Utility values among glaucoma patients: an impact on the quality of life

AIM: To ascertain utility values and associated quality of life with different severity and duration of glaucoma among Indian patients. METHODS: Utility values of 105 consecutive patients with primary glaucoma of at least 12 months' duration were evaluated in a cross sectional study. Utility values were ascertained in five groups using both the time-trade off and standard gamble methods: group 1 (best corrected visual acuity in the better eye of 6/9 or better), group 2 (best corrected visual acuity in the better eye of 6/18 to 6/12), group 3 (best corrected visual acuity in the better eye of 6/36 to6/24), group 4 (best corrected visual acuity in the better eye of 3/60 to 6/60), and group 5 (best corrected visual acuity in the better eye of 3/60 or worse). RESULTS: The mean utility value for the glaucoma group as a whole was 0.64 (SD 0.69; 95% confidence interval (CI), 0.58 to 0.70) with the time-trade off method and 0.86 (SD 1.00; 95% CI, 0.81 to 0.90) with the standard gamble method for a gamble of death and 0.97 (SD 1.00; 95% CI, 0.94 to 0.99) for a gamble of blindness. The mean utility results by the time-trade off method were as follows: group 1 = 0.66, group 2 = 0.66, group 3 = 0.62, group 4 = 0.55, and group 5 = 0.61. The utility value was much lower (0.46) in those with no formal education or only primary education compared to those with postgraduate education (0.75) (p = 0.038). Those patients with glaucoma of less than 5 years' duration had a utility score of 0.62 while those with glaucoma for more than 10 years had a score of 0.74 (p = 0.40). CONCLUSIONS: Visual acuity loss occurring secondary to glaucoma is associated with a substantial decrease in patient utility value (and quality of life) in a developing country like India. The utility value is directly dependent on the degree of visual acuity loss associated with the disease and educational status and not on the duration of disease, the number of medications, or the visual field indices.     

Long-term assessment of prostaglandin analogs and timolol fixed combinations vs prostaglandin analogs monotherapy

AIM: To draw a Meta-analysis over the comparison of the intraocular pressure (IOP)-lowering efficacy and safety between the commonly used fixed-combinations of prostaglandin analogs and 0.5% timolol with prostaglandin analogs (PGAs) monotherapy. METHODS: After searching the published reports from MEDLINE, EMBASE, the Cochrane Library, all randomized controlled clinical trials (RCTs) comparing the fixed combination of PGAs/timolol therapy (FCs) and PGAs monotherapy with treatment duration at least 6mo were included. The efficacy outcomes were mean diurnal IOP, percentage of participants whose IOP were lower than 18 mm Hg, incidence of visual field change, while the safety outcomes included corneal side effects, hyperemia and eye irritation. The analysis was carried out in RevMan version 5.3 software. RESULTS: After six-month medical intervention, the mean diurnal IOP of FCs was lower than PGAs (MD -1.14, 95% CI -1.82 to -0.46, P=0.001); the percentage of target IOP achieving between FCs and PGAs showed no significant difference (RR 1.18, 95% CI 0.97 to 1.43, P=0.10). No statistically significant differences of the incidence of hyperemia (RR 0.67, 95% CI 0.45 to 1.01, P=0.06) and eye irritation (RR 1.20, 95% CI 0.95 to 1.51, P=0.12) between the FCs and PGAs monotherapy were detected. Only one research involved in corneal events, result of this trial revealed no difference between two intervention groups regarding corneal effects (central endothelial cell density, MD -0.20, 95% CI -0.72 to 0.32, P=0.45; central corneal thickness, MD -0.01, 95% CI -0.02 to 0.00, P=0.23). The evaluation of visual field change was not performed due to the limited duration of the trials included in this Meta-analysis. CONCLUSION: The long-term efficacy of the FCs overweighed the PGAs monotherapy in lowering IOP, but in the incidence of hyperemia and eye irritation syndromes, the differences are not statically significant. More RCTs with detailed and authentic data over the assessments of visual functions and morphology of optic nerve heads are hoped to be conducted.     

