3501
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Tan J, Jia T, Liao R, Stapleton F. Effect of a formulated eye drop with Leptospermum spp honey on tear film properties. Br J Ophthalmol 2020; 104:1373-1377. [DOI: 10.1136/bjophthalmol-2019-315160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/10/2019] [Accepted: 12/27/2019] [Indexed: 11/03/2022]
Abstract
AimTo evaluate the effects of a proprietary formulated eye drop with Leptospermum spp honey versus a conventional lubricant eye drop on tear film properties in subjects with symptoms related to dry eye disease after 28 days of treatment.MethodsForty-six subjects with symptoms related to dry eye (Ocular Surface Disease Index (OSDI) score >12) were enrolled and randomly assigned to receive either the test formulated eye drop (Optimel by Melcare Biomedical Pty Ltd) or control eye drops (Alcon, USA) in this double-masked study. Inferior lipid layer thickness (LLT), tear film evaporation rate (TER), fluorescein tear film break-up time (TBUT), corneal staining and subjective symptoms (OSDI and visual analogue scales (VAS)) were measured before and after 28 days of instilling the eye drops.ResultsForty-two subjects completed the study (21 subjects in each group). After 28 days of treatment, TER showed a significantly greater reduction with the formulated eye drop compared with the control (p=0.01). TBUT showed a slight but not statistically significant increase with the formulated eye drop compared with the control (p=0.06), and a significantly greater reduction (improvement) in OSDI scores was observed with the formulated eye drop compared with the control (p=0.01). No significant differences were found between the two groups for inferior LLT, corneal staining and any of the VAS scores.ConclusionsThe formulated eye drops were effective in reducing tear film evaporation rate and were more effective for improving symptoms of dry eye compared with the control eye drops after 28 days of treatment.Trial registration numberNCT03622619.
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3502
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Markey K, Mitchell J, Botfield H, Ottridge RS, Matthews T, Krishnan A, Woolley R, Westgate C, Yiangou A, Alimajstorovic Z, Shah P, Rick C, Ives N, Taylor AE, Gilligan LC, Jenkinson C, Arlt W, Scotton W, Fairclough RJ, Singhal R, Stewart PM, Tomlinson JW, Lavery GG, Mollan SP, Sinclair AJ. 11β-Hydroxysteroid dehydrogenase type 1 inhibition in idiopathic intracranial hypertension: a double-blind randomized controlled trial. Brain Commun 2020; 2:fcz050. [PMID: 32954315 PMCID: PMC7425517 DOI: 10.1093/braincomms/fcz050] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/05/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
Treatment options for idiopathic intracranial hypertension are limited. The enzyme 11β-hydroxysteroid dehydrogenase type 1 has been implicated in regulating cerebrospinal fluid secretion, and its activity is associated with alterations in intracranial pressure in idiopathic intracranial hypertension. We assessed therapeutic efficacy, safety and tolerability and investigated indicators of in vivo efficacy of the 11β-hydroxysteroid dehydrogenase type 1 inhibitor AZD4017 compared with placebo in idiopathic intracranial hypertension. A multicenter, UK, 16-week phase II randomized, double-blind, placebo-controlled trial of 12-week treatment with AZD4017 or placebo was conducted. Women aged 18–55 years with active idiopathic intracranial hypertension (>25 cmH2O lumbar puncture opening pressure and active papilledema) were included. Participants received 400 mg of oral AZD4017 twice daily compared with matching placebo over 12 weeks. The outcome measures were initial efficacy, safety and tolerability. The primary clinical outcome was lumbar puncture opening pressure at 12 weeks analysed by intention-to-treat. Secondary clinical outcomes were symptoms, visual function, papilledema, headache and anthropometric measures. In vivo efficacy was evaluated in the central nervous system and systemically. A total of 31 subjects [mean age 31.2 (SD = 6.9) years and body mass index 39.2 (SD = 12.6) kg/m2] were randomized to AZD4017 (n = 17) or placebo (n = 14). At 12 weeks, lumbar puncture pressure was lower in the AZD4017 group (29.7 cmH2O) compared with placebo (31.3 cmH2O), but the difference between groups was not statistically significant (mean difference: −2.8, 95% confidence interval: −7.1 to 1.5; P = 0.2). An exploratory analysis assessing mean change in lumbar puncture pressure within each group found a significant decrease in the AZD4017 group [mean change: −4.3 cmH2O (SD = 5.7); P = 0.009] but not in the placebo group [mean change: −0.3 cmH2O (SD = 5.9); P = 0.8]. AZD4017 was safe, with no withdrawals related to adverse effects. Nine transient drug-related adverse events were reported. One serious adverse event occurred in the placebo group (deterioration requiring shunt surgery). In vivo biomarkers of 11β-hydroxysteroid dehydrogenase type 1 activity (urinary glucocorticoid metabolites, hepatic prednisolone generation, serum and cerebrospinal fluid cortisol:cortisone ratios) demonstrated significant enzyme inhibition with the reduction in serum cortisol:cortisone ratio correlating significantly with reduction in lumbar puncture pressure (P = 0.005, R = 0.70). This is the first phase II randomized controlled trial in idiopathic intracranial hypertension evaluating a novel therapeutic target. AZD4017 was safe and well tolerated and inhibited 11β-hydroxysteroid dehydrogenase type 1 activity in vivo. Reduction in serum cortisol:cortisone correlated with decreased intracranial pressure. Possible clinical benefits were noted in this small cohort. A longer, larger study would now be of interest.
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Affiliation(s)
- Keira Markey
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - James Mitchell
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| | - Hannah Botfield
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Ryan S Ottridge
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Tim Matthews
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| | - Anita Krishnan
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK
| | - Rebecca Woolley
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Connar Westgate
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Andreas Yiangou
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| | - Zerin Alimajstorovic
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Pushkar Shah
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow G51 4TF, UK
| | - Caroline Rick
- Nottingham Clinical Trials Unit, Queens Medical Centre, Nottingham NG7 2UH, UK
| | - Natalie Ives
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Angela E Taylor
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Lorna C Gilligan
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Carl Jenkinson
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - William Scotton
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| | - Rebecca J Fairclough
- Emerging Innovations Unit, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge CB2 0SL, UK
| | - Rishi Singhal
- Upper GI Unit and Minimally Invasive Unit, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B9 5SS, UK
| | | | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology & Metabolism (OCDEM), NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Headington, Oxford OX3 7LJ, UK
| | - Gareth G Lavery
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK
| | - Susan P Mollan
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| | - Alexandra J Sinclair
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK.,Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham B15 2TH, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
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3503
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Clinical Trials of Limbal Stem Cell Deficiency Treated with Oral Mucosal Epithelial Cells. Int J Mol Sci 2020; 21:ijms21020411. [PMID: 31936462 PMCID: PMC7014181 DOI: 10.3390/ijms21020411] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 12/11/2022] Open
Abstract
The corneal surface is an essential organ necessary for vision, and its clarity must be maintained. The corneal epithelium is renewed by limbal stem cells, located in the limbus and in palisades of Vogt. Palisades of Vogt maintain the clearness of the corneal epithelium by blocking the growth of conjunctival epithelium and the invasion of blood vessels over the cornea. The limbal region can be damaged by chemical burns, physical damage (e.g., by contact lenses), congenital disease, chronic inflammation, or limbal surgeries. The degree of limbus damage is associated with the degree of limbal stem cells deficiency (partial or total). For a long time, the only treatment to restore vision was grafting part of the healthy cornea from the other eye of the patient or by transplanting a cornea from cadavers. The regenerative medicine and stem cell therapies have been applied to restore normal vision using different methodologies. The source of stem cells varies from embryonic stem cells, mesenchymal stem cells, to induced pluripotent stem cells. This review focuses on the use of oral mucosa epithelial stem cells and their use in engineering cell sheets to treat limbal stem cell deficient patients.
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3504
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Meadway A, McKeown A, Samuels B, Sincich L. Life Cycle and Lensing of a Macular Microcyst. Ophthalmic Res 2020; 63:383-391. [DOI: 10.1159/000505785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
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3505
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Pye DC. A clinical method for estimating the modulus of elasticity of the human cornea in vivo. PLoS One 2020; 15:e0224824. [PMID: 31914133 PMCID: PMC6948750 DOI: 10.1371/journal.pone.0224824] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 10/22/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To develop a method, using current clinical instrumentation, to estimate the Young's modulus of the human cornea in vivo. METHODS Central corneal curvature (CCC), central corneal thickness(CCT), intraocular pressure (IOP) was measured with the Goldmann tonometer (IOPG) and the Pascal Dynamic Corneal Tonometer(PDCT) in one eye of 100 normal young human subjects (21.07 ± 2.94 years) in vivo. The Orssengo and Pye algorithm was used to calculate the Young's modulus of the corneas of these subjects. RESULTS The Young's modulus(E) of the corneas of the subjects using the PDCT and IOPG results (Ecalc) was 0.25 ± 0.10MPa, and without the PDCT results (Eiopg) was 0.29 ± 0.06MPa. The difference in these results is due to the difference in tonometry results between the two instruments, as the mean PDCT result for the subjects was 16.89 ± 2.49mmHg and the IOPG result 15.06 ± 2.71mmHg. E was affected by the CCC of the subjects but more particularly by the CCT and IOP measurements. Corneal stiffness results are also presented. CONCLUSION Two methods have been developed to estimate the Young's modulus of the human cornea in vivo using current clinical instrumentation. One method (Ecalc) is applicable to the general corneal condition, and Eiopg to the normal cornea, and these results can be used to calculate corneal stiffness.
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Affiliation(s)
- David C. Pye
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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3506
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Self-rated eyesight and handgrip strength in older adults. Wien Klin Wochenschr 2020; 132:132-138. [PMID: 31912286 DOI: 10.1007/s00508-019-01597-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to investigate the association between self-rated eyesight and handgrip strength in a large, representative population of older adults. METHODS Data were from 7433 older adults (≥52 years) participating in the English Longitudinal Study of Ageing. Linear regression was used to analyze the association between self-rated eyesight and handgrip strength cross-sectionally in 2004/2005, and longitudinally over 4‑year follow-up, adjusting for a range of sociodemographic and health-related variables. RESULTS In cross-sectional and prospective models, poor eyesight was strongly associated with lower handgrip strength after adjustment for age, sex, ethnicity, socioeconomic status and body mass index (BMI, cross-sectional B = -1.39 kg, 95% confidence interval, CI -1.84 to -0.94, p < 0.001, prospective B = -0.68 kg, 95% CI -1.14 to -0.22, p = 0.004). The association was attenuated but remained statistically significant when health behaviours were included in the model (cross-sectional B = -0.93 kg, 95% CI -1.42 to -0.44, p < 0.001, prospective B = -0.50, 95% CI -0.99 to -0.02, p = 0.044). CONCLUSION Older adults in England with poor self-rated eyesight have lower levels of physical function compared with those with good eyesight. This association can be predominantly explained by differences in age, sex, ethnicity, socioeconomic status, BMI, and health behaviours, as well as chronic conditions, disability and depression.
