MicroRNA-related polymorphisms in pseudoexfoliation syndrome,pseudoexfoliative glaucoma,and primary open-angle glaucoma

Background: Pseudoexfoliation syndrome (PEX) and glaucoma (pseudoexfoliative glaucoma; PEXG, primary open-angle glaucoma; POAG) have mainly been studied for their associations with genes’ polymorphisms. The purpose of this exploratory study was to investigate the role of polymorphisms in genes encoding for micro RNAs (miRNAs) and in genes related to miRNA biogenesis.

Material and Methods: In the present genetic association study, ninety-two polymorphisms were investigated for their contribution to PEX (n = 203), PEXG (n = 38), and POAG (n = 40) pathogenesis compared to a control group (n = 188). The next generation sequencing (NGS) genotypic analysis revealed data for additional 28 variants.

Results: A protective association was found between PEX and polymorphism 11382316 (mir-3161) [odds ratio (OR) = 0.64, 95% confidence interval (CI): 0.47–0.86, p = 0.003], rs2155248 (mir-1304) [OR = 0.66, 95%CI: 0.47–0.94, p = 0.019], and rs28635903 (mir-1268a) [OR = 0.30, 95%CI: 0.10–0.94, p = 0.029]. Polymorphism rs113297757 (mir-3196) was associated with an increased risk of POAG [OR = 7.75, 95%CI: 2.13–28.76, p = 3 × 10^?4]. Polymorphism rs1057035 (DICER) and rs55671916 (XPO5) in the 3?-UTR of genes related to miRNA biogenesis was associated with decreased risk of PEX [OR = 0.65, 95%CI: 0.46–0.92, p = 0.014] and increased risk of PEXG [OR = 2.84, 95%CI: 1.02–7.94, p = 0.038], respectively. The aforementioned associations according to the allelic model were further supported by the genotypic models of statistical analyses.

Conclusions: This is the first study to report distinct associations of PEX, PEXG, and POAG in the same population with variants of genes involved in miRNA biogenesis and with miRNA genes’ polymorphisms. Further studies in larger groups of patients of various origins are needed to confirm the reported preliminary results.     

The Role of Genetic Variants (rs869109213 and rs2070744) Of the eNOS Gene and BglII in the α2 Subunit of the α2β1 Integrin Gene in Diabetic Retinopathy in a Tunisian Population

Purpose: In this study, we investigated the association of two polymorphisms (rs869109213 and rs2070744) in the eNOS gene and one polymorphism BglII in the α₂β₁ integrin gene (ITGA2) with the risk of diabetic retinopathy (DR) in a Tunisian population.

Methods: The study investigated of 110 type 2 diabetes mellitus (T2DM) and 127 DR patients. The genotypes of the eNOS 4b/4a (rs869109213) and ?786T/C (rs2070744) polymorphisms and of the BglII polymorphism of ITGA2 were studied using the PCR or PCR-RFLP method.

Results: The genotype distributions of the two polymorphisms in eNOS 4b4a and eNOS (?786T/C) were significantly different between T2DM and DR patients (p < .004 and p = .033, respectively). These polymorphisms were associated with the risk of DR (OR = 2.65, 95%CI [1.45–4.84], p = .002) for the eNOS 4b4a genotype and (OR = 2.43, 95%CI [1.06 ? 5.56], p = .036) for the CC genotype of the eNOS gene (?786T/C). Similarly, the genotype distribution of the BglII polymorphism was significantly different between the two groups studied (p = .037). This polymorphism was associated with an increased risk of DR (OR = 4.03, 95% CI [1.17 ? 7.85], p = .022) for BglII(+/+).

Conclusion: The present study suggests that the polymorphisms 4b4a and ?786T/C in the eNOS gene might be associated with DR. In addition, the BglII polymorphism in the ITGA2 gene was a risk factor for DR.     

