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Publisher: Elsevier   (Total: 3184 journals)

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Showing 1 - 200 of 3184 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 37, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 25, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 100, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 430, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 293, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 6, 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: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
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  
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: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 180, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, 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: 16, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, 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: 11, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, 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: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 32, 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: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, 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: 20, 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: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 11)
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: 43, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 49, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 62, 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: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
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: 36, 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: 8, 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: 20, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 12, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
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: 4)
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: 17, 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: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 17)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, 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: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
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: 65)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, 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: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 414, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
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: 36, 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: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 51, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 365, 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: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 468, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, 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: 6, 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: 11)
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: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 5, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 5, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 57, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 62, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 45, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, 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: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 49)
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: 234, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, 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: 30, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, 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: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 20, 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: 5, 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: 202, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, 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: 24, 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: 208, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 6, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Ophthalmology
Journal Prestige (SJR): 3.184
Citation Impact (citeScore): 4
Number of Followers: 66  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9394
Published by Elsevier Homepage  [3184 journals]
  • Efficacy and Safety of Intravitreal Aflibercept for Polypoidal Choroidal
           Vasculopathy: Two-Year Results of the Aflibercept in Polypoidal Choroidal
           Vasculopathy Study
    • Abstract: Publication date: August 2019Source: American Journal of Ophthalmology, Volume 204Author(s): Tien Yin Wong, Yuichiro Ogura, Won Ki Lee, Tomohiro Iida, Shih-Jen Chen, Paul Mitchell, Chui Ming Gemmy Cheung, Zhongqi Zhang, Sérgio Leal, Tatsuro Ishibashi, the PLANET InvestigatorsPurposeWe sought to evaluate longer-term efficacy and safety of intravitreal aflibercept monotherapy (IAI) vs IAI plus rescue photodynamic therapy (rPDT) in patients with polypoidal choroidal vasculopathy (PCV).DesignThis was a prospective multicenter, double-masked, sham-controlled randomized clinical study across 62 centers.MethodsIn this phase 3b/4 study, patients with PCV with best-corrected visual acuity of 73–24 Early Treatment Diabetic Retinopathy Study letters (20/40–20/320 Snellen equivalent) received IAI 2 mg every 4 weeks until week 12, when they were randomized 1:1 to receive IAI or IAI plus rPDT if rescue criteria were met. Patients not requiring rescue received IAI every 8 weeks; those requiring rescue received IAI every 4 weeks plus sham/active PDT. At week 52 (the primary endpoint), IAI was noninferior to IAI plus rPDT. After week 52, treatment intervals could be extended beyond 8 weeks at the investigators' discretion. Noninferiority of IAI vs IAI plus rPDT for mean best-corrected visual acuity change from baseline to week 96 was evaluated.ResultsOver 96 weeks, 54 patients (17.0%) met rescue criteria. At week 96, IAI was noninferior to IAI plus rPDT in terms of Early Treatment Diabetic Retinopathy Study letters gained (+10.7 vs +9.1, P = .48). Proportions of patients with complete polyp regression (33.1% vs 29.1%) or without active polyps (82.1% vs 85.6%) were similar. In year 2, the mean number of injections was 4.6 in both arms. No new safety signals were observed.ConclusionIAI monotherapy was noninferior to IAI with rescue PDT up to 96 weeks, and functional and anatomical improvements achieved at 52 weeks were maintained. Few patients required rescue PDT, which provided no additional visual benefit.
  • Projection-Resolved Optical Coherence Tomographic Angiography of Retinal
           Plexuses in Retinitis Pigmentosa
    • Abstract: Publication date: August 2019Source: American Journal of Ophthalmology, Volume 204Author(s): Ahmed M. Hagag, Jie Wang, Kevin Lu, Gareth Harman, Richard G. Weleber, David Huang, Paul Yang, Mark E. Pennesi, Yali JiaPurposeTo use projection-resolved optical coherence tomographic angiography (PR-OCTA) to characterize the microvascular changes in 3 distinct retinal plexuses in retinitis pigmentosa (RP) patients.DesignProspective cross-sectional study.MethodsA commercial 70-kHz spectral-domain optical coherence tomography (OCT) system was used to acquire 6-mm macular scans from RP patients and age-matched healthy participants at a tertiary academic center. Blood flow was detected using a commercial version of split-spectrum amplitude-decorrelation angiography (SSADA) algorithm. The PR-OCTA algorithm was used to suppress projection artifacts and resolve microvasculature in 3 plexuses around the macula. Vessel density was calculated from en face OCTA of the parafoveal and perifoveal regions in each of the 3 plexuses, as well as the all-plexus inner retinal slab. Inner and outer retinal thicknesses were measured form structural OCT scans. Generalized estimating equations and Spearman’s rank correlation statistical methods were used.ResultsForty-four eyes from 26 RP patients and 34 eyes from 26 healthy subjects were included. Significant reduction in vessel density was detected in the perifovea but not the parafovea of inner retinal slab of RP patients (P = .001 and P = .56, respectively) compared to controls. We also found deeper retinal plexuses (intermediate and deep capillary plexuses, ICP and DCP) were primarily damaged by RP, compared to superficial vascular complex (SVC). Significant thickening of the inner retina and thinning of the outer retina were also observed. Strong correlation was found between the vessel density in the perifoveal ICP and DCP and outer retinal thickness in RP patients with no history of cystoid macular edema.ConclusionsPR-OCTA enables the detection of microvascular changes in the perifoveal regions of the ICP and DCP in RP, with relative sparing of the SVC. OCT and OCTA parameters might be able to provide better understanding of the pathophysiology of the disease, as well as monitoring disease progression and the response to experimental treatments.
  • Association of Macular and Circumpapillary Microvasculature with Visual
           Field Sensitivity in Advanced Glaucoma
    • Abstract: Publication date: August 2019Source: American Journal of Ophthalmology, Volume 204Author(s): Elham Ghahari, Christopher Bowd, Linda M. Zangwill, James Proudfoot, Kyle A. Hasenstab, Huiyuan Hou, Rafaella C. Penteado, Patricia Isabel C. Manalastas, Sasan Moghimi, Takuhei Shoji, Mark Christopher, Adeleh Yarmohammadi, Robert N. WeinrebPurposeTo evaluate the association between optical coherence tomography angiography (OCTA) macular and circumpapillary vessel density and visual field mean deviation (MD) in advanced primary open angle glaucoma.DesignCross-sectional study.MethodsMacula (superficial layer) and optic nerve head (ONH) with capillary density (CD) and without vessel density (VD) automated removal of large vessels OCTA of 34 eyes (34 patients, MD < -10 dB) were investigated as macula whole image VD (wiVD), parafoveal VD (pfVD), ONH wiVD, wiCD, circumpapillary VD, and cpCD. Spectral domain OCT circumpapillary retinal nerve fiber layer, macular ganglion cell complex, and ganglion cell inner plexiform layer were also analyzed.ResultsMacular and ONH VD decreased significantly with worsening MD. Each 1-dB decrease in MD was associated with a reduction of 0.43% and 0.46% for macular wiVD and pfVD with R2 of 0.28 and 0.27, respectively (all P < .01). The association between MD and VD was strongest for measures of ONH with large vessels removed, wiCD, and cpCD, followed by wiVD and circumpapillary VD with R2 of 0.26, 0.22, 0.17, 0.14, and a VD reduction of 0.43%, 0.51%, 0.33%, and 0.40%, respectively (all P < .02). There was a reduction of 1.19 μm in Avanti parafoveal ganglion cell complex, 1.13 μm in Spectralis ganglion cell inner plexiform layer, and 1.01 μm in Spectralis circumpapillary retinal nerve fiber layer, with R2 of 0.19 (P = .006), 0.23 (P = .002), and 0.24 (P = .002), respectively.ConclusionsONH and macula OCTA VD and thickness are associated with the severity of visual field damage in advanced primary open angle glaucoma.
  • Lessons Learned From Avastin and OCT–The Great, the Good, the Bad, and
           the Ugly: The LXXV Edward Jackson Memorial Lecture
    • Abstract: Publication date: August 2019Source: American Journal of Ophthalmology, Volume 204Author(s): Philip J. RosenfeldPurposeTo describe the synergistic benefits and cost savings from the use of optical coherence tomography (OCT) and vascular endothelial growth factor (VEGF) inhibitors, particularly intravitreal bevacizumab, in the treatment of exudative age-related macular degeneration (AMD).DesignRetrospective literature review and personal perspective.MethodsRetrospective literature review and personal perspective.ResultsThe introduction of the first clinically useful OCT instrument coincided with early-phase clinical trials of a drug that would become known as ranibizumab. OCT provided a noninvasive imaging strategy that unambiguously showed the macular fluid associated with exudative AMD and the ability of anti-VEGF therapy to resolve this fluid with concomitant visual acuity improvement. Clinicians came to embrace the use of OCT imaging as the basis for dosing with anti-VEGF drugs, rather than the fixed-interval dosing that was the standard in clinical trials and recommended by industry after approval. But, before ranibizumab was approved for the treatment of exudative AMD, intravenous bevacizumab was approved to treat cancer. Both drugs shared a common molecular lineage, and this led to a clinical trial using intravenous bevacizumab for the treatment of exudative AMD. Intravenous bevacizumab resulted in visual acuity and OCT improvements similar to ranibizumab, and this observation soon led to the intravitreal use of bevacizumab in 2005. Fortuitously, both ranibizumab and bevacizumab were packaged at similar molar concentrations, so similar volumes of both drugs when injected into an eye would result in similar anti-VEGF activity. With ranibizumab not yet commercially available, intravitreal bevacizumab rapidly became adopted worldwide for the treatment of VEGF-driven ocular diseases. Despite numerous attempts by industry and anonymous sources to discredit and prevent its use, bevacizumab spread globally owing to its availability; its low treatment cost, which was $5.50 per 1 mg in the United States; the evidence of efficacy based on OCT imaging and vision improvement; and its perceived safety. In the United States alone, the use of OCT-guided therapy and the use of bevacizumab for the treatment of exudative AMD has saved Medicare over $40 billion since 2008.ConclusionsThe rapid adoption of OCT-guided therapy and the use of intravitreal bevacizumab by the global retinal community has prevented blindness from exudative and neovascular ocular diseases worldwide while saving healthcare providers and patients billions of dollars.
  • Characterization and Management of Late Postoperative Capsular Block
           Syndrome Following Phacoemulsification or Phacovitrectomy
    • Abstract: Publication date: August 2019Source: American Journal of Ophthalmology, Volume 204Author(s): Yuchen Lin, Jijian Lin, Zhitao Su, Zhiqing Chen, Ke YaoPurposeTo compare the clinical characteristics of eyes affected by late postoperative capsular block syndrome (CBS) after routine phacoemulsification or phacovitrectomy, and to demonstrate the outcomes of neodymium-doped yttrium-aluminum-garnet (Nd:YAG) capsulotomy and posterior continuous curvilinear capsulorrhexis (PCCC) in the treatment of CBS.DesignRetrospective interventional case series study.MethodsTwenty-eight patients with late postoperative CBS, comprising 13 eyes after phacoemulsification (Group A) and 15 eyes after phacovitrectomy (Group B), were analyzed. Seventeen patients with minimal (degree I), mild (II), and moderate (III) posterior capsular opacification (PCO) underwent Nd:YAG capsulotomy (Group A, 10 eyes and Group B, 7 eyes), while 11 patients with severe (degree IV) PCO underwent PCCC (Group A, 3 eyes and Group B, 8 eyes).ResultsA statistically significant postoperative improvement in best-corrected visual acuity (Group A, P = .0002 and Group B, P = .0070) and a significant postoperative decrease in aqueous flare value (Group A, P = .0077 and Group B, P = .0127) were observed. No significant differences were observed in intraocular pressure, aqueous depth, and diopters (P> .05). No surgical complications were experienced by either group.ConclusionsLate postoperative CBS had similar characteristics whether it developed after phacoemulsification or after phacovitrectomy. Nd:YAG capsulotomy and the PCCC technique are efficient approaches to mild and moderate PCO and severe PCO with CBS, respectively. PCCC may be a viable alternative for treating dense PCO with CBS in pseudophakic eyes.
  • Anti–Vascular Endothelial Growth Factor Therapy for Diabetic
           Retinopathy: Consequences of Inadvertent Treatment Interruptions
    • Abstract: Publication date: August 2019Source: American Journal of Ophthalmology, Volume 204Author(s): Thomas J. Wubben, Mark W. Johnson, Elliott H. Sohn, James J. Peairs, Christine N. Kay, Stephen J. Kim, Thomas W. Gardner, Yannis M. Paulus, David N. Zacks, Nathan C. Steinle, Robert L. Avery, Maria H. BerrocalPurposeTo illustrate that patients with diabetic retinopathy who are treated exclusively with anti–vascular endothelial growth factor (VEGF) therapy and have an interruption in treatment may experience marked progression of disease with potentially devastating visual consequences.DesignRetrospective, multicenter, case series.MethodsRetrospective review of patients treated exclusively with anti-VEGF therapy for proliferative diabetic retinopathy (PDR) or nonproliferative diabetic retinopathy (NPDR), with or without diabetic macular edema (DME), and temporarily lost to follow-up. Baseline disease characteristics, cause and duration of the treatment interruption, and resulting disease progression, complications, and outcomes were assessed.ResultsThirteen eyes of 12 patients with type 2 diabetes were identified. The mean age was 57 ± 10 years, and 50% were women. Anti-VEGF therapy was indicated for PDR with DME in 7 (54%) eyes, PDR without DME in 3 (23%) eyes, and moderate to severe NPDR with DME in 3 (23%) eyes. Eight eyes had visual acuity (VA) of 20/80 or better before treatment interruption. The median duration of treatment hiatus was 12 months. Reasons for treatment interruption included intercurrent illness (31%), noncompliance (31%), and financial issues (15%). Complications upon follow-up included vitreous hemorrhage (9 eyes), neovascular glaucoma (5 eyes), and traction retinal detachment (4 eyes). Despite treatment of these complications, 77% of eyes lost ≥3 lines of VA, with 46% of eyes having a final VA of hand motion or worse.ConclusionsDiabetic patients are subject to significant lapses in follow-up because of illness, financial hardship, or noncompliance. In patients with diabetic retinopathy, especially PDR, who are managed with anti-VEGF therapy alone, unintentional treatment interruptions can result in irreversible blindness.
  • Handheld Optical Coherence Tomography Normative Inner Retinal Layer
           Measurements for Children
    • Abstract: Publication date: Available online 21 June 2019Source: American Journal of OphthalmologyAuthor(s): Maria E. Lim, Kim Jiramongkolchai, Limin Xu, Sharon F. Freedman, Vincent Tai, Cynthia A. Toth, Mays A. El-Dairi PurposeMeasurements of the ganglion cell complex (GCC), comprising the retinal nerve fiber (RNFL), ganglion cell, and inner plexiform layers, can be correlated with vision loss caused by optic nerve disease. Handheld optical coherence tomography (HH-OCT) can be used with sedation in children not amenable to traditional imaging. Purpose: to report GCC and RNFL measurements in normal children using HH-OCT.DesignProspective observational study of normal children ≤ 5-years of age.MethodsHealthy, full-term children ≤5 years-old undergoing sedation or anesthesia were enrolled. Exclusion criteria: prematurity, pre-existing neurologic, genetic, metabolic or intraocular pathology. Demographic data, axial length (Master-Vu Sonomed Escalon, NY), and HH-OCT macular and optic nerve volume scans at 0 degrees (Bioptigen, Inc., NC) were obtained. Retinal segmentation was completed with DOCTRAP software, creating average volume thickness maps.ResultsSixty-seven children (67 eyes, 31 male, age range 3.4-70.9 months) were enrolled. Average axial length was 21.2±1.0 mm with mean spherical equivalent +1.49±1.34 diopters (range: -2.25 to +4.25). Average GCC volume for the total retina was 0.28±0.04 mm3. Forty-seven of these eyes had RNFL analysis. Average RNFL thickness of the papillomacular bundle was 38.2±9.5 μm. There was no correlation between GCC volume, RNFL thickness, patient age, or axial length.ConclusionAverage GCC volume and RNFL thickness was stable from 6-months to 5-years of age. This study provides normative data for GCC and RNFL obtained by HH-OCT in healthy eyes of young children, to serve in evaluating those with optic neuropathies.