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3507
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Hazel YP, Malla C, Afford A, Hillgrove T, Gurung R, Dahal A, Shah S, Shrestha MK, Manandhar A. Continuous Knowledge Translation in Action: Designing a Programmatic Research Trial for Equitable Eye Health for Rural Nepalese Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010345. [PMID: 31947881 PMCID: PMC6981358 DOI: 10.3390/ijerph17010345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022]
Abstract
Reaching vulnerable populations through programmatic eye health interventions requires a focus on not only the intervention strategies, but the adaptability of the program design process itself. Knowing who is left behind and why solutions that will be effective on the ground at the time of implementation are not necessarily generated. There is a need for eye health programmatic design processes that can trial interventions and allow for continuous knowledge translation along the way. In rural Nepal, women are impacted by multiple and interconnected determinants of health, as well as unique barriers to accessing information and services, requiring targeted programming strategies. This article describes a programmatic design and knowledge translation process that aims to increase women’s uptake of eye health services in rural Nepal. The article outlines key learnings of this knowledge translation process, and how this may contribute to addressing gender equity in eye health.
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Affiliation(s)
- Yadira Perez Hazel
- Fred Hollows Foundation, Melbourne, VIC 3053, Australia;
- Correspondence: (Y.P.H.); (C.M.)
| | - Cathy Malla
- Fred Hollows Foundation, Darwin, NT 0810, Australia;
- Correspondence: (Y.P.H.); (C.M.)
| | - Anita Afford
- Fred Hollows Foundation, Darwin, NT 0810, Australia;
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
| | - Anjila Dahal
- Fred Hollows Foundation, Kathmandu 44600, Nepal;
| | - Sarita Shah
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
| | - Mohan Krishna Shrestha
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
| | - Anu Manandhar
- Tilganga Institute of Ophthalmology, Kathmandu 44600, Nepal; (R.G.); (S.S.); (M.K.S.); (A.M.)
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3508
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Yildirim TM, Labuz G, Khoramnia R, Son HS, Schickhardt SK, Lieberwirth I, Knorz MC, Auffarth GU. Impact of Primary Calcification in Segmented Refractive Bifocal Intraocular Lenses on Optical Performance Including Straylight. J Refract Surg 2020; 36:20-27. [DOI: 10.3928/1081597x-20191119-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/14/2019] [Indexed: 11/20/2022]
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3509
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Kim U, Ramasamy D. How can we make the most of allied health personnel? COMMUNITY EYE HEALTH 2020; 33:S11-S12. [PMID: 34007119 PMCID: PMC8115715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Usha Kim
- Director - Mid-level Ophthalmic Personnel: Aravind Eye Care System, Madurai, India
| | - Dhivya Ramasamy
- Senior Faculty, LAICO: Aravind Eye Care System, Madurai, India
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3510
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Gottlieb M, Egan DJ, Krzyzaniak SM, Wagner J, Weizberg M, Chan T. Rethinking the Approach to Continuing Professional Development Conferences in the Era of COVID-19. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:187-191. [PMID: 32658014 DOI: 10.1097/ceh.0000000000000310] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The COVID-19 pandemic has required a substantial change to the approach used for traditional, in-person continuing professional development (CPD) conferences. Running a virtual CPD conference will necessitate consideration of digital platforms and conversion of large group and small group sessions, abstract presentations, and networking events to a digital medium. This paper will discuss these challenges and present strategies to address them for CPD conference planning in the era of COVID-19.
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Affiliation(s)
- Michael Gottlieb
- Dr. Gottlieb: Associate Professor, Ultrasound Division Director, and Clinical Ultrasound Fellowship Director, Department of Emergency Medicine, Rush University Medical Center, Chicago, IL. Dr. Egan: Vice Chair of Education, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York City, NY. Dr. Krzyzaniak: Associate Professor and Associate Residency Program Director, Department of Emergency Medicine, University of Illinois College of Medicine, Peoria, IL. Dr. Wagner: Residency Program Director, Department of Emergency Medicine, Washington University, Saint Louis, MO. Dr. Weizberg: Residency Program Director and Associate Chair for Education, Department of Emergency Medicine, Staten Island University Hospital, New York, NY. Dr. Chan: Associate Professor and Assistant Dean for Faculty Development, Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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3511
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Carrasco J, Pietsch GA, Nicolas MP, Koerber C, Bennison C, Yoon J. Real-World Effectiveness and Real-World Cost-Effectiveness of Intravitreal Aflibercept and Intravitreal Ranibizumab in Neovascular Age-Related Macular Degeneration: Systematic Review and Meta-Analysis of Real-World Studies. Adv Ther 2020; 37:300-315. [PMID: 31728825 PMCID: PMC6979459 DOI: 10.1007/s12325-019-01147-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Indexed: 12/22/2022]
Abstract
Introduction Treatment of neovascular age-related macular degeneration (nAMD) has evolved with the advent of anti-vascular endothelial growth factor agents such that intravitreally administered aflibercept and ranibizumab (RBZ) have become the standard of care. Randomized clinical trials (RCTs) have demonstrated the benefits of these agents in nAMD; however, results achieved under RCT protocols may not always be replicated in clinical practice. Assessing real-world outcomes is important to estimate the effectiveness and cost-effectiveness of these two agents. Our objective was to assess the real-world effectiveness of intravitreally administered aflibercept and RBZ in treatment-naive patients with nAMD and determine the cost-effectiveness of intravitreally administered aflibercept versus RBZ in a real-world setting. Methods A multistage approach was undertaken. A systematic literature review (SLR) was completed to identify studies describing real-world outcomes in patients with nAMD treated intravitreally with aflibercept or RBZ. A meta-analysis of data identified in the SLR generated a pooled estimate of the effectiveness of intravitreally administered aflibercept and RBZ at 52 weeks and an estimate of treatment burden (injection frequency and monitoring). The impact of treatment effect modifiers, such as baseline visual acuity (VA) and age, were corrected through a multivariable meta-regression. A Markov state transition model was developed to estimate the real-world cost-effectiveness of intravitreally administered aflibercept using results from the pooled estimates for effectiveness and treatment burden as primary inputs. The analysis considered the perspective of the French National Healthcare System. Results Patients treated intravitreally with aflibercept had a mean age of 79.52 years and mean baseline VA of 55.80 Early Treatment Diabetic Retinopathy Study (ETDRS) letters. At week 52, mean VA gain was 5.30 ETDRS letters in patients reporting an average of 7.10 intravitreal injections of aflibercept and 8.65 visits (injection and/or monitoring). RBZ-treated patients were younger (77.28 years), with a lower mean baseline VA (52.81 ETDRS letters). At week 52, mean VA gain from baseline was 4.24 ETDRS letters, with an average of 5.88 injections and 10.10 visits (injection and/or monitoring). After correcting for differences in age (77.28 years) and baseline VA (52.81 ETDRS letters) and considering the current clinical practice with aflibercept and RBZ, the mean VA gain was 6.57 ETDRS letters for patients treated intravitreally with aflibercept and 4.42 ETDRS for patients treated intravitreally with RBZ. The cost-effectiveness analysis showed that intravitreally administered aflibercept is a more effective treatment option with an incremental gain in quality-adjusted life years (QALYs) (4.918 versus 4.880) and an incremental cost-effectiveness ratio (ICER) of €27,087 per QALY. Conclusions The analysis identified differences in the overall treatment approach and how ophthalmologists use intravitreally administered aflibercept and RBZ in clinical practice. These differences ultimately influence the mean real-world effectiveness of the two agents. Intravitreal treatment with aflibercept (injection frequency and patients follow-up) was consistent and in line with the European label recommendations. Patients treated intravitreally with aflibercept in clinical practice reported a mean gain in VA of similar magnitude to the mean VA gain reported in the pivotal RCT. Conversely, treatment with RBZ varied significantly across the different studies. On average, RBZ-treated patients reported a low injection frequency and a frequent follow-up, driven in part by the high number of patients treated with pro re nata (PRN) regimens. RBZ-treated patients reported gains in VA versus baseline; however, the magnitude of the gain in VA was not comparable to the VA gains reported in the RBZ pivotal RCT. Intravitreal treatment with aflibercept was associated with better mean VA outcomes and an incremental gain in QALYs compared with RBZ and can be considered cost-effective for the treatment of nAMD in patients in France despite a higher price for each individual intravitreal injection of aflibercept compared with RBZ. Funding Bayer AG, Basel. Electronic supplementary material The online version of this article (10.1007/s12325-019-01147-6) contains supplementary material, which is available to authorized users.
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3512
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Hui M, Galvin J, Chilov M, Gabrielle PH, Fung AT. POPPER MACULOPATHY: LONG-TERM FOLLOW-UP AND CASE SERIES. Retin Cases Brief Rep 2020; 14:195-199. [PMID: 29135704 DOI: 10.1097/icb.0000000000000650] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To report a case series of popper maculopathy. METHODS Clinical history, examination findings, retinal imaging, and progress of the disease are described. RESULTS Four male patients with a mean age of 37 years (range 25-48) and different duration of popper use (ranging from first time user to chronic user) presented with central scotomata, phosphenes, or photophobia. Optical coherence tomography in all cases demonstrated subfoveal disruption of the ellipsoid zone. Three cases also showed hyperreflectivity of the ellipsoid zone, and one case had a foveal detachment. Chronic user of poppers was associated with more severe macular changes. One patient had a 3-year follow-up and demonstrated complete resolution of signs on retinal imaging after ceasing popper use. CONCLUSION Popper maculopathy may show complete resolution of signs on long-term follow-up, even after chronic popper ingestion.
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Affiliation(s)
- Michelle Hui
- Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia
| | | | - Michael Chilov
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, Concord Repatriation Hospital, Sydney, New South Wales, Australia
| | | | - Adrian T Fung
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia; and
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University Hospital, New South Wales, Australia
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3513
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Olawoye O, Fawole O, Monye H, Ashaye A. Eye care practices, knowledge, and attitude of glaucoma patients at community eye outreach screening in Nigeria. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2020; 10:16-22. [PMID: 35814968 PMCID: PMC9267041 DOI: 10.4103/jwas.jwas_48_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/07/2022] [Indexed: 11/11/2022]
Abstract
Background: Community eye outreach (CEO) screening is an important model which has been widely employed to detect eye conditions such as cataract and glaucoma in high-risk groups. There is a dearth of data on the eye care practices of glaucoma patients identified using this model in South West Nigeria. Objectives: The aim of this article is to assess the eye care practices, knowledge, and attitudes of glaucoma patients/suspects identified at CEO screenings in Nigeria. Design of the Study: This was a mixed method study with quantitative and qualitative approaches. Setting in Which the Study Took Place: The study was carried out at 24 outreach screening centres in communities in Oyo and Osun states. Materials and Methods: The quantitative component of this study was a cross-sectional survey of patients with suspected glaucoma identified at routine CEO in South West Nigeria. Surveys were administered by trained personnel and gathered information on knowledge and attitudes towards glaucoma. The qualitative component consisted of structured interviews with providers to assess their knowledge and perspectives of glaucoma patients’ attitudes and behaviours. Results: A total of 1881 patients were screened at 24 outreach screenings in South West Nigeria, among which 120 glaucoma cases/suspects were identified. Fifty-six (46.7%) of the glaucoma patients were aware of glaucoma, but only 39 (32.5%) patients could answer at least one knowledge question correctly. Predictors of awareness of glaucoma were minimum of secondary school education [adjusted odds ratio (OR) 8.76; 95% confidence interval (CI) 3.18–24.13] and having had an eye check-up in the past (adjusted OR 5.87; 95% CI 1.92 – 17.92). Patients said cost and ‘not knowing the disease was serious’ were reasons for not following up at the main hospital. Health workers interviewed said that cost and poor knowledge were the main reasons glaucoma patients frequently attended free outreach screening events rather than seeking definitive care. Conclusion: Although CEO screenings improve access to eye care, provision of appropriate health education programs and strengthening of the health insurance scheme are needed to improve its impact in glaucoma care.