Streptococcal keratitis after myopic laser in situ keratomileusis

A 24-year-old healthy male underwent uncomplicated laser in situ keratomileusis (LASIK) in left eye. One day after the surgery, he complained of ocular pain and multiple corneal stromal infiltrates had developed in left eye. Immediately, the corneal interface and stromal bed were cleared, and maximal antibiotic treatments with fortified tobramycin (1.2%) and cefazolin (5%) were given topically. The causative organism was identified as 'Streptococcus viridans' both on smear and culture. Two days after antibiotic therapy was initiated, the ocular inflammation and corneal infiltrates had regressed and ocular pain was relieved. One month later, the patient's best corrected visual acuity had returned to 20/20 with -0.75 -1.00 x 10 degrees, however minimal stromal scarring still remained. This case demonstrates that microbial keratitis after LASIK, if treated promptly, does not lead to a permanent reduction in visual acuity.     

A comparison of anterior and posterior chamber lenses after cataract extraction in rural Africa: a within patient randomised trial

BACKGROUND: Extracapsular cataract extraction (ECCE) with a posterior chamber intraocular lens (PC IOL) is the preferred method of cataract surgery in developed countries. However, intracapsular cataract extraction (ICCE) with an anterior chamber lens (AC IOL) may be appropriate in rural Africa. A randomised controlled trial was carried out to compare these surgical strategies. METHODS: Participants over 50 years requiring bilateral cataract surgery were recruited from outreach clinics in rural north and east Uganda. One eye was randomly allocated to AC IOL or PC IOL, the other eye being allocated to the second strategy. The main outcome measure was WHO distance visual acuity (VA) category after a minimum of 1 year. Secondary outcomes were numbers and causes of complications and refractive corrections. RESULTS: Of the 110 participants recruited, 98 (89%) were assessed at least 1 year after the operation (median follow up 17.5 months). Nine eyes randomised to PC IOL were converted to AC IOL; one eye randomised to AC IOL inadvertently received PC IOL. There was no difference in VA between 95 pairs of eyes for which data for both eyes were available (uncorrected VA, p = 0.26; corrected VA, p = 0.59). 80 (82%, 95% CI 73 to 89) and 82 (84%, 95% CI 75 to 90) eyes randomised to AC IOL and PC IOL respectively had corrected VA of 6/18 or better. 16 (16%, 95% CI 10 to 25) and eight (8%, 95% CI 4 to 15) eyes respectively had secondary procedures or other complications. CONCLUSIONS: Where both strategies are available, ECCE with PC IOL should be first choice because of fewer complications. Where ECCE with PC IOL is not immediately feasible, ICCE with AC IOL is an acceptable interim technique.     

Overnight orthokeratology-associated microbial keratitis

PURPOSE: This study was designed to report the clinical aspects, microbiologic findings, and treatment outcomes of overnight orthokeratology-associated microbial keratitis. METHODS: Medical records of patients with overnight orthokeratology-associated microbial keratitis at National Taiwan University Hospital from August 2000 to October 2001were reviewed. The clinical and microbiologic characteristics and treatment outcomes were investigated. RESULTS: Nine patients (in total 10 eyes) from aged 8 to 17 (mean, 12.3 +/- 2.9) years were included in this study. Eight patients had a unilateral infection and one had a bilateral infection. The initial best corrected visual acuities ranged from hand motion to 20/20. The lesions were located at the central cornea in nine eyes (90%). Smears and cultures from corneal scrapings were obtained from all patients. Four eyes were culture-positive, which included nonfermentative Gram-negative bacillus, Pseudomonas aeruginosa and Acanthamoeba. Positive smears from another two eyes revealed Gram-negative bacilli and double-walled cyst. All patients were cured using antimicrobial medications with complete re-epithelization and disappearance of corneal infiltrates. Four eyes had a final best corrected visual acuity of 20/30 or worse after a mean follow-up of 9.4 months, including one eye that had visual acuity of hand motion only. Complications included corneal opacity in all eyes, glaucoma in one eye, and cataract in one eye. CONCLUSIONS: Overnight orthokeratology is an important risk factor of microbial keratitis, especially in school children. Acanthamoeba and Gram-negative bacilli, especially Pseudomonas aeruginosa, are the most common pathogens in our series. The risk of microbial keratitis after overnight orthokeratology should not be overlooked.     

