jin Wook JeoungAbstractPurposeTo evaluate the long-term incidence and risk of glaucoma after bilateral congenital cataract surgery in microphthalmic eyes.DesignRetrospective, observational case series.SubjectsChildren with microphthalmic eyes who had undergone surgery for bilateral congenital cataract within 6 months of birth and been followed up for at least 5 years.MethodsReview of medical records at our institution.Main Outcome MeasuresProbability of an eye’s developing glaucoma after bilateral congenital cataract surgery and associated risk factors.ResultsThirty-eight eyes of 19 children with bilateral congenital cataract were included. The mean age at surgery was 3.2 ± 1.7 months, and the mean follow-up duration was 7.79 ± 2.61 years. After cataract surgery, 11 eyes (29.0%) developed glaucoma at the age of 4.0 ± 1.4 years. Three of these eyes underwent Ahmed glaucoma valve implantation surgery. The probability of an eye’s developing glaucoma was estimated to be 32.0% by 10 years after surgery. In a multivariate analysis, axial length was significantly associated with glaucoma development (odds ratio = 0.364, P = .025). Age at the time of cataract surgery, corneal diameter, and aphakia did not affect the risk of glaucoma (P> .10). Eyes without glaucoma had a better final visual outcome than those with glaucoma (0.75 ± 0.60 and 1.47 ± 1.10 logMAR, respectively, P = .049).ConclusionsThe long-term cumulative risk of post-operative glaucoma development was 32.0% by 10 years after bilateral congenital cataract surgery. Because the risk of developing glaucoma persists for several years after surgery, careful monitoring and control of intraocular pressure is needed to preserve vision in such patients.
  • Anterior Segment Optical Coherence Tomography Angiography in Patients
           Following Cultivated Oral Mucosal Epithelial Transplantation
    • Abstract: Publication date: Available online 23 August 2019Source: American Journal of OphthalmologyAuthor(s): Shoko Kiritoshi, Yoshinori Oie, Kanako Nampei, Shinnosuke Sato, Misa Morota, Kohji NishidaAbstractPurposeTo analyze corneal neovascularization using anterior segment optical coherence tomography angiography (AS-OCTA) in patients following cultivated oral mucosal epithelial sheet transplantation (COMET).DesignObservational case series.MethodsNine eyes in 7 patients were analyzed. Four images of corneal quadrant were obtained by AS-OCTA from each patient during follow-up post-COMET in the Department of Ophthalmology at Osaka University Hospital. The depth of corneal neovascularization was evaluated using en face and B-scan images. Each quadrant image was classified as one of the following five types: stromal, predominantly stromal, epithelial, predominantly epithelial, or avascular. The image quality of slit-lamp photography and AS-OCTA was graded from 0 to 4. Manually segmented images of the epithelial and stromal vessels were obtained.Main Outcome MeasuresDepth and image quality of corneal neovascularization following COMET.ResultsSix patients were male and 1 was female. The mean patient age was 61.3 ± 19.1 years. Thirty-six quadrant images were obtained, of which 4 (11.1%) were stromal, 16 (44.4%) were predominantly stromal, 3 (8.3%) were epithelial, 11 (30.6%) were predominantly epithelial, and 2 (5.6%) were avascular. The image quality obtained by AS-OCTA was significantly better than that obtained by slit-lamp photography (2.38±0.94 vs 2.03±0.90; P = 0.021). Segmentation images clearly demonstrated both epithelial and stromal vasculatures individually.ConclusionsAS-OCTA is useful for evaluation of depth of corneal neovascularization and has the potential to distinguish between conjunctivalization and stromal neovascularization following COMET. Findings on AS-OCTA could contribute to clinical decision-making, given that retreatment is required for conjunctivalization after COMET.