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3514
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Méjécase C, Malka S, Guan Z, Slater A, Arno G, Moosajee M. Practical guide to genetic screening for inherited eye diseases. Ther Adv Ophthalmol 2020; 12:2515841420954592. [PMID: 33015543 PMCID: PMC7513416 DOI: 10.1177/2515841420954592] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022] Open
Abstract
Genetic eye diseases affect around one in 1000 people worldwide for which the molecular aetiology remains unknown in the majority. The identification of disease-causing gene variant(s) allows a better understanding of the disorder and its inheritance. There is now an approved retinal gene therapy for autosomal recessive RPE65-retinopathy, and numerous ocular gene/mutation-targeted clinical trials underway, highlighting the importance of establishing a genetic diagnosis so patients can fully access the latest research developments and treatment options. In this review, we will provide a practical guide to managing patients with these conditions including an overview of inheritance patterns, required pre- and post-test genetic counselling, different types of cytogenetic and genetic testing available, with a focus on next generation sequencing using targeted gene panels, whole exome and genome sequencing. We will expand on the pros and cons of each modality, variant interpretation and options for family planning for the patient and their family. With the advent of genomic medicine, genetic screening will soon become mainstream within all ophthalmology subspecialties for prevention of disease and provision of precision therapeutics.
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Affiliation(s)
- Cécile Méjécase
- Institute of Ophthalmology, University College
London, London, UK
| | - Samantha Malka
- Institute of Ophthalmology, University College
London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust,
London, UK
| | - Zeyu Guan
- Moorfields Eye Hospital NHS Foundation Trust,
London, UK
| | - Amy Slater
- Royal Brompton and Harefield NHS Foundation
Trust, London, UK
| | - Gavin Arno
- Institute of Ophthalmology, University College
London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust,
London, UK
- Great Ormond Street Hospital for Children NHS
Trust, London, UK
| | - Mariya Moosajee
- Professor, Institute of Ophthalmology,
University College London, 11-43 Bath Street, London EC1V 9EL, UK
- Moorfields Eye Hospital NHS Foundation Trust,
London, UK
- Great Ormond Street Hospital for Children NHS
Trust, London, UK
- The Francis Crick Institute, London, UK
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3515
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Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Patient selection to optimize near vision performance with a low-addition trifocal lens. JOURNAL OF OPTOMETRY 2020; 13:50-58. [PMID: 31680039 PMCID: PMC6951843 DOI: 10.1016/j.optom.2019.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/31/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To assess the impact of ocular biometric variables on the visual performance achieved with a low addition trifocal intraocular lens (MIOL). METHODS Retrospective observational study including 34 eyes. Preoperative measured variables included mean corneal power (Km), corneal regular astigmatism (RA), anterior chamber depth (ACD), axial length (AXL), total irregular astigmatism (IA), spherical aberration (SA) and distance from pupil center to vertex normal (µ). Same variables were retrieved from the three month visit follow-up in addition to the actual lens position (ALP), the calculated effective addition (EA), the IOL centration from vertex normal (d), and the visual acuity defocus curve. The area under the defocus curve was computed along the total curve (TAUC) and ranges for far (FAUC), intermediate (IAUC) and near vision (NAUC). The sample was split in two groups of 17 eyes with TAUCs above and below the mean, and the differences among groups for different ocular parameters were assessed. RESULTS The group of eyes above TAUC of 2.03 logMAR*m-1 showed significantly lower Km and greater AXL and SA. Km was negatively correlated with TAUC and NAUC. NAUC was negatively correlated with IA and positively with d. A multiple lineal regression model including Km, d, and IA predicted NAUC (r-square = 34%). No significant differences between IA and SA were found between preoperative and postoperative values but µ significantly decreased after surgery. CONCLUSIONS The mean corneal power, irregular astigmatism, and centration from vertex normal should be considered for optimizing the near visual performance with this MIOL.
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Affiliation(s)
- Joaquín Fernández
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, 04120, Almería, Spain
| | | | - Javier Martínez
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, 04120, Almería, Spain
| | - Ana Tauste
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, 04120, Almería, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain; Department of Ophthalmology (IMQO-Oftalmar), Vithas Medimar International Hospital, Alicante, Spain
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3516
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Iancu RC, Bujor IA, Iliuță C, Tudor Ș, Ungureanu E, Pașca IG, Istrate S. Correlations between corneal biomechanics and specular microscopy in patient with cataract. Rom J Ophthalmol 2020; 64:132-145. [PMID: 32685779 PMCID: PMC7339691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study aimed to analyze the connection between corneal biomechanics (corneal hysteresis, CH) and endothelial cell density of cornea (mean endothelial cell density, MCD) in patients diagnosed with cataract. This retrospective, observational study was performed in the Ophthalmology Clinic of the University Emergency Hospital in Bucharest. Of 60 patients (120 eyes) with cataract, who were included in this study, we analyzed the CH values obtained using with the Ocular Response Analyzer (ORA) and the MCD values obtained using the specular microscopy. The study groups comprised both men and women with ages ranging from 45 to 63 years. Patients were divided into three study groups according to CH values. In each batch, the CH values obtained with the Ocular Response Analyzer (ORA) were correlated with age, gender and MCD, then the subgroups were compared. All the data gathered showed no correlation to be statistically significant regarding the biomechanical properties of the cornea and the corneal endothelial cell density in patients with cataract.
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Affiliation(s)
| | - Inna Adriana Bujor
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Cătălina Iliuță
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | - Ștefania Tudor
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Emil Ungureanu
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
| | | | - Sînziana Istrate
- Department of Ophthalmology, University Emergency Hospital, Bucharest, Romania
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3517
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Short-term effects of text-background color combinations on the dynamics of the accommodative response. Vision Res 2020; 166:33-42. [DOI: 10.1016/j.visres.2019.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 11/21/2022]
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3518
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Elevated Intraocular Pressure Causes Abnormal Reactivity of Mouse Retinal Arterioles. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:9736047. [PMID: 31976030 PMCID: PMC6954472 DOI: 10.1155/2019/9736047] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/27/2019] [Accepted: 11/27/2019] [Indexed: 11/20/2022]
Abstract
Objective Glaucoma is a leading cause of severe visual impairment and blindness. Although high intraocular pressure (IOP) is an established risk factor for the disease, the role of abnormal ocular vessel function in the pathophysiology of glaucoma gains more and more attention. We tested the hypothesis that elevated intraocular pressure (IOP) causes vascular dysfunction in the retina. Methods High IOP was induced in one group of mice by unilateral cauterization of three episcleral veins. The other group received sham surgery only. Two weeks later, retinal vascular preparations were studied by video microscopy in vitro. Reactive oxygen species (ROS) levels and expression of hypoxia markers and of prooxidant and antioxidant redox genes as well as of inflammatory cytokines were determined. Results Strikingly, responses of retinal arterioles to stepwise elevation of perfusion pressure were impaired in the high-IOP group. Moreover, vasodilation responses to the endothelium-dependent vasodilator, acetylcholine, were markedly reduced in mice with elevated IOP, while no differences were seen in response to the endothelium-independent nitric oxide donor, sodium nitroprusside. Remarkably, ROS levels were increased in the retinal ganglion cell layer including blood vessels. Expression of the NADPH oxidase isoform, NOX2, and of the inflammatory cytokine, TNF-α, was increased at the mRNA level in retinal explants. Expression of NOX2, but not of the hypoxic markers, HIF-1α and VEGF-A, was increased in the retinal ganglion cell layer and in retinal blood vessels at the protein level. Conclusion Our data provide first-time evidence that IOP elevation impairs autoregulation and induces endothelial dysfunction in mouse retinal arterioles. Oxidative stress and inflammation, but not hypoxia, appear to be involved in this process.
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3519
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Hovanesian JA, Lane SS, Allen QB, Jones M. Patient-Reported Outcomes/Satisfaction and Spectacle Independence with Blended or Bilateral Multifocal Intraocular Lenses in Cataract Surgery. Clin Ophthalmol 2019; 13:2591-2598. [PMID: 31920282 PMCID: PMC6938179 DOI: 10.2147/opth.s227629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare patient-reported outcomes (PROs) and satisfaction results after multifocal intraocular lens (IOL) implantation in three groups: two receiving bilateral implantation of the same IOL and another undergoing blended vision with two different multifocal IOLs. Patients and methods A questionnaire was administered to patients who had undergone uncomplicated cataract surgery and 2 months of follow-up: the first group underwent bilateral implantation with Alcon’s AcrySof ReSTOR 3.0 lens (“3.0/3.0,” n=78); the second group underwent implantation with the ReSTOR ActiveFocus 2.5 or the ReSTOR ActiveFocus 2.5 toric lens (“2.5 mini-monovision,” n=102); and the third group underwent implantation with the ReSTOR 2.5 lens in the dominant eye and the ReSTOR 3.0 lens in the non-dominant eye (“2.5/3.0,” n=89). Results Overall PROs and satisfaction was similar among the groups. Refractive outcomes and accuracy were similar among the groups, but the 2.5 mini-monovision group reported better intermediate vision. Refractive outcome differences were not meaningful among the groups and were not a differentiating factor in PROs. Substantially fewer patients in the 2.5 mini-monovision group noticed glare and halo compared with the 3.0/3.0 group (P<0.0001, chi-square test). No new safety concerns were reported. Conclusion The 2.5 mini-monovision results in a higher percentage of patients being satisfied with intermediate vision than bilateral ReSTOR 3.0 or blended vision with ReSTOR 2.5/3.0 implants, but overall PRO differences were not statistically significant.
