Characteristics of Geographic atrophy in an elderly UK population—The Bridlington Eye Assessment Project (BEAP): a cross-sectional study (2002–2006)

Background/objectivesGeographic atrophy (GA) is a common cause of visual loss. The UK population prevalence is unknown. We studied GA prevalence, characteristics, and associations in an elderly UK population.MethodsMasked grading of colour fundus photographs from 3549 participants in the cross-sectional study of Bridlington residents aged ≥65 years. GA size, shape and foveal involvement were correlated with demography and vision.ResultsGA was detected in 130 eyes (101 individuals) of 3480 participants with gradable images (prevalence 2.90%; 95% CI 2.39–3.52 either eye), was bilateral in 29/3252 subjects (0.89%, 95% CI 0.62–1.28) with bilateral gradable photos, with mean age of 79.26 years (SD 6.99, range 67–96). Prevalence increased with age, from 1.29% (95% CI 0.69–2.33) at 65–69 to 11.96% (95% CI 7.97–17.50) at 85–90 years. Mean GA area was 4.51 mm² (SD 6.48, 95% CI 3.35–5.66); lesions were multifocal in 47/130 eyes (36.2%; 95% CI 28.4–44.7). Foveal involvement occurred in 41/130 eyes (31.5%; 95% CI 24.2–40.0). In eccentric GA, mean distance from circumference to fovea was 671μm (SD 463; 95% CI 570–773). Older age (OR 1.10/year increase; 95% CI 1.06–1.14), RPD (OR 1.87; 95% CI 1.10–3.19) and large drusen/RPD ≥ 125 μm (OR 6.16; 95% CI 3.51–10.75) were significantly associated with GA in multivariate analysis. GA lesions (18/31 eyes; 58%; 95% CI 40.7–73.6) had U-shape configuration more frequently in RPD subjects than those without (9/99 eyes, 9.1%; 95% CI 4.66–16.6) (p = 0.0001).ConclusionGA, commonly solitary and eccentric, occurred in the perifovea. However, one third of GA eyes had foveal and bilateral involvement. Possible association of RPD with GA phenotype exists. Population multimodal imaging studies may improve understanding further.Subject terms: Macular degeneration, Risk factors, Epidemiology     

Long-term visual and treatment outcomes of whole-population pre-school visual screening (PSVS) in children: a longitudinal,retrospective, population-based cohort study

BackgroundThis study reports the long-term visual and treatment outcomes in a whole-population, orthoptic-delivered pre-school visual screening (PSVS) programme in Scotland and further examines their associations with socioeconomic backgrounds and home circumstances.MethodsRetrospective case review was conducted on 430 children who failed PSVS. Outcome measures included best corrected visual acuity (BCVA), severity of amblyopia (mild, moderate and severe), binocular vision (BV) (normal, poor and none), ophthalmic diagnosis and treatment modalities. Parameters at discharge were compared to those at baseline and were measured against the Scottish index of multiple deprivation (SIMD) and Health plan indicator (HPI), which are indices of deprivation and status of home circumstances.ResultsThe proportion of children with amblyopia reduced from 92.3% (373/404) at baseline to 29.1% (106/364) at discharge (p < 0.001). Eighty percent (291/364) had good BV at discharge compared to 29.2% (118/404) at baseline (p < 0.001). Children from more socioeconomically deprived areas (OR 2.19, 95% CI 1.01–4.30, p = 0.003) or adverse family backgrounds (OR 3.94, 95% CI 1.99–7.74, p = 0.002) were more likely to attend poorly and/or become lost to follow-up. Children from worse home circumstances were five times more likely to have residual amblyopia (OR 5.37, 95% CI 3.29–10.07, p < 0.001) and three times more likely to have poor/no BV (OR 3.41, 95% CI 2.49–4.66, p < 0.001) than those from better home circumstances.ConclusionsOrthoptic-delivered PSVS is successful at screening and managing amblyopia. Children from homes requiring social care input are less likely to attend and are more likely to have poorer visual outcomes.Subject terms: Vision disorders, Refractive errors, Ocular motility disorders, Paediatrics, Health care economics     

Efficacy and safety of the mineralocorticoid receptor antagonist treatment for central serous chorioretinopathy: a systematic review and meta-analysis