  • Deep Learning Classifiers for Automated Detection of Gonioscopic Angle
           Closure Based on Anterior Segment OCT Images
    • Abstract: Publication date: Available online 22 August 2019Source: American Journal of OphthalmologyAuthor(s): Benjamin Y. Xu, Michael Chiang, Shreyasi Chaudhary, Shraddha Kulkarni, Anmol A. Pardeshi, Rohit VarmaAbstractPurposeTo develop and test deep learning classifiers that detect gonioscopic angle closure and primary angle closure disease (PACD) based on fully automated analysis of anterior segment OCT (AS-OCT) images.MethodsSubjects were recruited as part of the Chinese-American Eye Study (CHES), a population-based study of Chinese Americans in Los Angeles, CA. Each subject underwent a complete ocular examination including gonioscopy and AS-OCT imaging in each quadrant of the anterior chamber angle (ACA). Deep learning methods were used to develop three competing multi-class convolutional neural network (CNN) classifiers for modified Shaffer grades 0, 1, 2, 3, and 4. Binary probabilities for closed (grades 0 and 1) and open (grades 2, 3, and 4) angles were calculated by summing over the corresponding grades. Classifier performance was evaluated by five-fold cross validation and on an independent test dataset. Outcome measures included area under the receiver operating characteristic curve (AUC) for detecting gonioscopic angle closure and PACD, defined as either two or three quadrants of gonioscopic angle closure per eye.Results4036 AS-OCT images with corresponding gonioscopy grades (1943 open, 2093 closed) were obtained from 791 CHES subjects. Three competing CNN classifiers were developed with a cross-validation dataset of 3396 images (1632 open, 1764 closed) from 664 subjects. The remaining 640 images (311 open, 329 closed) from 127 subjects were segregated into a test dataset. The best-performing classifier was developed by applying transfer learning to the ResNet-18 architecture. For detecting gonioscopic angle closure, this classifier achieved an AUC of 0.933 (95% confidence interval, 0.925-0.941) on the cross-validation dataset and 0.928 on the test dataset. For detecting PACD based on two- and three-quadrant definitions, the ResNet-18 classifier achieved AUCs of 0.964 and 0.952, respectively, on the test dataset.ConclusionDeep learning classifiers effectively detect gonioscopic angle closure and PACD based on automated analysis of AS-OCT images. These methods could be used to automate clinical evaluations of the ACA and improve access to eyecare in high-risk populations.
  • Improved diagnosis of retinal laser injuries using near-infrared
    • Abstract: Publication date: Available online 12 June 2019Source: American Journal of OphthalmologyAuthor(s): Samantha R. De Silva, James E. Neffendorf, Johannes Birtel, Philipp Herrmann, Susan M. Downes, Chetan K. Patel, Göran D. Hildebrand, Martin Gliem, Peter Charbel IssaAbstractPurposeTo assess whether near infrared autofluorescence (NIR-AF) imaging is a useful imaging modality in the diagnosis of handheld laser retinal injuries.DesignRetrospective observational case series.Methods12 patients identified to have handheld laser retinal injuries were included at two academic centers. Patients underwent ophthalmic assessment and retinal imaging including fundus photography, optical coherence tomography (OCT), conventional blue autofluorescence (B-AF) and NIR-AF imaging.ResultsIn all cases, lesions consistent with retinal laser injury were detected by NIR-AF imaging. The lesions showed a characteristic appearance with central hyperfluorescence and surrounding hypofluorescence although the number and extent of lesions varied between patients. Findings using other imaging modalities were variable: on color fundus photography these included localized pigmentary changes and on OCT imaging an ellipsoid zone interruption or outer nuclear layer changes. Only subtle changes were evident on B-AF imaging. Other macular conditions, such as poppers retinopathy or solar maculopathy, which may have similar findings on OCT imaging as laser damage, can be differentiated using NIR-AF imaging.ConclusionAn increased incidence of retinal injuries secondary to handheld lasers has been reported in recent years. We show that the diagnosis and full extent of retinal laser injuries is best demonstrated by NIR-AF, as other modalities give variable results. We propose that NIR-AF should be included when investigating patients suspected of macular injury secondary to exposure to handheld lasers.
