Incidence and prevalence of glaucoma in severe ocular surface disease

PURPOSE: To describe the incidence and prevalence of glaucoma in a patient population with severe ocular surface disease (OSD). METHODS: A retrospective case series was compiled from all charts of patients in the Cincinnati Eye Institute/University of Cincinnati and University of Minnesota population with a diagnosis of severe OSD from 1991 to 2003. The incidence and prevalence of glaucoma in the overall patient population were identified, and stratified into disease subgroups. RESULTS: Of the 108 eyes evaluated in this study, 71 were diagnosed with glaucoma. The overall prevalence of glaucoma in patients with severe OSD is 65.7%, with a range from 42.9% to 88.4%. Analysis by subgroup shows the highest percentage of patients with concurrent glaucoma fall into the categories of aniridia and chemical injury, and the lowest was noted in those patients with autoimmune or iatrogenic OSD. Overall, the incidence of glaucoma was 20.4%, with a range of 13.6% to 60%. CONCLUSIONS: Compared with previous studies, our results show a significantly higher prevalence of glaucoma in patients with severe OSD. This information warrants increased attention to treatment and management of OSD and concurrent glaucoma.     

Incidence and prevalence of short wavelength automated perimetry deficits in ocular hypertensive patients

PURPOSE: To determine the prevalence and incidence of short wavelength automated perimetry deficits in comparison to standard automated perimetry deficits in patients with ocular hypertension. METHODS: Five hundred eyes of 250 patients with ocular hypertension were recruited into a prospective, longitudinal study and tested with standard automated perimetry and short wavelength automated perimetry annually for 5 years. Both eyes of 60 normal subjects, 21 to 85 years of age, were used to establish normative data for short wavelength automated perimetry and standard automated perimetry. This allowed independent evaluation of left and right eyes of patients. All normal data were corrected for age, and short wavelength automated perimetry results were corrected for lens transmission. The lowest fifth and first percentiles for the normal observers were derived for the 10 glaucoma hemifield test zones for short wavelength automated perimetry and standard automated perimetry. Visual fields were considered outside normal limits if two glaucoma hemifield test zones were below the normal fifth percentile or one glaucoma hemifield test zone was below the normal first percentile. RESULTS: Baseline prevalence of short wavelength automated perimetry and standard automated perimetry deficits were 9.4% and 1.4%, respectively. During the study, incident rates of field loss were 6.2% (1.23% per year) for short wavelength automated perimetry and 5.9% (1.18% per year) for standard automated perimetry. Once abnormal, 80% of short wavelength automated perimetry fields remained abnormal on the next examination, whereas only 45% of abnormal standard automated perimetry fields remained abnormal. New short wavelength automated perimetry deficits in ocular hypertensives were more prominent and more persistent than new standard automated perimetry deficits. CONCLUSIONS: Our findings are consistent with the interpretation that short wavelength automated perimetry deficits occur before standard automated perimetry deficits in glaucoma. The similar incidence rates suggest that both standard automated perimetry and short wavelength automated perimetry are monitoring the same underlying glaucomatous disease process.     

Incidence of manifest glaucoma.

The incidence of manifest glaucoma was determined by means of repeated automatic perimetry in a defined general population. It was estimated at 0.24% per year. It was largely independent of age but higher in women than in men and higher in the countryside than in the villages. In fact the incidence of manifest glaucoma was five times higher among women in the countryside than among men in the villages.     

Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study

PURPOSE: To determine the incidence and prevalence of uveitis in a large, well-defined population in Northern California. DESIGN: Cross-sectional study using retrospective database and medical record review. PARTICIPANTS: A group of 2070 people within 6 Northern California medical center communities (N = 731 898) who had a potential diagnosis of uveitis. METHODS: The patient database of a large health maintenance organization (2 805 443 members at time of the study) was searched for all patients who, during a 12-month period, had the potential diagnosis of uveitis. Detailed quarterly gender- and age-stratified population data were available. Medical records of patients who potentially had uveitis and who were members of the 6 target communities were reviewed by 2 uveitis subspecialists to confirm the diagnosis of uveitis and to establish time of onset. Demographic and clinical data were gathered for patients meeting the clinical definition of uveitis. Incidence rates were calculated by using a dynamic population model. Prevalence rates were based on the mid-study period population. MAIN OUTCOME MEASURES: Presence and date of onset of uveitis. RESULTS: At midstudy, the population for the 6 communities was 731 898. During the target period, 382 new cases of uveitis were diagnosed; 462 cases of uveitis were diagnosed before the target period. These data yielded an incidence of 52.4/100 000 person-years and a period prevalence of 115.3/100 000 persons. The incidence and prevalence of disease were lowest in pediatric age groups and were highest in patients 65 years or older (P<0.0001). The prevalence of uveitis was higher in women than in men (P<0.001), but the difference in incidence between men and women was not statistically significant. Comparison between the group of patients who had onset of uveitis before the target period (ongoing uveitis) and the entire cohort of uveitis patients showed that women had a higher prevalence of ongoing uveitis than men and that this difference was largest in the older age groups (P<0.001). CONCLUSION: In this largest population-based uveitis study in the United States to date, the incidence of uveitis was approximately 3 times that of previous U.S. estimates and increased with the increasing age of patients. Women had a higher prevalence of uveitis than men, and the largest differences were in older age groups.     

The prevalence of glaucoma.

The occurrence of glaucoma was studied in a population comprising 1963 persons born during 1907 to 1921 and living in a small Swedish suburban and rural district. The records of 24 patients treated for glaucoma were examined. An estimate of the prevalence of glaucoma in untreated persons was based on an examination of 1511 subjects by standardised methods (including automatic perimetry) and strict diagnostic criteria. About 20% of all cases of glaucoma with visual field defects in the whole population were already known. Only 7 out of 15 cases of previously unknown but manifest glaucoma had intraocular pressures above 20-5 mmHg. The reduction in visual capacity caused by glaucoma in the present population was limited.     

Ocular prevalence and stereoacuity.

Background: Most people attribute a higher weight to the input from one eye than to that from the other eye when they have to align stereodisparate objects in the same visual direction. This preference for visual directions has been termed ‘ocular prevalence’, according to the Latin praevalentia = superior power. Questions: (1) Is ocular prevalence of one eye (or its correlate, partial suppression of the other eye in the prevalence task) restricted to large stereodisparities, close to Panum's limit, or does it occur also at small stereodisparities, near the stereoscopic threshold? (2) Is ocular prevalence a handicap for stereoacuity? Methods: Six non‐strabismic observers with equal visual acuity of their two eyes were examined. To determine their ocular prevalence, they were presented with vertical vernier lines at stereodisparities ranging between 30 and 430 arcsec. They had to judge whether the lower, anterior line was located on the right‐ or left‐hand side of the upper, posterior line. Their stereoscopic threshold was measured with an adaptive staircase procedure, using the Freiburg Stereoacuity Test. Results: All six observers exhibited some ocular prevalence. It changed considerably on repeated measurements. In three observers, it even switched from one eye to the other. Ocular prevalence occurred not only at large stereodisparities, close to Panum's limit, but also at small stereodisparities. The stereoscopic threshold of the six observers ranged between 1.7 and 12.3 arcsec. Conclusion: Ocular prevalence is common, intra‐individually variable and occurs even at small stereodisparities close to the stereoscopic threshold. It is compatible with ‘optimal’ stereoacuity. Hence, ocular prevalence appears to be a harmless feature of normal binocular vision.     

Incidence of keratoconus in spring catarrh.