ObjectivesWe performed a systematic review and meta-analysis to assess the efficacy and safety of the mineralocorticoid receptor antagonist (MRA) treatment for central serous chorioretinopathy (CSC).MethodsWe searched the PubMed, Embase, and the Cochrane Library to identify relevant clinical studies published prior to March 2020. The primary outcome was change in best-corrected visual acuity (BCVA), and the secondary outcomes included the subretinal fluid (SRF), subfoveal choroidal thickness (SFCT), and central macular thickness (CMT).ResultsFive randomized controlled trials (RCT) and four cohort studies met the inclusion criteria with a total of 352 eyes. The MRA treatment was not superior to placebo in BCVA at 1 month (WMD = −0.06, 95% CI −0.15–0.02, P = 0.15, I² = 86%), 3 months (WMD = −0.04, 95% CI −0.14–0.06, P = 0.44, I² = 77%) and 6 months (WMD = −0, 95% CI −0.05–0.05, P = 0.92, I² = 0%). The MRA treatment resulted in significant reduction than the placebo in the SRF (WMD = −60.64, 95% CI −97.91 to −23.37, P = 0.001, I² = 49%), SFCT (WMD = −39.15, 95% CI −52.58 to −25.72, P < 0.001, I² = 0%), and CMT (WMD = −60.75, 95% CI −97.85 to −23.65, P = 0.01, I² = 53%).ConclusionsOur meta-analysis shows that the MRA treatment can improve anatomical structure in CSC patients, but it is not effective for achieving BCVA gain. The applicant of the MRA is safe and have no severe effect.Subject terms: Prognostic markers, Retinal diseases     

Association between dry eye and depressive symptoms in an elderly Chinese population in Taiwan: the Shihpai Eye Study

BackgroundDry eye may impact quality of life and daily activities and depression is a widespread illness. Many studies showed the two diseases often coexist. However, studies were limited to retrospective chart review. This study aimed to investigate the association between dry eye and depressive symptoms in an older Asian population.MethodsThe Shihpai Eye Study was a community-based, cross-sectional survey of vision and eye diseases among noninstitutionalized subjects 65 years of age and older in Shihpai, Taipei, Taiwan. Residents fulfilling these criteria were randomly selected to be invited to participate in the study, which included a questionnaire and an eye examination conducted between July 1, 1999 and December 31, 2000.ResultsOf the 2045 subjects recruited, 1361 (66.6%) completed the examination. 8.8% (95% confidence interval (CI): 7.3–10.3%) of the participants were diagnosed to have depressive symptoms. Under multivariate analysis, depressive symptoms were significantly associated with frequent symptoms of dry eye (odds ratio (OR): 1.97, 95% CI: 1.36–2.92; p < 0.001). None of the dry eye signs was associated with depressive symptoms. For participants reporting frequent symptoms, tear-film break-up time ≤ 10 s (OR: 2.06, 95% CI: 1.38–3.05; p < 0.001), Schirmer test score ≤ 5 mm (OR: 2.01, 95% CI: 1.33–3.03; p < 0.001), and meibomian gland disease (OR: 1.99, 95% CI: 1.31–3.01; p = 0.001) were significantly related to depressive symptoms. Fluorescein staining of the cornea was not correlated to depressive symptoms in participants with dry eye symptoms.ConclusionsDepressive symptoms are more highly correlated with dry eye symptoms than dry eye signs.Subject terms: Risk factors, Epidemiology     

Seasonal patterns of incidence,demographic factors and microbiological profiles of infectious keratitis: the Nottingham Infectious Keratitis Study

PurposeThe purpose of this study is to examine the seasonal patterns of incidence, demographic factors and microbiological profiles of infectious keratitis (IK) in Nottingham, UK.MethodsA retrospective study of all patients who were diagnosed with IK and underwent corneal scraping during 2008–2019 at a UK tertiary referral centre. Seasonal patterns of incidence (in per 100,000 population-year), demographic factors, culture positivity rate and microbiological profiles of IK were analysed.ResultsA total of 1272 IK cases were included. The overall incidence of IK was highest during summer (37.7, 95% confidence interval (CI): 31.3–44.1), followed by autumn (36.7, 95% CI: 31.0–42.4), winter (36.4, 95% CI: 32.1–40.8) and spring (30.6, 95% CI: 26.8–34.3), though not statistically significant (p = 0.14). The incidence of IK during summer increased significantly over the 12 years of study (r = 0.58, p = 0.049), but the incidence of IK in other seasons remained relatively stable throughout the study period. Significant seasonal variations were observed in patients’ age (younger age in summer) and causative organisms, including Pseudomonas aeruginosa (32.9% in summer vs. 14.8% in winter; p < 0.001) and gram-positive bacilli (16.1% in summer vs. 4.7% in winter; p = 0.014).ConclusionThe incidence of IK in Nottingham was similar among four seasons. No temporal trend in the annual incidence of IK was observed, as reported previously, but there was a significant yearly increase in the incidence of IK during summer in Nottingham over the past decade. The association of younger age, P. aeruginosa and gram-positive bacilli infection with summer was likely attributed to contact lens wear, increased outdoor/water activity and warmer temperature conducive for microbial growth.Subject terms: Epidemiology, Corneal diseases     