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3520
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Mecum NE, Cyr D, Malon J, Demers D, Cao L, Meng ID. Evaluation of Corneal Damage After Lacrimal Gland Excision in Male and Female Mice. Invest Ophthalmol Vis Sci 2019; 60:3264-3274. [PMID: 31369671 PMCID: PMC6675517 DOI: 10.1167/iovs.18-26457] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Lacrimal gland excision (LGE) has been utilized in several studies to model aqueous tear deficiency, yet sex as a biological variable has not been factored in to these reports. This study compared corneal pathology in male and female mice following LGE-induced dry eye. Methods An LGE of either the extraorbital lacrimal gland (single LGE) or both the extraorbital and intraorbital lacrimal glands (double LGE) was performed in male and female C57BL/6J and Balb/cJ mice to produce dry eye of graded severity. Following excision, tearing was evaluated with phenol red thread, and corneal fluorescein staining was scored to quantify the severity of damage. Corneas were evaluated for apoptosis by the TUNEL assay and for cell proliferation using Ki67 staining. Furthermore, corneas were harvested and analyzed for macrophages via flow cytometry. Results Baseline tearing levels were similar in male and female mice, and LGE resulted in comparable reductions in tearing with the lowest levels recorded after double LGE. As determined by fluorescein staining, LGE produced more severe damage to the cornea in female C57BL/6J and Balb/cJ mice. Double LGE increased TUNEL and Ki67 staining in the cornea, with greater increases found in female mice. Furthermore, LGE produced a greater increase in the total number of corneal macrophages in female mice. Conclusions These results indicate that female mice are more susceptible to LGE-induced corneal damage. The mechanisms involved in producing these sex differences still need to be elucidated but may involve increased inflammation and macrophage infiltration.
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Affiliation(s)
- Neal E Mecum
- Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine, United States.,Molecular and Biomedical Sciences, University of Maine, Orono, Maine, United States
| | - Dan Cyr
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, Maine, United States
| | - Jennifer Malon
- Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine, United States
| | - Danielle Demers
- Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine, United States
| | - Ling Cao
- Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine, United States.,Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, Maine, United States
| | - Ian D Meng
- Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine, United States.,Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, Maine, United States
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3521
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Fogt JS, Fogt N, King-Smith PE, Liu H, Barr JT. Changes in Tear Lipid Layer Thickness and Symptoms Following the Use of Artificial Tears with and Without Omega-3 Fatty Acids: A Randomized, Double-Masked, Crossover Study. Clin Ophthalmol 2019; 13:2553-2561. [PMID: 31908411 PMCID: PMC6930022 DOI: 10.2147/opth.s228261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/27/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine if an eye drop containing omega-3 fatty acids (Refresh Optive MEGA-3®, Allergan plc, Dublin, Ireland) increases the lipid layer thickness (LLT) of the tear film versus a non-emollient eye drop (Refresh Optive, Allergan plc). Methods Patients (≥30 years) with baseline LLT ≤75 nm completed the Current Symptoms Survey (CSS – a visual analog survey of dry eye symptoms), and LLT was measured pre- and post-instillation (15 and 60 mins) of their randomly assigned treatment. After washout, patients were tested with the other treatment. Primary endpoint: change in LLT from baseline. Secondary endpoint: CSS results. Results Of 21 patients enrolled, 19 completed the study. With the omega-3–containing eye drop, the mean (standard deviation) LLT increase from baseline at 15 mins was statistically significant in the overall field (8.8 [11.5] nm; P<0.001), and in each individual zone (superior, central, and inferior). At 1 hr, the LLT change from baseline was statistically significant overall (4.4 [9.7] nm; P<0.02) and in the inferior and central zones. With the aqueous eye drop, LLT change from baseline was only significant at 15 mins in the inferior field. The CSS analysis revealed a ≥8.68-unit decrease in mean average dryness score from baseline at 15 and 60 mins post-instillation of the lipid-based treatment (P≤0.03). Conclusion The eye drop containing omega-3 fatty acids increased LLT at 15 mins, maintaining it at 1 hr post-instillation. Dryness symptoms also improved and maintained improved levels 1 hr after instillation, indicating that the product may benefit symptomatic patients with evaporative dry eye.
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Affiliation(s)
- Jennifer S Fogt
- Ohio State University College of Optometry, Columbus, OH, USA
| | - Nick Fogt
- Ohio State University College of Optometry, Columbus, OH, USA
| | | | | | - Joseph T Barr
- Ohio State University College of Optometry, Columbus, OH, USA
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3522
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Oh JK, Lima de Carvalho JR, Sun YJ, Ragi S, Yang J, Levi SR, Ryu J, Bassuk AG, Mahajan VB, Tsang SH. Novel mutations in the 3-box motif of the BACK domain of KLHL7 associated with nonsyndromic autosomal dominant retinitis pigmentosa. Orphanet J Rare Dis 2019; 14:295. [PMID: 31856884 PMCID: PMC6924004 DOI: 10.1186/s13023-019-1275-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/05/2019] [Indexed: 02/03/2023] Open
Abstract
Background Mutations in the Kelch-like protein 7 (KLHL7) represent a recently described and, to date, poorly characterized etiology of inherited retinal dystrophy. Dominant mutations in KLHL7 are a cause of isolated, non-syndromic retinitis pigmentosa (RP). In contrast, recessive loss-of-function mutations are known to cause Crisponi or Bohring-Opitz like cold induced sweating syndrome-3 (BOS-3). In this study, the phenotype and progression of five unrelated patients with KLHL7 mediated autosomal dominant RP (adRP) are characterized. Clinical evaluation of these patients involved a complete ophthalmic exam, full-field electroretinography (ffERG), and imaging, including fundus photography, spectral domain optical coherence tomography (SD-OCT), short wavelength fundus autofluorescence (SW-AF), and near-infrared fundus autofluorescence (NIR-AF). Molecular diagnoses were performed using whole-exome sequencing or gene panel testing. Disease progression was monitored in three patients with available data for a mean follow up time of 4.5 ± 2.9 years. Protein modeling was performed for all variants found in this study in addition to those documented in the literature for recessive loss-of-function alleles causing Crisponi or Bohring-Opitz like cold-induced sweating syndrome. Results Genetic testing in three patients identified two novel variants within the 3-box motif of the BACK domain: c.472 T > C:p.(Cys158Arg) and c.433A > T:p.(Asn145Tyr). Clinical imaging demonstrated hyperautofluorescent ring formation on both SW-AF and NIR-AF in three patients, with diffuse peripheral and peripapillary atrophy seen in all but one case. SD-OCT demonstrated a phenotypic spectrum, from parafoveal atrophy of the outer retina with foveal sparing to widespread retinal thinning and loss of photoreceptors. Incidence of cystoid macular edema was high with four of five patients affected. Protein modeling of dominant alleles versus recessive loss-of-function alleles showed dominant alleles localized to the BTB and BACK domains while recessive alleles were found in the Kelch domain. Conclusions We report the phenotype in five patients with KLHL7 mediated adRP, two novel coding variants, and imaging biomarkers using SW-AF and NIR-AF. These findings may influence future gene-based therapies for adRP and pave the way for mechanistic studies that elucidate the pathogenesis of KLHL7-mediated RP.
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Affiliation(s)
- Jin Kyun Oh
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA.,State University of New York at Downstate Medical Center, Brooklyn, NY, USA
| | - Jose Ronaldo Lima de Carvalho
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA.,Department of Ophthalmology, Empresa Brasileira de Servicos Hospitalares (EBSERH) - Hospital das Clinicas de Pernambuco (HCPE), Federal University of Pernambuco (UFPE), Recife, Brazil.,Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Young Joo Sun
- Omics Laboratory, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sara Ragi
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Jing Yang
- Omics Laboratory, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Sarah R Levi
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Joseph Ryu
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA
| | - Alexander G Bassuk
- Department of Pediatrics, University of Iowa, Iowa City, USA.,Department of Neurology, University of Iowa, Iowa City, USA
| | - Vinit B Mahajan
- Omics Laboratory, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Stephen H Tsang
- Department of Ophthalmology, Columbia University Medical Center, New York, NY, USA. .,Department of Pathology & Cell Biology, and Columbia Stem Cell Initiative, Columbia University Medical Center, 635 West 165th Street, Box 212, New York, NY, 10032, USA.
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3523
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Takhar JS, Joye AS, Somkijrungroj T, Laovirojjanakul W, Lin CP, Lietman TM, Porco TC, Keenan JD, Gebreegziabher EA, Seitzman GD, Rose-Nussbaumer J, Doan TA, Acharya NR, Gonzales JA. A double masked randomised 4-week, placebo-controlled study in the USA, Thailand and Taiwan to compare the efficacy of oral valganciclovir and topical 2% ganciclovir in the treatment of cytomegalovirus anterior uveitis: study protocol. BMJ Open 2019; 9:e033175. [PMID: 31862739 PMCID: PMC6937053 DOI: 10.1136/bmjopen-2019-033175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/04/2019] [Accepted: 11/25/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Cytomegalovirus (CMV) anterior uveitis is a recognised cause of anterior uveitis in immunocompetent patients and is preventable cause of vision loss. Ocular sequelae include corneal endothelial damage which can cause corneal oedema and failure, as well as glaucoma. Recurrences of inflammation are common and therefore patients are often exposed to long-term therapy. Oral therapy is available in the form of valganciclovir, although with the caveat of systemic side effects such as bone marrow suppression and renal failure necessitating regular interval laboratory monitoring. Recent reports have demonstrated that topical 2% ganciclovir solution may offer promising treatment outcomes in patients with CMV anterior uveitis with superior safety, cost-effectiveness and convenience profiles. An investigation into the relative equipoise of these therapies is warranted for these reasons. METHODS AND ANALYSIS The Systemic and Topical Control of Cytomegalovirus Anterior uveitis: Treatment Outcomes (STACCATO) trial is designed as a multicentre, block randomised by site, double-masked, placebo-controlled trial comparing the efficacy of oral valganciclovir, 2% topical ganciclovir and placebo in treating PCR-proven CMV anterior uveitis. Participant clinical evaluation will occur at three study time points by a masked study ophthalmologist over a 28-day period to assess resolution of ocular inflammation (secondary outcome). A control group will provide additional information about the possible impact that the infected host's immune response may play in controlling local viral replication. The primary analysis is an analysis of covariance (three arms) correcting for baseline to compare quantitative CMV viral load in the anterior chamber (AC) aqueous fluid before and 7 days after treatment. ETHICS AND DISSEMINATION The University of California San Francisco Committee on Human Research and the Khon Kaen University Institutional Review Board have given ethical approval. The results of this trial will be presented at local and international meetings and submitted for peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER NCT03576898.