Blindness, visual impairment and the problem of uncorrected refractive error in a Mexican-American population: Proyecto VER

PURPOSE: To report the prevalence of blindness and visual impairment and the contribution of uncorrected refractive error to visual loss, in a population-based sample of Mexican Americans aged 40 and older. METHODS: Proyecto VER is a population-based study of blindness and visual impairment in Mexican Americans in Arizona. Block groups in Tucson and Nogales were randomly selected with probability proportional to the size of the Mexican-American population aged 40 and older. Participants had a complete ophthalmic evaluation, including assessment of presenting and best corrected visual acuity using standardized procedures. Those with presenting visual acuity worse than 20/30 had refraction to determine best corrected vision. A home questionnaire and a clinic examination provided data on education, perception of visual impairment, income, and acculturation. RESULTS: The prevalence of presenting visual acuity worse than 20/40 was 8.2%, with uncorrected refractive error accounting for 73% of the impaired acuity. In multivariate models comparing those who improved two or more lines on the acuity chart with proper refraction with those who had adequate optical correction, uncorrected refractive error showed a strong association with age, less than 13 years of education (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.5-2.0), low acculturation index (OR 1.3, CI 1.1-1.3), lack of insurance coverage (OR 1.4, CI 1.1-1.7), and not having seen an eye-care provider in the past 2 years (OR 2.5, CI 2.1-3.0). Prevalence of best corrected acuity worse than 20/40 increased from 0.3% in those aged 40 to 49 years to 18% in those aged 80 years or more. CONCLUSIONS: Visual loss in this Mexican-American population is higher than has been reported in whites and is comparable to that in African Americans. Almost three quarters of those with visual acuity impairment would improve with optical correction. Socioeconomic factors that are probable markers of limited access to health care services were associated with uncorrected refractive error. These data suggest that education programs and interventions to improve access to eye care could significantly decrease the burden of visual loss among Mexican Americans.     

Blindness and vision impairment in the elderly of Papua New Guinea

BACKGROUND: To estimate the magnitude and causes of blindness and vision impairment in Papua New Guinea for service delivery planning and ophthalmic education development. METHODS: Using the World Health Organization standardized Rapid Assessment of Cataract Surgical Services protocol, a population-based cross-sectional survey was conducted in 2005. By systematic, two-stage cluster random sampling, 39 clusters each of 30 people aged 50 years and over were selected from urban and rural locations. A cause of vision loss was determined for each eye with a presenting visual acuity worse than 6/18. RESULTS: Of the 1191 people enumerated, 1174 were examined (98.6%). The 50 years and older age-gender adjusted prevalence of vision impairment (presenting visual acuity less than 6/18 in the better eye) was 29.2% (95% Confidence Interval [CI]: 27.6, 35.1, Design Effect [deff] = 2.3). That of functional blindness (presenting visual acuity less than 6/60 in the better eye) was 8.9% (95% CI: 8.4, 12.0, deff = 1.2), and of World Health Organization blindness (but presenting, rather than best corrected, visual acuity of less than 3/60 in the better eye) was 3.9% (95% CI: 3.4, 6.1, deff = 1.0). Uncorrected refractive error (13.1%, 95% CI: 11.3, 15.1, deff = 1.2) and cataract (7.4%, 95% CI: 6.4, 10.2, deff = 1.3) were leading causes of vision impairment, age-gender adjusted. Cataract was the most common (age-gender adjusted 6.4%, 95% CI: 5.1, 7.3, deff = 1.1) cause of functional blindness. On bivariate analysis, increasing age (P < 0.001), illiteracy (P < 0.001) and unemployment (P < 0.001) were associated with functional blindness. Gender was not. CONCLUSIONS: The identification and treatment of refractive error and cataract need to be priorities for eye health services in Papua New Guinea if the burden of vision impairment and blindness is to be diminished. The education of community and hospital eye care providers, whether medical, nursing or other cadres, must emphasize these. Eye care services must be structured and provided to allow and encourage accessibility and uptake, with satisfactory treatment outcomes for these conditions.     

Risk factors for treatment failure of anisometropic amblyopia.