Role of the tissue-type plasminogen activator -7351C > T and plasminogen activator inhibitor 1 4G/5G gene polymorphisms in central serous chorioretinopathy

ABSTRACT

Background: Central serous chorioretinopathy (CSC) is a common chorioretinal disease, characterized by choroidal hyperpermeability leading to neurosensory and/or retinal pigment epithelial detachments. Hypofibrinolysis due to higher plasma concentrations of plasminogen activator type 1 (PAI-1) or lower activity of tissue-type plasminogen activator (t-PA) has been implicated in the pathogenesis of CSC. Functional polymorphisms in the PAI-1 (SERPINE1) and t-Pa (PLAT) are thus potential risk factors for CSC. The aim of the present study was therefore to investigate a hypothesized association between the PAI-1 4G/5G and the t-PA -7351C > T gene variants and the presence of CSC.

Methods: The present study comprised 172 CSC patients and 313 control subjects. Genotypes of the PAI-1 4G/5G and the t-PA -7351C > T polymorphisms were determined by TaqMan^TM fluorogenic 5′-exonuclease assays.

Results: Allelic frequencies or genotype distributions of neither the PAI-1 4G/5G nor the t-PA -7531C > T polymorphisms were significantly different between patients with CSC and control subjects (PAI-1 4G/4G: 24.4% vs. 20.4, p = 0.36; t-PA -7351CC: 42.4% vs. 46.0%, p = 0.50). After adjusting for age and gender presence of the PAI-1 4G/4G genotype was associated with a non-significant odds ratio (OR) of 1.21 (95% confidence interval [95% CI]: 0.77–1.92, p = 0.41), while homozygosity for the t-PA -7351C allele yielded a non-significant OR of 0.91 (95% CI: 0.62–1.33, p = 0.62) for CSC.

Conclusion: The present study suggests that both the t-PA -7351C > T and the PAI-1 4G/5G gene variants are unlikely major risk factors for CSC.     

Association of LOC387715/ARMS2 (rs10490924) Gene Polymorphism with Age-Related Macular Degeneration in the Brazilian Population

Background: An association between LOC387715/ARMS2 (rs10490924) gene polymorphism and AMD has been reported. The aim of this study was to evaluate whether this polymorphism is associated with AMD in a Brazilian cohort.

Materials and Methods: In total, 126 unrelated AMD patients (mean age 74.17?±?7.64) were compared with 86 healthy controls (mean age 71.82?±?7.12). Study subjects were classified according to the International ARM Epidemiological Study Group definition for early and late-stage AMD. LOC387715/ARMS2 rs10490924 polymorphism was evaluated through polymerase chain reaction and direct sequencing.

Results: The T allele frequency was significantly higher in AMD patients than in controls (39.6% compared to 20.3%). The odds ratio (OR) for AMD was 2.05 (95% CI 1.13–3.71) for heterozygotes (TG) and 8.32 (95% CI 2.30–45.99) for homozygotes (TT).

Conclusions: These results suggest that there is a contribution of the rs10490924 SNP of the LOC387715/ARMS2 gene to AMD susceptibility in this sample of the Brazilian population.     

Risk Factors for Discontinuation of Treatment for Neovascular Age-Related Macular Degeneration

Purpose: To investigate risk factors for treatment discontinuation for neovascular age-related macular degeneration (nAMD).

Methods: Data from the Swedish Macula Register and the Skåne Healthcare Register are reported on the treatment received by 932 nAMD patients diagnosed 2013?2015. Treatment discontinuation is defined as having a termination visit or lacking a control or treatment visit during the period of 10?14 months after the diagnostic visit. The risk of treatment discontinuation during the first year is estimated using a Poisson model and a classification tree.

Results: 503 eyes (50.9%) discontinued the treatment within the first year. Patients with visual acuity below 60 ETDRS letters (20/60 Snellen) at baseline, serious comorbidities, or treated at the university hospital have a 42% (95% CI 25?61%, P < 0.001), 27% (95% CI 13?43%, P = 0.001) and 30% (95% CI 15?46%, P < 0.001) increased risk to discontinue treatment compared with similar patients. Patients on ranibizumab therapy have a 45% (95% CI 28?63%, P < 0.001) increased risk for treatment discontinuation during year 1 compared with patients on aflibercept therapy. The classification tree also shows that patients on ranibizumab therapy and those with low VA at baseline are at a higher risk of terminating treatment.

Conclusions: Almost half of the patients starting anti-VEGF therapy discontinue treatment during the first year. Patients with risk factors may require additional support to continue with the treatment. Aflibercept therapy could be an alternative to patients at risk of treatment discontinuation.     

