Is there an association of socioeconomic deprivation with acute primary angle closure?

BackgroundSocioeconomic deprivation is known to increase the risk of late presentation of many diseases. This is the largest study in United Kingdom investigating the relationship between socioeconomic deprivation and acute primary angle closure (APAC).MethodsA retrospective review of case notes was conducted of 718 consecutive patients who underwent laser peripheral iridotomy (LPI) in Edinburgh (Princess Alexandra Eye Pavilion) and Fife (Queen Margaret Hospital) between 2015 and 2019. Baseline demographics including sex, age, ethnicity, pre-existing diabetes, use of anti-depressants, and family history of glaucoma were collected. Deprivation was scored using the Scottish Index of Multiple Deprivation (SIMD) Index 2020v2. A lower rank and decile indicate higher degrees of deprivation. We investigated differences in characteristics between patients who were referred routinely versus patients who referred as APAC.ResultsThe SIMD rank and deciles were consistently lower in patients who were referred urgently with APAC in both centres (P = <0.05) when compared to those referred routinely for LPI. On univariate and multivariate logistic regression, the presentation of APAC is negatively associated with SIMD Decile (OR = −0.101, 95% CI −0.178 to −0.026, P = 0.008) and family history of glaucoma (OR = −1.010, 95% CI −1.670 to −0.426, P = 0.001), and positively associated with age (OR = 0.029, 95% CI 0.009–0.049, P = 0.004).ConclusionsSocioeconomic deprivation is an important risk factors for patients presenting with APAC. Socioeconomic deprivation should be incorporated into the design of glaucoma services and considered when triaging patients for prophylactic and therapeutic LPI and cataract surgery.Subject terms: Epidemiology, Optic nerve 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     

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     

Factors predicting long-term changes in refraction after lamellar keratoscleroplasty in children with limbal dermoids

ObjectivesThe objective of this study is to determine the factors that predict long-term changes in refraction after lamellar keratoscleroplasty in paediatric patients with limbal dermoids.MethodsA retrospective study of 66 children with limbal dermoids who had lamellar keratoscleroplasty correction with more than 1-year follow-up. Univariate and multivariate regression analyses were performed to investigate factors associated with the long term in refractive parameters, including spherical equivalent, astigmatism, and mean keratometry. The change value was defined as the postoperative refractive value minus the preoperative refractive value. The lower the value of changes, the more satisfied the effects on the correction of the preoperative refraction.ResultsA total of 66 patients (mean surgical age: 3.5 ± 2.1 years) were assessed with at least 1-year follow-up. Amblyopia treatment duration was the only independent factor predicting the long-term changes in spherical equivalent between baseline and last follow-up visit (β = −0.030, P < 0.001). Lesion encroachment on the central and paracentral cornea (β = 0.502, P = 0.024), suture-related complications (β = 1.571, P < 0.001) and graft rejection (β = 0.983, P = 0.035) were significantly correlated with long-term changes in astigmatism. The long-term changes in refraction were not correlated with surgical age, lesion size, lesion depth, steroid-induced high intraocular pressure and changes in mean keratometry.ConclusionSuture-related complications and graft rejection should be carefully observed and appropriately treated in order to avoid the possible postoperative increase in astigmatism, especially for patients with lesion encroachment on the central and paracentral cornea. The long-duration amblyopia treatment after surgery appears to have a better correction effect on spherical equivalent in the long term, compared with astigmatism.Subject terms: Outcomes research, Corneal diseases     

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     

Glaucoma-related central visual field deterioration after vitrectomy for epiretinal membrane: topographic characteristics and risk factors