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Affiliation(s)
- Jaskirat S Takhar
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- John Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Ashlin S Joye
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Touro University California College of Osteopathic Medicine, Vallejo, California, USA
| | - Thanapong Somkijrungroj
- Ophthalmology, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- Ophthalmology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Chang-Ping Lin
- Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Thomas M Lietman
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Travis C Porco
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jeremy D Keenan
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | | | - Gerami D Seitzman
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jennifer Rose-Nussbaumer
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Kaiser Permanente, Redwood City, California, USA
| | - Thuy A Doan
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Nisha R Acharya
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - John A Gonzales
- Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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3524
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Wang JJ, Gao XY, Li HZ, Du SS. Treating with besifloxacin for acute bacterial conjunctivitis: a Meta-analysis. Int J Ophthalmol 2019; 12:1898-1907. [PMID: 31850176 DOI: 10.18240/ijo.2019.12.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 09/25/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the relative efficacy and safety of besifloxacin for treatment of acute bacterial conjunctivitis. METHODS A comprehensive search in PubMed, EMBASE Web of Science, Cochrane Central Database and CNKI was undertaken for randomized controlled trials (RCTs) comparing besifloxacin with other treatments or placebo. The primary outcome measures were clinical resolution, rates of bacterial eradication, individual clinical outcomes, cure rates, and bacterial eradication rates of different kinds of pathogens. Safety outcomes were the number of adverse effects (AEs). The final search was performed on August 2018. RESULTS Six RCTs were included. Four studies compared the efficacy and safety of besifloxacin with placebo, 1 study compared besifloxacin with moxifloxacin, and 1 study compared besifloxacin with gatifloxacin. A total of 2780 patients met the inclusion criteria. Besifloxacin presented higher efficacy and safety than did placebo in clinical resolution, rates of bacterial eradication, individual clinical outcomes, cure rates, bacterial eradication rates of different kinds of pathogens and the number of AEs. There was no significant difference between besifloxacin and moxifloxacin or gatifloxacin in the comparison items mentioned above. CONCLUSION Besifloxacin is highly effective and safe for treatment of acute bacterial conjunctivitis. Further comparative trials regarding the effect of besifloxacin for treatment of acute bacterial conjunctivitis will aid in treatment decisions.
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Affiliation(s)
- Jun-Jie Wang
- Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Xin-Yi Gao
- Shaanxi Ophthalmic Medical Center, Xi'an No.4 Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
| | - Hong-Zhuo Li
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, Shanxi Province, China
| | - Shan-Shuang Du
- Shaanxi Ophthalmic Medical Center, Xi'an No.4 Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China
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3525
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Cissé Y, Bai L, Chen MT. LncRNAs in ocular neovascularizations. Int J Ophthalmol 2019; 12:1959-1965. [PMID: 31850182 PMCID: PMC6901876 DOI: 10.18240/ijo.2019.12.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/29/2019] [Indexed: 12/13/2022] Open
Abstract
The prevalence of eye diseases worldwide is dramatically increasing and represents a major concern in underdeveloped and developed regions. Ocular diseases, previously associated with a higher depression risk, also impose a substantial economic burden on affected families, thus early detection and/or accurate treatment in order to avoid and prevent blindness should be emphasized. Ocular neovascularization (NV), the leading cause of blindness in a variety of eye diseases, is a pathologic process characterized by the formation, proliferation and infiltration of anomalous, tiny and leaky fragile blood vessels within the eye. Genetics have been suspected to play an important role in the occurrence of eye diseases, with the detection of a numbers of specific gene mutations. Long non-coding RNA (lncRNAs) are novel class of regulatory molecules previously associated with various biological processes and diseases, however the nature of the relation and pathways by which they might contribute to the development of corneal, choroidal and retinal NV have not yet been completely elucidated. In this review, we focus on the regulation and characteristics of lncRNAs, summarize results from ocular NV-related studies and discuss the implication of lncRNAs in ocular NV development.
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Affiliation(s)
- Yacouba Cissé
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Lang Bai
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Min-Ting Chen
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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3526
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Shi L, Hager T, Fries FN, Daas L, Holbach L, Hofmann-Rummelt C, Zemova E, Seitz B, Szentmáry N. Reactive uveitis, retinal vasculitis and scleritis as ocular end-stage of Acanthamoeba keratitis: a histological study. Int J Ophthalmol 2019; 12:1966-1971. [PMID: 31850183 DOI: 10.18240/ijo.2019.12.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/21/2019] [Indexed: 11/23/2022] Open
Abstract
We analysed histologically two Acanthamoeba keratitis (AK) eyes with anterior and posterior segment inflammation and blindness. Two enucleated eyes of 2 patients (age 45 and 51y) with AK (PCR of epithelial abrasion positive) were analysed. Histological analysis was performed using hematoxylin-eosin, periodic acid-Schiff and Gömöri-methenamine silver staining. We could not observe Acanthamoeba trophozoites or cysts neither in the cornea nor in other ocular tissues. Meanwhile, we found uveitis, retinal vasculitis and scleritis in these eyes, due to the long-standing, recalcitrant AK. So in this stage of AK, systemic immune suppression may be necessary for a longer time period.
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Affiliation(s)
- Lei Shi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany.,Department of Ophthalmology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, P.R. China
| | - Tobias Hager
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Fabian Norbert Fries
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Leonard Holbach
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Carmen Hofmann-Rummelt
- Department of Ophthalmology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Elena Zemova
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany
| | - Nóra Szentmáry
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar 66424, Germany.,Department of Ophthalmology, Semmelweis University, Budapest 1093, Hungary
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3527
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Özsoy F, Alim S. Optical coherence tomography findings in patients with alcohol use disorder and their relationship with clinical parameters. Cutan Ocul Toxicol 2019; 39:54-60. [PMID: 31847594 DOI: 10.1080/15569527.2019.1700379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: In our study, we aimed to investigate the ganglion cell-inner plexiform layer thickness (GCIPL), retinal nerve fibre layer thickness (RNFL), mean macular volume (MMV), central macular thickness (CMT), mean macular thickness (MMT), and choroidal thickness (CT) values with optical coherence tomography (OCT) in patients who are diagnosed with alcohol use disorder (AUD).Materials and methods: The study included 43 patients who were diagnosed with AUD, and 43 healthy controls. Detailed biomicroscopic examinations of all the participants, visual acuity, intraocular pressure, anterior and posterior segment examinations, and then, OCT measurements were carried out.Results: Although the measured values for RNFL in the superior and temporal quadrant are within normal limits, they were slightly higher compared to those in the control group (p values 0.127 and 0.191 for superior quadrant and temporal quadrant, respectively). The CT measurements in all quadrants were higher than the control group; however, these measurements were not statistically significant (p > 0.05). When the relation between clinical features and OCT findings of the patients were examined, it was determined that the ages of the patients were statistically significantly and inversely correlated with the temporal CT and also the nasal and temporal quadrants of RNFL.Conclusions: Our study is the first study that examines the retinal GCIPL and CT with OCT in patients who are diagnosed with AUD. In our results, it was determined that there were no statistically significant differences between the participants in terms of OCT parameters. Further studies with larger sampling groups evaluating neurotransmission findings may provide wider results.
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Affiliation(s)
- Filiz Özsoy
- Clinic of Psychiatry, Tokat State Hospital, Tokat, Turkey
| | - Sait Alim
- Department of Ophthalmology, School of Medicine, Gaziosmanpaşa University Hospital, Tokat, Turkey
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3528
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Transthyretin Upregulates Long Non-Coding RNA MEG3 by Affecting PABPC1 in Diabetic Retinopathy. Int J Mol Sci 2019; 20:ijms20246313. [PMID: 31847264 PMCID: PMC6940950 DOI: 10.3390/ijms20246313] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of the study was to demonstrate how transthyretin (TTR) could affect long non-coding RNA (lncRNA) of maternally expressed gene 3 (MEG3) and play important roles in diabetic retinopathy (DR). A DR model in C57BL/6 mice was established after intraperitoneal injection of streptozotocin (STZ). After intravitreal injection with TTR pAAV vector, MEG3 short hairpin RNA (shRNA), scrambled shRNA, or MEG3, retinal imaging, retinal trypsin digestion, and fundus vascular permeability tests were performed. Cell counting kit-8 (CCK8), transwell, and Matrigel assays were employed to detect the proliferation and migration of human retinal microvascular endothelial cells (hRECs). The binding between long non-coding RNA of maternally expressed gene 3 (lncRNA-MEG3) and microRNA-223-3p (miR-223-3p) was observed by using luciferase reporter assays, while co-immunoprecipitation (co-IP) was employed to confirm the interaction between TTR and the target. In the DR mice model, retinal vascular leakage and angiogenesis were repressed by overexpressing TTR. In vitro, the added TTR promoted the level of lncRNA-MEG3 by interacting with poly (A) binding protein cytoplasmic 1 (PABPC1), and then repressed proliferation and angiogenesis of hRECs. In vivo, silencing or overexpressing lncRNA-MEG3 significantly affected retinal vascular phenotypes. Additionally, the interaction between lncRNA-MEG3 and miR-223-3p was confirmed, and silencing of miR-223-3p revealed similar effects on hRECs as overexpression of lncRNA-MEG3. In summary, in the DR environment, TTR might affect the lncRNA MEG3/miR-223-3p axis by the direct binding with PABPC1, and finally repress retinal vessel proliferation.
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3529
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Shirahama S, Kaburaki T, Takada S, Nakahara H, Tanaka R, Komae K, Fujino Y, Kawashima H, Aihara M. Comparison of visual field defect progression in secondary Glaucoma due to anterior uveitis caused by three types of herpes viruses. Graefes Arch Clin Exp Ophthalmol 2019; 258:639-645. [PMID: 31832767 DOI: 10.1007/s00417-019-04559-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/24/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To clarify the prevalence of secondary glaucoma (SG) and its speed of progression in patients with herpes simplex virus (HSV)-anterior uveitis (AU), varicella zoster virus (VZV)-AU, and cytomegalovirus (CMV)-AU. METHODS In total, 170 patients with herpetic AU were enrolled in this retrospective observational case series. Patients with visual field (VF) defects and glaucomatous disc abnormalities were diagnosed with SG. Moreover, the speed of SG progression was defined as decreasing mean deviation (MD) values per year. SG prevalence and annual MD-value decrease were compared among the three types of herpetic AU. RESULTS SG prevalence was 16%, 9%, and 72% in patients with HSV-AU, VZV-AU, and CMV-AU, respectively. Patients with CMV-AU had the highest SG prevalence (odds ratio = 3.15; 95% confidence interval = 1.15-8.65; P < 0.05). Furthermore, the annual MD-value change was significantly higher in SG caused by CMV-AU than in that caused by HSV/VZV-AU (-2.6 ± 2.4 dB/year and -0.45 ± 0.54 dB/year, respectively; P < 0.05). CONCLUSIONS Our results demonstrated that patients with CMV-AU may have a higher risk and faster speed of progression of SG than patients with HSV/VZV-AU. Therefore, clinicians should monitor glaucoma onset and VF-defect progression in patients with CMV-AU.