PURPOSE: This study sought to explore factors which might predict the lack of vision improvement following therapy of anisometropic amblyopia. METHODS: We retrospectively reviewed the records of 104 children aged 3 to 8 years who had anisometropic amblyopia with a difference in the refractive power between the two eyes of at least 1 diopter, a difference in corrected visual acuity between the two eyes of at least 3 logMAR units, visual acuity in the amblyopic eye of 20/50 or worse, and no ocular structural abnormalities. Patients were treated with either patching or atropine penalization therapy. Patients with strabismus were included. Treatment failure was defined in two ways: (1) functional failure indicating a final visual acuity in the amblyopic eye worse than 20/40 and (2) relative failure indicating less than three lines of logMAR visual acuity improvement regardless of final vision. RESULTS: Failure risk factors were as follows: age above 6 at the onset of treatment (adjusted odds ratio [OR] (95% confidence limits [CL] = 4.69 [1.55, 14.2]), the presence astigmatism of more than 1.50 diopters in the amblyopic eye (adjusted [OR] (95% CL) = 5.78 [1.27, 26.5]), poor compliance with treatment (adjusted [OR] (95% CL) = 5.47 [1.70, 17.6]), and initial visual acuity in the amblyopic eye of 20/200 or worse (adjusted [OR] (95% CL) = 3.79 [1.28, 11.2]). Strabismus was not found to be a significant risk factor. Neither the type or amount of refractive error nor the difference in the refractive power between the two eyes was a significant risk factor for treatment failure. CONCLUSION: Eyes with poor initial visual acuity, the presence of significant astigmatism, and age over 6 years were less likely to achieve successful outcome. The clinical profile of patients with anisometropic amblyopia may be useful in predicting response to therapy, but compliance with treatment has a major effect on response to therapy.     

Cataract extraction outcomes in patients with Fuchs' heterochromic cyclitis

PURPOSE: To analyze the visual outcomes and complication rate after cataract extraction and posterior chamber intraocular lens (PC IOL) implantation in patients with Fuchs' heterochromic cyclitis. SETTING: L.V. Prasad Eye Institute, Hyderabad, India. METHODS: This retrospective nonrandomized interventional study comprised 103 patients who were examined at the uvea clinic at L.V. Prasad Eye Institute between March 2000 and March 2004 and who were diagnosed with Fuchs' heterochromic cyclitis and cataract. They had extracapsular cataract extraction or phacoemulsification with IOL implantation. Outcomes measures were postoperative visual acuity, ocular inflammation, and complication rate. RESULTS: There were 57 men and 54 women in the study; the mean age was 31.36 years +/- 11.55 (SD) (range 10 to 60 years). Postoperative best corrected visual acuity (BCVA) at 5 weeks was 20/40 or greater in 91 patients (88.3%) (95% confidence interval [CI], 82.1-94.5). Eight patients (7.8%) had vitreous inflammation 5 weeks postoperatively. Five patients (4.9%) preoperatively and 3 patients (2.9%) postoperatively had elevated intraocular pressure. Clinically detected cystoid macular edema developed in 1 patient. The mean follow-up was 12.9 months in 53 patients. At the final follow-up, 49 of 53 patients (91.5%) (95% CI, 99.0-84.0) had a visual acuity of 20/40 or greater. Ten eyes (18.9%) had mild anterior chamber reaction. Decreased visual acuity (20/40 or worse) was the result of anterior chamber reaction in 4 patients, glaucoma in 3 patients, vitreous inflammation in 2 patients, and posterior capsule opacification, corneal edema, macular hole, and astigmatism in 1 patient each. CONCLUSIONS: Cataract surgery with PC IOL implantation in patients with Fuchs' heterochromic cyclitis resulted in good visual outcomes. Postoperative inflammation was mild and developed in few cases.     

Nontraumatic corneal perforation

PURPOSE: To study the predisposing conditions, treatments, and visual outcomes of nontraumatic corneal perforations. METHODS: A retrospective chart review was conducted of all nontraumatic corneal perforations seen between January 1992 and December 1998, with > or = 3 months of follow-up, at the Cornea Service Wills Eye Hospital. RESULTS: A total of 40 nontraumatic corneal perforations was analyzed. Sixty-two percent of the cases were female. At presentation, 35 of 40 eyes (87.5%) had best corrected visual acuity of 20/200 or worse. The most common diseases associated with perforations were keratoconjunctivitis sicca (12 eyes, 30%), bacterial keratitis (6 eyes, 15%), exposure keratopathy (5 eyes, 12.5%), and herpes simplex virus (HSV) keratitis (4 eyes, 10%). Visual acuity improved > or = 2 Snellen lines in 3 of 8 eyes (37.5%) treated with penetrating keratoplasty, 5 of 14 eyes (35.7%) treated with tissue adhesive, and 1 of 12 eyes (8.3%) given medical treatment. After allowing for the different levels of presenting vision, treatment modality was not significantly related to final visual outcome. CONCLUSION: Keratoconjunctivitis sicca is the most common underlying disease associated with nontraumatic corneal perforation. Corneal perforations were managed successfully using tissue adhesive, medical therapy, or penetrating keratoplasty. Treatment depended on the characteristics of the perforation and on the visual potential of the eye.     