Long-term follow-up of primary silicone oil tamponade for retinal detachment secondary to macular hole in highly myopic eyes: a prognostic factor analysis

PurposeTo investigate the risk factors associated with retinal detachment recurrence after first vitrectomy in high myopic eyes with macular hole retinal detachment (MHRD).MethodsPatients with high myopic eyes with MHRD who underwent pars plana vitrectomy and silicone oil (SO) tamponade with a follow-up period more than 12 months and more than 3 months after SO removal were included in this retrospective study. Logistic regression was performed to determine the risk factors associated with retinal re-detachment.ResultsA total of 45 eyes from 43 patients were included in this study (11 male and 34 female patients). The retinal re-detachment rate after the first removal of silicon oil was 35.5% (16/45) in a mean postoperative follow-up time of 35.64 ± 32.94 months. Complete macular atrophy on fundus photography (odds ratio (OR) = 17.021, 95% confidence interval (95% CI): 2.218–130.609, p = 0.006) was a risk factor for MHRD after SO removal, while internal limiting membrane (ILM) peeling (OR = 0.091, 95% CI: 0.013–0.633, p = 0.015) and duration of SO tamponade (OR = 0.667, 95% CI: 0.454–0.980, p = 0.039) were protective factors.ConclusionFor high myopic eyes with MHRD, complete macular atrophy was a significant risk factor for retinal re-detachment after silicon oil removal. ILM peeling and the duration of silicon oil tamponade were protective factors.Subject terms: Retinal diseases, Risk factors     

Variations in the cone packing density with eccentricity in emmetropes

Aim

To describe the parafoveal cone arrangement in emmetropic subjects and its variations with eccentricity, meridians and change in axial length in Indian eyes.

Methods

We imaged 25 subjects using compact adaptive optics (AO) retinal camera prototype, the rtx1. Imaging was done at 1, 2, and 3° eccentricity from the fovea in four meridians: nasal, temporal, superior, and inferior.

Results

A statistically significant drop in the cone packing density was observed from 2 to 3° (2° eccentricity=25 350/mm² (5300/mm², 8400–34 800/mm²) 3° eccentricity=20 750/mm² (6000 mm², 9000–33 670/mm²)) P<0.05. The spacing correspondingly increased with increase in distance from the fovea (2° eccentricity=6.9 μm (0.70 μm, 5.95–11.6 μm)) and 3°eccentricity=7.80 μm (1.00 μm, 6.5–13.5 μm) P<0.05. As the axial length increases, the cone density significantly decreases. Interocular variations were noted.

Conclusion

With the advent of AO, visualization at the cellular level is now possible. Understanding the photoreceptor mosaic in the parafoveal space in terms of its density, spacing, and arrangement is crucial so as to detect early pathology and intervene appropriately. Newer therapeutic modalitites that are targeted at the cellular level like yellow micropulse laser, stem cells, gene therapy and so on may be better monitored in terms of safety and efficacy.     

Choroidal vascularity index as an indicator of vascular status of choroid,in eyes with nanophthalmos

PurposeTo investigate choroidal vascular index (CVI) in eyes with nanophthalmos (NO) with the use of optical coherence tomography (OCT).MethodsMacular enhanced depth imaging OCT scans of 25 eyes of 25 patients with NO and age–gender-matched 25 eyes of 25 control subjects were analysed. Images were binarized using the ImageJ software, and total choroid area (TCA), luminal area (LA) and stromal area (SA) were acquired. The main outcome measure was CVI, defined as the ratio of LA to TCA.ResultsTwenty-five eyes of 25 patients with NO and age–gender-matched control subjects were enrolled. The mean TCA, SA and LA were found to be significantly higher in patients with NO (2.51 ± 0.44 vs. 1.91 ± 0.35 mm², P < 0.001; 0.86 ± 0.17 vs. 0.63 ± 0.13 mm², P < 0.001; and 1.65 ± 0.29 vs. 1.27 ± 0.23 mm², P < 0.000, respectively). On the contrary, CVI did not significantly differ between the two groups (65.72, 67.68, P = 0.099).ConclusionAs a novel OCT-based marker, CVI could be used to assess vascular status of the choroid in eyes with NO and can provide better understanding of the pathogenesis of this disease.Subject terms: Eye abnormalities, Scleral diseases, Predictive markers, Hereditary eye disease, Uveal diseases     