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Affiliation(s)
- Shintaro Shirahama
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Sachiko Takada
- Department of Ophthalmology, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hisae Nakahara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Keiko Komae
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Tokyo Shinjuku Medical Center, 5-1 Tsukudo-cho, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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3530
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Dabrowiecki A, Villalobos A, Krupinski EA. Impact of blue light filtering glasses on computer vision syndrome in radiology residents: a pilot study. J Med Imaging (Bellingham) 2019; 7:022402. [PMID: 31824984 DOI: 10.1117/1.jmi.7.2.022402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/18/2019] [Indexed: 11/14/2022] Open
Abstract
Computer vision syndrome (CVS) is an umbrella term for a pattern of symptoms associated with prolonged digital screen exposure, such as eyestrain, headaches, blurred vision, and dry eyes. Commercially available blue light filtering lenses (BLFL) are advertised as improving CVS. Our pilot study evaluates the effectiveness of BLFL on reducing CVS symptoms and fatigue in a cohort of radiologists. A prospective crossover study was conducted with ten radiology residents randomized into two cohorts: one wearing BLFL first then a sham pair (non-BLFL), and the other wearing a sham pair first then BLFL, over two weeks during normal clinical work. Participants filled out a questionnaire using the validated computer vision syndrome questionnaire (CVS-Q) and the Swedish Occupational Fatigue Inventory (SOFI). The majority of symptoms [11/16 (68.8%) and 13/16 (81.3%) symptoms on the CVS-Q and SOFI, respectively] were reduced (i.e., symptoms less severe) with the BLFL compared to the sham glasses. Females rated symptoms of sleepiness and physical discomfort in the SOFI, and overall CVS-Q, as more severe. Postgraduate year (PGY)-2 residents rated all symptoms as more severe than PGY-3/4s. BLFL may ameliorate CVS symptoms. Future studies with larger sample sizes and participants of different ages are required to verify the potential of BLFL.
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Affiliation(s)
- Alexander Dabrowiecki
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia, United States
| | - Alexander Villalobos
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia, United States
| | - Elizabeth A Krupinski
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia, United States
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3531
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Monsálvez-Romín D, González-Méijome JM, Esteve-Taboada JJ, García-Lázaro S, Cerviño A. Light distortion of soft multifocal contact lenses with different pupil size and shape. Cont Lens Anterior Eye 2019; 43:130-136. [PMID: 31812508 DOI: 10.1016/j.clae.2019.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To study the light distortion effects of soft multifocal contact lenses and the influence of different pupil size and shape. METHODS A total of 14 eyes of 7 healthy contact lens users (mean age 28.6 ± 8.5 years) were recruited. The "Light Disturbance Analyser" device was employed for light characterization. The selected lenses were the monthly disposable "Biofinity multifocal" (CooperVision, CA, USA), both centre-distance and centre-near designs (addition power +2.50 D). Two circular pupils of 3 mm and 5 mm of diameter, and an elliptical shape (3 horizontal and 5 vertical mm) were used. Metrics such as the light distortion index (LDI), best-fit circle radius and its irregularity were analysed, among others. RESULTS The LDI was generally higher with multifocal lenses, varying from 3.7 ± 0.3 % of the single vision lens to 6.1 ± 3.3 % of the multifocal centre-distance design and the 5-mm pupil. Larger pupils gave higher LDI values, changing from 4.5 ± 2.0 % (3 mm) to 6.1 ± 3.3 % (5 mm) with the centre-distance design. The elliptical pupil produced the largest discrepancy in the distortion size between the vertical and horizontal directions. The centre-distance and centre-near designs behaved similarly in terms of light distortion. CONCLUSIONS The multifocal contact lenses of the study increased light distortion effects under low light conditions, especially with larger pupils. The shape of the distortion pattern is associated with the shape of the pupil. It seems that not all, but a big percentage of light distortion would be produced by the presence of the out-of-focus images given by a multifocal lens.
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Affiliation(s)
- Daniel Monsálvez-Romín
- From the Optometry Research Group (GIO), Optics Department, University of Valencia, Spain.
| | | | - José J Esteve-Taboada
- From the Optometry Research Group (GIO), Optics Department, University of Valencia, Spain
| | - Santiago García-Lázaro
- From the Optometry Research Group (GIO), Optics Department, University of Valencia, Spain
| | - Alejandro Cerviño
- From the Optometry Research Group (GIO), Optics Department, University of Valencia, Spain
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3532
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An update on retinal prostheses. Clin Neurophysiol 2019; 131:1383-1398. [PMID: 31866339 DOI: 10.1016/j.clinph.2019.11.029] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/23/2022]
Abstract
Retinal prostheses are designed to restore a basic sense of sight to people with profound vision loss. They require a relatively intact posterior visual pathway (optic nerve, lateral geniculate nucleus and visual cortex). Retinal implants are options for people with severe stages of retinal degenerative disease such as retinitis pigmentosa and age-related macular degeneration. There have now been three regulatory-approved retinal prostheses. Over five hundred patients have been implanted globally over the past 15 years. Devices generally provide an improved ability to localize high-contrast objects, navigate, and perform basic orientation tasks. Adverse events have included conjunctival erosion, retinal detachment, loss of light perception, and the need for revision surgery, but are rare. There are also specific device risks, including overstimulation (which could cause damage to the retina) or delamination of implanted components, but these are very unlikely. Current challenges include how to improve visual acuity, enlarge the field-of-view, and reduce a complex visual scene to its most salient components through image processing. This review encompasses the work of over 40 individual research groups who have built devices, developed stimulation strategies, or investigated the basic physiology underpinning retinal prostheses. Current technologies are summarized, along with future challenges that face the field.
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3533
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Suwal B, Khadka D, Shrestha A, Shrestha S, Shrestha N, Khatri B. Baseline Predictive Factors of Visual Outcome and Persistence of Subretinal Fluid Based on Morphologic Changes in Spectral Domain Optical Coherence Tomography in Patients with Idiopathic Central Serous Chorioretinopathy. Clin Ophthalmol 2019; 13:2439-2444. [PMID: 31849441 PMCID: PMC6910099 DOI: 10.2147/opth.s233273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 11/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background To determine the influence of spectral domain optical coherence tomography (OCT) changes on visual outcome and persistence of subretinal fluid (SRF) in patients with idiopathic central serous chorioretinopathy (CSCR). Materials and methods In a retrospective study done in 48 eyes of 45 patients diagnosed as CSCR, all eyes were subjected to fundus photography, spectral domain OCT, and fluorescein angiography (FA) in selected cases. Results Retinal pigment epithelium detachment was present in 22.91% of the cases at presentation. The logMar best corrected visual acuity improved from 0.46±0.29 at presentation to 0.18±0.22 at 3 months (P-value<0.01). The mean foveal thickness was 486.81±146.06 µm at presentation and 259±94.5 µm at 3 months (P-value<0.01) (paired T-test). OCT factors that were associated with poor visual outcome (BCVA>0.3 logMar) were disruption in the inner segment (IS)/outer segment (OS) junction or external limiting membrane (ELM) line and hyper-reflective dots in the intra/subretinal layer (P-value<0.05) (Fischer’s Exact test). Out of the total 48 eyes, 26 had persistent SRF at 3 months. The presence of discontinuation in IS/OS junction and hyper-reflective dots in the intra/subretinal layer were the only two OCT factors that were associated with the persistence of SRF (P-value<0.01) (Pearson’s Chi-square test). Conclusion Visual outcome and persistence of subretinal fluid at 3 months can be predicted on the basis of early morphologic changes in OCT. This will aid in counseling patients regarding its course and may guide us in its management.
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Affiliation(s)
- Barsha Suwal
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Arjun Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Sangeeta Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Nirsara Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT and Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
| | - Bijay Khatri
- Department of Academics and Research, Hospital for Children, Eye, ENT, Rehabilitation Services (CHEERS), Lokanthali, Bhaktapur, Nepal
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3534
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De Silva MEH, Hill LJ, Downie LE, Chinnery HR. The Effects of Aging on Corneal and Ocular Surface Homeostasis in Mice. Invest Ophthalmol Vis Sci 2019; 60:2705-2715. [PMID: 31242280 DOI: 10.1167/iovs.19-26631] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Aging is a risk factor for dry eye disease. The aim of this study was to investigate if aging is associated with a range of signs of dry eye disease, including tear hyperosmolarity, reduced nerve density, and increased dendritic cell number, in mice. Method Healthy C57BL/6 female mice, aged 2 months (young, n = 10) and 22 months (aged, n = 11) were used. Clinical assessments included corneal sensitivity (Cochet-Bonnet esthesiometry), tear secretion (Phenol red thread test), tear film osmolarity (TearLab osmometer), and corneal thickness (optical coherence tomography). The sum length of the corneal superficial terminals and sub-basal nerves, density of vertical nerve projections, and density and tree area of resident epithelial dendritic cells, were assessed using immunofluorescence and confocal microscopy. Results Aged mice had significantly higher tear secretion, lower corneal sensitivity, and a thicker corneal stroma but thinner epithelium. There was no significant intergroup difference for tear osmolarity. Aged mice showed a significantly lower sum length of nerves in the superficial terminals and sub-basal plexus, relative to young mice. Dendritic cell density and morphology were similar in both groups. Conclusions In mice, aging is associated with higher tear secretion and corneal epithelial thinning, together with lower corneal nerve density and sensitivity. However, aging was not significantly associated with changes to tear osmolarity or dendritic cell density or size, despite a significant reduction in total nerve length. These findings demonstrate that aged mice exhibit some changes to ocular surface parameters that parallel the anomalies evident in dry eye disease.
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Affiliation(s)
| | - Lisa J Hill
- Neuroscience and Ophthalmology Research Group, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Laura E Downie
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Holly R Chinnery
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
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3535
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Retinal Nerve Fiber Layer in Patients with Alcohol Use Disorder. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9245331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The objectives of the present study are to determine the effects of alcohol use on the retinal nerve fiber layer (RNFL) thickness and macular thickness of abstinent patients with alcohol use disorders (AUD) and to assess whether it correlates with alcohol consumption and/or cognitive impairment. This was a prospective, observational study that included 21 patients (42 eyes) and 21 controls (42 eyes). Patients met the criteria for early remission AUD at the moment of inclusion. We used optical coherence tomography to assess retinal thickness. Macular thickness in the group of AUD patients was lower in all quadrants (p < 0.05), with the exception of the peripheral and central. Regarding the nerve fiber layer in the macular and papilla areas, we found no significant differences. At the retina ganglion cell layer and in the nerve fiber of the macula, we found significant differences in all quadrants (p < 0.05), with the exception of the superior and superior nasal area, for the right eye. For the left eye, the only differences were found in the lower quadrant. Finally, when comparing the AUD patients to the controls, we found significant reductions in the ganglion cell layer of the macula in all quadrants in the former. There was a significant correlation between these findings and cognitive impairment (measured with the Test de Detección de Deterioro Cognitivo en Alcoholismo (TEDCA)), but not with alcohol consumption. Alcohol consumption is correlated with retinal harm and related cognitive decline.