  • Integration of Genetic and Biometric Risk Factors for Detection of Primary
           Angle-Closure Glaucoma
    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of OphthalmologyAuthor(s): Monisha E. Nongpiur, Chiea-Chuen Khor, Ching-Yu Cheng, Rahat Husain, Pui Yi Boey, Annabel Chew, Ching Lin Ho, Tina T. Wong, Shamira Perera, Tien Yin Wong, Eranga N. Vithana, Tin AungPurposeThe purpose of this study was to investigate whether the addition of primary angle closure glaucoma (PACG) associated genetic loci allows improved detection of PACG, compared to anterior segment parameters measured by imaging.DesignCase-control studyMethodsGenotype data of the 8 PACG SNPs (rs11024102 at PLEKHA7, rs3753841 at COL11A1, rs1015213 located between PCMTD1 and ST18 on Chromosome 8q, rs3816415 at EPDR1, rs1258267 at CHAT, rs736893 at GLIS3, rs7494379 at FERMT2, and rs3739821 mapping in between DPM2 and FAM102A) were available. Customized software was used to measure anterior segment optical coherence tomography (ASOCT) parameters, namely anterior chamber depth, width, and area (ACD, ACW, ACA) and lens vault (LV). Statistical analysis for positive predictive values was modelled using the Receiver operating characteristic curve (AUC). Statistical significance comparing predictive power of the different parameters was calculated using permutation.ResultsA total of 388 PACG subjects and 751 controls with both ASOCT and genetic data were available for analysis. Anterior segment parameters including ACD, ACA, and LV had excellent predictive value (AUC)>0.94), except ACW (AUC=0.65) for identifying PACG. The inclusion of genetic risk alleles (either singly or as a composite genetic risk score for 8 GWAS SNPs) to ACD only provided a +0.50% improvement in re-classifying PACG cases and controls over and above the discriminatory value of ACD. This +0.50% improvement was not statistically significant (P>0.05).ConclusionsAlthough significant on their own, the incorporation of genetic data in the context of anterior segment imaging parameters like ACD provided only a marginal improvement of PACG detection.
  • A New Era in the Treatment of Thyroid Eye Disease
    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of OphthalmologyAuthor(s): Amy Patel, Huasheng Yang, Raymond S. DouglasAbstractPurposeImproved understanding of thyroid eye disease (TED) pathogenesis has facilitated identification of a targeted molecular approach for TED treatment offering the potential to halt or slow disease progression in a nonsurgical manner. Herein, we provide a summary of the current knowledge of TED management, followed by discussion of a novel insulin-like growth factor-1 receptor (IGF-1R) antagonist antibody and its potential to change the course of the disease.DesignPerspective.MethodsReview of the literature and authors’ experience.ResultsMany publications demonstrate IGF-1R overexpression in TED, and its activation as an autoantigen as a critical factor in TED pathogenesis. Several in vitro studies demonstrate that IGF-1R inhibition attenuates downstream molecular events including cytokine and hyaluronan production, and cellular differentiation. These observations led to the hypothesis that blocking the IGF-1R may abrogate the clinical progression of TED. The recent completion of phase 2 and 3, randomized, placebo-controlled trials demonstrate the efficacy and safety of teprotumumab, a fully human monoclonal IGF-1R antagonist antibody, in patients with moderate-to-severe active TED. Both the phase 2 and the recent phase 3 study results demonstrate that more patients with active TED receiving teprotumumab experienced a meaningful improvement in proptosis.ConclusionsCurrent TED treatment strategies target inflammation and symptoms, but do not modify the disease course. Therefore, proptosis as well as strabismus and its resulting diplopia often remain, impacting patient well-being and quality of life over the long-term. Targeted molecular therapy using teprotumumab demonstrates disease-modifying benefits with the potential to shift the paradigm for TED treatment.