Microperimetry and mfERG as functional measurements in diabetic macular oedema undergoing intravitreal ranibizumab treatment

PurposeTo evaluate Microperimetry (MP) and multifocal electroretinogram (mfERG) as whole-macula functional markers of treatment response in naive diabetic macular oedema (DMO) patients undergoing ranibizumab treatment.MethodsAn exploratory sub-analysis of a prospective study ({"type":"clinical-trial","attrs":{"text":"NCT01947881","term_id":"NCT01947881"}}NCT01947881-CHARTRES). Patients received three monthly ranibizumab injections (loading dose) followed by pro re nata (PRN) regimen during 1 year. At baseline, during and after treatment (Months 0, 3, 6 and 12), subjects were tested using BCVA, OCT, MP and mfERG. MP was performed in the central 12°, and retinal sensitivity was measured overall (mean sensitivity (MS)), and in three concentric rings (R1–R3). mfERG P1 amplitude and implicit time were measured over six concentric rings (R1–R6).ResultsThirty-two eyes were included. MP mean and rings sensitivity were significantly lower in DMO (p < 0.001). After loading dose, a significant improvement in retina sensitivity was observed, particularly in good BCVA responders (MS = +2.28 dB; R1 = +2.33 dB, R2 = +2.20 dB, R3 = +2.25 dB; p = 0.049). Overall retinal sensitivity was significantly correlated with BCVA improvement (r = 0.54; p = 0.026) and inversely correlated with OCT central subfield thickness improvement (r = −0.39; p = 0.026). mfERG amplitude and implicit time were also lower in DMO (p < 0.011). An improvement of mfERG P1 amplitude and implicit time in R1 was noted in good responders after ranibizumab loading dose (+16.49 nV/deg²; p = 0.013 and −0.005 ms; p = 0.048, respectively). When changing to PRN treatment regimen, BCVA was maintained during the 12 months of follow-up but worsening of the visual function was detected by MP and mfERG.ConclusionsMicroperimetry and mfERG were able to demonstrate DMO functional improvement after treatment loading dose, as well as early visual changes when treatment regimen was switched to PRN.Subject terms: Predictive markers, Retinal diseases     

Postoperative severe visual impairment: surgical outcome of 165 patients with orbital tumours in the muscle cone

ObjectiveThis study aimed to evaluate the risk factors of postoperative severe vision impairment (PSVI) for a primary orbital tumour in the muscle cone.MethodsA retrospective analysis of the patients who underwent orbitotomy for primary intraconal tumours at the Tianjin Medical University Eye Hospital from January 2010 to December 2015.ResultsA total of 165 cases of orbitotomy for primary orbital tumours in the muscle cone were included in the study. Postoperatively, 12 cases with vision acuity ≤20/400 or ≥4 rows of vision decline and without any corrected effect were analysed as PSVI, including no light perception (NLP) for 3 cases. The multivariate logistic regression indicated that the tumour in orbital apex (P = 0.048, OR = 4.912, 95% CI: 1.011–23.866), severe optic nerve displacement (P = 0.030, OR = 6.007, 95% CI: 1.184–30.473) and intraoperative tight adhesion (P = 0.003, OR = 12.031, 95% CI: 2.282–63.441) were the independent risk factors for PSVI.ConclusionsThe incidence of PSVI for the intraconal tumour was 7.3%, and the incidence of NLP was 1.8%. The tumour in orbital apex, severe optic nerve displacement and intraoperative tight adhesion were independent risk factors for PSVI.Subject terms: Risk factors, Vision disorders, Surgery     

Predictive factors for exudation of quiescent choroidal neovessels detected by OCT angiography in the fellow eyes of eyes treated for a neovascular age-related macular degeneration