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3536
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Prokopiou E, Kolovos P, Georgiou C, Kalogerou M, Potamiti L, Sokratous K, Kyriacou K, Georgiou T. Omega-3 fatty acids supplementation protects the retina from age-associated degeneration in aged C57BL/6J mice. BMJ Open Ophthalmol 2019; 4:e000326. [PMID: 31799410 PMCID: PMC6861077 DOI: 10.1136/bmjophth-2019-000326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/28/2019] [Accepted: 09/22/2019] [Indexed: 11/03/2022] Open
Abstract
Objective To evaluate the therapeutic effects of omega-3 (ω3) fatty acids in the retina of aged mice when the blood arachidonic acid (AA)/eicosapentaenoic acid (EPA) ratio is maintained between 1.0 and 1.5. Methods and analysis Aged (24-month-old) wild-type C57BL/6J mice were allocated to two groups: ω3 treated and untreated. Treatment with ω3 was by daily gavage administration of EPA and docosahexaenoic acid for 60 days. Gas chromatography was used to identify and quantify fatty acids in the blood and retina. To count lipofuscin granules and measure the photoreceptor layer, eyecups were examined histologically using transmission electron microscopy and light microscopy. We also analysed eyecups using mass spectrometry-based proteomics. Results AA levels were lower, and EPA levels were higher, in the blood and retinas of the ω3-treated group than in the untreated group, resulting in a lower AA/EPA ratio. The ω3-treated group also showed significantly fewer lipofuscin granules and a thicker outer nuclear layer than the untreated group. Proteomic analysis revealed significantly greater expression of myelin basic protein, myelin regulatory factor-like protein, myelin proteolipid protein and glial fibrillar acidic protein in the ω3-treated group than in the untreated group. Three different pathways were significantly affected by ω3 treatment: fatty acid elongation, biosynthesis of unsaturated fatty acids and metabolic pathways. Conclusion Two months of ω3 supplementation (when the blood AA/EPA~1.0-1.5) in aged mice reduced lipofuscin granule formation in the retina and protected the photoreceptor layer, suggesting that ω3 supplementation slows normal age-related retinal degeneration.
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Affiliation(s)
- Ekatherine Prokopiou
- Ophthalmos Research and Educational Institute, Nicosia, Cyprus.,University of Nicosia Medical School, Nicosia, Cyprus
| | | | | | - Maria Kalogerou
- Ophthalmos Research and Educational Institute, Nicosia, Cyprus
| | - Louiza Potamiti
- Department of Electron Microscopy/Molecular Pathology, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kleitos Sokratous
- Department of Electron Microscopy/Molecular Pathology, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,Bioinformatics Group, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Kyriacos Kyriacou
- Department of Electron Microscopy/Molecular Pathology, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.,The Cyprus School of Molecular Medicine, Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Tassos Georgiou
- Ophthalmos Research and Educational Institute, Nicosia, Cyprus
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3537
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Asbell P, Messmer E, Chan C, Johnson G, Sloesen B, Cook N. Defining the needs and preferences of patients with dry eye disease. BMJ Open Ophthalmol 2019; 4:e000315. [PMID: 31909189 PMCID: PMC6936476 DOI: 10.1136/bmjophth-2019-000315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/04/2019] [Accepted: 11/09/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Dry eye disease is a multifactorial chronic disease, leading to ocular discomfort and visual disturbance with a substantial impact on quality of life. Therefore, the patient's perspective should be taken into account early in the drug development process. We have developed a step-by-step methodology based on the self-explicated conjoint approach to assess the needs and preferences of patients with moderate-to-severe dry eye disease. METHODS AND ANALYSIS Following a literature review and social media listening (step 0), qualitative phone call interviews were conducted with 12 patients (step 1). Patients' responses underwent content analysis and were coded, quantified and displayed as charts. Based on the emerging trends and attributes identified as relevant in steps 0 and 1, a quantitative online questionnaire was designed and conducted with 160 patients across four countries (step 2). RESULTS The online questionnaire was rated as easy/very easy to understand by 60% of respondents, 62% rated the survey as easy/very easy to complete and 71% rated it as interesting/very interesting. Treatment satisfaction was the most important aspect for patients, and the three most relevant attributes were as follows (with the most important indexed to 100%): 'treatment effectiveness on symptoms of dry eyes' (100%), 'frequency of treatment use' (96%) and 'how the treatment works' (95%). CONCLUSION Our methodology was well received by patients, and the results will help inform future clinical trial development and discussions with health technology assessment bodies and regulators on unmet needs and product attributes that are of most value to patients with dry eye disease.
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Affiliation(s)
- Penny Asbell
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Elisabeth Messmer
- Department of Ophthalmology, Ludwig Maximilians University, Munich, Germany
| | - Colin Chan
- Central Clinical School, University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | | | | | - Nigel Cook
- Global Patient Access, Novartis Pharma, Basel, Switzerland
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3538
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The Influence of Translaminar Pressure Gradient and Intracranial Pressure in Glaucoma: A Review. J Glaucoma 2019; 29:141-146. [DOI: 10.1097/ijg.0000000000001421] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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3539
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Hand GA, Giacobbi PR. A Review of Small Screen and Internet Technology-Induced Pathology as a Lifestyle Determinant of Health and Illness: A Commentary to Stevens and Egger (2019). Am J Lifestyle Med 2019; 14:122-125. [PMID: 32231474 DOI: 10.1177/1559827619890947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Gregory A Hand
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, West Virginia
| | - Peter R Giacobbi
- Department of Social and Behavioral Sciences, School of Public Health, and College of Physical Activity and Sports Sciences, West Virginia University, Morgantown, West Virginia
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3540
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Appaji A, Nagendra B, Chako DM, Padmanabha A, Jacob A, Hiremath CV, Varambally S, Kesavan M, Venkatasubramanian G, Rao SV, Webers CAB, Berendschot TTJM, Rao NP. Examination of retinal vascular trajectory in schizophrenia and bipolar disorder. Psychiatry Clin Neurosci 2019; 73:738-744. [PMID: 31400288 DOI: 10.1111/pcn.12921] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 12/11/2022]
Abstract
AIM Evidence suggests microvascular dysfunction (wider retinal venules and narrower arterioles) in schizophrenia (SCZ) and bipolar disorder (BD). The vascular development is synchronous with neuronal development in the retina and brain. The retinal vessel trajectory is related to retinal nerve fiber layer thinning and cerebrovascular abnormalities in SCZ and BD and has not yet been examined. Hence, in this study we examined the retinal vascular trajectory in SCZ and BD in comparison with healthy volunteers (HV). METHODS Retinal images were acquired from 100 HV, SCZ patients, and BD patients, respectively, with a non-mydriatic fundus camera. Images were quantified to obtain the retinal arterial and venous trajectories using a validated, semiautomated algorithm. Analysis of covariance and regression analyses were conducted to examine group differences. A supervised machine-learning ensemble of bagged-trees method was used for automated classification of trajectory values. RESULTS There was a significant difference among groups in both the retinal venous trajectory (HV: 0.17 ± 0.08; SCZ: 0.25 ± 0.17; BD: 0.27 ± 0.20; P < 0.001) and the arterial trajectory (HV: 0.34 ± 0.15; SCZ: 0.29 ± 0.10; BD: 0.29 ± 0.11; P = 0.003) even after adjusting for age and sex (P < 0.001). On post-hoc analysis, the SCZ and BD groups differed from the HV on retinal venous and arterial trajectories, but there was no difference between SCZ and BD patients. The machine learning showed an accuracy of 86% and 73% for classifying HV versus SCZ and BD, respectively. CONCLUSION Smaller trajectories of retinal arteries indicate wider and flatter curves in SCZ and BD. Considering the relation between retinal/cerebral vasculatures and retinal nerve fiber layer thinness, the retinal vascular trajectory is a potential marker for SCZ and BD. As a relatively affordable investigation, retinal fundus photography should be further explored in SCZ and BD as a potential screening measure.
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Affiliation(s)
- Abhishek Appaji
- Department of Medical Electronics, B. M. S. College of Engineering, Bangalore, India.,University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Bhargavi Nagendra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dona M Chako
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ananth Padmanabha
- Department of Medical Electronics, B. M. S. College of Engineering, Bangalore, India
| | - Arpitha Jacob
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chaitra V Hiremath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Shyam V Rao
- Department of Medical Electronics, B. M. S. College of Engineering, Bangalore, India.,University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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3541
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Chlasta-Twardzik E, Nowińska A, Wylęgała E. Comparison of the selected parameters of the anterior segment of the eye between femtosecond laser-assisted cataract surgery, microincision cataract surgery, and conventional phacoemulsification: A case-control study. Medicine (Baltimore) 2019; 98:e18340. [PMID: 31876707 PMCID: PMC6946246 DOI: 10.1097/md.0000000000018340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 10/17/2019] [Accepted: 11/13/2019] [Indexed: 11/26/2022] Open
Abstract
The purpose of our study was to compare the selected parameters of the anterior segment of the eye in patients after femtosecond laser-assisted cataract surgery (FLACS) with the results of microincision cataract surgery (MICS) and conventional phacoemulsification surgery (CPS). This single-center prospective randomized comparative observational study included 87 patients. Patients were randomly selected into group A (FLACS), group B (MICS) and group C (control group). All the surgeries were performed by the same experienced surgeon. Preoperative and postoperative parameters were evaluated: best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss percentage (ECL%), central corneal thickness (CCT), central anterior and posterior corneal astigmatism induction, posterior corneal elevation map were measured. Intraoperative parameters: effective phacoemulsification time (EPT), balanced salt solution use (BSS use), total surgical time and suction time were analyzed. Examination was performed preoperatively and on the first, seventh day, one and six months postoperatively. The follow up period was 6 months. There was no statistically significant difference in BCVA, central anterior and posterior astigmatism induction between studied groups. The ECL% was statistically significant lower in the group A on the 7th day, 1 month and 6-months postoperatively (P < .05). The CCT was statistically significant lower in the group A and in the group B than in the group C on the 7th postoperative day (P = .002). However, in the 6 months follow-up there was no statistically significant difference in the CCT between studied groups (P = .133). We observed statistically significant difference in change of the posterior corneal elevation map at the periphery assessed within the 90° to 120°meridian range between group A, group B and group C at every timepoint postoperatively (P < .05). The EPT and BSS use were statistically significant lower whilst total surgery time was statistically significant higher in the FLACS group (P < .05). To conclude in the 6 months follow-up there was statistically significant difference found between eyes undergoing FLACS, MICS and CPS with respect to the posterior corneal elevation map assessed within the studied range, ECL%, EPT, BSS use and total surgery time. Postoperative BCVA, central anterior and posterior astigmatism induction, CCT were comparable between studied groups.
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3542
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Oberhammer L, Mitterberger MJ, Lusuardi L, Kunit T, Drerup M, Colleselli D, Griessner H, Hager M. Sporadic renal hemangioblastoma: A case report of a rare benign renal tumor. Clin Case Rep 2019; 7:2321-2326. [PMID: 31893050 PMCID: PMC6935610 DOI: 10.1002/ccr3.2466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/30/2019] [Accepted: 08/27/2019] [Indexed: 11/25/2022] Open
Abstract
In renal tumors, suspicious for renal cell carcinoma, where there is any doubt and discrepancy between morphology and immune profile, we recommend performing further immunohistochemical staining for pan-cytokeratin, S100, NSE, and inhibin-alpha. Thus, follow-up overtreatment can be avoided in cases of benign kidney tumors.