Mitomycin C application after photorefractive keratectomy in high,moderate, or low myopia: Systematic review and meta-analysis

Photorefractive keratectomy (PRK) is considered a safe approach laser procedure with a clinical significance in correcting myopia results. PRK requires removing the whole superficial epithelium. The integrity of the epithelial basement membrane and the deposition of abnormal extracellular matrix can put the cornea in a probable situation for corneal haze formation. Mitomycin C (MMC) is applied after excimer laser ablation as a primary modulator for wound healing, limiting corneal haze formation. We aim to summarize the outcomes of MMC application after laser ablation. We searched Scopus, PubMed, Cochrane CENTRAL, and Web of Science till December 2020 using relevant keywords. The data were extracted and pooled as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI), using Review Manager software (version 5.4). Our analysis demonstrated a statistically significant result for MMC application over the control group in terms of corneal haze formation postoperatively (RR = 0.29, 95% CI: [0.19, 0.45], P < 0.00001). Regarding corrected distance visual acuity (CDVA), no significant difference was observed between the MMC group and the control group (MD = 0.02; 95% CI: [-0.04, 0.07]; P = 0.56). Regarding the uncorrected distance visual acuity (UDVA), the analysis favored the MMC application with (MD -0.03, 95% CI: [-0.06, -0.00]; P = 0.05). There was no statistically significant increase in complications with MMC. In conclusion, MMC application after PRK is associated with a lower incidence of corneal haze formation with no statistically significant side effects. The long term effect can show improvement regarding UDVA favoring MMC. However, there is no significant effect of MMCs application regarding CDVA, and SE.     

Utility values and diabetic retinopathy.

PURPOSE: To ascertain the utility values associated with diabetic retinopathy and varying degrees of visual loss. METHODS: One hundred consecutive patients with diabetic retinopathy and best-corrected visual acuity decreased to 20/40 or worse in at least one eye occurring primarily as a result of diabetic retinopathy were evaluated in a cross-sectional study. Utility values were ascertained in five groups using both the time trade-off and standard gamble methods: group 1 (best-corrected visual acuity in the better eye of 20/20 to 20/25), group 2 (best-corrected visual acuity in the better eye of 20/30 to 20/50), group 3 (best-corrected visual acuity in the better eye of 20/60 to 20/100), group 4 (best-corrected visual acuity in the better eye of 20/200 to 20/400), and group 5 (best-corrected visual acuity in the better eye of counting fingers to hand motions). RESULTS: The mean utility value for the diabetic retinopathy group as a whole was 0.77 (SD = 0.21; 95% confidence interval [CI], 0.73 to 0.81) with the time trade-off method and 0.88 (SD = 0.20; 95% CI, 0.84 to 0.92) with the standard gamble method. Employing the time trade-off method correlated with the best-corrected visual acuity in the better eye, the mean utility results were as follows: group 1 = 0.85 (95% CI, 0.75 to 0.95), group 2 = 0.78 (CI, 0.72 to 0.84), group 3 = 0.78 (CI, 0.67 to 0.89), group 4 = 0.64 (CI, 0.53 to 0.75), and group 5 = 0.59 (CI, 0.23 to 0.95). Thus, patients in group 1 (best-corrected visual acuity of 20/20 to 20/25 in the better eye) were willing to trade a mean of 15% of their remaining years of life in return for perfect vision in each eye, whereas those in group 5 (best-corrected visual acuity of counting fingers to hand motions in the better eye) were willing to trade a mean of 41% of their remaining years in return for perfect vision in each eye. There was no significant difference in mean utility values between patients who had decreased visual acuity from diabetic retinopathy for 1 year or less compared with those with decreased acuity for more than 1 year. There was also no significant difference in mean utility values between those with a 12th grade education or less compared with those with more than a 12th grade education. CONCLUSION: Visual loss occurring secondary to diabetic retinopathy is associated with a substantial decrease in patient utility value (and quality of life). The utility value is directly dependent on the degree of visual loss associated with the disease. The length of time of visual loss and amount of formal education do not appear to affect the utility value.     

Does identification of the causal organism of corneal ulcers influence the outcome?