Background/ObjectivesTo identify risk factors for glaucoma-related central visual field (VF) deterioration after vitrectomy with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM).Subjects/MethodsA prospective cohort study consisting of cases with or without glaucoma (33 eyes of 33 patients in each group) who underwent vitrectomy with ILM peeling for ERM. Humphrey 10–2 VFs and ganglion cell complex (GCC) thickness were measured at baseline and about 3, 6, and 12 months postoperatively. Longitudinal changes in VF indices and factors associated with their postoperative changes were investigated using mixed-effects models, as was sectorwise total deviation (TD) analysis using six sectors consisting of outer/inner arcuate and cecocentral sectors in each hemifield.ResultsVF mean deviation significantly deteriorated postoperatively only in the glaucoma group (P < 0.001). Older age, longer axial length, preoperative worse mean deviation, and thinner GCC were significant risk factors for postoperative deterioration (coefficient ± standard errors: −0.139 ± 0.067, −0.740 ± 0.241, 0.16 ± 0.07, 0.050 ± 0.020; P = 0.038, P = 0.002, P = 0.024, P = 0.012, respectively). Sectorwise analysis revealed that TD in the superior/inferior outer arcuate sectors significantly deteriorated only in the glaucoma group. Preoperative worse TD and thinner GCC were significant risk factors for deterioration in the superior outer arcuate sector (0.65 ± 0.11, 0.08 ± 0.03; P < 0.001, P = 0.042, respectively).ConclusionsCentral VF deterioration, especially in the outer arcuate sectors, found to be glaucoma-related changes after vitrectomy with ILM peeling for ERM. Preoperative worse VF and thinner GCC were identified as risk factors for postoperative VF deterioration.Subject terms: Diseases of the nervous system, Outcomes research, Diseases of the nervous system, Outcomes research     

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     

Characteristics of paediatric patients hospitalised for eye trauma in 2007–2015 and factors related to their visual outcomes

ObjectiveTo analyse the epidemiological characteristics and clinical features of children under the age of 16 years with ocular trauma at the Eye and Ear, Nose and Throat Hospital of Fudan University (Shanghai, China) and to investigate the preventive measurements taken to avoid vision-threatening eye trauma.MethodsThe inpatient medical records of children <16 years old treated for ocular trauma between January 2007 and December 2015 were collected. The age, sex, type of trauma, cause of injury, complications and visual acuity on admission and discharge were analysed statistically.ResultsA total of 2211 patients (2231 eyes) were enroled. Of these, 73.7% were male, and 61.2% were children aged 0–6 years. Mechanical ocular trauma was present in 75.3% of eyes, and penetrating injuries in 59.8%. The top three offending objects were scissors (16.3%), firecrackers (8%) and pencils (4.9%). Iris prolapse (odds ratio [OR] = 2.27), retinal detachment (OR = 2.91), endophthalmitis (OR = 2.25) or an intraocular foreign body (OR = 2.80) was associated with the same or worse visual prognosis among all the subjects. Traumatic cataract (OR = 0.37) was associated with final visual improvement.ConclusionsAn efficient strategy for preventing eye injury should focus on male children during preschool years. Our root cause analysis showed specific environmental patterns of vision-devastating objects. Specific preventive measures are proposed to reduce the incidence of paediatric eye injuries.Subject terms: Risk factors, Eye diseases     

Astigmatism and biometric optic components of diode laser-treated threshold retinopathy of prematurity at 9 years of age

Purpose

To assess the prevalence of astigmatism and its relationship with biometric optic components in preterm school children with diode laser-treated threshold retinopathy of prematurity (ROP).

Methods

A prospective, cross-sectional study in which cycloplegic keratometry, refraction, and ultrasound biometric measurement of optic components were performed on 24 consecutive preterm children with diode laser-treated threshold ROP at the age of 9 years. The study results were compared with data on 1021 age-matched full-term control children from a national survey.

Results

The laser-treated eyes had a mean astigmatism of 3.47 D, with a mean spherical equivalent of −4.49 D. Of the 46 eyes studied, 98% of eyes showed astigmatism ≥0.5 D and 50% had high astigmatism (>3.0 D). Most astigmatic eyes (97.7%) showed with-the-rule astigmatism, with the mean plus cylinder axis at 89.30^o. Further correlation analysis showed the astigmatism in refraction was highly correlated with the corneal astigmatism (r=0.921, P<0.001) and the vertical corneal curvature (r=0.405, P=0.005). There was significantly steeper vertical corneal curvature (P=0.003) and flatter horizontal corneal curvature (P=0.031) in eyes with laser-treated ROP when compared with age-matched full-term controls. The eyes with laser-treated ROP also show significantly thicker lens (3.93 mm) and shallower anterior chamber depth (ACD; 2.92 mm) than full-term controls (P<0.001).