  • Netarsudil/Latanoprost Fixed-Dose Combination for Elevated Intraocular
           Pressure: 3-Month Data From a Randomized Phase 3 Trial
    • Abstract: Publication date: Available online 21 June 2019Source: American Journal of OphthalmologyAuthor(s): Sanjay Asrani, Alan L. Robin, Janet B. Serle, Richard A. Lewis, Dale W. Usner, Casey C. Kopczynski, Theresa Heah, Mercury-1 Study Group PurposeTo compare the ocular hypotensive efficacy and safety of a fixed-dose combination (FDC) of the Rho kinase inhibitor netarsudil and latanoprost vs monotherapy with netarsudil or latanoprost.DesignThree-month primary endpoint analysis of a randomized, double-masked, phase 3 clinical trial.MethodsAdults with open-angle glaucoma or ocular hypertension (unmedicated intraocular pressure [IOP]>20 and
  • Effects of Crocin on Diabetic Maculopathy: A Placebo-Controlled Randomized
           Clinical Trial
    • Abstract: Publication date: Available online 21 June 2019Source: American Journal of OphthalmologyAuthor(s): Samaneh Sepahi, Seyed Ahmad Mohajeri, Seyedeh Maryam Hosseini, Elham Khodaverdi, Nasser Shoeibi, Maral Namdari, Sayyed Abolghasem Sajadi Tabassi
  • Systemic Determinants of Peripapillary Vessel Density in Healthy African
           Americans: the African American Eye Disease Study
    • Abstract: Publication date: Available online 21 June 2019Source: American Journal of OphthalmologyAuthor(s): Ryuna Chang, Andrew J. Nelson, Vivian LeTran, Brian Vu, Bruce Burkemper, Zhongdi Chu, Ali Fard, Amir H. Kashani, Benjamin Y. Xu, Ruikang K. Wang, Rohit Varma, Grace M. Richter, African American Eye Disease Study Group PurposeTo determine the relationship between systemic factors and radial peripapillary capillary (RPC) vessel density (VD) in healthy African American (AA) participants of the African American Eye Disease Study.DesignA population-based, cross-sectional study.Methods4135 eyes from 2127 AA participants aged 40 years and older in Inglewood, California, were imaged for 6x6mm optic disc scans on a spectral-domain optical coherence tomography angiography (OCTA) device. Of these, 1029 eyes from 1029 participants who met the inclusion and exclusion criteria were analyzed, including only one eye per participant. Custom software was used to quantify RPC VD. Multivariate linear regression was used to identify systemic factors associated with RPC VD with a significance level set at 0.05. The contribution of each variable to the final model was estimated with the magnitude of standardized regression coefficients (SRC). The fit of the final model was measured by the R2.ResultsAverage RPC VD was 0.346±0.045. Controlling for signal strength, the systemic variables in the final multivariate model associated with reduced RPC VD were older age (β=-0.0123 per decade; SRC=-0.2733; p=
  • Randomized, Controlled, Phase 2 Trial of Povidone-Iodine/Dexamethasone
           Ophthalmic Suspension for the Treatment of Adenoviral Conjunctivitis
    • Abstract: Publication date: Available online 21 June 2019Source: American Journal of OphthalmologyAuthor(s): Seema Ramakrishnan, Jyothi Vempati, Prabu Baskaran
  • Demodex Mite Infestation and its Associations with Tear Film and Ocular
           Surface Parameters in Patients with Ocular Discomfort
    • Abstract: Publication date: August 2019Source: American Journal of Ophthalmology, Volume 204Author(s): Dieter Franz Rabensteiner, Haleh Aminfar, Ingrid Boldin, Marianne Nitsche-Resch, Bujar Berisha, Gerold Schwantzer, Jutta Horwath-WinterPurposeThe presence of Demodex species can be associated with blepharitis. Their pathogenic potential in meibomian gland dysfunction is discussed herein. The purpose of this study was to determine the prevalence of Demodex mites in eyelashes of Austrian patients with ocular discomfort and to evaluate associated changes of the lid margins and meibomian glands.DesignThis is a case-control study.MethodsTwo hundred twenty-nine consecutive patients with ocular discomfort from an Austrian dry eye clinic were investigated for the presence of Demodex mites on sampled eyelashes. Associations of a mite infestation with individual dry eye and lid parameters were assessed. Lid margins were evaluated for scales, vascularization, Marx line, expressibility and quality of meibum, and drop-out of meibomian glands.ResultsDemodex mites were identified in 40.2% of patients suffering from ocular discomfort (mean mite count 3.3 ± 2.9 per patient). Infestation with mites was associated with the presence of significantly more cylindrical scales (sleeves), a higher Marx line score, and a lower quality of meibum compared with mite-free patients. There were no significant associations with the expressibility and the drop-out of meibomian glands.ConclusionThe prevalence of Demodex mites in patients with ocular discomfort is high. The mean mite count per patient in this Austrian dry eye unit population is lower compared with previously published data from Asian regions. The infestation of the eyelids with Demodex species is associated with changes of the anterior and posterior lid margin, suggesting a pathogenic role in blepharitis and meibomian gland dysfunction.
  • Impact of obstructive sleep apnea on optic nerve function in patients with
           craniosynostosis and recurrent intracranial hypertension
    • Abstract: Publication date: Available online 20 June 2019Source: American Journal of OphthalmologyAuthor(s): Josephine Q.N. Nguyen, Cory M. Resnick, Yoon-Hee Chang, Ronald M. Hansen, Anne B. Fulton, Anne Moskowitz, Carly E. Calabrese, Linda R. Dagi PurposeAssessment of combined impact of intracranial pressure (ICH) and obstructive sleep apnea (OSA) on optic nerve function in children with craniosynostosis (CS).DesignRetrospective cross-sectional studyMethodsPatients treated at Boston Children’s Hospital for CS who had an ophthalmic examination that included pattern reversal (pr)VEP (2013-2014) and history of ICH based on direct measurement, papilledema, or classic features on neuroimaging and during cranial vault expansion were included. History of OSA was determined by polysomnography and associated conditions, including apnea and (adeno)tonsillectomy. Subjects were divided into four groups: (1) resolved ICH absent history of OSA; (2) resolved ICH with history of OSA; (3) recurrent ICH absent history of OSA; and (4) recurrent ICH with history of OSA. Predictor variables included latency of P100 component of prVEP, best-corrected visual acuity, optic nerve appearance, visual fields and global RNFL. Primary outcome was association of prolonged P100 latency with resolved versus recurrent ICH and OSA.ResultsTwenty-eight children met inclusion criteria (mean age 11.6 ± 6.9 years): group 1 (N = 3); group 2 (N = 6); group 3 (N = 8); group 4 (N = 11). P100 latencies were not prolonged in groups 1 and 2. Three of 8 in group 3 and 9 of 11 in group 4 had prolonged P100 latency. Group 4 was significantly worse than group 3 (P=0.005).ConclusionsHistory of OSA, in addition to recurrent ICH, is associated with greatest risk of optic neuropathy with CS. Ophthalmologists should encourage early management of OSA as well as ICH to optimize ophthalmic outcomes.
  • Descemet Membrane Endothelial Keratoplasty versus Descemet Stripping
           Automated Endothelial Keratoplasty and Penetrating Keratoplasty
    • Abstract: Publication date: Available online 19 June 2019Source: American Journal of OphthalmologyAuthor(s): J.H. Woo, Marcus Ang, H.M. Htoon, D.T. Tan PurposeTo compare the long-term graft survival outcomes and complications of patients who underwent Descemet Membrane Endothelial Keratoplasty (DMEK), Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) and Penetrating Keratoplasty (PK) for Fuchs corneal endothelial dystrophy (FECD) and bullous keratopathy (BK).DesignRetrospective comparative cohort studyMethodsPatients with FECD and BK who underwent DMEK (121 eyes), DSAEK (423 eyes) or PK (405 eyes) from the prospective cohort from the Singapore Corneal Transplant Registry were included. A Kaplan-Meier survival analysis was conducted to compare the survival probabilities of the 3 groups. The main outcome measure was graft survival.ResultsThe DMEK group had the best overall cumulative graft survival of 97.4%, compared to DSAEK (78.4%) and PK (54.6%). (P
  • Retinal And Choroidal Optical Coherence Tomography Findings Of Carotid
           Cavernous Fistula
    • Abstract: Publication date: Available online 19 June 2019Source: American Journal of OphthalmologyAuthor(s): Onur Inam, Yonca Ozkan Arat, Guliz Fatma Yavas, Anil Arat PURPOSETo define the retinal and choroidal imaging findings of carotid cavernous fistula (CCF) including central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI) parameters and tortuosity indexes (TI) as compared to a control group (CG).DESIGNCross-sectional studyMATERIALS AND METHODSThe spectral domain enhanced-depth imaging optical coherence tomography (SD-EDI-OCT) images of 19 eyes of 19 consecutive patients with angiographically proven CCF and 19 eyes of 19 age- and sex- matched healthy control subjects were included. The patient group was divided according to CCF venous drainage pattern as anterior (A-CCF: draining into ophthalmic veins) and posterior (P-CCF: not draining into ophthalmic veins). The clinically affected eyes of the patient group, ipsilateral to the fistula, were included in the analysis.RESULTSThere were 15 (78.9%) A-CCFs, 4 (21.1%) P-CCFs. Mean SFCT of A-CCF (395.21 ± 111.69 μm) group was significantly higher than P-CCF (246.84 ± 94.12 μm) and CG (280.79 ± 111.36 μm) (p=0.039 and p=0.006 respectively). Mean CVI of the A-CCF group was significantly higher than the CG (68.97 ± 4.81 and 65.66 ± 3.37 respectively, p=0.033). A-CCF group had significantly higher inferior, superior and total venous TI, compared to CG (p=0.001, p=0.001 and p
  • Differentiating veins from arteries on optical coherence tomography
           angiography by identifying deep capillary plexus vortices
    • Abstract: Publication date: Available online 19 June 2019Source: American Journal of OphthalmologyAuthor(s): Xiaoyu Xu, Nicolas A. Yannuzzi, Pedro Fernández-Avellaneda, Jose J. Echegaray, Kimberly D. Tran, Jonathan F. Russell, Nimesh A. Patel, Rehan M. Hussain, David Sarraf, K Bailey Freund PurposeTo introduce a simple method for differentiating retinal veins from arteries on optical coherence tomography angiography (OCTA).DesignCross-sectional pilot study.MethodsFour default en face slabs including color depth encoded, greyscale full-thickness retina, superficial plexus, and deep capillary plexus (DCP) from 9 3x3 mm and 9 6x6 mm OCTA scans were exported and aligned. Nine ophthalmologists with minimum OCTA experience from 2 eye institutions were instructed to classify labeled vessels as arteries or veins in 3 stages. Classification was performed based on graders’ own assessment at Stage 1. Graders were taught that a capillary-free zone was an anatomic feature of arteries at Stage 2 and were trained to identify veins originating from vortices within the DCP at Stage 3. Grading accuracy was analyzed and correlated with grading time and graders’ years in practice.ResultsOverall grading accuracy in Stages 1, 2, and 3 was (50.4 ± 17.0) %, (75.4 ± 6.0) %, and (94.7 ± 2.6) %, respectively. Grading accuracy for 3x3 mm scans in Stages 1, 2, and 3 was (49.9 ± 16.3) %, (79.2 ± 9.6) %, and (96.9 ± 3.1) %, respectively. Accuracy for 6x6 mm scans in Stages 1, 2, and 3 was (51.4 ± 20.8) %, (72.3 ± 7.9) %, and (93.2 ± 3.3) %, respectively. Grading performance improved significantly at each stage (all P < .001). No significant correlation was found between accuracy and time spent grading or between accuracy and years in practice (r = -0.164 – 0.617, all P ≥ 0.077).ConclusionsWe describe a simple method for accurately distinguishing retinal arteries from veins on OCTA which incorporates the use vortices in the DCP to identify venous origin.
  • Influence Of Age, Sex And Generation On Physician Payments And Clinical
           Activity In Ontario, Canada: An Age-Period-Cohort Analysis
    • Abstract: Publication date: Available online 17 April 2019Source: American Journal of OphthalmologyAuthor(s): Yvonne M. Buys, Mayilee Canizares, Tina Felfeli, Yaping JinPurposeTo compare the effect of age, sex and generation on physician practice patterns in Ontario, Canada.DesignRetrospective cohort study.MethodsPhysician and patient data from 1992-2013 were used to calculate yearly number of physicians, distinct patients seen, patient visits, government payments, physician age, sex, specialty and year of birth. Age-period-cohort models were used for analysis.ResultsThere was a negligible change in the number of distinct patients for all physicians and family physicians and a 20.6% decrease for ophthalmologists. There were small declines in yearly visits for all physicians (14.2%) and family physicians (17.3%) and a 10.0% increase for ophthalmologists. There was a lower number of visits (and patients for ophthalmologists) in each succeeding recent birth cohort. For all groups and birth cohorts, male physicians had significantly greater number of visits and patients.Median payments increased over time in all groups and were less for women with an average women-to-men ratio of 0.64 for all physicians, 0.75 for family physicians and 0.59 for ophthalmologists. After adjusting for the number of visits and patients, sex differences in payments remained significant for all physicians and ophthalmologists but were no longer significant for family physicians.ConclusionYounger cohorts of Ontario physicians have greater yearly payments compared to older cohorts at the same age despite similar or slightly less number of visits and patients. The sex gap of payments was mostly explained by differences in the number of patients and visits for family physicians however remained significant for all physicians and ophthalmologists.
  • Post-Concussion: Receded Near Point of Convergence is Not Diagnostic of
           Convergence Insufficiency
    • Abstract: Publication date: Available online 17 April 2019Source: American Journal of OphthalmologyAuthor(s): Aparna Raghuram, Susan Cotter, Sowjanya Gowrisankaran, Jameel Kanji, David R. Howell, William P. Meehan, Ankoor S. Shah PurposeTo determine the frequency of receded near point of convergence (NPC) in patients with chronic concussion-related symptoms, and among those with receded NPC to enumerate the frequency of convergence insufficiency and other oculomotor disorders.StudyDesign: Retrospective cross-sectional studyMethodsClinic charts were retrospectively reviewed for the prior 3.5 years to identify all patients 28 days post-concussion, had chronic concussion-related symptoms, had normal visual acuity, and received a comprehensive sensorimotor examination. The frequency of receded NPC and oculomotor diagnoses were determined.ResultsOf the 83 eligible patients, 74 (89%) had receded NPC. Of these, 70 (95%) had oculomotor disorders; 30 (41%) had disorders of accommodation only, 21 (28%) had convergence insufficiency and accommodation deficits, and 6 (8%) had convergence insufficiency only. Six (8%) had a convergence deficit other than convergence insufficiency (all with concurrent accommodative disorders), 4 (5%) had both a non-specific vergence dysfunction and accommodation deficits, 2 (3%) had convergence excess only, and 1 (1%) had both convergence excess and accommodative deficits.ConclusionA receded NPC was present in the majority of young patients with chronic post-concussion symptoms. Associated with numerous underlying oculomotor dysfunctions, the clinical finding of a receded NPC is not synonymous with the diagnosis of convergence insufficiency. Because treatment options for the various oculomotor dysfunctions differ, it is prudent that these patients undergo a thorough examination of their vergence and accommodative systems so that an accurate diagnosis can be made and appropriate treatment prescribed.