PURPOSE: To investigate whether identification of the causal organism in corneal ulcers influences their outcome. METHODS: We retrospectively studied 114 patients, 72 males and 42 females aged 6-89 years, admitted to this eye clinic during the years 1994-2000 on account of an infectious corneal ulcer. Their examination included a detailed history, visual acuity measurement, and biomicroscopy in everyday follow-up. The ulcers were classified according to their severity and outcome. We assessed the cases where cultures had been done, reviewed the results, and searched for a possible correlation between the outcome and the fact of culturing the ulcer and identifying the causal organism. RESULTS: Of the 114 corneal ulcers studied, 23 were mild, 49 moderate, and 42 severe. Fifty (44%) had not been cultured, but 64 ulcers (56%) had been cultured, with a positive result in 37 cases (58%), Staphylococcus and Pseudomonas species being the most common organisms found. In moderate and severe ulcers, there was a tendency to a higher proportion of successful outcome for cultured ulcers, but with no significant correlation. CONCLUSIONS: Despite a tendency towards favorable results in culture-positive corneal ulcers, the influence of the detection of the organism on their outcome has not been proved. The role of the initial broad-spectrum antibiotic therapy remains important.     

Pellucid marginal corneal degeneration: report on corrective surgery

A successful corneal wedge resection was performed to correct the visual impairment in the left eye of a 30-year-old male who suffered from bilateral pellucid marginal degeneration. The patient had visual impairment in both eyes; it was worse in the left. Best corrected visual acuity in the left eye before surgery was 20/800 with 15.5 diopters (D) of corneal astigmatism. After surgery, corrected visual acuity was 20/50+, and astigmatism was reduced to 5.0 D. Further reduction in astigmatism from 5.0 D to 3.0 D was achieved by horizontal corneal relaxing incisions at the 3 o'clock and 9 o'clock positions. I believe this is the first report of the wedge resection procedure to correct visual impairment in pellucid marginal degeneration. The procedure may be an effective surgical treatment for this unique disorder.     

Efficiency and safety of laser photocoagulation with or without intravitreal ranibizumab for treatment of diabetic macular edema: a systematic review and Meta-analysis

AIM: To compare the therapeutic effect and safety of laser photocoagulation along with intravitreal ranibizumab (IVR) versus laser therapy in treatment of diabetic macular edema (DME). METHODS: Pertinent publications were identified through comprehensive searches of PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov to identify randomized clinical trials (RCTs) comparing IVR+laser to laser monotherapy in patients with DME. Therapeutic effect estimates were determined by weighted mean differences (WMD) of change from baseline in best corrected visual acuity (BCVA) and central retinal thickness (CRT) at 6, 12, or 24mo after initial treatment, and the risk ratios (RR) for the proportions of patients with at least 10 letters of improvement or reduction at 12mo. Data regarding major ocular and nonocular adverse events (AEs) were collected and analyzed. The Review Manager 5.3.5 was used. RESULTS: Six RCTs involving 2069 patients with DME were selected for this Meta-analysis. The results showed that IVR+laser significantly improved BCVA compared with laser at 6mo (WMD: 6.57; 95% CI: 4.37-8.77; P<0.00001), 12mo (WMD: 5.46; 95% CI: 4.35-6.58; P<0.00001), and 24mo (WMD: 3.42; 95% CI: 0.84-5.99; P=0.009) in patients with DME. IVR+laser was superior to laser in reducing CRT at 12mo from baseline with statistical significance (WMD: -63.46; 95% CI: -101.19 to -25.73; P=0.001). The pooled RR results showed that the proportions of patients with at least 10 letters of improvement or reduction were in favor of IVR+laser arms compared with laser (RR: 2.13; 95% CI: 1.77-2.57; P<0.00001 and RR: 0.37; 95% CI: 0.22-0.62; P=0.0002, respectively). As for AEs, the pooled results showed that a significantly higher proportion of patients suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye) in IVR+laser group compared to laser group (RR: 3.29; 95% CI: 1.53-7.09; P=0.002 and RR: 3.02; 95% CI: 1.24-7.32; P=0.01, respectively). The incidence of other ocular and nonocular AEs considered in this Meta-analysis had no statistical difference between IVR+laser and laser alone. CONCLUSION: The results of our analysis show that IVR+laser has better availability in functional (improving BCVA) and anatomic (reducing CRT) outcomes than laser monotherapy for the treatment of DME. However, the patients who received the treatment of IVR+laser may get a higher risk of suffering from conjunctival hemorrhage (study eye) and diabetic retinal edema (fellow eye).     