BackgroundTo identify predictive factors for exudation for quiescent choroidal neovessels (qCNV) in the fellow eyes of eyes treated for a neovascular age-related macular degeneration (AMD).MethodsProspective observational study. One hundred and forty-four contralateral eyes of 144 patients treated for wet AMD were analysed. At a baseline visit, multimodal imaging including dye angiographies and optical coherence tomography angiography (OCT-A) was performed in order to detect qCNV. Patients were followed up for 12 months with a monthly assessment. The manifestation of any type of exudation (either intra- or subretinal fluid or hyperreflective subretinal material) was monitored.ResultsThe prevalence of qCNV in the treatment-naive eyes was 15.9% with an incidence over a 12-month period of 2.8%. In total, 40.7% of the overall neovessels remained stable with no sign of exudation, while 59.3% presented some fluid during the follow-up. A statistically significant relationship was established for the following variables preceding the exudation: increase in central macular thickness (OR = 116; 95% CI [4.74; 50530] p = 0.038), increase in pigment epithelial detachment height (OR = 1.76; 95% CI [1.17; 3.18] p = 0.021) and width (OR = 1.53; 95% CI [1.12; 2.62] p = 0.042), increase in neovessels’ surface on OCT-A (OR = 6.32; 95% CI [1.62; 51.0] p = 0.033), emergence of a branching pattern (OR = 7.50; 95% CI[1.37; 61.5] p = 0.032) and appearance of a hypointense halo surrounding the lesion (OR = 10.00; 95% CI [1.41; 206] p = 0.048).ConclusionsThe risk of exudation in the treatment-naive fellow eyes of eyes treated for neovascular AMD was notably increased in the presence of qCNV. The biomarkers identified will help to detect their activation in order to ensure prompt antiangiogenic therapy.Subject terms: Risk factors, Tomography     

Outcomes of photorefractive keratectomy in patients with posterior corneal steepening

PurposeTo assess post-operative outcomes following photorefractive keratectomy (PRK) in patients with posterior corneal steepening compared to an age, gender and refraction matched control group.MethodsA retrospective matched case-control study that analysed outcomes of PRK in eyes with posterior corneal steepening as shown by the Sirius tomography (Sirius, CSO, Italy), versus normal eyes. Both groups were age, gender and refraction matched. Data collected include: demographic data, pre-operative and post-operative refraction, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), maximal ablation depth. Inferior–superior ratio, central corneal thickness (CCT), mean posterior keratometry (K), Baiocchi Calossi Versaci index for the front (BCV_f) and back (BCV_b) cornea, the symmetry index of front (SI_f) and back (SI_b) corneal curvature were assessed pre- and postoperatively.ResultsOverall, 89 study eyes and 954 normal myopic eyes were included. Compared to the control group, corneas with posterior steepening demonstrated significantly reduced CDVA (p < 0.0001 and p = 0.007) and lower CCT (p < 0.0001 and p = 0.03), before and following the operation, respectively. Pre-operative BCV_f, BCV_b, SI_f and SI_b were significantly higher in corneas with posterior steepening (p < 0.0001) and remained higher following the surgery except for BCV_f. Ectasia occurred in one eye (1.1%). The safety and efficacy indices at 12 months were comparable for both groups.ConclusionPRK on corneas with posterior steepening results in similar refractive outcomes compared to normal eyes, 1 year following the surgery. Keratectasia is a rare, however a possible complication.Subject terms: Outcomes research, Corneal diseases     

Manchester iStent study: long-term 7-year outcomes

ObjectivesTo determine the efficacy and safety of combined phacoemulsification and single first-generation iStent implantation over 84 months.Subjects/MethodsSingle-surgeon, single-centre, uncontrolled prospective interventional study in real-world settings. Forty-one patients with open-angle glaucoma on at least one antihypertensive drop underwent phaco-iStent surgery. This cohort was monitored over the subsequent 84 months. The primary outcome measure was intraocular pressure (IOP). Secondary outcome measures were number of glaucoma drops, visual acuity, cup-disc-ratio (CDR), mean deviation (MD) and visual field index (VFI). Thirty-one (76%) patients survived to 48 months and 19 (46%) patients to 84 months.ResultsAt 84 months, we demonstrate an absolute mean reduction of 4.87 mmHg (95% CI 1.62–7.64) for IOP and 0.59 (95% CI 0.03–1.16) for number of glaucoma drops. At the final clinic visit, LogMAR VA improved by 0.21 (95% CI 0.08–0.34), with no significant change in CDR, MD and VFI. Attrition was mainly due to death (27%) and further glaucoma surgery (12%). A single patient suffered from postoperative hyphaema, with no sequalae. Patients at high risk for progression to filtration surgery were defined as those on oral acetazolamide for IOP control, or those fulfilling all the following criteria: IOP ≥ 20 mmHg, CDR ≥ 0.7, MD ≤ −4.0 dB, number of drops ≥ 2. This group is to be considered for surgery as the next step in management according to NICE glaucoma guidelines. These patients (n = 14) demonstrated a more marked final IOP reduction of 6.85 mmHg (95% CI 3.97–9.75) vs 1.62 mmHg (95% CI 0.04–3.22) in their low-risk counterparts (n = 27). Reduction in glaucoma drops was 0.86 (95% CI 0.07–1.64) for the high-risk and 0.56 (95% CI 0.06–1.05) for the low-risk cohort. Further glaucoma surgery was required for 4 (29%) high-risk and 1 (0.5%) low-risk patients over the study period.ConclusionsOur results strongly suggest that the expected outcome of phaco-iStent surgery is a maintained reduction in intraocular pressure and number of glaucoma medications over 7 years. This is combined with a negligible rate of complications, a sustained improvement in central visual acuity, and a reliable maintenance of peripheral visual function.Subject terms: Outcomes research, Glaucoma     