  • Glucose tolerance levels and circumpapillary retinal nerve fiber layer
           thickness in a general Japanese population: the Hisayama Study
    • Abstract: Publication date: Available online 6 April 2019Source: American Journal of OphthalmologyAuthor(s): Kohta Fujiwara, Miho Yasuda, Jun Hata, Yoichiro Hirakawa, Sawako Hashimoto, Emi Ueda, Aiko Iwase, Makoto Araie, Takeshi Yoshitomi, Toshiharu Ninomiya, Koh-Hei Sonoda PurposeTo investigate the relationship between glucose tolerance levels and the circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in a general Japanese population.DesignPopulation-based, cross-sectional study.MethodsIn 2012 and 2013, a total of 2,809 Japanese community-dwellers aged 40–79 years in the Hisayama Study underwent eye examinations including cpRNFLT measurement with spectral domain optical coherence tomography. Of these, 1,324 subjects (578 men, 746 women) were enrolled. Glucose tolerance levels were determined by a 75-g oral glucose tolerance test. We conducted an analysis of covariance to estimate the mean values of cpRNFLT according to the subjects' glucose intolerance status.ResultsThe subjects with prediabetes or with diabetes mellitus had significantly lower age- and sex-adjusted mean cpRNFLT values than those with normal glucose tolerance (p=.04, p=.0004, respectively). The age- and sex-adjusted mean values of cpRNFLT decreased significantly with elevating fasting plasma glucose and 2-hr postload glucose levels (all p for trend
  • Border Tissue Morphology Is Spatially Associated with Focal Lamina
           Cribrosa Defect and Deep-Layer Microvasculature Dropout in Open-Angle
    • Abstract: Publication date: July 2019Source: American Journal of Ophthalmology, Volume 203Author(s): Jong Chul Han, Jae Hwan Choi, Do Young Park, Eun Jung Lee, Changwon KeePurposeTo investigate the topographic relationship among focal lamina cribrosa (LC) defect, microvasculature dropout (MvD) and border tissue morphology in open angle glaucoma (OAG) eyes using spectral-domain (SD) optical coherence tomography (OCT) and OCT angiography.DesignCross-sectional study.MethodsOne hundred twenty-six OAG eyes and 97 normal eyes were included. The maximum externally oblique border tissue (EOBT) length was measured by using enhanced depth imaging SD-OCT as well as focal LC defect size. Circumferential MvD width and height ratio were measured using OCT angiography.ResultsSignificant correlations were found among the locations of focal LC defect, MvD and maximum EOBT length. The mean absolute locational difference was 29.1° (95% CI, −47.6 to 105.7) between focal LC defect and MvD, 10.0° (95% CI, −79.4 to 99.4) between focal LC defect and maximum EOBT length, and 10.6° (95% CI, −71.1 to 92.3) between MvD and maximum EOBT length. In multivariate logistic regression analysis, a worse VF defect was significantly associated with the presence of focal LC defects and MvDs (P < .002; P = .002, respectively). MvD circumferential width was associated with glaucoma severity (R = −0.66, P < .001), whereas focal LC defect size and MvD height ratio were associated with maximum EOBT length (R = 0.48, P < .001; R = 0.65, P < .001, respectively) and AL (R = 0.53, P < .001; R = 0.52, P < .001, respectively).ConclusionsThere was a topographical correlation among the locations of focal LC defect, MvD and maximum border length. In addition, the presence of focal LC defect and MvD were also strongly associated with glaucoma severity. Thus, it is thought that focal LC defect and MvD may be biomarkers that reflect glaucoma severity especially at the location of maximum border tissue elongation.
  • Adalimumab in juvenile-idiopathic arthritis-associated uveitis (JIA-U):
           5-year follow-up of the Bristol participants of the SYCAMORE trial
    • Abstract: Publication date: Available online 13 June 2019Source: American Journal of OphthalmologyAuthor(s): S. Horton, A.P. Jones, C.M. Guly, B. Hardwick, M.W. Beresford, R.W.J. Lee, A.D. Dick, A.V. Ramanan PurposeTo determine longer-term outcomes of participants enrolled from a single center in the SYCAMORE trial, a randomized placebo-controlled trial of adalimumab versus placebo in children with juvenile idiopathic arthritis-associated uveitis (JIA-U) uncontrolled on methotrexate.DesignRetrospective interventional case series.MethodsMedical records of all 28 SYCAMORE participants recruited at the Bristol Eye Hospital were reviewed at approximately 3-monthly intervals up to 5 years from the trial randomization date. Uveitis activity, treatment course, visual outcomes, ocular complications and adverse events were recorded. Data are presented using summary statistics.ResultsFollowing withdrawal of the investigational medicinal product (IMP), 25 of the 28 participants were started on adalimumab for active juvenile idiopathic arthritis-associated uveitis (JIA-U). Of the 12 participants in the active treatment arm of the SYCAMORE study, 11 (92%) were restarted on adalimumab after withdrawal of the IMP for active JIA-U (median time to flare 188 days (range 42-413)). Two participants stopped adalimumab for uncontrolled JIA-U. One participant had a reduction in vision to 0.3 due to cataract. Mean visual acuity for the remaining 27 participants was -0.04 (right eye) and -0.05 (left eye).ConclusionsDrug-induced remission of JIA-U did not persist when adalimumab was withdrawn after 1-2 years treatment. Adalimumab was well tolerated and visual acuity outcomes were excellent.
  • 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 Issa PurposeTo 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.
  • Reply
    • Abstract: Publication date: Available online 10 June 2019Source: American Journal of OphthalmologyAuthor(s): Elodie Bousquet, Myriam Dhundass, Raphaël Lejoyeux, Ari Shinojima, Valérie Krivosic, Sarah Mrejen, Alain Gaudric, Ramin Tadayoni
  • Long-term outcomes after surgery of late in-the-bag intraocular lens
           dislocation: a randomized clinical trial
    • Abstract: Publication date: Available online 10 June 2019Source: American Journal of OphthalmologyAuthor(s): Marius Dalby, Olav Kristianslund, Liv Drolsum PurposeTo compare the long-term efficacy and safety of two operation methods for late in-the-bag intraocular lens (IOL) dislocation.DesignProspective, randomized, parallel-group surgical clinical trial.MethodsDuring a 3-year period, we randomly assigned 104 patients (104 eyes) to one group for IOL repositioning by scleral suturing (n = 54) or one for IOL exchange by retropupillary fixation of an iris-claw IOL (n = 50). A single surgeon performed all operations with an anterior approach. Patients were examined before surgery and 6 months, 1 year, and 2 years after surgery. The present study included the 66 patients (63%) who completed the 2-year follow-up, and the main outcome measure was corrected distance visual acuity (CDVA) 2 years after surgery.ResultsAfter 2 years, the mean CDVA was 0.20 ± 0.29 logarithm of the minimum angle of resolution (logMAR) units (range, -0.18 to 1.10) in the repositioning group and 0.22 ± 0.30 logMAR (range, -0.10 to 1.22) in the exchange group (P = .69). A CDVA of 20/40 or better was achieved by 76% of all patients. Four eyes (12%) had cystoid macular edema in the repositioning group compared with five eyes (15%) in the exchange group. Two eyes had re-dislocation (one in each group). There were no cases of endophthalmitis or retinal detachment.ConclusionsThere were no significant differences in visual acuity between IOL repositioning and IOL exchange 2 years after surgery. The two methods were equally efficient and safe from a long-term perspective and are both considered acceptable treatments.
  • Tomographic and Refractive Characteristics of Pediatric First-Degree
           Relatives of Keratoconus Patients
    • Abstract: Publication date: Available online 10 June 2019Source: American Journal of OphthalmologyAuthor(s): Shady T. Awwad, Madeleine Yehia, Carl-Joe Mehanna, Maamoun Abdul Fattah, Alain Saad, Ahmad Hatoum, Christiane Al-Haddad PurposeTo evaluate the tomographic and refractive characteristics of pediatric first-degree relatives of patients with keratoconus.DesignCross-sectional studyMethodsSetting: Department of Ophthalmology at the American University of Beirut Medical, Beirut, Lebanon.Study PopulationPediatric first-degree relatives of patients with keratoconus. Both eyes of all participants aged between 6 and 18 years were included and studied.Exclusion criteriasoft contact lens use in the past 2 weeks or rigid gas-permeable lens wear within 4 weeks, history of prior ocular surgery or infectious keratitis, and unreliable corneal tomography.Masking and randomizationTwo masked cornea and refractive surgeons of different training backgrounds independently evaluated the participants’ tomographical outputs. Additionally, the tomographic data was analyzed using Smadja’s decision tree.Observation proceduresScheimpflug tomography, manifest refraction, and slit-lamp examination.Main outcome measuresAnterior curvature indices, posterior elevation values, thinnest pachymetry, and subjective and objective tomographical interpretation.ResultsOne hundred eighty-three subjects were recruited. Tomographic evaluation after Cohen’s kappa coefficient analysis revealed 32 patients as having keratoconus (17.5%), while 35 patients (19.1%) were labelled as keratoconus by objective analysis. 11.5%-15.5% of patients with keratoconus aged less than 11 years, 18.0% aged 12-15 years, and 25.5% aged 16-18 years. Their respective steepest anterior curvature and thinnest pachymetry are 44.8±6.5D and 515.9±39.2μm, 47.34±3.4D and 496.1±37.9μm, and 49.7±6.1D and 486.0±66.5μm. 37.5% of the keratoconus patients were unilateral as evaluated by tomography alone.ConclusionsThe prevalence of keratoconus in pediatric first-degree relatives of diagnosed keratoconus patients is high. Screening in this high-risk group is warranted.
  • Distribution of Diabetic Neovascularization on Ultra-Widefield Fluorescein
           Angiography and on Simulated Widefield OCT Angiography
    • Abstract: Publication date: Available online 10 June 2019Source: American Journal of OphthalmologyAuthor(s): Jonathan F. Russell, Harry W. Flynn, Jayanth Sridhar, Justin H. Townsend, Yingying Shi, Kenneth C. Fan, Nathan L. Scott, John W. Hinkle, Cancan Lyu, Giovanni Gregori, Stephen R. Russell, Philip J. RosenfeldABSTRACTPurposeAreas of neovascularization (NV) in proliferative diabetic retinopathy (PDR) on ultrawide-field (UWF) fluorescein angiography (FA) were identified and compared with a simulated wide field (WF) swept-source OCT angiography (SS-OCTA) field of view (FOV) to determine whether the WF SS-OCTA FOV was sufficient for detection of NV in PDR.DesignRetrospective, consecutive case seriesMethodsAll patients with PDR and UWF FA imaging at the Bascom Palmer Eye Institute over a period of 5.5 years were identified. UWF FA images were reviewed and sites of NV were identified either as NV of the disc (NVD) or NV elsewhere (NVE). Sites of NVE were classified by disc-centered retinal quadrants. A simulated WF SS-OCTA montage FOV was overlaid on the UWF FA images to determine whether sites of NV would have been identified by this simulated WF SS-OCTA FOV.ResultsA total of 651 eyes with PDR from 433 patients had at least one UWF FA with NV. Of the 651 eyes, 50% were treatment-naïve, 9.8% had NVD only, 41.8% had NVE only, and 48.4% had both NVD and NVE. NVE was most prevalent in the superotemporal quadrant and least prevalent in the nasal quadrants. When the simulated WF SS-OCTA FOV was overlaid on the UWF FA, 98.3% of all eyes, 99.4% of treatment-naive eyes, and 97.2% of previously-treated eyes had NV within the WF SS-OCTA FOV. In those eyes with a repeat UWF FA within 6 to 18 months of the first FA, the distribution of NV did not change in either the treatment-naive or previously-treated eyes.ConclusionsNVE in PDR was most prevalent superotemporally, and 99.4% of treatment-naïve eyes had NV within the simulated WF SS-OCTA FOV. Combined with previous research using WF SS-OCTA to identify NV in PDR, these findings suggest that WF SS-OCTA may be the only imaging modality needed for the diagnosis and longitudinal management of PDR.
  • Effect of Graft Attachment Status and Intraocular Pressure on Descemet
           Stripping Automated Endothelial Keratoplasty Outcomes in the Cornea
           Preservation Time Study
    • Abstract: Publication date: July 2019Source: American Journal of Ophthalmology, Volume 203Author(s): Anthony J. Aldave, Mark A. Terry, Loretta B. Szczotka-Flynn, Wendi Liang, Allison R. Ayala, Maureen G. Maguire, Robert C. O'Brien, Beth Ann Benetz, John E. Bokosky, Steven P. Dunn, Thomas E. Gillette, Kristin M. Hammersmith, David R. Hardten, Bennie H. Jeng, Marc F. Jones, Richard L. Lindstrom, Kenneth J. Maverick, Verinder S. Nirankari, Matthew S. Oliva, Irving M. RaberPurposeTo examine the association of donor, recipient, and operative factors on graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS) as well as the effects of graft dislocation and elevated IOP on graft success and endothelial cell density (ECD) 3 years postoperatively.DesignCohort study within a multi-center, double-masked, randomized clinical trial.Methods1090 individuals (1330 study eyes), median age 70 years, undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (6% of eyes). Recipient eyes receiving donor corneal tissue randomized by preservation time (PT) of 0-7 days (N = 675) or 8-14 days (N = 655) were monitored for early or late graft failure through 3 years. Donor, recipient, operative, and postoperative parameters were recorded including graft dislocation (GD), partial detachment, and pre- and post-operative IOP. Pre- and postoperative central donor ECD were determined by a central image analysis reading center. Proportional hazards, mixed effects, and logistic regression models estimated risk ratios and (99% confidence intervals).ResultsThree independent predictive factors for GD were identified: a history of donor diabetes (odds ratio [OR]: 2.29 [1.30, 4.02]), increased pre-lamellar dissection central corneal thickness (OR: 1.13 [1.01, 1.27] per 25µ increase), and operative complications (OR: 2.97 [1.24, 7.11]). Among 104 (8%) eyes with GD, 30 (28.9%) developed primary donor or early failure and 5 (4.8%) developed late failure vs. 15 (1.2%; P < .001) and 29 (2.4%; P = .04), respectively, of 1226 eyes without GD. 24 (2%) of 1330 study eyes had early acutely elevated postoperative IOP that was associated with a higher risk of graft failure through 3 years (hazard ratio: 3.42 [1.01, 11.53]), but not with a lower mean 3-year ECD (mean difference 61 (–479, 601) cells/mm2, P = .77). History of elevated postoperative IOP beyond 1 month was not significantly associated with 3-year graft success or ECD.ConclusionsDonor diabetes, increased donor corneal thickness, and intraoperative complications were associated with an increased risk of GD. Early acutely elevated postoperative IOP and GD significantly increased the risk for graft failure following DSAEK.