Conclusions

There is significantly higher prevalence and greater magnitude of astigmatism in eyes with laser-treated threshold ROP compared with full-term controls. The steeper vertical corneal curvature component contributes to the increased astigmatism in eyes with laser-treated ROP.     

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     

Effect of age and refractive error on quick contrast sensitivity function in Chinese adults: a pilot study

PurposeTo evaluate the potential effect of age and refractive error on visual acuity (VA) performance and quick contrast sensitivity function (qCSF) in normal Chinese adults.MethodNinety-two subjects with normal best corrected distance VA (BCDVA) were enrolled in this pilot study. Measurements included BCDVA, best corrected near VA (BCNVA), unaided VA (UNVA), habitual spectacle-corrected near VA (SCNVA) and qCSF. For analyses, subjects were categorized into three age groups (20~40 years, 41~60 year and >60 years) and four refractive groups (hyperopia, emmetropia, myopia and high myopia). Relationships between age, refractive error, types of VA and qCSF were tested using simple and multiple linear regressions analyses.ResultMean age and refractive error of the study participants were 44.04 ± 12.68 years and −1.86 ± 2.91D, respectively. Among the stratified age groups, a hyperopic shift of refraction (−3.24 ± 2.88D vs. −1.24 ± 2.64D vs. 0.39 ± 1.42D, respectively; P < 0.001) and a reduction in BCNVA (P = 0.014), SCNVA (P < 0.001) and cut-off spatial frequency (SF) (P = 0.032) were found with increasing age. Among the four refractive groups, the SCNVA and cut-off SF of hyperopia were worse compared to the other refractive statuses (all P < 0.05). Age was significantly associated with cut-off SF (standardized β = −0.29, P = 0.005) after adjustment for SER, gender and all types of VA.ConclusionFor normal Chinese adults with normal BCDVA, age was the main factor associated with CSF, which may be independent of refractive error.Subject terms: Outcomes research, Public health     

Intraocular endoscopy in the management of ocular trauma: clinical settings and treatment outcomes at a tertiary eye care centre

PurposeTo report the application of endoscopy in the management of ocular trauma, describe the clinical settings and the treatment outcomes.MethodsRetrospective, consecutive, non-comparative case series at a tertiary eye care centre. Data recorded included aetiology of trauma, presenting vision, corneal condition at presentation, per-operative clinical findings during endoscopy, prognostication of the cases on table, final visual and anatomic outcome. Odds ratios for a favourable outcome were computed for various surgical indications.ResultsThe study included 58 eyes of 58 patients. Males constituted 82% of all cases. Mean age at presentation was 35.55 ± 18.9 years, median 31.5 years. Commonest corneal condition causing opaque media was corneal oedema (44.8%) followed by corneal laceration in 25.8%, repaired corneal laceration in 13.7% and scarred cornea in 12%. Commonest indication for surgery was retinal detachment (36.2%) followed by vitreous haemorrhage (29.3%), retained foreign body (13.7%) and combined detachment with haemorrhage in 10.3%. Of the 58 eyes, 17 eyes were deemed inoperable on endoscopic examination and 11 eyes were deemed to have poor prognosis. Of the fair prognosis (n = 30), 60% had final vision of 20/400 (p = 0.0001) compared to 10% before surgery and 13.33% had final vision of 20/40 (p = 0.03) as compared to nil in the pre-operative period. Odds ratio for a favourable visual outcome was best for the indication of vitreous haemorrhage (OR = 9, p = 0.0006).ConclusionEndoscopy in ocular trauma with opaque media provides adequate visualisation and allows for prognostication. In cases deemed to have prognosis, suitable intervention leads to globe and vision salvage.Subject terms: Trauma, Outcomes research     