Changes in visual acuity in a population over a 10-year period : The Beaver Dam Eye Study

PURPOSE: To describe the change in visual acuity in a 10-year period. DESIGN: Population-based cohort study. PARTICIPANTS: Included 3684 persons 43 to 86 years of age at the time of a baseline examination in 1988 to 1990, living in Beaver Dam, Wisconsin, at a follow-up examination in 1993 to 1995 and/or 1998 to 2000. METHODS: Best-corrected visual acuity was measured, after refraction, with logarithm of the minimum angle of resolution charts using a modification of the Early Treatment Diabetic Retinopathy Study protocol. MAIN OUTCOMES MEASURES: Doubling of the visual angle and incidence of visual impairment. RESULTS: The change in the mean number of letters read correctly over the 10-year period varied in the right eye from -0.9 (standard deviation [SD] = 5.5) and in the left eye from -1.2 (SD = 6.6) in people between 43 and 54 years of age to -11.0 (SD = 20.0) in the right eye and -12.6 (SD = 20.4) in the left eye in people 75 years of age or older (n = 184) at baseline. Over the 10-year period, 5.9% of the population had impaired vision (20/40 or worse in the better eye) develop, 0.8% had severe visual impairment (20/200 or worse in the better eye) develop, 4.8% had doubling of the visual angle, and 3.9% had improved vision. People who were 75 years of age or older at baseline were 15.0 times (95% confidence interval [CI], 10.9-20.6; P < 0.001) as likely to have impaired vision develop, 9.3 times (95% CI, 6.5-13.3; P < 0.001) as likely to have doubling of the visual angle, and 19.8 times as likely (95% CI, 8.4-46.4; P < or = 0.001) to have severe visual impairment develop than people younger than 75 years of age at baseline. For the 82 persons 75 years of age or older, currently residing in a nursing or group home at follow-up, they were 2.6 times (95% CI, 1.45-4.52) as likely to have impaired vision develop, 1.6 times (95% CI, 0.47-5.62) as likely to have severely impaired vision develop, and 3.6 times (95% CI, 1.96-6.78) as likely to have had a doubling of the visual angle than those not residing in a nursing or group home at follow-up. CONCLUSIONS: These data provide precise population-based estimates of the 10-year incidence of loss of vision over a wide spectrum of ages and show that decreased visual acuity in people 75 years of age after 10 years is a common finding, especially in those who are admitted to nursing or group homes.     

超声乳化术治疗高度近视并发性白内障术后视力恢复的影响因素

目的　分析超声乳化术治疗高度近视并发性白内障术后视力恢复的影响因素。方法　对６３例（８７眼）高度近视并发性白内障患者行超声乳化联合人工晶状体植入术,术后随访３个月,分别测量患者视力、最佳矫正视力及眼底检查,术后最佳矫正视力分为＜０．３和≥０．３两个等级,并用Ｌｏｇｉｓｔｉｃ回归分析年龄、近视病史时间、术前眼轴长度、术前角膜散光度、术前角膜屈光度、玻璃体后脱离、后巩膜葡萄肿及黄斑病变多种因素对术后视力恢复的影响。结果　术后２周视力:裸眼视力:＜０．３者４５眼（５１．７２％）,≥０．３者４２眼（４８．２８％）;最佳矫正视力:＜０．３者３２眼（３６．７８％）,≥０．３者５５眼（６３．２２％）。术后３个月视力:裸眼视力:＜０．３者３８眼（４３．６８％）,≥０．３者４９眼（５６．３２％）;最佳矫正视力:＜０．３者２３眼（２６．４４％）,≥０．３者６４眼（７３．５６％）。术后最佳矫正视力＜０．３和≥０．３组比较,眼轴长度、角膜散光度、黄斑病变差异均有统计学意义（均为＜０．０５）。黄斑病变（ＯＲ:８．０６,９５％ＣＩ:１．７５～３７．０７）、角膜散光度（ＯＲ:３．８７,９５％ＣＩ:１．２０～１２．４８）和眼轴长度（ＯＲ:１．５０,９５％ＣＩ:１．０９～２．０６）是术后矫正视力恢复的独立影响因素;有黄斑病变者术后矫正视力预后差;随着角膜散光度和眼轴长度的增加,术后矫正视力恢复差;其他因素尚不能认为是术后视力恢复的独立影响因素。结论　超声乳化术治疗高度近视并发性白内障是安全有效地,伴随黄斑病变、角膜散光度过大和眼轴过长是超声乳化术治疗高度近视并发性白内障术后低视力的独立影响因素,影响强度:黄斑病变＞角膜散光度过大＞眼轴过长。     