  • Spectrum of Disease Severity and Phenotype in Choroideremia Carriers
    • Abstract: Publication date: Available online 8 June 2019Source: American Journal of OphthalmologyAuthor(s): Ruben Jauregui, Karen Sophia Park, Akemi J. Tanaka, Ahra Cho, Maarjaliis Paavo, Jana Zernant, Jasmine H. Francis, Rando Allikmets, Janet R. Sparrow, Stephen H. Tsang PurposeTo characterize and bring awareness to the disease spectrum of female choroideremia patients, as severity can vary from mild, to severe disease comparable to that observed in males.DesignRetrospective cohort study.Methods12 female carriers of disease-causing variants in the CHM gene confirmed by molecular genetic sequencing were characterized clinically and imaged with short-wave fundus autofluorescence (SW-FAF), spectral-domain optical coherence tomography (SD-OCT), and color fundus imaging.ResultsTwelve unrelated female patients with a clinical and genetic diagnosis of choroideremia carriers were included in this study. Disease severity among these phenotypes ranged from mild to severe resembling the typical presentation of choroideremia in males. Mild disease presented with retinal pigment epithelium mottling, a patchy pattern of hypoautofluorescent speckles on SW-FAF, and intact retinal layers on SD-OCT. Severe disease presented with widespread chorioretinal atrophy as shown by SW-FAF and SD-OCT. Each of the identified genetic variants in CHM was predicted to be disease-causing according to in silico prediction software. Disease progression analysis of four patients with follow-up showed a decline in visual acuity for two patients, with progression observed on SD-OCT in one of the patients. No significant disease progression on SW-FAF was observed for any of the patients.ConclusionsFemale carriers of choroideremia can present with a wide range of clinical phenotypes and disease severity, from mild to severe disease similar to males. Symptomatic females should be considered for current and upcoming gene replacement therapy clinical trials.
  • Schisis of the Retinal Nerve Fiber Layer in Epiretinal Membranes
    • Abstract: Publication date: Available online 8 June 2019Source: American Journal of OphthalmologyAuthor(s): S. Amal Hussnain, Tarun Sharma, Donald C. Hood, Stanley Chang PurposeTo describe schisis of the retinal nerve fiber layer (sRNFL) associated with epiretinal membranes (ERMs) seen on spectral domain optical coherence tomography (SD-OCT) prior to vitreoretinal surgery. Areas of sRNFL (size and location) were noted during preoperative planning. SD-OCT scans were obtained to study the inner retinal morphology postoperatively.DesignRetrospective observational consecutive case-series.MethodsPre- and post-operative SD-OCT and en-face images of 41 eyes with ERMs that had undergone vitrectomy by a single surgeon were analyzed to record the presence of sRNFL. The extent of sRNFL was classified as focal or diffuse. Other characteristics such as involvement of the papillomacular bundle and areas of fibrillary protrusion of sRNFL above the ILM were documented. Color fundus photographs were reviewed to correlate with the SD-OCT images.ResultsMean patient age and length of follow-up were 69.3 years (range 52-82 years) and 6.8 months (range 0.25-21 months), respectively. Mean pre-operative and post-operative central thicknesses were 477μm and 387μm, respectively (p1 disc diameter) in 90.5% (19/21 eyes). Protrusion of sRNFL through the ILM was present in 76.2% (16/21 eyes) and occurred in areas of dehiscence of the adjacent internal limiting membrane (ILM). sRNFL was best visualized on SD-OCT and en-face imaging at the vitreoretinal interface (VRI) and sometimes correlated with areas of retinal whitening. sRNFL resolved in all cases post-operatively.ConclusionssRNFL was a relatively common occurrence in ERMs, correlated frequently with areas of dehisced ILM intra-operatively, and resolved post-operatively in all cases.
  • Reply
    • Abstract: Publication date: Available online 7 June 2019Source: American Journal of OphthalmologyAuthor(s): Sang Jun Park, Hee Kyung Yang, Seong Jun Byun, Kyu Hyung Park, Jeong-Min Hwang
  • Multistep Grading System for Evaluation of Chronic Ocular Sequelae in
           Patients With Stevens-Johnson Syndrome
    • Abstract: Publication date: July 2019Source: American Journal of Ophthalmology, Volume 203Author(s): Namrata Sharma, Renu Venugopal, Prafulla K. Maharana, Manthan Chaniyara, Tushar Agarwal, Neelam Pushker, Ravinder Mohan Pandey, Sushil Sangwan, Seema Sen, Seema Kashyap, Arundhati Sharma, Neena Khanna, Rasik B. VajpayeePurposeTo propose a new scoring system for grading of chronic ocular sequelae in Stevens-Johnson syndrome (SJS).DesignReliability and validity analysis.MethodsParticipants: Four hundred eyes of 200 patients with chronic ocular SJS/toxic epidermal necrolysis (TEN) were included in the study. Settings: Single-center, tertiary eye care referral center. Procedure: All patients with SJS/TEN with chronic (more than 1 year) ocular sequelae were recruited for the study. Corneal, eyelid, and conjunctival signs were evaluated and given scores ranging from 0 to 5 depending on the increasing severity. Twelve signs (6 corneal, 3 conjunctival, and 3 eyelid) were evaluated to obtain the total severity score for each eye. Based on the corrected distance visual acuity (CDVA) and total score, each eye was graded using receiver operating characteristic (ROC) analysis. Main Outcome Measures: Correlation of CDVA with the severity score determined on the basis of 12 corneal, eyelid, and conjunctival signs.ResultsMean age was 24.09 ± 10.9 years. The most common inciting agent for SJS was oral medications (85%). The scores of 12 ocular surface parameters correlated significantly with CDVA (P < .001). ROC analysis revealed 4 grades of total severity score of 0-11 (stage 0), 12-16 (stage 1), 17-22 (stage 2), and 23-53 (stage 3). The total severity score correlated significantly with logMAR visual acuity grades with an agreement of 60.7% using Cohen's kappa analysis (kappa coefficient = 0.420 ± 0.03). The most common stage of total severity score was stage 3 in 49% of eyes (196/400), followed by stage 0 (107/400, 26.7%).ConclusionsThe multistep scoring system of chronic ocular features in SJS/TEN sequelae is a useful tool to grade all levels of severity. This may help to evaluate the efficacy of the surgical intervention by comparing preoperative with postoperative ocular grades.
  • Prolonged cone b-wave on electroretinography is associated with severity
           of inflammation in non-infectious uveitis.
    • Abstract: Publication date: Available online 4 June 2019Source: American Journal of OphthalmologyAuthor(s): Anna H. Brouwer, Gerard C. de Wit, Ninette H. ten Dam, Ralph Wijnhoven, Maria M. van Genderen, Joke H. de Boer PurposeTo investigate retinal function of non-infectious uveitis patients using full-field electroretinography (ERG) and correlate the ERG to disease duration and severity of inflammation.DesignProspective cohort study.MethodsPatients (n=200) with non-infectious uveitis and a disease duration of 5 years (group B, n=120) were included. ERGs of the total 355 uveitis eyes were measured according to an extended ISCEV protocol. ERG abnormalities were related to demographics and uveitis characteristics, including anatomical classification, the duration of uveitis, severity of inflammation, best corrected visual acuity (BCVA), cystoid macular edema (CME), and the highest fluorescein angiography (FA) score during the course of the disease.ResultsThe ERG showed abnormalities in 235 eyes (66.2%). The most frequent and pronounced ERG abnormality was a prolonged implicit time of the cone b-wave (151 eyes, 42.5%), which was associated with vitritis (p=.005), cells in the anterior chamber (p=.007), highest FA score (p=.011), age (p
  • Tilted disc syndrome associated with serous retinal detachment: long-term
           prognosis. A retrospective multicenter survey
    • Abstract: Publication date: Available online 4 June 2019Source: American Journal of OphthalmologyAuthor(s): Fumihiro Kubota, Tetsuyuki Suetsugu, Aki Kato, Fumi Gomi, Seiji Takagi, Takamasa Kinoshita, Hiroto Ishikawa, Yoshinori Mitamura, Mineo Kondo, Chiharu Iwahashi, Soichiro Kuwayama, Yasuo Kurimoto, Yuichiro Ogura, Tsutomu Yasukawa, Japanese Clinical Retina Study (J-CREST) Group PurposeWe evaluated the long-term visual prognosis of a serous retinal detachment (SRD) secondary to tilted disc syndrome with or without an SRD at a final visit and the interventions.DesignA retrospective, observational case seriesMethodsThis was a multicenter study with an enrollment of 48 eyes of 41 treatment-naïve patients (14 men, 27 women) diagnosed as tilted disc syndrome related SRDs at a first visit. Investigators at each institution decided whether to observe the patients without interventions or to treat with intravitreous injections of anti-vascular endothelial growth factor agents, photodynamic therapy, or combined therapies of both. The patients were followed up for at least 12 months. Main outcome measures were the changes of best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from a baseline.ResultsAnalyses of all eyes showed improvement from a baseline when best BCVA was measured (p
  • Indications for Fine Needle Aspiration Biopsy of Posterior Segment
           Intraocular Tumors
    • Abstract: Publication date: Available online 3 June 2019Source: American Journal of OphthalmologyAuthor(s): Zélia Maria Corrêa, James Jay Augsburger PurposeTo define four indication categories of fine needle aspiration biopsies (FNABs) of solid intraocular tumors and describe the differences among the patients, tumors, and results of biopsy in these four indication categories.MethodsRetrospective descriptive analysis of 880 FNABs of a solid intraocular tumor of the posterior ocular segment performed by in the authors’ ocular oncology practice during the period July 1980 through July 2014.ResultsFNABs were performed as a separate procedure in 372 cases (42.3%), at plaque implantation in 279 (31.7%), post-enucleation in 225 (25.6%), and post-resection/pre-laser in 4 (0.4%). FNABs were categorized as diagnostic in 292 (33.2%), confirmatory in 121 (13.8%), investigational in 187 (21.3%), and prognostic in 280 (31.8%). Prior to the biopsy, all patients who underwent diagnostic FNAB had a tumor of uncertain pathological type, while all patients who underwent confirmatory FNAB had a clinically diagnosed malignant intraocular neoplasm. In contrast, all patients who underwent a prognostic FNAB had an unequivocal primary posterior uveal melanoma clinically, while patients who underwent an investigational biopsy all had an unequivocal or probable malignant intraocular tumor of a specific type. Most diagnostic FNABs were performed transvitreous (n=255, 87.3%) compared to prognostic FNABs (n=143, 51.1%) (p < 0.001). Overall, 733 FNABs (83.3%) yielded a sufficient specimen for cytological diagnosis. Diagnostic and confirmatory FNABs were the most likely to yield an insufficient aspirate (28.4% and 20.7% respectively), while investigational and prognostic FNABs were most likely to yield sufficient specimens (94.7% and 90.0% respectively) (p < 0.001). Mean post-FNAB follow-up of the entire group was 62.7 months (SD = 59.8, 95% CI = 58.7-66.6). Mean post-treatment follow-up or total follow-up of untreated patients was 53.7 months (SD = 58.7, 95% CI = 49.8-57.6).ConclusionsBecause of the substantial differences shown among FNAB cases performed for different indications, it seems appropriate to report results of FNAB or other biopsy methods according to the category (indication) of the biopsy.
  • Trends and Disparities in Inpatient Costs for Eye Trauma in the United
           States (2001-2014)
    • Abstract: Publication date: Available online 3 June 2019Source: American Journal of OphthalmologyAuthor(s): Mustafa Iftikhar, Asad Latif, Bushra Usmani, Joseph K. Canner, Syed M.A. ShahABSTRACTPurposeTo determine the trends and disparities in inpatient costs for eye trauma in the United States (US) from 2001 through 2014.DesignRetrospective population-based cross-sectional study.MethodsNational Inpatient Sample, a representative sample of US hospital discharges, was used to determine costs of eye trauma hospitalizations. Linear regression was used to estimate changes in mean inflation-adjusted cost per admission. Multivariable logistic regression was used to evaluate factors associated with a cost in the highest quartile (>$13,000) including age, sex, race, income quartile, primary payer, hospital location, size, and type. The model was adjusted for year of admission, length of stay, type of trauma, comorbidities, and the type and number of procedures performed.ResultsThe inpatient costs for eye trauma from 2001 through 2014 totaled $1.72 billion. The mean cost (95% CI) per stay remained relatively constant: $12,000 ($11,000–13,000) in 2001 to $11,000 ($10,000–12,000) in 2014 (p=0.643). A cost in the highest quartile was more likely in African-Americans compared to Whites (adjusted odds ratio [aOR], 1.3; 95% CI, 1.2-1.5), patients in the highest income quartile compared to those in the lowest (1.3; 1.2-1.5), uninsured patients compared to publicly insured patients (1.2; 1.1-1.4), teaching hospitals compared to non-teaching ones (1.5; 1.2-1.8), and the West compared to the South (2.4; 2.0-2.8).ConclusionsInpatient costs of eye trauma have remained steady and can be potentially reduced by addressing associated disparities. Further research including outpatient costs and eye trauma in vulnerable populations will be key to optimizing care and advancing healthcare equity.
  • Projection-Resolved Optical Coherence Tomography Angiography of the
           Peripapillary Retina in Glaucoma
    • Abstract: Publication date: Available online 3 June 2019Source: American Journal of OphthalmologyAuthor(s): Liang Liu, Beth Edmunds, Hana Takusagawa, Shandiz Tehrani, Lorinna Lombardi, John C. Morrison, Yali Jia, David HuangPurposeTo detect plexus-specific peripapillary retinal perfusion defects in glaucoma using projection-resolved optical coherence tomography angiography (PR-OCTA).DesignProspective cross-sectional study.MethodsOne eye each of 45 perimetric glaucoma participants and 37 age-matched normal participants were scanned using 4.5-mm OCTA scans centered on the disc. The PR-OCTA algorithm removed flow projection artifacts in OCT angiograms. Five en face OCTA slabs were analyzed: nerve fiber layer plexus (NFLP), ganglion cell layer plexus (GCLP), superficial vascular complex (SVC = NFLP + GCLP), deep vascular complex (DVC), and all plexuses combined. Peripapillary retinal capillary density (CD) and vessel density (VD) were calculated using a reflectance-compensated algorithm.ResultsFocal capillary dropout could be visualized more clearly in the NFLP than the other slabs. The NFLP, SVC and all-plexus CD in the glaucoma group were significantly lower (P
  • Risk of rhegmatogenous retinal detachment in acute retinal necrosis with
           and without prophylactic intervention
    • Abstract: Publication date: Available online 3 June 2019Source: American Journal of OphthalmologyAuthor(s): Sara Risseeuw, Joke H. de Boer, Ninette H. ten Dam – van Loon, Redmer van Leeuwen PurposeTo study whether preventive laser or preventive vitrectomy is able to lower the risk of rhegmatogenous retinal detachment (RRD) in patients with acute retinal necrosis (ARN).DesignA retrospective, interventional case-series.MethodsWe performed a retrospective study of 59 patients (63 eyes) with ARN treated in a single tertiary referral center. We analyzed different groups with either no prophylaxis, prophylactic laser, or prophylactic vitrectomy. Main outcome measure was incidence of a RRD.ResultsOverall incidence of RRD was 44.4%, including 13% at presentation. In a crude analysis, the risk of RRD was highest in 33 patients with prophylactic laser (45.5%), lower in 15 patients with no prophylaxis (26.7%), and lowest in 7 patients with prophylactic vitrectomy (14.3%). Baseline BCVA differed between these groups, but zone and percentage of involved retina did not. In a multivariable model including prophylactic laser and ARN severity, only zone was predictive of RRD.ConclusionWhen correcting for severity of disease, we did not observe a reduction in the risk of RRD by prophylactic laser in eyes with ARN. Therefore, prophylactic laser may be abandoned. The role of prophylactic vitrectomy is still unclear, but deserves further investigation.
  • Large field of view corneal epithelium and Bowman’s layer thickness maps
           in keratoconic and healthy eyes.