CFH (rs1410996), HTRA1 (rs112000638) and ARMS2 (rs10490923) Gene Polymorphisms are Associated with AMD Risk in Spanish Patients

ABSTRACT

Purpose: Age-related macular degeneration (AMD) is the main cause of legal blindness in the western adult population. We investigated the association between SNPs located in CFH, ARMS2 and HTRA1 and AMD in Spanish patients.

Patients and Methods: We obtained peripheral blood samples from 121 patients with a diagnosis of AMD (84 exudative and 37 atrophic) at the Department of Ophthalmology of the University Hospital of Salamanca. We took 91 subjects as a control group. We studied a single nucleotide polymorphism (SNP) in each patient for each of the genes associated with high susceptibility to developing AMD using Real-time PCR with TaqMan probes for CFH and ARMS2 polymorphisms and PCR-RFLP for HTRA1 polymorphism.

Results: We observed a statistically significant difference between patients and controls in the distribution of CFH rs1410996 genotypes, patients homozygous for the C-allele have twice the risk of developing the disease (p?=?0.010; OR?=?2,176 (1.194–3.964)). The analysis of ARMS2 rs10490923 polymorphism also showed differences in allelic distribution between the case and control groups (p?<?0.001). Carriers of the T-allele appear more frequently in the group of patients (p?<?0.001; OR?=?3.340 (1.848–6.060)). Our results also confirm significant differences in the distribution of HTRA1 rs112000638 polymorphism with an increased representation of the G-allele in the patient’s group (p?<?0.001; OR?=?6.254(3.463–12.280)). Our study also indicates that TTGG ARMS2/HTRA1 (rs10490923/rs112000638) haplotype increases the risk of developing AMD by 9 times.

Conclusions: Our results show that genotypes of ARMS2 (rs10490923), HTRA1 (rs112000638) and CFH (rs1410996) polymorphisms are related to an increased risk of suffering AMD in Spanish patients.     

Regression Discontinuity and Randomized Controlled Trial Estimates: An Application to The Mycotic Ulcer Treatment Trials

Purpose: We compare results from regression discontinuity (RD) analysis to primary results of a randomized controlled trial (RCT) utilizing data from two contemporaneous RCTs for treatment of fungal corneal ulcers.

Methods: Patients were enrolled in the Mycotic Ulcer Treatment Trials I and II (MUTT I &; MUTT II) based on baseline visual acuity: patients with acuity ≤ 20/400 (logMAR 1.3) enrolled in MUTT I, and >20/400 in MUTT II. MUTT I investigated the effect of topical natamycin versus voriconazole on best spectacle-corrected visual acuity. MUTT II investigated the effect of topical voriconazole plus placebo versus topical voriconazole plus oral voriconazole. We compared the RD estimate (natamycin arm of MUTT I [N = 162] versus placebo arm of MUTT II [N = 54]) to the RCT estimate from MUTT I (topical natamycin [N = 162] versus topical voriconazole [N = 161]).

Results: In the RD, patients receiving natamycin had mean improvement of 4-lines of visual acuity at 3 months (logMAR ?0.39, 95% CI: ?0.61, ?0.17) compared to topical voriconazole plus placebo, and 2-lines in the RCT (logMAR ?0.18, 95% CI: ?0.30, ?0.05) compared to topical voriconazole.

Conclusions: The RD and RCT estimates were similar, although the RD design overestimated effects compared to the RCT.     

Gender-related effects of vision impairment characteristics on depression in Korea

Purpose: To investigate the gender-specific associations between perceived vision impairment and symptoms of depression.

Methods: We used the data from the 2012 Korean Longitudinal Study of Aging database of 7448 individuals aged 45 years and older. Questionnaires assessing depression symptoms and perceived visual impairment at near, distance, and in general were administered. Logistic regression analyses were used to evaluate if visual impairment could lead to depression, adjusting for the potential confounders of age, socioeconomic status (household income, education level, marital status, and employment status), and health behaviors (alcohol consumption, smoking, and physical activity level) after gender stratification.