Five hundred and thirty cases of spring catarrh were studied at the Department of Ophthalmology, Khyber Hospital Peshawar, Pakistan. Corneal complications occurred in 259 patients, of which 48 cases were of keratoconus, consisting of 41 male and seven female patients. Most of the patients affected (37) were between the ages of 10 and 30 years. Six patients developed acute hydrops, which in one case affected both eyes, though after an interval of a few months. Keratoconus was progressive in many patients, resulting in gross visual loss, often not correctable with glasses or contact lenses and thus requiring keratoplasty. The importance of association of keratoconus with atopic disorders is discussed and its association with spring catarrh is stressed.     

Incidence of aphakic macular oedema. A prospective study.

A prospective angiographic study of 77 aphakic eyes demonstrated cystoid macular oedema in 36 eyes (46-7 per cent) 6 to 7 weeks postoperatively. This subsequently resolved in 16 eyes, improved in eight, and was no better or worse in five (eight patients failed to return for follow-up). Of those patients with cystoid oedema, 16-6 per cent had a visual acuity of less than 6/12 at the time of the original examination; this was reduced to 13-8 per cent at the time of the follow-up study. The mean visual acuity of the group with oedema improved from 6/9 to 6/7-5 between the two examinations compared with 6/6 in the remaining 53-3 per cent without oedema. Preoperative ocular or general disease, specific surgical technique, and vitreous loss were not shown to be associated with macular oedema. However, there was some indication that intraocular inflammation predisposed to macular oedema.     

Incidence of retinopathy of prematurity among infants weighing 2000 g or less at birth

A retrospective study was carried out to determine the incidence of retinopathy of prematurity (ROP) among 157 neonates who weighed 2000 g or less at birth and who were examined at a referral centre for critically ill newborns between January 1983 and December 1985. Overall, 24 cases (15%) of ROP were detected, 18 (75%) among neonates with a birth weight of 1000 g or less. The incidence of ROP was more than eight times higher among neonates in this birth weight category than among those who weighed between 1001 and 2000 g. Grade I ROP accounted for 16 cases (67%), grade II for 7 cases (29%). Only one case (4%) of grade IV ROP was diagnosed, in an infant who weighed 1020 g at birth.     

Incidence of enucleation in a defined population.

We conducted a population-based study of long-term trends in the incidence of enucleation. From 1956 through 1988, enucleation was performed on 99 residents (55 males and 44 females) of Olmsted County, Minnesota. The mean annual age-adjusted incidence per 100,000 population for males (5.17) was 50% greater than that for females (3.49; P = .04). An increase in the enucleation rate was noted with increasing age (P = .001), with the highest incidence in patients who were 70 to 79 years of age. A decrease in the incidence of enucleation over time (P = .002) was observed in Olmsted County residents who were at least 40 years of age and was caused primarily by the decreasing incidence of neovascular glaucoma and tumor-related enucleations. The incidence of traumatic enucleations did not significantly decrease (P = .25) over this three-decade study period.     

Von Recklinghausen neurofibromatosis. Incidence of iris hamartomata

The results of a prospective survey of the ophthalmic manifestations of neurofibromatosis (NFT) have never been published. We studied the ocular features of NFT in 77 patients (ages 5 weeks to 69 years) among whom the diagnosis was made by nonophthalmic parameters. Of subjects ages 6 years and older, 92% had hamartomatous lesions of the iris, termed Lisch nodules, as distinguished from common iris nevi in nonaffected individuals. The presence of Lisch nodules is correlated to age, but not to number of café-au-lait spots, number of neurofibromata, or severity of disease. Lisch nodules appear among prepubertal children and are apparently unique to NFT. They are a valuable criterion by which to diagnose NFT in problematic cases.     

Results of exophthalmometry. Incidence of ciliary-choroid detachment

Examinations of 87 patients with different positions of the eyeball in the orbit have revealed that if the eyeball sinks even slightly deeper in the orbit than normally, collapse of the cornea is observed during cataract extraction and ciliary-choroid detachment develops during the postoperative period. If the eyeball protrudes forward no corneal collapse or ciliary-choroid detachment occur.