    • Abstract: Publication date: Available online 3 June 2019Source: American Journal of OphthalmologyAuthor(s): Niklas Pircher, Florian Beer, Stephan Holzer, Andreas Gschließer, Ruth Donner, Michael Pircher, Christoph K. Hitzenberger, Gerald Schmidinger, Jan Lammer PurposeTo assess differences in epithelium thickness (ET) and Bowman’s layer thickness (BLT) maps in keratoconic eyes and healthy eyesDesignCross-sectional study.Methods• Setting: Institutional• Study population: Forty-seven patients (one eye) with keratoconus (KC) and 20 healthy subjects (one eye).• Observation procedure: Epithelium and Bowman’s layer measurements were performed with a custom-designed polarization sensitive (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 measures: The mean ET and BLT of 25 sectors, the thinnest (minET, minBLT) and the thickest sector (maxET, maxBLT) were assessed. Ratios between thinnest/thickest sector (R1) as well as between mean ET and BLT of the inferior temporal quadrant/the 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 a highly irregular “moth damage” like pattern could be observed in keratoconic eyes. Highest AUC values were found for the thinnest sector of the BLT-map, R1ET and the thinnest sector of the ET-map.ConclusionsPS-OCT imaging enables the visualisation of significant differences of the corneal epithelium and the Bowman’s layer in en-face maps covering almost the entire cornea. Epithelial thickness and BLT profiles could clearly show their diagnostic importance for the distinguishing of keratoconic eyes and healthy eyes.
  • Regenerative Surgery of the Corneal Stroma for Advanced Keratoconus:
           1-Year Outcomes
    • Abstract: Publication date: July 2019Source: American Journal of Ophthalmology, Volume 203Author(s): Jorge L. Alió, Jorge L. Alió Del Barrio, Mona El Zarif, Albert Azaar, Nehman Makdissy, Charbel Khalil, Walid Harb, Ibrahim El Achkar, Ziad Abdul Jawad, María P. De MiguelPurposeThis study evaluated 1-year safety and efficacy outcomes of corneal stroma cell therapy. Therapy consisted of implanting autologous adipose-derived adult stem cells (ADASc) with or without sheets of decellularized donor human corneal stroma within the stroma of patients with advanced keratoconus.DesignThis was a prospective interventional non-randomized series of cases.MethodsFourteen consecutive patients were selected and divided into 3 experimental groups. Group A patients underwent implantation of autologous ADASc alone (3 × 106 cells/1 mL) (n = 5). Group B patients received decellularized donor 120-μm-thick corneal stroma lamina alone (n = 5). Group C patients had implantation of recellularized donor lamina with 1 × 106 autologous ADASc plus another 1 × 106 cells/1 mL at the time of the surgery (n = 4). Autologous ADASc were obtained by elective liposuction. Implantation was performed in the corneal stroma through a femtosecond-assisted 9.5-mm diameter lamellar dissection with the patient under topical anesthesia. Twelve months of follow-up data are presented.ResultsNo complications were observed during the 1-year follow-up, and full corneal transparency was recovered within 3 months in all patients. No patient lost lines of visual acuity. Corrected distance visual acuity improved 0.231, 0.264, and 0.094 Snellen lines in groups 1, 2, and 3, respectively. In group 1, refractive parameters showed an overall stability, whereas in groups 2 and 3, sphere improved 2.35 diopter (D) and 0.625 D, respectively. Anterior keratometry remained stable (group 1) and improved in groups 2 and 3 (mean improvement of 2D). Corneal aberrometry improved significantly. In optical coherence tomography scans, corneal thickness showed a mean improvement of 14.5 μm (group 1) and 116.4 μm (groups 2 and 3) in the central thickness, and new collagen production was observed at the surgical plane (group 1). Confocal biomicroscopy confirmed the host recellularization of the implanted laminas.ConclusionsIntrastromal implantation of autologous ADASc and decellularized human corneal stroma did not show complications at 1 year of follow-up and were moderately effective for the treatment of advanced keratoconus.
  • An association between large optic nerve cupping and cognitive function
    • Abstract: Publication date: Available online 1 June 2019Source: American Journal of OphthalmologyAuthor(s): Thasarat Sutabutr Vajaranant, Joelle Hallak, Mark A. Espeland, Louis R. Pasquale, Barbara E. Klein, Stacey M. Meuer, Stephen R. Rapp, Mary N. Haan, Pauline M. MakiABSTRACTPurposeTo determine if a larger cup-disc ratio is associated with poor cognitive function in postmenopausal women without glaucoma or ocular hypertension.MethodsWe used data from the Women’s Health Initiative (WHI), originally designed to test effects of hormone therapy (HT) on various health outcomes. Large cup-disc ratio was defined as greater than 0.6 in either eye based on stereoscopic optic nerve photographs. Global cognitive function was assessed annually by Modified Mini-Mental State Examination (3MSE) in the WHI Memory Study. Exclusions were no information on optic nerve grading; no 3MSE scores at the time of the eye examination, ocular hypertension (IOP>23 mm Hg, Goldmann applanation tonometry), or glaucoma medication use. A generalized linear model for log-transformed 3MSE scores was used for determining the association between large cup-disc ratio and 3MSE scores, adjusting for age, race, diabetes, body mass index, cardiovascular disease, smoking, HT randomization, education, and diabetic retinopathy.ResultsAnalyses included 1636 women (mean age ± SD, 69.57±3.64 years; 90.39% white). Of those, 122 women had large cup-disc ratio. The mean 3MSE scores in women with versus without large cup-disc ratio were 95.4±6 vs 96.6±5. In the adjusted model, women with large cup-disc ratio had statistically significant lower 3MSE scores, compared with those without large cup-disc ratio, yielding the predicted mean difference in 3MSE scores of 0.75 with a standard error of 0.05 units (P = 0.04).ConclusionsPostmenopausal women who had large cup-to-disc ratio without glaucoma or ocular hypertension exhibited lower global cognitive function. Further investigation is warranted.
  • Use of High-Resolution Optical Coherence Tomography in the Surgical
           Management of Ocular Surface Squamous Neoplasia: A Pilot Study
    • Abstract: Publication date: Available online 1 June 2019Source: American Journal of OphthalmologyAuthor(s): Carol L. Karp, Carolina Mercado, Nandini Venkateswaran, Marco Ruggeri, Anat Galor, Armando Garcia, Kavitha R. Sivaraman, Maria Paula Fernandez, Antonio Bermudez, Sander R. DubovyPurposeTo evaluate whether high-resolution optical coherence tomography (HR-OCT) can detect histologic tumor margins of ocular surface squamous neoplasia (OSSN).MethodsEight eyes of 8 patients with OSSN undergoing excision were studied prospectively. Immediately before surgery, the tumor was imaged using a commercially available HR-OCT (Bioptigen/Leica Microsystems, Buffalo Grove, IL) to identify the conjunctival margins of the neoplastic lesion. The tumor borders of the lesion determined by HR-OCT were mapped in relation to an anatomical reference point and transferred intraoperatively. The tumor was excised with 4 mm margins from the visible edge of the lesion with a “no-touch” technique. The specimens were sent for pathological analysis and the histologic tumor margin was compared to the HR-OCT predicted tumor border.ResultsMean age of the 8 patients were 67+ 9.9 years. Seven (87.5%) were male, 7(87.5%) were white and ethnically, 3 (37.5%) were Hispanic. All eight tumors were bulbar and in the exposure zone. Seven tumors were limbal. Corneal extension was present in 5(62.5%). Mean tumor area was 17.5±11.1 mm2. Clinically, two (25%) of the tumors were leukoplakic, 1(12.5%) papillomatous, and 3(37.5%) gelatinous. A conjunctival tumor margin identified with the HR-OCT coincided with the pathologically confirmed margin mark in all eyes.ConclusionsHR-OCT has the potential to predict histologic tumor margins in OSSN. Optical identification of tumor margins could potentially decrease the incidence of residual positive margins, and minimize healthy tissue removal. Advances in HR-OCT technology and integration into a microscope for ‘real-time” imaging are needed to further improve this technique.
  • Depression, Anxiety, and Stress in Parents of Patients with Retinoblastoma
    • Abstract: Publication date: Available online 1 June 2019Source: American Journal of OphthalmologyAuthor(s): Mary Louise Z. Collins, Jana Bregman, Jennifer S. Ford, Carol L. ShieldsABSTRACTPurposeTo assess depression, anxiety, and stress in parents of patients with retinoblastoma and to evaluate the impact of unifocal versus multifocal retinoblastoma.MethodsA cross-sectional, self-reported psychological assessment of parents of patients with retinoblastoma at a tertiary care ocular oncology center was performed. The Beck Depression Inventory–II (BDI), Beck Anxiety Inventory (BAI), The Parental Stress Index 4–Short Form (PSI 4-SF) and retinoblastoma Knowledge Assessment questionnaire were administered. Descriptive statistics for outcomes and comparative analyses were made.ResultsThere were 138 parents of children with retinoblastoma (unifocal: n = 77, multifocal: n=61). Overall, parents displayed mild, moderate or severe depression (BDI) (n=37, 26,7%), mild, moderate, or severe anxiety (BAI) (n=49, 35.8%), and stress scores within normal limits (n=138, 100%). A comparison (unifocal vs. multifocal) revealed parents of children with multifocal retinoblastoma with severe depression (1.4% vs. 10.2%, p
  • Use of Bevacizumab and Ranibizumab for Wet Age-Related Macular
           Degeneration: Influence of CATT Results and Introduction of Aflibercept
    • Abstract: Publication date: Available online 15 May 2019Source: American Journal of OphthalmologyAuthor(s): Suzann Pershing, Nidhi Talwar, Stephen T. Armenti, Joseph Grubbs, Julie M. Rosenthal, Vaidehi S. Dedania, Joshua D. Stein PurposeTo assess whether publication of Comparison of Age-related macular degeneration Treatment Trial (CATT) results and introduction of aflibercept to the marketplace affected intravitreal bevacizumab and ranibizumab utilization.Design: Retrospective analysis of treatment patterns.MethodsWe calculated weekly bevacizumab and ranibizumab utilization during 3 timeframes: (1) before CATT publication, (2) between CATT publication (4/28/2011) and assignment of a unique aflibercept billing code (1/1/2013), and (3) afterwards for 164188 Medicare beneficiaries with neovascular macular degeneration receiving ≥1 anti-Vascular Endothelial Growth Factor injections from 1/1/2008 to 12/31/2014. We identified ophthalmologists who predominantly (≥80%) administered bevacizumab or ranibizumab, and evaluated changes in preferences over the 3 periods. We replicated analyses on 881381 commercially-insured beneficiaries.ResultsAmong 317 ophthalmologists administering predominantly ranibizumab to Medicare beneficiaries pre-CATT, 221 (69.7%) reduced ranibizumab utilization post-CATT, whereas 96 (30.3%) continued using ranibizumab ≥80% of the time. Findings were reversed among 1041 ophthalmologists who predominantly administered bevacizumab pre-CATT—777 (74.6%) continued bevacizumab-predominant use while 264 (25.4%) reduced bevacizumab utilization post-CATT. Among the 145 ophthalmologists who predominantly administered ranibizumab before aflibercept’s availability, 77 (53.1%) reduced ranibizumab utilization and 68 (46.9%) continued using ranibizumab ≥80% of the time after aflibercept became available. Corresponding numbers among the 909 ophthalmologists who predominantly administered bevacizumab pre-aflibercept were 381 (41.9%) reducing and 528 (58.1%) continuing bevacizumab-predominant use. Similar results were observed for commercially-insured patients.ConclusionsMany ophthalmologists who favored ranibizumab switched to bevacizumab after CATT publication while most who favored bevacizumab prior to CATT publication continued favoring it afterwards. Aflibercept’s introduction had little impact on preferences for ranibizumab or bevacizumab.
  • Racial, Ethnic, and Socioeconomic Disparities in Retinoblastoma
           Enucleation: A Population-Based Study, SEER 18 2000-2014
    • Abstract: Publication date: Available online 9 May 2019Source: American Journal of OphthalmologyAuthor(s): Nitya Rajeshuni, Alice S. Whittemore, Cassie A. Ludwig, Prithvi Mruthyunjaya, Darius M. Moshfeghi PURPOSETo determine the effect of race, ethnicity, and census-tract-level composite socioeconomic status (SES) on retinoblastoma enucleation. This study augments Truong et al., providing multivariate analyses combining sociodemographic and clinical characteristics with more accurate SES measures. We hypothesized children from non-white, Hispanic, and lower socioeconomic backgrounds would have increased adjusted odds of enucleation.DESIGNRetrospective cohort analysis.METHODSSetting: Multicenter population-based study using the Surveillance, Epidemiology, and End Results (SEER) 18 Registries.Study PopulationChildren aged 18 and under diagnosed with retinoblastoma between 2000-2014. Subjects were identified using International Classification of Diseases Oncology (ICD-O) site and morphology codes.Main Outcome MeasuresEnucleation Odds Ratios and 95% Confidence IntervalsRESULTSAnalysis of 959 retinoblastoma patients revealed that 70.8% were enucleated. Adjusted analyses showed associations between enucleation and Asian (Odds Ratio (OR) 2.00, Confidence Interval (CI) 1.08-3.71) or Black (2.42, 1.41-4.16) race, Hispanic ethnicity (1.69, 1.16-2.46), and low SES (1.68, 1.09-2.58). Significantly increased enucleation risk was associated with older age at diagnosis (Age 1-2 years 2.55, 1.80-3.61;>2 years 4.88, 2.57-9.25), unilateral disease (5.00, 3.45-7.14), and advanced stage (Regional 4.71, 2.51-8.84; Distant 3.15, 1.63-6.08). No interactions were observed between race, ethnicity, SES, and stage at diagnosis. Enucleation rates decreased over time across all racial, ethnic, and socioeconomic groups.CONCLUSIONSChildren from non-white, Hispanic, and lower socioeconomic backgrounds are more likely to receive enucleation. These associations are independent of stage of diagnosis, suggesting larger systemic disparities in retinoblastoma care. The origin of these differences requires further study and attention by clinicians and policy-makers.
  • A Deep Learning System for Automated Angle-Closure Detection in Anterior
           Segment Optical Coherence Tomography Images
    • Abstract: Publication date: July 2019Source: American Journal of Ophthalmology, Volume 203Author(s): Huazhu Fu, Mani Baskaran, Yanwu Xu, Stephen Lin, Damon Wing Kee Wong, Jiang Liu, Tin A. Tun, Meenakshi Mahesh, Shamira A. Perera, Tin AungPurposeAnterior segment optical coherence tomography (AS-OCT) provides an objective imaging modality for visually identifying anterior segment structures. An automated detection system could assist ophthalmologists in interpreting AS-OCT images for the presence of angle closure.DesignDevelopment of an artificial intelligence automated detection system for the presence of angle closure.MethodsA deep learning system for automated angle-closure detection in AS-OCT images was developed, and this was compared with another automated angle-closure detection system based on quantitative features. A total of 4135 Visante AS-OCT images from 2113 subjects (8270 anterior chamber angle images with 7375 open-angle and 895 angle-closure) were examined. The deep learning angle-closure detection system for a 2-class classification problem was tested by 5-fold cross-validation. The deep learning system and the automated angle-closure detection system based on quantitative features were evaluated against clinicians' grading of AS-OCT images as the reference standard.ResultsThe area under the receiver operating characteristic curve of the system using quantitative features was 0.90 (95% confidence interval [CI] 0.891–0.914) with a sensitivity of 0.79 ± 0.037 and a specificity of 0.87 ± 0.009, while the area under the receiver operating characteristic curve of the deep learning system was 0.96 (95% CI 0.953–0.968) with a sensitivity of 0.90 ± 0.02 and a specificity of 0.92 ± 0.008, against clinicians' grading of AS-OCT images as the reference standard.ConclusionsThe results demonstrate the potential of the deep learning system for angle-closure detection in AS-OCT images.