Effects of different mydriatics on the choroidal vascularity in healthy subjects

PurposeTo evaluate choroidal vasculature changes after the instillation of mydriatic parasympatholytic and sympathomimetic agents in healthy subjects.MethodsA total of 95 healthy subjects were enrolled in this prospective, randomized comparative study. Study participants were divided into three different groups depending on the drug to be administered: tropicamide (1%) group (n = 31), tropicamide (0.5%) + phenylephrine (10%) group (n = 30) and control group receiving artificial tears (n = 34). All participants underwent a complete ophthalmological examination including best corrected visual acuity, refractive status and axial length. Subfoveal choroidal thickness (CT), total choroidal area (TCA), luminal and stromal choroidal area (LCA and SCA) and choroidal vascularity index (CVI) were measured before and after eye drops instillation.ResultsAll the baseline characteristics were matched between the three groups (all P > 0.05). Before the mydriatic instillation, there were no significant differences of CT, TCA, LA, SCA, and CVI among the three groups (all P > 0.05). After drug administration, CT, TCA, LCA, SCA, and CVI did not show any significant change as well (respectively, P = 0.265; P = 0.483; 0.573; P = 0.405 and P = 0.708).ConclusionsInstillation of mydriatic eye drops did not induce significant changes of the choroidal vasculature, suggesting that their use do not alter CT and CVI evaluation.Subject terms: Medical research, Outcomes research     

Deep optic nerve head morphology and glaucoma progression in eyes with and without laminar dot sign: a longitudinal comparative study

PurposeTo investigate the association between the laminar dot sign (LDS) and the deep optic nerve head (ONH) structure in eyes with primary-open-angle glaucoma (POAG).MethodsEighty-four eyes of 84 patients with POAG were prospectively included. All of the patients underwent stereo optic disc photography (SDP), red-free retinal nerve fibre layer (RNFL) photography, SS-OCT, and standard automated perimetry. By evaluating the SDP, patients were classified into laminar dot sign (LDS) and non-LDS groups. The deep structure of the ONH including the anterior prelaminar depth (APLD) and prelaminar tissue thickness (PTT) were quantitated using SS-OCT. Progression was assessed by structural or functional deterioration during the average 4.3 ± 1.2 years of follow-up.ResultsThe LDS group had deeper APLD (405.47 ± 107.55 vs. 302.45 ± 149.51, P < 0.001) and thinner PTT (74.34 ± 24.46 vs. 137.29 ± 40.07, P = 0.001) relative to the non-LDS group. By multivariate analysis, thin PTT was significantly associated with the presence of LDS (odds ratio = 0.939, P < 0.001). Structural progression was detected in 45 eyes (84.9%) in the LDS group and 8 eyes (25.8%) in the non-LDS group. Functional progression was demonstrated in 29 eyes (34.5%) in the LDS group and 6 eyes (19.4%) in the non-LDS group. The eyes with LDS had a significantly higher risk of glaucoma progression (χ² = 5.00, degree of freedom = 1, P = 0.033).ConclusionsIn eyes with POAG, the presence of LDS was associated with thinner prelaminar tissue and faster disease progression.Subject terms: Optic nerve diseases, Outcomes research, Optic nerve diseases, Outcomes research, Optic nerve diseases     

Assessment of retinal neurodegeneration with spectral-domain optical coherence tomography: a systematic review and meta-analysis

ObjectivesTo comprehensively assess diabetic retinopathy neurodegeneration (DRN) as quantified by retinal neuronal and axonal layers measured with spectral-domain optical coherence tomography (SD-OCT) in subjects with diabetes mellitus (DM).MethodsArticles on the topic of examining macular ganglion cell-inner plexiform layer (m-GCIPL), macular retinal nerve fibre layer (m-RNFL), macular ganglion cell complex (m-GCC), and peripapillary RNFL (p-RNFL) measured with SD-OCT in DM subjects without DR (NDR) or with non-proliferative DR (NPDR) were searched in PubMed and Embase up to November 31, 2019. Standardized mean difference (SMD) as effect size were pooled using random-effects model.ResultsThirty-six studies searched from online databases and the CUHK DM cohort were included in the meta-analysis. In the comparison between NDR and control, macular measures including mean m-GCIPL (SMD = −0.26, p = 0.003), m-RNFL (SMD = −0.26, p = 0.046), and m-GCC (SMD = −0.28; p = 0.009) were significantly thinner in the NDR group. In the comparison between NPDR and NDR, only mean p-RNFL was significantly thinner in the NPDR group (SMD = −0.27; p = 0.03), but not other macular measures.ConclusionsThinning of retinal neuronal and axonal layers at macula as measured by SD-OCT are presented in eyes with NDR, supporting DRN may be the early pathogenesis in the DM patients without the presence of clinical signs of DR. In the future, these SD-OCT measures may be used as surrogates of DRN to stratify DM patients with a high risk of DR, and may be used as a therapeutic target if neuroprotection treatment for DR is available.Subject terms: Retinal diseases, Eye abnormalities     