Results: Perceived general and near vision impairment were significantly associated with symptoms of depression in males (odds ratio [OR] = 2.78 and 2.54; 95% confidence interval [CI], 1.91–4.04 and 1.78–3.63). Perceived general and distance vision impairment were significantly associated with symptoms of depression in females (OR = 2.16 and 2.08; 95% CI, 1.67–2.79 and 1.61–2.69). General sight with near vision impairment in males and general sight with distance vision impairment in females could be stronger predictors of depression than other vision impairment combinations (area under the receiver operating characteristic curve [AUROC], 0.6461; p = 0.0425 in males; AUROC, 0.6270; p = 0.0318 in females).

Conclusion Gender differences were found in the characteristics of visual impairment on symptoms of depression. Ophthalmologists should be aware that near vision impairment in males and distance vision impairment in females have an adjunctive effect that might contribute to symptoms of depression.     

Epidemiology of Hyphema-Related Emergency Department Visits in The United States Between 2006 and 2015

Purpose: To describe epidemiological trends, risk factors, and hospital-associated charges for patients presenting with hyphema to emergency departments (EDs) throughout the United States (U.S.).

Methods: Cross-sectional analysis of all hyphema-related ED cases in the U.S. Nationwide Emergency Department Sample (NEDS) between 2006 and 2015 to determine population-based incidence rates, patient demographics, visit characteristics and associated charges.

Results: Between 2006 and 2015, there were a total of 16,222 cases with hyphema as primary visit diagnosis (0.52 ED visits per 100,000 population). The mean (SD) age at presentation was 37.4 (24.8) years, and males accounted for 66.2% of these cases. Trauma (n = 4,994, 30.8%) was the most frequently identified etiology, with sports-related injuries as important contributor. On multivariate analysis, traumatic hyphema was more likely for patients aged 5–14 years (Odds ratio [OR] = 1.88 [95% Confidence interval [CI]: 1.04–3.40, p = 0.04]) than 0–4 years, males (OR = 1.33 [95% CI: 1.09–1.62, p = 0.01]), in May through September (OR = 1.66–1.93 [95% CI: 1.08–3.05, p = 0.005–0.03]),and for those in the highest income quartile (OR = 1.42 [95% CI: 1.10–1.83, p = 0.01]). Visits were less likely for patients aged ≥55 years (OR = 0.49 [95% CI: 0.25–0.994, p = 0.03]) than 0–4 years. During the study period, hyphema accounted for $21 million in ED associated and $9 million in inpatient charges.

Conclusion: ED visits with hyphema as primary diagnosis occur at an annual rate of 0.52 per 100,000 population. Young males are particularly at risk and there has been an increase in the number of sports-related injuries which may represent a modifiable cause. Hyphema management costs $3 million in hospital-related charges annually.     

Genetic and clinical factors associated with reticular pseudodrusen in exudative age-related macular degeneration

Backgrounds

Reticular pseudodrusen (RPD) is considered to be a distinct entity from soft drusen and a risk factor for age-related macular degeneration (AMD). In the present study, we investigate the genetic and clinical factors associated with reticular pseudodrusen (RPD) in patients with exudative AMD, including polypoidal choroidal vasculopathy (PCV), typical neovascular AMD, and retinal angiomatous proliferation (RAP).

Methods

The presence or absence of RPD was studied among 408 patients with exudative AMD in at least one eye, and the clinical characteristics of those with RPD were investigated as well as genetic polymorphisms of ARMS2 A69S (rs10490924) and CFH I62V (rs800292). Subfoveal choroidal thickness was also evaluated in a limited number of subjects using the EDI mode of spectral-domain optical coherence tomography.

Results

The prevalence of RPD was significantly higher in RAP eyes than in typical neovascular AMD or in PCV eyes (38.2 % of 26 eyes, 13.6 % of 132 eyes and 0 % of 250 eyes respectively, P?P?P?P?ARMS2 A69S was significantly higher in eyes with RPD than in those without RPD (85.7 % vs 63.8 %, P?=?0.0009), although the frequency of CFH I62V was not significantly different between those with and without RPD. Logistic regression analysis revealed that age (odds ratio [OR]:1.10; 95 % confidence interval [CI]: 1.04–1.18; p?=?0.002), female gender (OR:4.26; 95%CI: 1.72–10.4; p?=?0.002), T-allele at ARMS2 A69S (OR: 3.23; 95%CI: 1.36–7.68; p?=?0.008) and RAP (OR: 4.25; 95%CI:1.49–12.1; p?=?0.007) were risk factors for RPD.