  • Expanded phenotypic spectrum of retinopathies associated with autosomal
           recessive and dominant mutations in PROM1
    • Abstract: Publication date: Available online 24 May 2019Source: American Journal of OphthalmologyAuthor(s): Marta Del Pozo-Valero, Inmaculada Martin-Merida, Belen Jimenez-Rolando, Ana Arteche, Almudena Avila-Fernandez, Fiona Blanco-Kelly, Rosa Riveiro-Alvarez, Caroline Van Cauwenbergh, Elfride De Baere, Carlo Rivolta, Blanca Garcia-Sandoval, Marta Corton, Carmen Ayuso PurposeTo describe the genetic and phenotypic characteristics of a cohort of patients with PROM1 variants.DesignCase-case study.MethodWe screened a cohort of 2216 families with inherited retinal dystrophies using classical molecular techniques and next-generation sequencing approaches. The clinical histories of 25 patients were reviewed to determine age of onset of symptoms, and the results of ophthalmoscopy, best corrected visual acuity, full-field electroretinography, and visual field studies. Fundus autofluorescence and spectral-domain optical coherence tomography were further assessed in 7 patients.ResultsPROM1 variants were identified in 32 families. Disease-causing variants were found in 18 autosomal recessive and 4 autosomal dominant families. Monoallelic pathogenic variants or variants of unknown significance were identified in the remaining 10 families. Comprehensive phenotyping of 25 patients from 22 families carrying likely disease-causing variants revealed clinical heterogeneity associated with the PROM1 gene. Most of these patients presented cone-rod dystrophy and some exhibited macular dystrophy or retinitis pigmentosa, while all presented macular damage. Phenotypic association of a dominant splicing variant with late-onset mild maculopathy was established. This variant is one of the 3 likely founder variants identified in our Spanish cohort.ConclusionsWe report the largest cohort of patients with PROM1 variants, describing in detail the phenotype in 25 of them. Interestingly, within the variability of phenotypes due to this gene, macular involvement is a common feature in all patients.
  • Response to Correspondence “In Pseudotumor cerebri, hormonal
           contraception is not associated, and the diagnosis remains as
           ‘Idiopathic Intracranial Hypertension’”
    • Abstract: Publication date: Available online 23 May 2019Source: American Journal of OphthalmologyAuthor(s): Khin P. Kilgore, Michael S. Lee, Jacqueline A. Leavitt, Ryan D. Frank, Collin M. McClelland, John J. Chen
  • Predictive Factors of Response to Mineralocorticoid Receptor Antagonists
           in Nonresolving Central Serous Chorioretinopathy
    • Abstract: Publication date: Available online 22 May 2019Source: American Journal of OphthalmologyAuthor(s): Upma Awasthi, Rohini Grover, Abhishek Varshney, Chetan Videkar
  • Genetic correlations between diabetes and glaucoma: an analysis of
           continuous and dichotomous phenotypes
    • Abstract: Publication date: Available online 20 May 2019Source: American Journal of OphthalmologyAuthor(s): Vincent Laville, Jae H. Kang, Clara C. Cousins, Adriana I. Iglesias, Réka Nagy, Jessica N. Cooke Bailey, Robert P. Igo, Yeunjoo E. Song, Daniel I. Chasman, William G. Christen, Peter Kraft, Bernard A. Rosner, Frank Hu, James F. Wilson, Puya Gharahkhani, Alex W. Hewitt, David A. Mackey, Pirro G. Hysi, Christopher J. Hammond, Cornelia M. vanDuijn PurposeA genetic correlation is the proportion of phenotypic variance between traits that is shared on a genetic basis. Here we explore genetic correlations between diabetes- and glaucoma-related traits.DesignCross-sectional study.MethodsWe assembled genome-wide association study summary statistics from European-derived participants regarding diabetes-related traits like fasting blood sugar (FBS) and type 2 diabetes (T2D) and glaucoma-related traits (intraocular pressure (IOP), central corneal thickness (CCT), corneal hysteresis (CH), corneal resistance factor (CRF), cup-disc ratio (CDR), and primary open-angle glaucoma (POAG)). We included data from the National Eye Institute Glaucoma Human Genetics Collaboration Heritable Overall Operational Database, the UK Biobank and the International Glaucoma Genetics Consortium. We calculated genetic correlation (rg) between traits using linkage disequilibrium score regression. We also calculated genetic correlations between IOP, CCT and selected diabetes-related traits based on individual level phenotype data in two Northern European population-based samples using pedigree information and Sequential Oligogenic Linkage Analysis Routines (SOLAR).ResultsOverall, there was little rg between diabetes- and glaucoma-related traits. Specifically, we found a non-significant negative correlation between T2D and POAG (rg=-0.14; p=0.16). Using SOLAR, the genetic correlations between measured IOP, CCT, FBS, fasting insulin and hemoglobin A1c, were null. In contrast, genetic correlations between IOP and POAG (rg ≥0.45; p≤3.0E-04) and between CDR and POAG were high (rg =0.57; p=2.8E-10). However, genetic correlations between corneal properties (CCT, CRF and CH) and POAG were low (rg range: -0.18 – 0.11) and non-significant (p≥0.07).ConclusionThese analyses suggest there is limited genetic correlation between diabetes- and glaucoma-related traits.
  • Intraocular Oxygen and Antioxidant Status: New Insights on the Effect of
           Vitrectomy and Glaucoma Pathogenesis
    • Abstract: Publication date: July 2019Source: American Journal of Ophthalmology, Volume 203Author(s): Carla J. Siegfried, Ying-Bo ShuiPurposeThe purpose of this study was to investigate correlations of partial pressure of oxygen (pO2) in the ocular anterior segment of human eyes and aqueous humor antioxidant levels of ascorbate (AsA) and total reactive antioxidant potential (TRAP) with glaucoma and vitreous status.MethodsThis prospective, cross-sectional study stratified patients (n = 288 eyes) by lens and vitreous status and the presence of primary open-angle glaucoma for statistical analyses. Intraocular pO2 concentrations were measured using a fiberoptic probe in patients at the beginning of planned glaucoma and/or cataract surgery. Aqueous humor specimens were obtained for antioxidant analysis of AsA and TRAP.ResultsFollowing prior pars plana vitrectomy, pO2 levels were significantly higher than in the reference group of cataract surgery in the anterior chamber angle (16.2 ± 5.0 vs. 13.0 ± 3.9 mm Hg; P = .0171) and in the posterior chamber (7.6 ± 3.1 vs. 3.9 ± 2.7 mm Hg; P < .0001). AsA and TRAP levels were significantly lower (1.1 ± 0.4 vs. 1.4 ± 0.5 mM, respectively; 403.3 ±116.5 vs. 479.0 ± 146.7 Trolox units, respectively; P = .004 and P = .024, respectively) in patients after vitrectomy. In patients with an intact vitreous, neither pO2 nor antioxidant status correlated with lens status or glaucoma.ConclusionsIncreased pO2 and antioxidant depletion following vitrectomy suggests an alteration of the intraocular oxidant-antioxidant balance. Our study links physiologic factors such as increased pO2 in the anterior chamber angle and the posterior chamber to decreased antioxidant levels in aqueous humor following vitrectomy. Oxidative stress/damage to the trabecular meshwork in such post-vitrectomy cases may contribute to intraocular pressure elevation and increased risk of glaucoma.
  • In Vivo Confocal Microscopy Demonstrates Increased Immune Cell Densities
           in Corneal Graft Rejection Correlating With Signs and Symptoms
    • Abstract: Publication date: July 2019Source: American Journal of Ophthalmology, Volume 203Author(s): Chareenun Chirapapaisan, Alessandro Abbouda, Arsia Jamali, Rodrigo T. Müller, Bernardo M. Cavalcanti, Clara Colon, Deborah Witkin, Afsun Sahin, Reza Dana, Andrea Cruzat, Pedram HamrahPurposeDiagnosis of graft rejection is based on patient symptoms and on clinical signs detected by slit-lamp biomicroscopy. This study investigated whether laser in vivo confocal microscopy (IVCM) can aid in the diagnosis of corneal graft rejection by detecting cellular corneal changes that take place after transplantation.DesignProspective case-control study.SubjectsThirty-eight eyes of 38 patients with penetrating keratoplasty (15 eyes with corneal graft rejection, 23 eyes without rejection) and 9 age-matched normal controls.MethodsLaser IVCM was performed in the corneal grafts centrally. The density of immune cells (IC) was assessed for epithelial, sub-epithelial, stromal, and endothelial layers by 2 masked observers. IC density was compared among different groups and correlated to clinical signs and symptoms of corneal graft rejection.Main Outcome MeasurementsOutcome measurement was the IC density in the corneal layers and its associations with the presence of clinical signs and symptoms of corneal graft rejection.ResultsThe IC density was significantly different between rejected and non-rejected grafts (P = 0.004) and different from that of normal controls (P = 0.001). Among corneal layers, IC density was significantly higher in rejected grafts than in non-rejected grafts in only the sub-basal (611.54 ± 573.74 vs. 340.61 ± 268.60 cells/mm2, respectively; P = 0.049) and endothelial layers (250.62 ± 267.13 vs. 103.47 ± 81.91 cells/mm2, respectively; P = 0.001). Patients with decreased best corrected visual acuity, Khodadoust line, and anterior chamber cells demonstrated a significant increase in total IC density (P < 0.05), whereas patients with symptoms of irritation, light sensitivity, and pain revealed a specific increase in IC density in the sub-basal layer (P < 0.05). Patients with ocular pain had higher IC density in the epithelial layer than those without pain (P = 0.03).ConclusionsPatients with corneal graft rejection demonstrate a significant increase in corneal immune cells, particularly, in the sub-basal and endothelial layers compared to patients with non-rejected grafts and controls. Although symptoms associated with endothelial rejection demonstrate a general increase in IC, pain, irritation, and light sensitivity are associated with increased IC in the sub-basal layer. Assessment of patients with corneal graft rejection by IVCM may serve as an adjunctive tool in the diagnosis and management of corneal graft rejection.
  • Are Risk Factors for Growth of Choroidal Nevi Associated With Malignant
           Transformation' Assessment With a Validated Genomic Biomarker
    • Abstract: Publication date: Available online 18 May 2019Source: American Journal of OphthalmologyAuthor(s): Hans E. Grossniklaus, Erwin G. Van Meir
  • Risk of Stroke After Nonarteritic Anterior Ischemic Optic Neuropathy
    • Abstract: Publication date: Available online 18 May 2019Source: American Journal of OphthalmologyAuthor(s): Yueh-Chang Lee, Rong-Kung Tsai
  • Anterior Segment Optical Coherence Tomography Angiography Imaging of
           Conjunctiva and Intrasclera in Treated Primary Open-Angle Glaucoma
    • Abstract: Publication date: Available online 16 May 2019Source: American Journal of OphthalmologyAuthor(s): Tadamichi Akagi, Akihito Uji, Yoko Okamoto, Kenji Suda, Takanori Kameda, Hideo Nakanishi, Hanako Ohashi Ikeda, Masahiro Miyake, Eri Nakano, Naohiro Motozawa, Akitaka Tsujikawa PurposeTo investigate conjunctival and intrascleral vasculature in glaucoma eyes using anterior segment (AS)-optical coherence tomography angiography (OCTA) and assess the factors contributing to the vessel density in AS-OCTA images.DesignProspective, cross-sectional study.MethodsThirty-four patients with primary open-angle glaucoma and 20 healthy subjects were included. A swept-source OCT system was used to obtain AS-OCTA images of the corneal limbus at the nasal and temporal quadrants. Vessel densities were measured in the superficial (from the conjunctival epithelium to a depth of 200 μm) and deep (from a depth of 200 μm to 1000 μm) layers. The vessel density was compared between healthy and glaucoma eyes, and the associations of the vessel density with possible confounding factors were analyzed using univariable and multivariable analyses.ResultsThe vessel density was not significantly different between healthy eyes and eyes with glaucoma. There was a significant association of superficial vessel density with the use of a prostaglandin analog (P = .007) and with nasal location (P = .016) in eyes with glaucoma. Deep vessel density was significantly smaller with advancing age (P = .029) in healthy eyes and greater with higher intraocular pressure (P = .021) in eyes with treated glaucoma.ConclusionsAS-OCTA images may be useful for objective assessment of conjunctival hyperemia and helpful for understanding the pathophysiology of post-trabecular aqueous humor outflow.
  • Twelve-year incidence and baseline risk factors for pseudoexfoliation: The
           Thessaloniki Eye Study (An American Ophthalmological Society Thesis)
    • Abstract: Publication date: Available online 13 May 2019Source: American Journal of OphthalmologyAuthor(s): Fotis Topouzis, Panayiota Founti, Fei Yu, M Roy Wilson, Anne L. Coleman PurposeTo determine the 12-year incidence of pseudoexfoliation (PEX), baseline risk factors for incident PEX and risk factors for incident pseudoexfoliative glaucoma (PEXG) among those with PEX in an elderly Caucasian population.MethodsLongitudinal, population-based study in Thessaloniki, the major urban center in Northern Greece. The baseline cohort included 2,554 participants ≥60 years old. The surviving cohort was reexamined 12 years later using the same methodology. PEX was defined as typical fibrillar material at the pupil margin and/or on the lens capsule. Glaucoma was defined as both structural and functional damage, irrespective of intraocular pressure (IOP).ResultsOut of 1,468 eligible subjects in the surviving cohort, 1,092 (74%) participated in the follow-up study. The mean age±standard deviation (SD) at baseline was 68.9±4.6 years. The mean follow-up time was 11.6±1.6 years. The 12-year incidence of PEX was 19.6% (95% confidence intervals (CI), 17.1–22.2), with females more likely to be affected than males (Fisher's exact test, p=.0197). Higher axial length was associated with lower odds of incident PEX (odds ratio (OR) = 0.72 per mm; 95% CI, 0.57-0.92). PEX at baseline was not associated with an increased likelihood of major vascular disease (p=.9038). Higher baseline IOP (OR=1.26 per mmHg; 95% CI, 1.07-1.48) and history of heart attack at baseline (OR=13.49; 95% CI, 2.85-63.87) were associated with a greater likelihood of developing PEXG among those with PEX. A history of alcohol consumption at baseline was protective of individuals developing PEXG if they had PEX at baseline.ConclusionThis is one of the very few longitudinal population-based studies that has specifically assessed the incidence of PEX. The association with axial length was previously found only in a cross-sectional study. The associations with heart attack and alcohol consumption are new findings. In individuals with baseline PEX, higher IOP at baseline, history of heart attack at baseline, and no alcohol consumption were associated with a greater likelihood of developing glaucomatous damage approximately 12 years later.