Consequences of amblyopia on education, occupation, and long term vision loss

AIMS: To describe the effect of amblyopia on education, occupation, and 5 year incident vision loss. METHODS: 3654 participants aged 49 years or older participated in the Blue Mountains Eye Study (BMES I, 1992-4) and 2335 (75.1% of survivors) were re-examined (BMES II, 1997-9). All participants underwent detailed eye examination. Amblyopia, defined as best corrected visual acuity of less than or equal to 6/9 and not attributable directly to any underlying structural abnormality of the eye or the visual pathway, was identified in 118 participants (3.2%) in BMES I, of whom 73 were re-examined in BMES II. Occupation and educational classifications used definitions of the Australian Bureau of Statistics. RESULTS: The mean age of people with amblyopia seen at baseline was 67.0 years. Amblyopia did not affect lifetime occupational class (p = 0.5), but fewer people completed higher university degrees (p = 0.05). In people with amblyopia, there was an increased risk of 5 year incident visual impairment in the better seeing eye worse than 6/12, relative risk (RR) 2.7, 95% confidence interval (CI) 1.6 to 4.6. One of 11 (9.1%) people with amblyopia showed significant improvement in visual acuity in the poorer seeing eye after a two line (10 logMAR letter) vision loss in the better seeing eye. CONCLUSION: This study further documents the longitudinal history of amblyopia using population based data.     

The epidemiology of ocular trauma in rural Nepal

AIMS: To estimate the incidence of ocular injury in rural Nepal and identify details about these injuries that predict poor visual outcome. METHODS: Reports of ocular trauma were collected from 1995 through 2000 from patients presenting to the only eye care clinic in Sarlahi district, Nepal. Patients were given a standard free eye examination and interviewed about the context of their injury. Follow up examination was performed 2-4 months after the initial injury. RESULTS: 525 cases of incident ocular injury were reported, with a mean age of 28 years. Using census data, the incidence was 0.65 per 1000 males per year, and 0.38 per 1000 females per year. The most common types of injury were lacerating and blunt, with the majority occurring at home or in the fields. Upon presentation to the clinic, 26.4% of patients had a best corrected visual acuity worse than 20/60 in the injured eye, while 9.6% had visual acuity worse than 20/400. 82% were examined at follow up: 11.2% of patients had visual acuity worse than 20/60 and 4.6% had vision worse than 20/400. A poor visual outcome was associated with increased age, care sought at a site other than the eye clinic, and severe injury. 3% of patients were referred for further care at an eye hospital at the initial visit; 7% had sought additional care in the interim between visits, with this subset representing a more severe spectrum of injuries. CONCLUSIONS: The detrimental effects of delayed care or care outside of the specialty eye clinic may reflect geographic or economic barriers to care. For optimal visual outcomes, patients who are injured in a rural setting should recognise the injury and seek early care at a specialty eye care facility. Findings from our study suggest that trained non-ophthalmologists may be able to clinically manage many eye injuries encountered in a rural setting in the "developing" world, reducing the demand for acute services of ophthalmologists in remote locations of this highly agricultural country.     

Utility assessment among cataract surgery patients

PURPOSE: To evaluate the utility values (time trade-off, standard gamble for death, standard gamble for blindness) of patients scheduled for cataract surgery. SETTING: Tertiary eye hospital in Singapore. METHODS: Questions on time trade-off, standard gamble for death, standard gamble for blindness utilities, and visual function from an adapted version of the VF-14 were asked in a clinic interview of 217 Chinese patients. RESULTS: The mean utility time trade-off of cataract surgery patients was 0.77 (95% confidence interval [CI] 0.76, 0.78), mean standard gamble for death was 0.77 (95% CI 0.77, 0.78), and mean standard gamble for blindness was 0.76 (95% CI 0.75, 0.77). Adults with lower VF-14 scores had lower utilities, although there was no relationship between visual acuity and utilities. Utilities were also lower in patients who reported difficulty seeing in bright light. CONCLUSIONS: The utilities of cataract patients scheduled for surgery were comparable to those in patients with other chronic ocular diseases. Cataract surgery patients with lower utilities tended to have worse visual function and greater difficulty seeing in bright light.