Conclusions

Among eyes with exudative AMD, RPD is more common in eyes with RAP having a thin choroid at the fovea, especially in old, female patients with the risk variant of ARMS2 A69S.     

Glaucoma Control Strategies in Sub-Saharan Africa: A Review of the Clinical and Health Economic Evidence

Purpose: A review of the effectiveness, costs, and cost-effectiveness of detection and treatment strategies for glaucoma control in Sub-Saharan Africa (SSA) was conducted.

Methods: Detailed searches were performed using the Ovid Medline, Ovid Embase, The Cochrane Library, Web of Science, Scopus, and LILACS databases up to September 2016. The key Medical Subject Heading search terms used included glaucoma, diagnosis, treatment, effectiveness, costs, cost-effectiveness, and Sub-Saharan Africa. Effectiveness was measured as the proportion of study participants with an intra-ocular pressure less than or equal to 22 mmHg.

Results: A total of 5658 records were examined with 48 papers identified. The sensitivity and specificity of portable instruments or smartphone technologies to detect glaucomatous changes ranged from 58.3% to 93.8% and from 82.4% to 96.8%, respectively. The overall effect size for various glaucoma interventions was: 0.39 (95% confidence interval (CI) 0.27–0.54, I² = 64.85, p = 0.036) for laser trabeculoplasty; 0.56 (95% CI 0.23–0.84, I² = 85.74, p = 0.001) for drainage implant devices; 0.66 (95% CI 0.61–0.71, I² = 0.00, p = 0.402) for medical management; and 0.73 (95% CI 0.65–0.80, I² = 93.25, p = 0.000) for all other non-drainage tube surgical interventions, including trabeculectomy surgery and the use of anti-metabolites. The mean annual cost of anti-glaucoma drugs across SSA was USD 394, with a mean direct non-medication cost per year of USD 54, and a mean surgical cost per year of USD 283.

Conclusions: While effective glaucoma control interventions exist, their widespread use and diffusion across SSA remain challenging principally due to low per capita income levels and high glaucoma treatment costs.     

American Uveitis Society Winter Symposium,January 1997

Abstract

Purpose: To investigate the association between smoking and prognosis of ocular Behçet disease.

Material/Methods: Medical records of 202 patients with Behçet uveitis were collected retrospectively. Patients were assigned to two groups according to smoking habits. In group I, 72 patients were current smokers. In group II, 130 were nonsmokers. The localization of uveitis, time to resolution of uveitis, time to recurrences, visual acuities, and presence of cystoid macular edema were compared between groups.

Results: The demographic characteristics were similar in both groups. Smoking was not associated with types of uveitis with OR of 1.01 (95% CI, 0.99–1.04; p?=?0.21) for anterior uveitis, 0.96 (95%CI, 0.90–1.02; p?=?0.18) for posterior uveitis, and 1.80 (95% CI, 0.75–2.77; p?=?0.24) for panuveitis. The average times to inflammation resolution were 48?±?10.1 days in group I and 51?±?14 days in group II (p?=?0.82). The average times to recurrence were 8.6?±?5 months for smokers and 9.1?±?7 months for nonsmokers (p?=?0.43). Patients with CME in groups were 18 (25%) and 42 (32.3%), respectively (p?=?0.08).

Conclusions: Our findings suggest that smoking does not have a negative effect on the clinical findings and prognosis of uveitis in Behçet disease.     

A Longitudinal Analysis of Chlamydial Infection and Trachomatous Inflammation Following Mass Azithromycin Distribution

Background: Mass azithromycin distributions are effective for clearing ocular strains of Chlamydia trachomatis, yet infection frequently returns in areas with hyperendemic trachoma. A better understanding of the factors associated with chlamydial reinfection could be helpful to plan trachoma elimination strategies.

Methods: This was a prospective cohort study conducted in a trachoma-hyperendemic region of Ethiopia in 2003. As part of a larger cluster-randomized trial, 21 villages were treated with a single mass azithromycin distribution and all children 5 years and younger were monitored for ocular chlamydia and clinically active trachoma at baseline and at 2 and 6 months following the treatment.