  • OCT-Detected Optic Nerve Head Neural Canal Direction, Obliqueness and
           Minimum Cross-Sectional Area in Healthy Eyes
    • Abstract: Publication date: Available online 13 May 2019Source: American Journal of OphthalmologyAuthor(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. Burgoyne PurposeTo 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 studyMethodsAfter OCT optic nerve head (ONH) and retinal nerve fiber layer thickness (RNFLT) imaging, BMO and ASCO were manually segmented and 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 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
  • Optic disc pit maculopathy: new perspectives on the natural history
    • Abstract: Publication date: Available online 13 May 2019Source: American Journal of OphthalmologyAuthor(s): Edward Bloch, Odysseas Georgiadis, Marko Lukic, Lyndon da Cruz PurposeTo investigate the natural history of optic disc pit maculopathy and explore associations between demographic, anatomical and functional characteristics.Design: Retrospective, comparative case series.MethodsA single-center medical record review of previously untreated optic disc pit maculopathy. Baseline data of visual function, demography and pit physiognomy were collected and further subgroup analysis was undertaken on patients with long-term follow-up, according to whether they were monitored or received surgical intervention. LogMAR visual acuity was the primary outcome measure and anatomical characteristics were reported, where available.Results87 patients were identified with a new presentation of optic disc pit maculopathy. No demographic or pit features were correlated with vision at baseline. In 51 patients with available OCT data, only the presence of subretinal fluid at baseline was associated with poorer visual acuity (p
  • Patterns and Risk Factor Profiles of Visual Loss in a Multi-ethnic Asian
           Population: The Singapore Epidemiology of Eye Diseases Study
    • Abstract: Publication date: Available online 13 May 2019Source: American Journal of OphthalmologyAuthor(s): Tien Y. Wong, Yih-Chung Tham, Charumathi Sabanayagam, Ching-Yu Cheng PurposeTo describe the pattern and risk factor traits associated with visual loss (defined as either visual impairment[VI] or blindness) in a multi-ethnic Asian cohort of Malays, Indians and Chinese living in Singapore.Methods10,020 participants from the Singapore Epidemiology of Eye Diseases (SEED) Study were examined between 2004-2011. All underwent standardized examinations. VI [VA
  • A Model to Predict Postoperative Axial length in Children Undergoing
           Bilateral Cataract Surgery with Primary IOL Implantation
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Rupal H. Trivedi, Eliza Barnwell, Bethany Wolf, M. Edward Wilson PurposeTo develop a model for predicting postoperative globe axial length (AL) in children undergoing bilateral cataract surgery with primary IOL implantation in children above 2 years of age.DesignRetrospective case seriesMethodsChildren were included only if AL data were available for both eyes before surgery and at least one year after surgery. We analyzed variables that could influence globe axial growth and developed a multivariable generalized estimating equation regression model of to predict postoperative AL.Results64 children were included. The median age at surgery and at follow-up was 5.1 years and 12.5 years respectively. Axial length measurements were obtained in both eyes during 242 visits. The median AL before and at last follow-up was 22.2 and 23.1 mm respectively. Beta value for the final model to predict postoperative AL is as below: Intercept (1.93), preoperative AL (0.91), Age at cataract surgery (-0.07), Age at follow-up (0.14) and interaction between age at surgery and age at follow-up (-0.005). Using this model, for a hypothetical patient operated at 2.5 years of age with a 20.5 mm AL would be estimated to have a 22.8mm AL at 18 years of age.ConclusionIOL power selection is a major challenge of pediatric cataract surgery due to unpredictable future eye growth. This model could theoretically be used to predict individual future adult size AL for each child undergoing cataract surgery, helping the surgeon to customize the selection of an IOL power at implantation and also to help the parents to understand what to expect
  • Longitudinal Macular Structure-Function Relationships in Glaucoma and
           Their Sources of Variability
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Kouros Nouri-Mahdavi, Nima Fatehi, Joseph CaprioliABSTRACTPurpose1) Review central structure-function (SF) relationships in glaucoma; 2) compare contributions of within-session and between-session variability to total variability of macular optical coherence tomography (OCT) thickness measurements; and 3) test the hypothesis that longitudinal within-eye variability of central SF relationships is smaller than between-individual variability.MethodsWe reviewed the pertinent literature on central SF relationships in glaucoma. Thirty-eight eyes (20 normal or glaucoma subjects) had ×3 macular images per session over 3 sessions and superpixels thickness measurements for ganglion cell layer (GCL), ganglion cell/inner plexiform layer (GCIPL), ganglion cell complex (GCC) and full macular thickness (FMT) were exported. Linear mixed models were used for estimating contributions of between- and within-session variability to total thickness variability. 120 eyes with ≥3 10° visual fields (VFs)/OCT images were enrolled for the longitudinal study. We investigated within-eye longitudinal SF relationships (GCIPL thickness vs. VF test locations) with a change-point regression model and compared within-eye with between-individual variabilities with components-of-variance models.ResultsIn the cross-sectional study, between-session component contributed 8%, 11%, 11%, and 36% of total variability for GCL, GCIPL, GCC, and FMT. In the longitudinal study, between-individual variability explained 78%, 77%, and 67% of total SF variability at 3.4°, 5.6°, and 6.8° eccentricities (P
  • Caregiver Burden in Primary Congenital Glaucoma
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Aditi Kantipuly, Manju R. Pillai, Sujani Shroff, Rakhee Khatiwala, Ganesh V. Raman, S.R. Krishnadas, Alan Lee Robin, Joshua R. Ehrlich PurposeTo evaluate the demographic, clinical, and socioeconomic factors associated with quality of life (QOL) in caregivers of children with primary congenital glaucoma (PCG) in south India.DesignCross-sectional survey.MethodsCaregivers of children under age 18 with diagnosed PCG were prospectively enrolled at Aravind Eye Hospital in Madurai and Coimbatore, India. Participants completed 2 questionnaires, the PHQ-9 (9-item Patient Health Questionnaire) and the CarCGQoL (Caregivers Congenital Glaucoma Quality of Life Questionnaire). Clinical, demographic, and socioeconomic data were obtained for each child-caregiver dyad. Rasch-calibrated scores were calculated for patient-reported outcome measures. Spearman correlation and linear regression were used to analyze data to determine associations with caregiver QOL.ResultsThere were 70 caregivers (mean age 32.1, 77.1% female) of 70 children with PCG (mean age 7.7, 37.1% female) included in the study. In univariate and multivariable analyses, child’s age (β=-0.04, 95%CI -0.08, -0.01) and duration of disease (β=- 0.03, 95%CI -0.07, -0.01) were the only factors associated with CarCGQoL. Survey items related to anger, self-confidence, irritability, appetite and interest in leisure activities had the lowest scores. There was a negative correlation between CarCGQoL and PHQ-9 scores (r=-0.66, p
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Amani A. Fawzi, Alaa E. Fayed, Robert A. Linsenmeier, Jing Gao, Fei YuABSTRACTPurposeTo evaluate the macular microvascular changes in eyes with proliferative diabetic retinopathy (PDR) following panretinal photocoagulation (PRP)MethodsUsing OCT angiography, we prospectively studied 10 eyes of 10 subjects with high risk PDR immediately before, 1 month and 3-6 months following PRP, using 3x3mm OCTA scan at each visit. The following parameters were calculated for the superficial (SCP), middle (MCP), and deep capillary plexuses (DCP): parafoveal vessel density, adjusted flow index (AFI) and percent area of non-perfusion (PAN). Parafoveal SCP vessel length density (VLD) was also evaluated. We performed univariate and multivariable statistics, adjusting for age and signal strength. To model the hemodynamic effect of PRP, we also present a mathematical model based on electrical circuits.ResultsWe found no significant difference for the vascular density parameters following PRP, except for decreased density at the MCP at the latest timepoint in the adjusted multivariable model. PAN, a metric of non-perfusion adjusted for noise, as well as AFI, a surrogate metric of blood flow showed significant increase at all capillary levels in the adjusted model. Our mathematical model explained how PRP would increase macular blood flow.ConclusionUsing OCTA, we found an overall increase in the flow metrics of all capillary layers in the macula following PRP, unrelated to macular edema or thickening, in line with the mathematical model. Our results suggest an overall redistribution of blood flow to the posterior pole following PRP, adding a new dimension to our understanding of the complex biologic effects of PRP in PDR.
  • The Role of Fgf9 In The Production of Neural Retina And Rpe In A
           Pluripotent Stem Cell Model of Early Human Retinal Development
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): David M. Gamm, Eric Clark, Elizabeth E. Capowski, Ruchira SinghABSTRACTPurposeTo investigate the role of fibroblast growth factors (FGFs) in the production of neural retina (NR) and retinal pigmented epithelium (RPE) in a human pluripotent stem cell model of early retinal development.MethodsHuman induced pluripotent stem cell (hiPSC) lines from an individual with microphthalmia caused by a functional null mutation (R200Q) in Visual systems homeobox 2 (VSX2), a transcription factor involved in early NR progenitor cell (NRPC) production, and a normal sibling were differentiated along the retinal and forebrain lineages using an established protocol. Quantitative and global gene expression analyses (microarray and RNAseq) were used to investigate endogenous FGF expression profiles in these cultures over time. Based on these results, mutant and control hiPSC cultures were treated exogenously with selected FGFs and subjected to gene and protein expression analyses to determine their effects on RPE and NR production.ResultsWe found that FGF9 and 19 were selectively increased in early hiPSC-derived optic vesicles (OVs) when compared to isogenic cultures of hiPSC-derived forebrain neurospheres. Furthermore, these same FGFs were downregulated over time in (R200Q)VSX2 hiPSC-OVs relative to sibling control hiPSC-OVs. Interestingly, long-term supplementation with FGF9, but not FGF19, partially rescued the mutant retinal phenotype of the (R200Q)VSX2 hiPSC-OV model. However, antagonizing FGF9 in wildtype control hiPSCs did not alter OV development.ConclusionsOur results show that FGF9 acts in concert with VSX2 to promote NR differentiation in hiPSC-OVs and has potential to be used to manipulate early retinogenesis and mitigate ocular defects caused by functional loss of VSX2 activity.
  • Posterior Chamber Phakic Intraocular Lens Implantation for the Correction
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Tomoaki Nakamura, Naoki Isogai, Takashi Kojima, Yoko Yoshida, Yasuo Sugiyama PurposeTo assess the 10-year clinical outcomes of implantable collamer lens (ICL) implantation for myopia and astigmatism.DesignRetrospective observational case series.MethodsThis study included 114 eyes of 61 patients who underwent ICL implantation for correction of myopia and myopic astigmatism. We assessed the safety, efficacy, predictability, stability, and adverse events preoperatively, at 6 months (106 eyes), and 1 (94 eyes), 3 (58 eyes), 5 (65 eyes), 8 (89 eyes), and 10 (70 eyes) years postoperatively. Only the eyes with clinical data available at each follow-up time were analyzed.ResultsThe mean logMAR uncorrected and corrected distance visual acuities were -0.01 ± 0.24 and -0.18 ± 0.07 at 10 years post-surgery. The mean indices for safety and efficacy were 0.88 ± 0.15 and 0.66 ± 0.26, respectively. At 10 years post-surgery, 71.4% and 87.1% of the eyes were within 0.5 and 1.0 D, respectively, of the attempted spherical equivalent correction. The mean intraocular pressure was 13.1 ± 2.4 mmHg preoperatively and 13.1 ± 2.9 mmHg at 10 years postoperatively. The mean endothelial cell loss was 5.3% at 10 years post-surgery. Twelve of 114 eyes (10.5%) developed anterior subcapsular cataract at 5-10 years the follow-up; among these, four eyes (3.5%) were symptomatic and ICL explantation and phacoemulsification surgery were performed. No vision-threatening complications occurred during the observation period.ConclusionICL implantation offered good overall outcomes in all measures of safety, efficacy, predictability, and stability for the correction of myopia and myopic astigmatism throughout a long-term follow-up period of 10 years.
  • Measurable Aspects Of The Retinal Neurovascular Unit In Diabetes, Glaucoma
           And Controls
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Richard F. SpaideABSTRACTPurposeTo study structural and angiographic optical coherence tomography (OCT) data of the macula from controls, diabetics, and those with glaucoma to evaluate neurovascular and structural relationships.MethodsThis is a retrospective study of 89 eyes from 49 patients in a community-based retinal referral practice with diabetes, glaucoma, and normal controls. The patients were evaluated with OCT to include retinal nerve fiber layer (RNFL) thickness measurement and ganglion cell layer (GCL) volume determination. The vascular density of the radial peripapillary capillary network and the vascular plexuses in the macula were evaluated with OCT angiography. The main outcome measures were the data obtained per disease state and the interrelationships the data displayed.ResultsThe mean GCL volumes were significantly lower than the Control Group in both the Diabetic (P=.016) and Glaucoma groups (P
  • Distribution of Non-perfusion and Neovascularization on Ultra-Wide Field
           Fluorescein Angiography in Proliferative Diabetic Retinopathy (RECOVERY
           Study): Report 1
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Wenying Fan, Muneeswar Gupta Nittala, Swetha B. Velaga, Takao Hirano, Charles C. Wykoff, Michael Ip, Shaun I.R. Lampen, Jano van Hemert, Alan Fleming, Michael Verhoek, SriniVas R. SaddaPurposeTo explore the distribution of non-perfusion area (NPA) on ultra-wide field fluorescein angiography (UWF FA) in proliferative diabetic retinopathy (PDR) and its relationship with the presence of neovascularization of the optic disc (NVD) and distribution of neovascularization elsewhere (NVE).DesignProspective, observational case series.MethodsBaseline Optos 200Tx UWF FA images of 38 eyes with treatment-naïve early-stage PDR from the RECOVERY (NCT02863354) study were stereographically projected at the Doheny Image Reading Center. Two independent/masked certified graders manually delineated the NPA and the total visible retinal area (TRA). NPA and TRA were then computed in mm2 using the manufacturer software. Ischemic index (ISI) was calculated by dividing NPA by TRA. NPA and ISI were correlated with the presence and distribution of neovascularization in the corresponding zones.ResultsEyes with NVD appeared to have more severe global NPA than those without (P = 0.026). Although the ISI appeared to increase with increasing distance from the foveal center (P < 0.001), NVE was more likely to be located in the posterior pole than the mid-periphery or far-periphery (P < 0.001). Presence of NVE in the posterior polar retina appeared to demonstrate more severe ischemia in the posterior pole and mid-periphery than those without (P < 0.05), but interestingly, was not correlated with the severity of overall global ischemia or of ischemia in the far-periphery alone (P> 0.05).ConclusionsWhereas the presence of NVD was associated with the severity of global ischemia, the distribution of NVE did not appear to be influenced by the distribution of ischemia.
  • Accuracy and precision of intraocular lens calculations using the new
           Hill-RBF version 2.0 in eyes with high axial myopia
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Kelvin H. Wan, Thomas CH. Lam, Marco CY. Yu, Tommy CY. Chan PurposeTo compare the accuracy and precision of the new Hill-RBF version 2.0 (Hill-RBF 2) formula with other formulas (Barrett Universal II, Haigis, Hoffer Q, Holladay 1, and SRK/T) in predicting residual refractive error after phacoemulsification in high axial myopic eyes.DesignRetrospective case series.Methods127 eyes of 127 patients with axial length (AL) ≥ 26mm were included. The refractive prediction error (PE) was calculated as the difference between the postoperative refraction and the refraction predicted by each formula for the intraocular lens (IOL) power actually implanted. Standard deviation (SD) of PE, median absolute PE (MedAE), proportion of eyes within ±0.25 D, ±0.50 D, ±1.00 D of PE were compared. A generalized linear model was used to model the mean function and variance function of the PE (indicative of the accuracy and precision) with respect to biometric variables.ResultsThe MedAE and SD of Hill-RBF 2 were lower than that of Hoffer Q, Holladay 1, and SRK/T (p≤0.036), and were comparable to Barrett Universal II and Haigis (p≥0.077). Hill-RBF 2 had more eyes within ±0.25 D of the intended refraction (59.84%) compared to other formulas (p≤0.034) except Barrett Universal II (p=0.472). AL was associated with the mean function or variance function of the PE for all formulas except Hill-RBF 2.ConclusionsIn this study, the precision of Hill-RBF 2 is comparable to Barret Universal II and Haigis. Unlike the other 5 formulas, its dispersion and the accuracy of the refractive prediction is independent of the AL.