  • Validation of the Pediatric Eye Questionnaire (PedEyeQ) in Children with
           Visual Impairment
    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of OphthalmologyAuthor(s): David A. Leske, Sarah R. Hatt, Yolanda S. Castañeda, Suzanne M. Wernimont, Laura Liebermann, Christina S. Cheng-Patel, Eileen E. Birch, Jonathan M. HolmesAbstractPurposeTo evaluate the recently developed Pediatric Eye Questionnaire (PedEyeQ) in visually impaired and visually normal children, as an initial validation of the PedEyeQ.Design: Questionnaire validation studyMethods48 children with visual impairment (retinal, cortical, and corneal conditions) and 59 visually normal controls were enrolled at two centers. Five- to 17-year-old children completed the Child PedEyeQ (5-11 and 12-17 year-old versions), and parents completed the Proxy PedEyeQ (0-4, 5-11, 12-17 year-old versions) and the Parent PedEyeQ. Rasch scores were calculated, by age group, for each distinct domain within each age-specific PedEyeQ (converted to 0-100 for interpretation). Domains for the Child PedEyeQ are functional vision, bothered by eyes/vision, social, frustration/worry. Proxy PedEyeQ domains are: functional vision, bothered by eyes/vision, social, frustration/worry, eye-care. Parent PedEyeQ domains are: impact on parent and family, worry about child’s eye condition, worry about child’s self-perception/interactions, worry about child’s functional vision. For each domain, median PedEyeQ scores were compared between visually impaired and visually normal cohorts.ResultsChild 5-11 and 12-17 PedEyeQ scores were significantly lower (worse) for visually impaired children than for controls for each domain (P
  • Safety and Effectiveness of CyPass Supraciliary Micro-Stent in Primary
           Open-Angle Glaucoma: Five-Year Results from the COMPASS XT Study
    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of OphthalmologyAuthor(s): George Reiss, Bill Clifford, Steven Vold, Jonathan He, Cody Hamilton, Jaime Dickerson, Stephen LaneAbstractPurposeTo characterize the long-term (up to five years) safety and effectiveness of the supraciliary micro-stent implanted at the time of phacoemulsification in eyes with coexisting open-angle glaucoma (OAG) and visually significant cataractDesignThree-year safety extension of a two-year randomized clinical trial.MethodsPatients from the multicenter COMPASS trial who underwent micro-stent implantation plus phacoemulsification (n=215) or phacoemulsification alone (n=67) were evaluated 36, 48, and 60 months postoperatively. The primary outcome measure was the occurrence of sight-threatening ocular serious adverse events. Evaluations at each time point included best-corrected visual acuity (BCVA), anterior and posterior segment examinations, tonometry, gonioscopy, pachymetry, perimetry, specular microscopy, and assessment of adverse events.ResultsThree sight-threatening ocular adverse events occurred, two in the micro-stent and one in the control group, but none of these events was related to the micro-stent device. Ocular adverse events were of similar frequencies in both groups, the most common of which were BCVA loss >2 lines compared with best BCVA in COMPASS and worsening of visual field mean defect (VFMD) >2.5 dB compared with Month 24. Changes from baseline in mean BCVA, clinical examinations, pachymetry and VFMD were similar in the two groups. At 60 months, a higher proportion of subjects in the micro-stent (46%; 95% CI 38.9% –53.2%) than in the control (32.1%; 95% CI 19.9%–46.3%) group achieved ≥ 20% IOP reduction without using hypotensive medication.ConclusionsFew sight-threatening serious ocular adverse events occurred following micro-stent implantation, and clinical evidence of corneal decompensation was minimal.
  • Corneal Endothelial Cell Loss and Morphometric Changes 5 Years after
           Phacoemulsification With or Without CyPass Micro-Stent
    • Abstract: Publication date: Available online 1 August 2019Source: American Journal of OphthalmologyAuthor(s): Jonathan H. Lass, Beth Ann Benetz, Jonathan He, Cody Hamilton, Mark Von Tress, Jaime Dickerson, Stephen LaneAbstractPurposeTo characterize long-term corneal endothelial cell changes following phacoemulsification with or without supraciliary micro-stent (CyPass, Alcon, Ft. Worth, TX) implantation in eyes with open-angle glaucoma (OAG) and visually-significant cataract.DesignThree-year safety extension of a two-year randomized clinical trial.MethodsPatients from the multicenter COMPASS trial who underwent micro-stent implantation plus phacoemulsification (n=282) or phacoemulsification alone (n=67) were analyzed post-hoc. Specular microscopy was used to assess endothelial cell loss (ECL), including changes from baseline in endothelial cell density (ECD), coefficient of variation, and percentage of hexagonal cells,.ResultsPreoperative ECD was similar in the microstent (2432.6 cells/mm2 [95% CI: 2382.8, 2482.4]) and control (2434.5 cells/mm2 [95% CI: 2356.5, 2512.4]) groups. ECL at Months 48 and 60 was greater in the micro-stent than in the control group. At Month 60, mean percent changes in ECD were -20.4% (95% CI: -23.5%, -17.5%) in the micro-stent and -10.1% (95% CI: -13.9%, -6.3%) in the control group. No statistically significant between-group changes from baseline in cellular morphology were observed. Nine adverse events were possibly related to ECL, including three eyes with transient focal corneal edema and four eyes that required micro-stent trimming due to protrusion.ConclusionsIn eyes with OAG, ECL following phacoemulsification is acute and stabilizes after 3 months, whereas ECL following phacoemulsification plus micro-stent implantation proceeds for at least 5 years. Clinical findings associated with ECL in these eyes were uncommon (3.3% of implanted eyes), suggesting that ECL is generally a subclinical phenomenon.