Results: In 20 villages with available data, azithromycin treatment coverage was 88.7% (95% confidence interval [CI] 85.7–91.8%). In total, 1005 children tested negative for ocular chlamydia at the 2-month visit, of whom 41 became infected by 6 months (1.0 incident chlamydia infections per 100 person-months, 95%CI 0.7–1.4). The presence of intense trachomatous inflammation (TI) at baseline was associated with incident infection at 6 months (incidence rate ratio 1.91, 95%CI 1.03–3.55). Ocular chlamydia infections clustered more within households than communities: (intraclass correlation coefficient 0.01 for communities and 0.29 for households six months posttreatment). Younger children were more likely to have persistent clinically active trachoma (P = 0.03).

Conclusions: More intensive antibiotic distributions may be warranted for younger children, for children with TI, and for households containing children with ocular chlamydia infections.     

Complement factor B polymorphism (rs641153) and susceptibility to age-related macular degeneration:evidence from published studies

AIM:To determine whether single nucleotide polymorphism (SNP) rs641153 is associated with the risk of age-related macular degeneration (AMD), we performed a systematic meta-analysis of 15 eligible studies. SNP in the complement factor B (CFB) gene is considered to have significant association with AMD susceptibility, but there is great discrepancy in these results.METHODS: The eligible studies were identified by searching the databases of PubMed, EMBASE, and Web of Science. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the association. All data were analyzed using Stata software.RESULTS:The association between rs641153 and AMD risk was statistically significant under the homozygous model (AA vs GG:OR=0.26, 95%CI=0.15-0.45, Ph=0.973, I²=0.0%, fixed effects), dominant model (AA+GA vs GG:OR=0.49, 95%CI=0.40-0.59, Ph=0.004, I²=56.4%, random effects) and recessive model (AA vs GA+GG:OR=0.30, 95%CI=0.17-0.51, Ph=0.983, I²=0.0%, fixed effects). The same results were also observed in the stratified analyses by ethnicity, source of control and sample size.CONCLUSION:Our meta-analysis suggests that rs641153 in the CFB gene may play a protective role in AMD susceptibility, the late AMD in particular, both in Caucasians and in Asians.     

The Distribution of Macular Thickness and Its Determinants in a Healthy Population

Purpose: To determine the distribution of macular thickness in a healthy Iranian population aged 45–69 years and its association with certain determinants.

Methods: All participants underwent optometric examinations including measurement of uncorrected and corrected visual acuity, objective refraction by retinoscopy, and subjective refraction. Subsequently, all participants underwent slit-lamp biomicroscopy followed by fundus examination through direct and indirect ophthalmoscopy, and optical coherence tomography (OCT) imaging under pupil dilation.

Results: Mean central macular thickness was 255.4 µm (95% confidence interval, CI, 254.5–256.3 µm), average inner macular thickness was 316.5 µm (95% CI 315.9–317.1 µm), average outer macular thickness was 275.3 µm (95% CI 274.8–275.8 µm), and overall average thickness was 278.6 µm (95% CI 278.1–279.1 µm). A linear multiple regression model showed that all indexes were significantly larger in male participants (p < 0.001). Central macular thickness increased with age (coef = 0.25, p < 0.001) while overall, inner and outer macular thickness decreased with age (coef = ?0.18, ?0.15, ?0.19, respectively, all p < 0.001). Central and inner macular thickness had a positive correlation (coef = 3.8, 2.6, respectively, both p < 0.001) and outer macular thickness had a negative correlation (coef = ?1.6, p < 0.001) with axial length.

Conclusion: Age, sex, refractive error, axial length, and keratometry were found to be associated with macular thickness. These factors should be taken into account when interpreting macular thickness measurements with spectral-domain OCT.     

Ultraviolet radiation and incidence of cataracts in a nationwide US cohort

Purpose: We examine the risk of cataract and cataract surgery with measures of ultraviolet radiation (UVR) exposure and UVR sensitivity in a large, nationwide population of indoor workers.

Methods: Participants from the US Radiologic Technologists Study were followed from age at baseline survey (2003–2005) to age at earliest of cataract diagnosis, cataract surgery, or completion of last survey (2012–2013). UVR-related factors included satellite-based ambient UVR linked to lifetime residences, time spent outdoors across various age periods, history of blistering sunburns, prior diagnosis of keratinocyte carcinoma, and iris color. We used Cox proportional hazards models with age as timescale to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for cataract and cataract surgery.