  • Visual impairment and spectacle use in university students in central
           China: The Anyang University Students Eye Study
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Shifei Wei, Yunyun Sun, Shi-Ming Li, Jianping Hu, Kai Cao, Jialing Du, Wenzai An, Xintong Liang, Jiyuan Guo, He Li, Ningli Wang :PurposeTo investigate the prevalence and associations of visual impairment and the spectacle use in university students in central China.DesignCross-sectional studyMethodsThis study included students aged 16-26 years in China. Subjects from two universities underwent distance visual acuity (VA) assessment in both eyes using a logarithm of the minimum angle of resolution chart and refraction measurement by cycloplegic autorefraction. Blindness was defined as presenting VA
  • Development of a spatial model of age-related change in the macular
           ganglion cell layer to predict function from structural changes
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(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 Zangerl PurposeTo 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) sensitivity and compared these results to actual VF sensitivities.DesignRetrospective cohort studyMethodsSingle 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 utilized to characterize age-related GCL decline. 40 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 =
  • Anterior segment optical coherence tomographic angiography assessment of
           acute chemical injury
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Simon S.M. Fung, Rosalind M.K. Stewart, Sandeep K. Dhallu, Dawn A. Sim, Pearse A. Keane, Mark R. Wilkins, Stephen J. Tuft PurposeTo compare routine clinical examination with optical coherence tomography angiography (OCTA) for the assessment of limbal conjunctival ischemia following a chemical burn.SettingValidity analysisMethodsWe assessed ten participants (15 eyes) with an acute chemical injury. Clinical photographs were used to determine the extent of any limbal conjunctival epithelial defect and ischemia. These were compared with the extent of limbal ischemia identified on OCTA images of the ocular surface. Quantitative and longitudinal analysis using the OCTA software were also performed. Correlations with visual outcome were sought using clinical and OCTA-derived variables.ResultsThe extent of clinically determined limbal ischemia was less than that identified with OCTA (2.3±3.6 clock hours v 5.1±4.2 clock hours, p = 0.003), which in turn was less than the size of limbal conjunctival epithelial defect (7.3±5.1 clock hours, p = 0.03). Longitudinal OCTA analysis showed that mean vessel area increased by 0.2 ±0.1% during the study, corresponding to a rate of vascular recovery of 0.9mm2/day. Significant correlations were found between visual outcome at 3 months and limbal conjunctival fluorescein staining (r = 0.67, p = 0.006), and limbal conjunctival ischemia on OCTA (r = 0.76, p = 0.001).ConclusionsOCTA can objectively identify and monitor the recovery of limbal ischemia following an acute ocular chemical injury. OCTA confirms that limbal ischemia is usually more extensive than is suggested by clinical examination, and the former is highly correlated with visual outcome. OCTA therefore is a useful tool in the management of ocular chemical injury.
  • Quantitative Assessment of Choriocapillaris Flow Deficits in Eyes with
           Advanced Age-Related Macular Degeneration Versus Healthy Eyes
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Ahmed Roshdy Alagorie, Aditya Verma, Marco Nassisi, Srinivas R. Sadda PurposeTo compare choriocapillaris (CC) flow deficits in eyes with geographic atrophy (GA) or choroidal neovascularization (CNV) associated with age-related macular degeneration (AMD) and age-matched healthy control subjects.DesignCross-sectional study.MethodsPatients with GA due to AMD, CNV due to AMD, and age-matched healthy subjects presenting to the Doheny-UCLA Eye Centers were enrolled in this cross-sectional IRB-approved study. Swept-source optical coherence tomography angiography (SS-OCTA) was performed using a Zeiss PLEX Elite instrument with a 6 × 6 mm scan pattern centered on the fovea. Two repeated volume scans were acquired to allow for image averaging. The instrument pre-defined en face slab of the CC was used to isolate and display the CC. Both the structural and OCTA slabs from this location were exported for averaging and signal compensation using Image J. The resultant image was then binarized. The CC flow deficit percentage (FD %) was computed in four peripheral 1 mm × 1 mm squares located at the corners of the images to allow comparison between equidistant regions unaffected by atrophy or CNV.ResultsTwenty eyes of twenty subjects were enrolled in each of the three groups (CNV, GA, normal) for this study. The average CC FD % of the 4 peripheral squares was 17.24% ± 2.86% in GA eyes, 15.55% ± 1.03% in CNV eyes, and 15.31% ± 0.93% in healthy controls of a similar age. The FD% in GA eyes was significantly greater than in both normal eyes and eyes with CNV (p= 0.012 and 0.038 respectively). The difference in FD% was not significantly different between CNV eyes and normal eyes for the tested peripheral macular regions (p= 0.678).ConclusionsThe choriocapillaris in peripheral macular regions in eyes with GA shows greater impairment than in eyes with CNV.
  • The ocular phenotype in primary hyperoxaluria type 1
    • Abstract: Publication date: Available online 10 May 2019Source: American Journal of OphthalmologyAuthor(s): Johannes Birtel, Philipp Herrmann, Sander F. Garrelfs, Simon Dulz, Yevgeniya Atiskova, Roselie M. Diederen, Martin Gliem, Florian Brinkert, Frank G. Holz, Camiel J.F. Boon, Bernd Hoppe, Peter Charbel Issa PurposeTo investigate ophthalmic features in a large group of patients with primary hyperoxaluria type 1 (PH1), and to determine the relation between ocular involvement and systemic disease severity.DesignRetrospective, cross-sectional multicenter study of the OxalEurope Registry Network.MethodsSixty-eight patients with PH1 were included Infantile PH1 was diagnosed in 12 patients, and non-infantile PH1 in 56 patients (17 with end-stage renal disease) Ophthalmic examination included best corrected visual acuity (BCVA) testing and multimodal retinal imaging including fundus photography and optical coherence tomography (OCT) In selected cases fundus autofluorescence (AF) imaging was performed.ResultsAll eyes (n=24) of infantile PH1 patients revealed severe retinal alterations and oxalate deposits, including macular crystals and hyperpigmentations (n=9, 38%), subretinal fibrosis (n=15, 63%) with (n=7, 47%) or without (n=8; 53%) associated chronic retinal edema In 9 eyes (38%, all with subretinal fibrosis), BCVA was significantly reduced (
  • Effects of hydrogen in prevention of corneal endothelial damage during
           phacoemulsification: a prospective randomized clinical trial
    • Abstract: Publication date: Available online 9 May 2019Source: American Journal of OphthalmologyAuthor(s): Tsutomu Igarashi, Ikuroh Ohsawa, Maika Kobayashi, Yusuke Umemoto, Takeshi Arima, Hisaharu Suzuki, Toru Igarashi, Toshiaki Otsuka, Hiroshi Takahashi PurposeHydrogen (H2) has been reported to scavenge free radicals, particularly the hydroxyl radical (·OH). Ultrasound oscillation in an aqueous solution produces ·OH. Our recent study demonstrated that H2 dissolved in an irrigation solution prevented corneal endothelial damage during phacoemulsification in an animal model. We examined the effects of H2 during clinical phacoemulsification.DesignA single-center, prospective, randomized, double-masked clinical trial.Methods: Patient populationThirty-two patients who had cataracts of similar nucleus hardness in both eyes (age: 75.4±7.68 years; 17 males, 15 females). Intervention procedures: Phacoemulsification was performed using a solution of dissolved H2 in one eye, and a conventional solution in the contralateral eye.Main outcome measuresEndothelial cell density (ECD) at the center of the cornea was measured using noncontact specular microscopy preoperatively and at 1 day, 1 week and 3 weeks postoperatively.ResultsReduction rates of ECD (mean ± standard deviation) were 16.0±15.7% at 1 day, 15.4±16.1% at 1 week, and 18.4±14.9% at 3 weeks in the control group, compared to 6.5±8.7% at 1 day (p=0.003), 9.3±11.0% at 1 week (p=0.039), and 8.5±10.5% at 3 weeks (p=0.004) in the H2 groups. These rates were significantly smaller in the H2 group at all time points.ConclusionsH2 dissolved in irrigation solution reduced corneal endothelial damage during phacoemulsification. This suggests that a considerable part of the corneal endothelial damage during phacoemulsification is caused by oxidative stress, and that H2 is useful in clinical phacoemulsification.
  • Performance Of The 2win Photoscreener With “Cr” Strabismus Estimation
           In High Risk Patients
    • Abstract: Publication date: Available online 9 May 2019Source: American Journal of OphthalmologyAuthor(s): Stephanie L. Arnold, Andrew W. Arnold, Jacob H. Sprano, Robert W. Arnold BackgroundAccurate estimation of refractive error and ocular alignment is critical for identifying amblyopia risk factors. The 2WIN photoscreener (Adaptica, Italy) uses a novel infrared-transmitting occluder wand to quickly estimate intermittent deviations.Design; Reliability analysis.Methods2WIN refraction was compared to dry and cycloplegic retinoscopy and Retinomax. 2WIN “CR” function with wand was compared to cover test.Results371 patients, 0.6-63 years, median age 6 years had refraction and 2WIN yielding high degrees of correlation (Pearson Product Moment) on linear regression for spherical equivalent (0.73-0.79), Cylinder power (0.78-0.79), J0 vector (0.79-0.83) and J45 vector (0.64-0.67) . Similar proportions of 2WIN and Retinomax were inside target refraction values for spherical equivalent (70% vs 69%), cylinder power (94% vs 90%) and cylinder axis (69% vs 71%). 2WIN CR above 10 PD correlated with cover test for constant and intermittent deviations (Pearson 0.64-0.71). 2WIN + CR screened for 2003 AAPOS amblyopia risk factors with 68% sensitivity and 84% specificity in preschool children with 56% prescreening probability and 31% developmental delays.ConclusionThe 2WIN correlated well with exam and Retinomax. The CR function reliably estimated constant and intermittent strabismus over 10 PD.
  • Clinical and molecular characterization of familial exudative
           vitreoretinopathy associated with microcephaly
    • Abstract: Publication date: Available online 8 May 2019Source: American Journal of OphthalmologyAuthor(s): Sarah Hull, Gavin Arno, Pia Ostergaard, Nikolas Pontikos, Anthony G. Robson, Andrew R. Webster, Chris R. Hogg, Genevieve A. Wright, Robert H.H. Henderson, Carol-Anne Martin, Andrew P. Jackson, Sahar Mansour, Anthony T. Moore, Michel Michaelides PurposeFamilial exudative vitreoretinopathy (FEVR) is a rare finding in patients with genetic forms of microcephaly. This study documents the detailed phenotype and expands the range of genetic heterogeneity.Design; Retrospective case-seriesMethodsTwelve patients (ten families) with a diagnosis of FEVR and microcephaly were ascertained from pediatric genetic eye clinics and underwent full clinical assessment including retinal imaging. Molecular investigations included candidate gene Sanger sequencing, whole-exome sequencing (WES) and whole-genome sequencing (WGS).ResultsAll patients had reduced vision and nystagmus. Six were legally blind. Two probands carried bi-allelic LRP5 variants, both presenting with bilateral retinal folds. A novel homozygous splice variant, and two missense variants were identified. Subsequent bone density measurement, identified osteoporosis in one proband.Four families had heterozygous KIF11 variants. Two probands had a retinal fold in one eye and chorioretinal atrophy in the other; the other two had bilateral retinal folds. Four heterozygous variants were found, including two large deletions not identified on Sanger sequencing or WES.Finally, a family of two children with learning difficulties, abnormal peripheral retinal vasculogenesis and rod-cone dystrophy were investigated. They were found to have bi-allelic splicing variants in TUBGCP6.Three families remain unsolved following WES and WGS.ConclusionsMolecular diagnosis has been achieved in seven of ten families investigated including a previously unrecognized association with LRP5. WGS enabled molecular diagnosis in three families after prior negative Sanger sequencing of the causative gene. This has enabled patient-specific care with targeted investigations and accurate family counseling.
  • In Pseudotumor Cerebri, Hormonal Contraception is Not Associated, and the
           Diagnosis Remains Idiopathic Intracranial Hypertension
    • Abstract: Publication date: Available online 20 April 2019Source: American Journal of OphthalmologyAuthor(s): Brendon W.H. Lee, Ian C. Francis
  • Utility of screening investigations for systemic sarcoidosis in
           undifferentiated uveitis
    • Abstract: Publication date: Available online 19 April 2019Source: American Journal of OphthalmologyAuthor(s): Rachael L. Niederer, Joanne L. Sims
  • Refractive Laser-Assisted Cataract Surgery vs. Conventional Manual
           Surgery: Comparing Efficacy and Safety in 3144 Eyes
    • Abstract: Publication date: Available online 19 April 2019Source: American Journal of OphthalmologyAuthor(s): Harrish Nithianandan, Vibeeshan Jegatheeswaran, Vishruti Dalal, Steve A. Arshinoff, Raj Maini, Fariba Nazemi, Tran Le, Eric S. Tam, Sohel Somani PurposeTo report on outcomes of efficacy and safety in one of the largest series of eyes undergoing either conventional manual cataract surgery (MCS) or refractive femtosecond laser-assisted cataract surgery (ReLACS).DesignRetrospective, consecutive, interventional comparative case series.MethodsThis study included 3144 consecutive eyes of which 1580 were treated via MCS and 1564 were treated via ReLACS at Uptown Surgical Centre in Vaughan, Canada. Preoperative characteristics, best corrected visual acuity (BCVA), mean absolute spherical error (MAE), rates of intraoperative posterior capsular rupture (PCR), and postoperative complications were evaluated.ResultsAcross all eyes, ReLACS was superior to MCS for reducing surgical time (MCS: 7.7±0.1 min vs. ReLACS: 6.8±0.1 min, p
  • Changes in Retinal Microcirculation Precede the Clinical Onset of Diabetic
           Retinopathy in Children with Type 1 Diabetes Mellitus
    • Abstract: Publication date: Available online 19 April 2019Source: American Journal of OphthalmologyAuthor(s): Merve Inanc, Kemal Tekin, Hasan Kiziltoprak, Servan Ozalkak, Sibel Doguizi, Zehra Aycan PurposeTo investigate whether abnormal glucose metabolism in diabetes mellitus (DM) affects the retinal microcirculation of children with well-controlled type 1 DM and to compare these results with those obtained from healthy children.DesignCross-sectional prospective study.MethodsThis study enrolled 60 patients with DM without clinically detectable diabetic retinopathy (DR) and who met 57 age-matched controls. Optical coherence tomography angiography (OCT-A) was performed using AngioVue (Avanti, Optivue). Foveal avascular zone (FAZ) area, non-flow area, superficial and deep vessel densities, FAZ perimeter, acircularity index of FAZ (AI; the ratio of the perimeter of FAZ and the perimeter of a circle with equal area), and foveal density (FD-300; vessel density in 300 microns around FAZ) were analyzed. Correlations between the investigated OCT-A parameters with DM duration and glycated hemoglobin (HbA1c) levels were evaluated among patients with type 1 DM.ResultsDifferences in the mean values for FAZ perimeter, AI, and FD-300 were statistically significant between DM group and control group (P
  • Fluctuations of the intraocular pressure in medically versus surgically
           treated glaucoma patients by a contact lens sensor
    • Abstract: Publication date: Available online 14 February 2019Source: American Journal of OphthalmologyAuthor(s): María Jesús Muniesa Royo, Juan Ezpeleta Campaña, Iván Benítez Iglesias PurposeTo compare fluctuations in intraocular pressure (IOP) in medically versus surgically treated glaucoma patients.DesignProspective, non-randomized case series.MethodsIOP-related fluctuations were measured for 24 hours using a contact lens sensor (CLS).SubjectsWe perform monitoring with CLS in 91 eyes of 77 patients; 59 eyes were receiving ocular hypotensive medication and had no previous history of glaucoma surgery (medical group), while 32 eyes with open angle glaucoma (OAG) had previously undergone glaucoma surgery (surgical group).Main Outcomes MeasuresThe amplitude, expressed as an indicator of the IOP-related fluctuation; and the presence of a nocturnal acrophase. We also identified maximum and minimum IOP-related values for each patient.ResultsThe mean (SD) amplitude of IOP-related CLS signal in the group of surgically treated eyes was 100(41) mV eq, while in the medically treated group, it was 131(69) mV eq (difference: p=0.010). We found that 42.9% of the surgically treated glaucoma group exhibited an absence of nocturnal acrophase, while only 13.8% of the medically (difference: p=0.011). The maximum and minimum IOP-related values for the medical group were statistically higher than the surgical group (P = 0.001 and P = 0.006, respectively).ConclusionsIOP-related fluctuations were larger in eyes with medically treated glaucoma than in surgically treated glaucoma. A significantly larger fraction of surgical group exhibited an absence of nocturnal acrophase compared to the medically treated group.
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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