  • Preoperative risk assessment for progression to DMEK following cataract
           surgery in Fuchs Endothelial Corneal Dystrophy.
    • Abstract: Publication date: Available online 29 July 2019Source: American Journal of OphthalmologyAuthor(s): Francisco Arnalich-Montiel, David Mingo-Botín, Pablo De Arriba-PalomeroAbstractPurposeTo identify preoperative corneal tomographic features that predict progression to Endothelial Keratoplasty (EK) following cataract surgery in Fuchs Endothelial Corneal Dystrophy (FECD) and establish a regression model to identify high-risk patients.DesignProspective, observational cohort study.MethodsSettingHospital Universitario Ramón y Cajal, MadridStudy populationSixty-eight patients (84 eyes) with FECD who underwent phacoemulsification.Intervention We assessed preoperative best-corrected visual acuity; ultrasound central corneal thickness (CCT); pachymetric, anterior chamber depth and corneal backscatter variables using Scheimpflug imaging; and endothelial cell density.Main Outcome MeasuresProgression to EK.ResultsA total of 39.3 % (33 eyes) needed EK after phacoemulsification to rehabilitate vision. On multivariate analysis, Anterior-Layer (AL) corneal backscatter between 0 and 2 mm from the apex and relative increase in central corneal thickness from the “Relative Pachymetry Display” by the Pentacam were significant predictors of the risk of progression to EK. Using these two variables, a risk score (RISC score) was derived from the regression model (area under the curve (AUC) = 0.973; best cutoff point with a specificity of 95% representing a sensitivity of 96%). Excluding corneal backscatter data from the multivariate regression model, corneal thickness at the pupil center by the Pentacam, and relative increase in central corneal thickness were significant predictors and provided a modified risk score (RIPT score) with similar performance.ConclusionBoth scores demonstrated accuracy in predicting progression to EK using easily accessible preoperative data. This approach, which can be readily implemented by surgeons, allows for individualized risk assessment.
  • Influence of Bruch’s Membrane Opening Area in Diagnosing Glaucoma with
           Neuroretinal Parameters from Optical Coherence Tomography
    • Abstract: Publication date: Available online 24 July 2019Source: American Journal of OphthalmologyAuthor(s): Lucas A. Torres, Glen P. Sharpe, Donna M. Hutchison, Camila S. Zangalli, Reinhard O. Burk, Alexandre S.C. Reis, Vital P. Costa, Marcelo T. Nicolela, Balwantray C. Chauhan, Jayme R. ViannaAbstractPurposeTo determine whether the glaucoma diagnostic accuracy of age and Bruch’s membrane opening area (BMOA) adjusted normative classifications of minimum rim width (MRW) and retinal nerve fibre layer thickness (RNFLT) is dependent on BMOA, in a European descent population.DesignRetrospective, cross-sectional study.MethodsWe included 182 glaucoma patients and 166 healthy controls for the primary study, and 105 glaucoma patients in a second sample used for a replication study. Optical coherence tomography (Spectralis) measurements of BMOA, global MRW and RNFLT and normative classifications from the device software were exported for analysis. Sensitivity and specificity were calculated for a conservative criterion (abnormal = “outside normal limits” classification) and a liberal criterion (abnormal = “outside normal limits” or “borderline” classifications). The dependence of sensitivity and specificity on BMOA was analysed with comparison among subgroups divided by tertiles of BMOA, and with logistic regression.ResultsFor the conservative criterion, MRW sensitivity was independent of BMOA (p≥0.76), while RNFLT sensitivity increased in the large BMOA subgroup (p=0.04, odds ratio: 1.2 per mm2 [p=0.02]). For the liberal criterion, MRW and RNFLT sensitivities were independent of BMOA (p≥0.53). Specificities were independent of BMOA (p≥0.07). For the replication sample, which included younger patients, with larger BMOA, and worse visual field damage than the primary sample, sensitivities were independent of BMOA for both criteria (p≥0.10).ConclusionsRNFLT sensitivity was higher in eyes with larger BMOA, however, age and visual field damage may influence that association. MRW diagnostic accuracy was not dependent on BMOA.