Ophthalmic nurse practitioner assessment of glaucoma: evaluating agreement within an initiative to enhance capacity in glaucoma clinics

AimsA local service evaluation was conducted in order to compare clinical assessment measures and management decisions between an ophthalmic nurse practitioner and a reference standard glaucoma consultant, for patients referred into secondary care with suspected Chronic Open Angle Glaucoma or Ocular Hypertension.MethodsOne hundred patients were selected. A clinical pathway incorporating the assessment methods recommended by National Institute for Health and Care Excellence (NICE) Glaucoma update 2017 (NG81) was delivered by a single ophthalmic nurse practitioner and the reference standard glaucoma consultant. Clinical findings and outcomes were recorded, with both practitioners being masked to each other’s findings. Agreement was determined employing Cohen’s kappa, measuring inter-rater agreement allowing for chance agreement.ResultsAgreement was observed as follows: Visual field assessment (kappa k = 0.806, 95% CI 0.661–0.951); Optical Coherence Tomography evaluation (kappa k = 0.648, 95% CI 0.507–0.798); C:D Ratio assessment (Cronbach’s alpha α = 0.96, 95% CI 0.88–0.94); Diagnosis (kappa k = 0.874, 95% CI 0.818–0.914); and Treatment planning (kappa κ = 0.844, 95% CI 0.733–0.955). In three cases the nurse practitioner judged the optic nerve to appear normal, where the reference standard examiner detected glaucoma and commenced treatment.ConclusionThis service evaluation demonstrates how an ophthalmic nurse practitioner with appropriate theoretical knowledge and practical training, can develop skills to reach a high level of agreement in patient assessment and management for those patients with suspected glaucoma. Within the limitations of a single centre and single practitioner evaluation, our findings provide evidence that this model of capacity expansion ought to merit wider consideration in secondary care glaucoma services.Subject terms: Medical research, Health care     

Evaluation of posterior and total corneal astigmatism with colour-LED topography

PurposeTo characterise the posterior and total corneal astigmatism using colour point-source light-emitting diodes (LED) topography.MethodsIn a prospective case series 400 eyes from 400 patients were evaluated by colour-LED topography. Only eyes with normal topographies were considered. The following parameters were studied: magnitude and distribution of SimK and posterior corneal astigmatism, correlation between SimK and posterior corneal astigmatism, and differences in magnitude and axis between total and anterior corneal astigmatism.ResultsThe mean SimK corneal astigmatism was 1.21 ± 0.94 D. The mean posterior corneal astigmatism was 0.37 ± 0.24 D. Posterior astigmatism was vertically oriented in 68% of eyes. Twenty-two percent of eyes showed a posterior corneal astigmatism ≥ 0.50 D. The correlation coefficients between SimK and posterior corneal astigmatism were: r² = 0.066; p = 0.371 in WTR eyes, r² = 0.112; p = 0.173 in ATR eyes and r² = −0.019; p = 0.879 in oblique eyes. A difference between SimK and total corneal astigmatism ≥ 0.50 D was found in 7% of eyes. A difference in axis between SimK and total corneal astigmatism ≥ 10° was found in 24% of eyes.ConclusionsThe percentage of eyes with posterior corneal astigmatism ≥ 0.50 D and the differences between anterior and total corneal astigmatism were higher than those previously reported in the literature. Therefore, this study supports the consideration of total corneal astigmatism magnitude and axis is mandatory for a precise surgical correction of astigmatism.Subject terms: Medical research, Health care     