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Affiliation(s)
- Lukas Oberhammer
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | | | - Lukas Lusuardi
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | - Thomas Kunit
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | - Martin Drerup
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | | | - Hubert Griessner
- Department of Urology and AndrologyUniklinikum SalzburgSalzburgAustria
| | - Martina Hager
- Department of PathologyUniklinikum SalzburgSalzburgAustria
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3543
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Jørstad ØK, Wigers AR, Marthinsen PB, Evang JA, Moe MC. Could optical coherence tomography add to the history of the pituitary incidentaloma? Acta Ophthalmol 2019; 97:e1157-e1158. [PMID: 31184420 DOI: 10.1111/aos.14151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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3544
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Bang SP, Moon K, Lee JH, Jun JH, Joo CK. Subsurface calcification of hydrophilic refractive multifocal intraocular lenses with a hydrophobic surface: A case series. Medicine (Baltimore) 2019; 98:e18379. [PMID: 31852151 PMCID: PMC6922436 DOI: 10.1097/md.0000000000018379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Opacification of monofocal intraocular lenses (IOLs) of various designs and materials has been reported. Hydrophilic acrylic IOLs are more prone to opacification than hydrophobic IOLs, but IOL surface modification by hydrophobic materials may improve biocompatibility, and few opacifications of such monofocal lenses have been reported to date. However, here we describe the characteristics of opacification of hydrophilic refractive multifocal IOLs with a hydrophobic surface modification in a cluster of patients who underwent uneventful cataract surgery. PATIENT CONCERNS In this retrospective observational case series, the medical records of 7 patients in whom opacification of the IOL was identified after implantation of LS-313 MF30 (Lentis M plus, Oculentis), from November 2017 to May 2019, were reviewed. DIAGNOSIS All patients had undergone bilateral implantation of LS-313 MF30 IOLs. Ten eyes of 7 patients showed significant opacification at a mean 49.1 ± 10.2 months postoperatively. INTERVENTIONS The IOLs of 4 cases were explanted. OUTCOMES All of the opacified cases had received LS-313 MF30 IOLs from February 2014 to August 2014 and experienced decreased visual acuity after 44.6 ± 10.5 months. The explanted IOLs of 4 cases were evaluated by scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), Alizarin-red, and von Kossa staining. These explanted IOLs showed fine and evenly distributed, whitish deposits on the entire IOL, particularly below the surface. Although the constituent of the deposits was identified as calcium by Alizarin-red and von Kossa stain, SEM, and EDX analysis showed no surface deposits of calcium. Paraffin-embedded sections of the IOLs were prepared, and calcium deposition was confirmed by EDX analysis at the subsurface region of the IOL. LESSENS Significant opacification of these hydrophilic refractive multifocal IOLs with hydrophobic surface modification was found to be due to abnormal calcification of the subsurface of the IOL. Clinicians must be aware of the opacification of this IOL design, despite surface modification. In particular, it should be noted that there is a high likelihood that the patient may experience vision-related symptoms even with moderate opacity and that opacification may lead to a burdensome IOL exchange.
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Affiliation(s)
- Seung Pil Bang
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States
| | | | | | - Jong Hwa Jun
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea
- Catholic Institute for Visual Science, Catholic University of Korea, College of Medicine, Seoul, Korea
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3545
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Hu JQ, Sarkar R, Sella R, Murphy JD, Afshari NA. Cost-Effectiveness Analysis of Multifocal Intraocular Lenses Compared to Monofocal Intraocular Lenses in Cataract Surgery. Am J Ophthalmol 2019; 208:305-312. [PMID: 30905724 DOI: 10.1016/j.ajo.2019.03.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the cost-effectiveness of multifocal intraocular lenses (IOLs) compared to that of monofocal IOLs from a societal and health care sector perspective. DESIGN Cost-effectiveness analysis. METHODS A Markov model was constructed that simulated patients who received either multifocal or monofocal IOLs during cataract surgery. Postoperatively, patients could experience spectacle dependence, glare, and haloes. Cost-effectiveness was determined by measuring the incremental cost-effectiveness ratio (ICER) as the incremental cost in dollars per quality-adjusted life year (QALY) gained. Treatments with an ICER below the standard willingness-to-pay (WTP) threshold of $50,000/QALY were considered cost effective. One-way sensitivity analyses and probabilistic sensitivity analyses were used to evaluate model sensitivity to cost, utilities, and other model inputs. RESULTS Multifocal IOLs were associated with a 0.71 QALY increase at an increased cost of $3,415 compared with monofocal IOLs, leading to an ICER of $4,805/QALY from the societal and health care sector perspectives. The cost-effectiveness model was most sensitive to patient age, probability of spectacle dependence with multifocal IOLs and monofocal IOLs, and the disutility of glasses. Probabilistic sensitivity analysis found multifocal IOLs to be the cost-effective option compared with monofocal IOLs 99.9% of the time at a WTP threshold of $50,000/QALY. CONCLUSIONS From a societal and health care perspective, multifocal IOLs would be considered a cost-effective strategy compared to monofocal IOLs for patients who desire a higher chance to be spectacle-free. However, more studies need to be conducted to further evaluate the efficacy of multifocal IOLs.
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Affiliation(s)
- Jenny Q Hu
- Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Reith Sarkar
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA; and the Clinical and Translational Research Institute, University of California San Diego, La Jolla, California, USA
| | - Ruti Sella
- Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California, USA; and the Clinical and Translational Research Institute, University of California San Diego, La Jolla, California, USA
| | - Natalie A Afshari
- Shiley Eye Institute, University of California San Diego, La Jolla, California, USA.
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3546
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Park SM, Moon BY, Kim SY, Yu DS. Diurnal variations of amplitude of accommodation in different age groups. PLoS One 2019; 14:e0225754. [PMID: 31770414 PMCID: PMC6879161 DOI: 10.1371/journal.pone.0225754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022] Open
Abstract
Clinical assessment of amplitude of accommodation (AA) involves measuring the ability of the eye to change its optical power and focus on near tasks/objects. AA gradually decreases with increasing age. However, details of age-related diurnal changes in AA are not well known. This study compared diurnal changes in AA in the adolescents, the twenties, and the forties age groups. Measurement of AA using the push-up method was performed in six sessions at two-hourly intervals for 154 subjects (48, 56, 50 subjects for the adolescents, twenties, and forties age groups, respectively); the first measurements were taken from 9:00–10:00 a.m. and the final measurements from 7:00–8:00 p.m. The mean AA was 14.67 D (highest: 16.15 D in the 3:00–4:00 p.m. session, lowest: 13.35 D in the 9:00–10:00 a.m. session) for the adolescent group; 11.13 D (highest: 11.69 D in the 3:00–4:00 p.m. session; lowest: 10.61 D in the 9:00–10:00 a.m. session) in the twenties group; and 5.53 D (highest: 5.80 D in the 1:00–2:00 p.m. session, lowest: 5.11 D in the 7:00–8:00 p.m. session) in the forties age group. The measured AA showed significant difference between sessions; however, diurnal variations were greater in the younger groups. The measured AA was low at the beginning of the day in the adolescents and twenties groups and low at the end of the day in the forties age group. All age groups showed a high AA during the afternoon hours of the day (1:00–4:00 p.m.). Since the difference between each session was larger in younger subjects, AA should be evaluated while taking the age-related diurnal variations into account.
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Affiliation(s)
- Sun-Mi Park
- Department of Optometry and Vision Science, Kyungwoon University, Gumi, Korea
| | - Byeong-Yeon Moon
- Department of Optometry, Kangwon National University, Samcheok, Korea
| | - Sang-Yeob Kim
- Department of Optometry, Kangwon National University, Samcheok, Korea
| | - Dong-Sik Yu
- Department of Optometry, Kangwon National University, Samcheok, Korea
- * E-mail:
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3547
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An evaluation of genetic causes and environmental risks for bilateral optic atrophy. PLoS One 2019; 14:e0225656. [PMID: 31765440 PMCID: PMC6876833 DOI: 10.1371/journal.pone.0225656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/08/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To assess the clinical utility of next-generation sequencing (NGS) for the diagnosis of patients with optic atrophy (OA). Design Retrospective cohort study. Methods 97 patients were referred to the McMaster University Medical Center (Hamilton, Ontario) for evaluation of bilateral OA. All patients were sent for NGS including a 22 nuclear gene panel and/or complete mitochondrial DNA (mtDNA) sequencing. Positive genetic test results and abnormal vibration sensation were compared in patients +/- environmental exposures or a family history. Results 19/94 (20.2%) had a positive nuclear variant, of which 15/19 (78.9%) were in the OPA1 gene. No positive mtDNA variants were identified. The detection of a positive genetic variant was significantly different in patients who reported excessive ethanol use, but not in patients who smoke (0/19 (0%) vs. 19/78 (24.4%), P = 0.0164 and 4/22 (18.2%) vs. 15/74 (20.3%), P = 0.829, respectively). Patients with a positive family history were more likely to have a positive genetic variant compared to patients with a negative family history (P = 0.0112). There were significantly more excessive drinkers with an abnormal vibration sensation (P = 0.026), and with a similar trend in smokers (P = 0.074). Conclusions All positive genetic variants were identified in nuclear genes. We identified a potential independent pathophysiological link between a history of excessive ethanol consumption and bilateral OA. Further investigations should evaluate and identify potential environmental risk factors for OA.
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3548
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Shoji T, Kato N, Ishikawa S, Ibuki H, Yamada N, Kimura I, Shinoda K. Association between axial length and in vivo human crystalline lens biometry during accommodation: a swept-source optical coherence tomography study. Jpn J Ophthalmol 2019; 64:93-101. [DOI: 10.1007/s10384-019-00700-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/05/2019] [Indexed: 12/14/2022]
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3549
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Patel BCK. Management of IgG4-related orbital disease: when not in doubt, cut it out? BMJ Open Ophthalmol 2019; 4:e000401. [PMID: 31750397 PMCID: PMC6830463 DOI: 10.1136/bmjophth-2019-000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Bhupendra C K Patel
- Division of Facial Cosmetic & Reconstructive Surgery, Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
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3550
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Romano F, Arrigo A, Sperti A, Bandello F, Battaglia Parodi M. Multimodal imaging of poppers maculopathy. Eur J Ophthalmol 2019; 31:NP71-NP73. [PMID: 31746225 DOI: 10.1177/1120672119887918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a case of poppers maculopathy by means of multimodal imaging. METHODS A 26-year-old male presented to our Department in April 2018 with a history of visual disturbances. He underwent a complete ophthalmologic examination, including optical coherence tomography, fundus autofluorescence, and ultra-widefield fundus photograph. RESULTS At baseline, the patient presented a visual acuity of 20/25 Snellen bilaterally, with an altered foveal reflex on funduscopic examination. Structural optical coherence tomography showed disruption of the outer retinal layers in both eyes. After 6-month observation, the status of the outer retinal layers on optical coherence tomography and his vision (20/20) appeared improved. In this occasion, we performed optical coherence tomography angiography that revealed clear and persisting choriocapillaris alterations. Upon further interrogation, he admitted the episodic use of poppers, hence leading to the diagnosis. CONCLUSION Our findings suggest that microvascular toxicity at the level of choriocapillaris may act as primary pathogenetic insult in poppers maculopathy.
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Affiliation(s)
- Francesco Romano
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.,Eye Clinic, Department of Biomedical and Clinical Science, Luigi Sacco University Hospital, Milan, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Sperti
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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