  • Comparison between Methotrexate and Mycophenolate Mofetil monotherapy for
           the control of Non- Infectious Ocular Inflammatory Diseases
    • Abstract: Publication date: Available online 22 July 2019Source: American Journal of OphthalmologyAuthor(s): Sapna S. Gangaputra, Craig W. Newcomb, Marshall M. Joffe, Kurt Dreger, Hosne Begum, Pichaporn Artornsombudh, Siddharth S. Pujari, Ebenezer Daniel, H. Nida Sen, Eric B. Suhler, Jennifer E. Thorne, Nirali P. Bhatt, C. Stephen Foster, Douglas A. Jabs, Robert B. Nussenblatt, James T. Rosenbaum, Grace A. Levy-Clarke, John H. Kempen, SITE Cohort Research GroupAbstract:PurposeTo compare mycophenolate mofetil (MMF) to methotrexate (MTX) as corticosteroid-sparing therapy for ocular inflammatory diseases.DesignRetrospective analysis of cohort study dataMethodsParticipants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics were obtained via medical record review. The study included 352 patients who were taking single agent immunosuppression with MTX or MMF at four tertiary uveitis clinics. Marginal structural models (MSM)-derived statistical weighting created a virtual population with covariates and censoring patterns balanced across alternative treatments. With this methodological approach, the results estimate what would have happened had none of the patients stopped their treatment. Survival analysis with stabilized MSM-derived weights simulated a clinical trial comparing MMF vs. MTX for non-infectious inflammatory eye disorders. The primary outcome was complete control of inflammation on prednisone ≤10 mg/day, sustained for ≥30 days.ResultsThe time-to-success was shorter (more favorable) for MMF than MTX (HR=0.68, 95% confidence interval: 0.46-0.99). Adjusting for covariates, the proportion achieving success was higher at every point in time for MMF than MTX from 2-8m then converges at 9 months. The onset of corticosteroid-sparing success took more than three months for most patients in both groups. Outcomes of treatment (MMF vs. MTX) were similar across all anatomic sites of inflammation. The incidence of stopping therapy for toxicity was similar in both groups.ConclusionsOur results suggest that, on average, MMF may be faster than MTX in achieving corticosteroid-sparing success in ocular inflammatory diseases.
  • Treatment for central-peripheral rivalry-type diplopia (“dragged-fovea
           diplopia syndrome”)
    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of OphthalmologyAuthor(s): Sarah R. Hatt, David A. Leske, Lindsay D. Klaehn, Andrea M. Kramer, Raymond Iezzi, Jonathan M. HolmesABSTRACTPurposeTo report the effectiveness of treatments for central-peripheral rivalry (CPR)-type diplopia due to retinal misregistration.DesignRetrospective, interventional case seriesSettingAdult strabismus clinic at a tertiary medical centerPatient population50 adults with retinal misregistration and CPR-type diplopia (minimum frequency of “sometimes” at distance and/or for reading), caused by epiretinal membrane (n=44) or other retinal disorders (n=6).InterventionsIncluded treatments were: Bangerter filter, tape, Fresnel prism, clear prism (incorporated into glasses or loose prism in office), iseikonic manipulation (using iseikonic lenses or contact lenses), MIN lens, or epiretinal membrane peeling (alone or in any combination). Not all treatments were trialed on all patients.Main outcome measuresDiplopia frequency evaluated using the Diplopia Questionnaire. Success was defined as “never” or “rarely” diplopic for distance and reading using the Diplopia Questionnaire, at an outcome examination as close as possible to 6 months.ResultsOverall, 17 (34%, 95% CI 21% to 49%) of 50 patients were classified a success: Fresnel prism 4 (57%, 18% to 90%) of 7 patients; Bangerter filter 4 (14%, 4% to 33%) of 28, epiretinal membrane peeling 8 (44%, 22% to 69%) of 18 patients, and iseikonic manipulation (using a contact lens) 1 (4%, 0% to 22%) of 23 patients.Conclusionsand relevance: CPR-type diplopia may be relieved in some patients using non-surgical treatment options of Fresnel prism or Bangerter filter. ERM peeling was surprisingly successful and should be considered.