Analysis of optical coherence angiography in cystoid macular oedema associated with gyrate atrophy

BackgroundTo evaluate the relationship between superficial, deep foveal avascular zone (FAZ) and foveal cyst areas in eyes with cystoid macular oedema (CMO) associated with gyrate atrophy of the choroid and retina (GA).MethodsThis is a retrospective collaborative multicenter study of optical coherence tomography-angiography (OCTA) images in GA. Superficial and deep FAZ and foveal cyst were measured using Image J by two independent experts. Values were corrected for myopia magnification. These values were compared with age-matched controls from normative data.ResultsTwenty-three eyes from 12 patients with GA and CMO were included in the study. The mean ± standard deviation age was 22 ± 19.7 years, mean Snellen spectacle-corrected visual acuity of 20/70 with mean myopia of 5.7 ± 4.1 dioptres. Qualitatively, no focal occlusion of superficial and deep capillary plexus was noted. Mean superficial FAZ area (0.484 ± 0.317 mm²), deep FAZ area (0.626 ± 0.452 mm²), and foveal cyst area (0.630 ± 0.503 mm²) were significantly larger than superficial and deep FAZ areas in controls of same age range (p < 0.001). Macular cyst area correlated with superficial FAZ area (R = 0.59; p = 0.0057) and more strongly with deep FAZ area (R = 0.69; p < 0.001).ConclusionsThe superficial and deep FAZ area in GA-associated CMO were noted to be significantly larger than in controls. It seems that RPE dysfunction leads to foveal cyst enlargement displacing the capillary plexus with resultant enlarged superficial and deep FAZ area.Subject terms: Anatomy, Medical research     

Lower foetal haemoglobin levels at 31- and 34-weeks post menstrual age is associated with the development of retinopathy of prematurity: PacIFiHER Report No. 1 PacIFiHER Study Group (Preterm Infants and Fetal Haemoglobin in ROP)

Background/objectivesPrevious studies have suggested that lower mean foetal haemoglobin (HbF) levels is associated with an increased risk for developing retinopathy of prematurity (ROP). Lower HbF levels may lead to high oxygen exposure to the developing retina thereby increasing the risk of acute ROP. In this study, we characterize the temporal relationship of HbF levels and the development of ROP.Subjects/methodsThis is a single institution prospective observational cohort study. Preterm infants (born <31 weeks gestational age or <1500 g) with HbF measured at birth (cord blood), 31-, 34-, and 37-weeks post menstrual age (PMA); and at least one ROP exam, were enrolled.ResultsA total of 60 preterm infants (28 females, 47%) were enrolled. At 31-, 34-, 37-weeks PMA, infants with ROP (mild = Type 2 or less severe and severe = Type 1 ROP) had statistically lower percentages of HbF than infants with no ROP (28.2 ± 15 and 9.7 ± 2.9 vs 67.1 ± 29.6; p < 0.0001; 23.3 ± 14.7 and 32.5 vs 60.1 ± 25; p < 0.005; 31.9 ± 15.8 and 41.6 vs 60.2 ± 20.0; p < 0.0019). Infants with HbF levels in the lowest tercile at 31-weeks PMA were 7.6 times more likely to develop mild and severe ROP (95% CI 2.1–24.0, p value = 0.0006) and this risk increased to 12.3 times (95% CI: 2.6-59.0, p value = 0.0017) at 34-weeks PMA.ConclusionsLow HbF levels at 31- and 34-weeks PMA are associated with significantly increased risk of developing ROP. The decrease in HbF precedes the development of ROP and may be important in its pathogenesis.Subject terms: Retinal diseases, Biomarkers     

Assessing financial insecurity among common eye conditions: a 2016–2017 national health survey study