Glaucoma in large-scale population-based epidemiology: a questionnaire-based proxy

PurposeTo improve upon self-reported glaucoma status in population-based cohorts by developing a questionnaire-based proxy incorporating self-reported status in conjunction with glaucoma-specific visual complaints.MethodsA vision specific questionnaire, including questions from the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25) was administered to 79,866 Lifelines participants, a population-based cohort study in the Northern Netherlands. We compared NEI-VFQ-25 responses between ‘definite’ glaucoma cases (n = 90; self-reported surgical cases) and an age- and gender-matched subset of controls (n = 1,800) to uncover glaucoma-specific visual complaints, using a case–control logistic regression. We defined ‘probable glaucoma’ as both self-reported disease status and visual complaints, and ‘possible glaucoma’ as either. To evaluate the resulting proxy, we determined age-stratified glaucoma prevalences in the remaining cohort and compared the result to the literature.ResultsPer unit increase in the vision subscales (range 0–100) distance, peripheral and low luminance, we observed significantly increased odds of definite glaucoma (2% [P = 0.03], 4% [P = 1.2 × 10⁻⁸] and 2% [P = 0.02], respectively); the associated area under the curve was 0.73. We identified 300 probable and 3,015 (1,434 by self-report) possible glaucoma cases. Standardised prevalences of definite, probable and possible glaucoma for 55+ were 0.4%, 1.1% and 7.3%, respectively. For self-reported glaucoma (combining definite, probable and possible by self-report), this was 5.2%.ConclusionsThe combination of self-reported glaucoma status and visual complaints can be used to capture glaucoma cases in population-based settings. The resulting prevalence of combined definite and probable glaucoma (1.5%) appears to be more consistent with previous reports than the prevalence estimate of 5.2% based only on self-report.Subject terms: Epidemiology, Epidemiology, Glaucoma     

Effect of systemic blood pressure on optical coherence tomography angiography in glaucoma patients

BackgroundThe association between retinal microvascular structure and glaucoma has been revealed in multiple studies using optical tomography angiography (OCTA), but limited information on the macular vessel density (mVD) in patients with glaucoma is available. In this study, we tried to identity the factors that affected macular VD (mVD) in glaucomatous eyes.MethodsThis retrospective cross-sectional study evaluated OCT and OCTA images from 92 eyes from 58 healthy subjects and 179 eyes from 103 glaucoma patients using the SD-OCT database from July 2017 to July 2018. Glaucomatous eyes were further divided into two groups according to history of disc haemorrhage (DH). Association between mVD and demographic characteristics, ganglion cell-inner plexiform layer (GCIPL) thickness, visual field mean deviation (MD) and systemic blood pressure was analysed in each group.ResultsIn both healthy and glaucomatous eyes, mVD was inversely associated with age (β = −0.035, P = 0.025; β = −0.039, P = 0.018). In the glaucomatous eyes, mVD was significantly decreased, as the MD value was worse (β = 0.109, P = 0.002). In glaucomatous eyes with DH, mVD decreased as blood pressure increased (β = -0.111, P = 0.003)ConclusionsReduced mVD is more common in older individuals in both healthy and glaucomatous eyes, and correlates with functional deterioration than structural damage in glaucomatous eyes. In glaucomatous eyes with DH, high systemic BP is associated with a reduction in mVD. This may indicate that glaucoma patients with DH are more susceptible to vascular damage secondary to hypertensionSubject terms: Optic nerve diseases, Ocular hypertension     