  • The effect of a spectral filter on visual quality in patients with an
           extended-depth-of-focus intraocular lens
    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of OphthalmologyAuthor(s): Grzegorz Łabuz, Gerd U. Auffarth, Aydin Özen, Thomas JTP. van den Berg, Timur M. Yildirim, Hyeck-Soo Son, Ramin KhoramniaPurposeWavelength dependence of diffractive intraocular lenses (IOLs) was recognized in vitro but not yet assessed in vivo. By examining pseudophakic patients who had extended-depth-of-focus diffractive implants, we clinically measured this spectral effect on their vision. We also tested the lens in vitro.DesignCross-sectional study with laboratory investigation.MethodsTwelve patients (23 eyes), all pseudophakic with a Symfony lens, were measured monocularly in red and white light at far, intermediate and near. Corrected distance visual acuity (CDVA), distance corrected intermediate and near visual acuity (DCIVA and DCNVA) were assessed. Contrast sensitivity was examined at several spatial frequencies. The in-vitro lens modulation transfer function (MTF) was measured, under different spectral conditions, using an IOL metrology device.ResultsCDVA was comparable in red and white light. DCIVA and DCNVA were significantly better in white light by 0.06 and 0.09, respectively. Contrast sensitivity was slightly better with a red filter at far, but it was worse at intermediate, though differences were significant only at one frequency. Near contrast sensitivity was better in polychromatic than red light, which was significant at three frequencies. The in-vitro analysis confirmed Symfony's wavelength dependence: performance is improved at far, but is worse at intermediate and near.ConclusionsSymfony's spectral dependence was observed to affect visual acuity and contrast sensitivity. Although the red filter did not improve distance vision, it caused visual deterioration at near. One might take this effect into account when optimizing the reading performance of patients with diffractive IOLs.
  • Quantification of choriocapillaris with OCTA: a comparison study
    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of OphthalmologyAuthor(s): Zhongdi Chu, Giovanni Gregori, Philip J. Rosenfeld, Ruikang K. WangAbstractPurposeTo demonstrate the variation in quantitative choriocapillaris (CC) metrics with various binarization approaches using optical coherence tomography angiography (OCTA).DesignRetrospective, observational, cross-sectional case series.Methods3x3 mm and 6x6 mm macular OCTA scans were obtained from normal eyes and from eyes with drusen secondary to AMD. The CC slab was extracted and the CC flow deficits (FDs) were segmented with two previously published algorithms: fuzzy C-means approach (FCM method) and Phansalkar’s local thresholding (Phansalkar method). Four different values for the radius were used in order to investigate the effect on the FD segmentation when using the Phansalkar method. FD density (FDD), mean FD size (MFDS), FD number (FDN), FD area (FDA) and inter-capillary distance (ICD) were calculated for comparison. Repeatability was assessed as coefficient of variation (CV) and Pearson’s correlation analysis was conducted.ResultsSix eyes from 6 subjects with normal eyes and 6 eyes from 6 subjects with drusen secondary to AMD were scanned. 3x3 mm scans resulted in higher repeatability compared to 6x6 mm scans. For the Phansalkar method, larger values of the radius resulted in higher repeatability. ANOVA tests resulted in significant differences (p
  • Machine learning-based predictive modeling of surgical intervention in
           glaucoma using systemic data from electronic health records
    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of OphthalmologyAuthor(s): Sally L. Baxter, Charles Marks, Tsung-Ting Kuo, Lucila Ohno-Machado, Robert N. WeinrebAbstractPurposeTo predict the need for surgical intervention in patients with primary open-angle glaucoma (POAG) using systemic data in electronic health records (EHR).DesignDevelopment and evaluation of machine learning models.MethodsStructured EHR data for 385 POAG patients from a single academic institution were incorporated into models using multivariable logistic regression, random forests, and artificial neural networks. Leave-one-out cross-validation was performed. Mean area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, and Youden Index were calculated for each model to evaluate performance. Systemic variables driving predictions were identified and interpreted.ResultsMultivariable logistic regression was most effective at discriminating patients with progressive disease requiring surgery, with an AUC of 0.67. Higher mean systolic blood pressure was associated with significantly increased odds of needing glaucoma surgery (odds ratio [OR] 1.09, p