ObjectiveTo explore the prevalence and demographics of financial insecurity in individuals with eye disease in the United States.MethodsThis retrospective cross-sectional study analysed questions from the nationally representative 2016–2017 National Health Interview Survey (NHIS) with the eye conditions macular degeneration, diabetic retinopathy, glaucoma, and cataract. Data was analysed as a whole and then further analysed by condition. Evaluated topics indicated financial insecurity such as individuals reporting difficulty paying bills among eye conditions studied and by demographics.ResultsSurvey responses estimated that the overall prevalence of reporting problems paying or unable to pay bills were 12.49% (95% C.I. 11.62–13.36%) among patients with eye conditions. The overall prevalence of patients delaying care was 6.77% (95% C.I. 6.17–7.36%) and 17.06% (95% C.I. 15.99–18.14%) of individuals with eye conditions reported worrying about housing payments. Multivariable logistic regression revealed that demographics who more frequently had difficulty paying medical bills include individuals age 45–64 (3.33 aOR, C.I. 2.79–3.98, p < 0.001), blacks (1.90 aOR, C.I., 1.48–2.45, p < 0.001), Hispanics (1.51 aOR, C.I. 1.07–2.12, p = 0.020), and those 100–200% of the federal poverty line (2.16 aOR, C.I. 1.76–2.66, p < 0.001) or below the poverty line (1.93 aOR, C.I. 1.48–2.53, p < 0.001).ConclusionThere are several demographics with eye disease that self-report financial insecurity. There should be greater concern for financial insecurity among diabetic retinopathy and glaucoma patients. Ophthalmologists should consider engaging in proactive discussions with at-risk patients to reduce potential non-adherence secondary to financial insecurity.Subject terms: Health care economics, Eye diseases     

Ultrasonographic measurement of the optic nerve sheath diameter in dysthyroid optic neuropathy

BackgroundThe aim of this study is to evaluate the optic nerve sheath diameter (ONSD) in eyes with dysthyroid optic neuropathy (DON) and its relationship with clinical characteristics and disease severity.MethodsPatients diagnosed as thyroid-associated ophthalmopathy (TAO), with or without DON, and healthy participants were recruited. Vertical and horizontal sectional images of the optic nerve were collected by B-scan ultrasonography. ONSDs at 3 mm and 6 mm behind the eyeball were measured independently by two researchers. Multivariate regression analysis was performed to evaluate the association of ONSD with demographic and ocular parameters in TAO patients. Areas under the receiver operating characteristic curves (AUROCs) were applied to evaluate the diagnostic accuracy of ONSD for DON.ResultsA total of 47 healthy eyes, 36 TAO eyes without DON, and 33 eyes with DON were studied. ONSDs at 3 mm and 6 mm of DON eyes were significantly higher than those in non-DON and healthy eyes (all P < 0.05). There was no significant difference in ONSDs between clinically active and inactive eyes (both P > 0.05). DON occurrence showed a positive association with both ONSDs at 3 mm (β = 0.49, 95% CI: 0.14–0.83, P = 0.007) and 6 mm (β = 0.58, 95% CI: 0.20–0.96, P = 0.003). ONSDs at 3 mm and 6 mm showed a desirable diagnostic capacity to distinguish DON from non-DON eyes (AUROC was 0.77 and 0.75, respectively).ConclusionsAn increase in ONSD is evident in DON eyes independent of clinical activity. Ultrasound-based ONSD has sufficient ability to distinguish DON from non-DON eyes.Subject terms: Eye diseases, Biomarkers     

Correlation between body composition and blepharoptosis in adults

BackgroundThe present study aimed to explore the association between body composition indices, such as fat mass (FM) and lean body mass (LBM), and blepharoptosis.MethodsThe study evaluated 12,168 Korean adults aged 40 years or older using data from the Korea National Health and Nutrition Examination Survey (2008–2011). FM index (FMI, kg/m²) and LBM index (LBMI, kg/m²) were used to correct for the effects of body size. Multivariable logistic regression analysis was performed to investigate the association between blepharoptosis and body composition indices such as FMI, LBMI, and fat percentage of whole body or head. Stratified analyses were also performed by levator function.ResultsHigher FMI and head fat percentage were significantly associated with blepharoptosis (adjusted odds ratio [aOR] = 1.35, 95% confidence interval [CI] = 1.10–1.65; and aOR = 1.32, 95% CI = 1.03–1.69 in the highest tertile compared with the lowest, respectively). In the subgroup with good levator function (≥8 mm), higher FMI, head fat percentage, and head lean mass were significantly associated with blepharoptosis (aOR for the right eye [aORr] = 1.42 and aOR for the left eye [aORl] = 1.36; aORr = 1.41 and aORl = 1.37; and aORr = 1.50 and aORl = 1.49 in the highest tertile compared with the lowest, respectively; all p < 0.05).ConclusionsBody compositions with high adiposity indices, such as high FMI and head fat percentage, were positively associated with blepharoptosis. Awareness of the potential correlation between obesity-associated fat deposition and blepharoptosis could improve management of the condition and contribute to understanding the pathogenesis of blepharoptosis.Subject terms: Risk factors, Epidemiology