Reproducibility of qualitative assessment of drusen volume in eyes with age related macular degeneration

BackgroundAlthough an optical coherence tomography (OCT)-derived central drusen volume ≥0.03 mm³ has been found to be a risk factor for progression to late age-related macular degeneration (AMD), this parameter is not currently available on most OCT devices or acquisition protocols. The purpose of this study was to evaluate the ability of human graders to qualitatively assess drusen volume by inspection of OCT B-scans.Methods100 subjects (200 eyes) from the Amish Eye Study diagnosed with early or intermediate AMD underwent OCT imaging with both Cirrus OCT and Spectralis OCT. Drusen volume was automatically computed from the Cirrus OCT volumes using the Cirrus Advanced RPE Analysis software. Spectralis volume scans were reviewed by two independent, masked graders who were asked to determine whether the central drusen volume was ≥0.03 mm³. Cohen’s kappa coefficients were computed to assess the agreement.ResultsAfter excluding 11 eyes with poor image quality and 5 eyes used for training of the graders, the remaining 184 eyes were included in this analysis. The agreement between the graders and the automated evaluation of drusen volume by the Cirrus OCT was excellent with K = 0.88 for grader 1 and K = 0.82 for grader 2. The agreement between graders was also excellent with a K = 0.88.ConclusionsThe presence of a high central drusen volume can be assessed reliably by qualitative inspection of OCT B-scans. This approach may be useful in the assessment of risk for progression to late AMD.Subject terms: Macular degeneration, Eye diseases     

Choroidal arterial watershed zone topography and its relationship with maculopathy in highly myopic eyes

ObjectivesTo evaluate choroidal arterial watershed zones (CWZ) in highly myopic patients. The relationships between CWZ location and myopic maculopathy location and classification were also examined.MethodsThis retrospective study included 102 consecutive patients who had been diagnosed with myopic maculopathy. Indocyanine green videoangiography was used to evaluate CWZ presence, location, and configuration. Maculopathy signs were used to examine the relationship between CWZ and myopic maculopathy.ResultsVarious CWZ types were identified in 102 of 158 eyes. The CWZ patterns were classified as vertical optic nerve head (vertical-ONH) in 30 eyes, stellate in 29 eyes, vertical-ONH extending to the macula in 28 eyes, horizontal fovea in eight eyes, and vertical parafovea in seven eyes. Choroidal neovascularization occurred within CWZs in 35 of 42 eyes, and macular atrophy was located within foveal CWZs in 20 of 23 eyes. The CWZ type was significantly correlated with mCNV presence (OR = 5.652, P = 0.014).ConclusionsVariations in CWZ topography are associated with myopic maculopathy, particularly in eyes with myopic choroidal neovascularization (mCNV) and macular atrophy, and CWZ is a risk factor for mCNV. This suggests that eyes with macular CWZs are vulnerable to developing myopic maculopathy and are predisposed to mCNV because of ischaemic hypoxia.Subject terms: Eye manifestations, Outcomes research     

Changes in intraocular pressure control in the first year after secondary intraocular lens implantation in children

PurposeTo compare intraocular pressure (IOP) control before and during the first year after secondary intraocular lens (IOL) implantation in children.MethodsThis was a retrospective chart review of children who received secondary IOL implantation. We analyzed IOP and antiglaucoma medications before and after implantation. The latest exam with IOP measurement found within the 2–15 month period after IOL implantation was used for the postoperative data. Failure to maintain IOP control was defined as either the addition of antiglaucoma medication(s) or a rise in IOP > 4 mm Hg. Statistical analyses were performed to assess risk factors for failure to control IOP after surgery, namely age at IOL implantation, preoperative glaucoma status, and IOL fixation location.ResultsA total of 100 eyes were included. The mean duration of follow-up was 7.74 months (SD = 3.11). Twenty-three of one hundred eyes failed to maintain IOP control according to our definition. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015). Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213). No other risk factors were found to have statistical significance.ConclusionSecondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk.Subject terms: Lens diseases, Glaucoma