  • Retinal detachment: Patient perspective and Electronic Medical Records
    • Abstract: Publication date: Available online 16 July 2019Source: American Journal of OphthalmologyAuthor(s): Gary D. Novack, Michele C. LimTwo perspectives are provided on the retinal detachment suffered by one of the authors on a national holiday. One perspective is the personal one - a disturbing visual symptom, the surgery, the recovery and the worry about potential long lasting sequelae, and the need to reiterate detailed medical information several times during a stressful period. The other perspective is a national one regarding electronic health records. Current systems have been called “soul-sapping”, requiring physicians to direct their focus to the computer, rather than the patient. While electronic health records are a national mandate, the lack of intraoperability between different physician and hospital systems means that we are far from achieving meaningful digitization of records. For example, only forty-one percent of hospitals in the US that have electronically available medical information from outside providers or sources when treating a patient. Physicians in outpatient settings fare worse with only 14% of office-based physicians sharing data with providers outside of their organization. The case report outlined in our article provides a close look at how it may be difficult to receive care in a fragmented health care model in which physician and hospital do not share the same EHR. Information blocking, now prohibited by federal law, still remains as an obstacle to intraoperability. It will take continued effort and commitment from key stakeholders such as health care providers, patients, the federal government, and industry to bring this dream to fruition.
  • Prediction of Glaucoma Progression with Structural Parameters: Comparison
           of Optical Coherence Tomography and Clinical Disc Parameters
    • Abstract: Publication date: Available online 25 June 2019Source: American Journal of OphthalmologyAuthor(s): Ramin Daneshvar, Adeleh Yarmohammadi, Reza Alizadeh, Sharon Henry, Simon K. Law, Joseph Caprioli, Kouros Nouri-MahdaviAbstractPurposeTo test the hypothesis that baseline optical coherence tomography (OCT) measures predict visual field (VF) progression in a cohort of patients with suspected or established glaucoma and compare their performance to semiquantitative optic disc measures.DesignObservational cohort study.MethodsSetting: Academic institution.Study PopulationOne-hundred seventy-one eyes of 95 patients with good-quality baseline retinal nerve fiber layer (RNFL) and macular OCT images and disc photographs with>2 years of follow-up and ≥5 VFs.Observation ProceduresBaseline macular and RNFL OCT measures and cup-to-disc ratio and disc damage likelihood score.Main Outcome MeasuresPrediction of glaucomatous visual field deterioration according to trend and event analyses.ResultsMedian (IQR) baseline mean deviation and follow-up were –2.9 (–6.4 to –1.1) dB and 54 (44-65) months, respectively. Seventeen and 25 eyes progressed by final visit based on pointwise event analysis and trend analysis of Visual Field Index (VFI), respectively. Thinner CCT (p =0.005), female gender (p =0.015), and thinner average pRNFL (p =0.001) predicted VF progression on proportional hazard models. Thinner RNFL at baseline (p =0.006) or thinner average GCIPL (p =0.028) along with higher baseline VFI (p =0.018 and 0.048, respectively) predicted VFI progression. Neither optic disc measures predicted VF progression in any of the explored models.ConclusionsBaseline structural OCT measures predicted subsequent VF progression in contrast to semiquantitative optic disc measures. OCT-based structural measures should be included in prognostic models of glaucomatous VF deterioration.
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