Results: Participants had a median age of entry of 54.0 years, were 80.0% female, and 95.7% white. Of the 44,?891 eligible participants, 9399 cases of cataract and 3826 cases of cataract surgery were reported. Ambient UVR (quintile 5 vs. 1) was associated with an increased risk of cataract (HR = 1.08; 95% CI: 1.01–1.16) and cataract surgery (HR = 1.16; 95% CI: 1.05–1.29). Lifetime average time spent outdoors was not associated with cataract risk. History of blistering sunburns before and after age 15, but not previous keratinocyte carcinoma diagnosis was associated with both cataract and cataract surgery.

Conclusion: Our results suggest a modest role for residence-based ambient UVR and cataract risk among indoor workers in the United States.     

Epidemiology,risk factors,and clinical outcomes in severe microbial keratitis in South India

Purpose: Here, we report risk factors associated with outcome in severe bacterial keratitis (BK), fungal keratitis (FK), and Acanthamoeba keratitis (AK) in India.

Methods: Prospective observational cohort study conducted in Aravind Eye Hospital, India. Adults presenting with severe microbial keratitis (MK) were enrolled (size ≥3 mm) and followed to 21 days post-enrolment. Ulcer clinical features were recorded at presentation. Outcomes by final visit were classified as good (completely healed or reduced infiltrate size) or poor (enlarged infiltrate size, perforated, or surgery performed).

Results: Of 252 participants with severe MK, 191 had FK, 18 had AK, 19 had BK, 4 had mixed BK/FK, and 20 were microbiologically negative. Median age was 50 years (interquartile range [IQR]: 37–60 years), 64% were male, 63% were agriculturalists, and 45% had no formal education. Corneal trauma occurred in 72%, and median symptom duration before presentation was 7 days (IQR: 5–15 days). Clinical features associated with FK were feathery margins (p < 0.001), raised profile (p = 0.039), or dry surface (p = 0.007). Hypopyon was more likely in BK (p = 0.001) and ring infiltrate in AK (p < 0.001). Ulcers with poor outcome (n = 106/214) were more likely to be larger (odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.30–2.05, p < 0.001), involve the posterior cornea at presentation (OR: 2.31, 95% CI: 1.16–4.59, p = 0.017), involve Aspergillus sp. (OR: 3.23, 95% CI: 1.26–8.25, p = 0.014), or occur in females (OR: 2.04, 95% CI: 1.03–4.04, p = 0.04). Even after treatment, 34% (n = 76/221) had severe visual impairment by the final visit.

Conclusions: Severe MK occurred predominantly in agriculturalists post-corneal trauma and often had poor outcomes. Provision of community-based eyecare may allow earlier treatment and improve outcomes.     

Prevalence of refractive error,presbyopia, and unmet need of spectacle coverage in a northern district of Bangladesh: Rapid Assessment of Refractive Error study

Purpose: To determine the prevalence of refractive error (RE), presbyopia, spectacle coverage, and barriers to uptake optical services in Bangladesh.

Method: Rapid assessment of refractive error (RARE) study following the RARE protocol was conducted in a northern district (i.e., Sirajganj) of Bangladesh (January 2010–December 2012). People aged 15–49 years were selected, and eligible participants had habitual distance and near visual acuity (VA) measured and ocular examinations were performed in those with VA<6/18. Those with phakic eyes with VA <6/18, but improving to ≥6/18 with pinhole or optical correction, were considered as RE and people aged ≥35 years with binocular unaided near vision of <N8 were considered presbyopic.

Result : A total of 3,043 people were examined, of which 143 had RE (4.7%, 95% CI: 3.9–5.5). Among people aged ≥35 years (n = 1402), 869 had presbyopia (62.0, 95% CI: 59.4–64.5). Spectacle coverage for RE and presbyopia were 13.3% (95% CI 7.7–18.9) and 3.2% (95% CI 2.2–4.6), respectively. “Unaware of the problem” was the main reason for not utilizing any optical services among the people with RE (92.8%) and presbyopia (89.5%). Extrapolating the survey findings to the 2011 national census data, the magnitude of RE among people aged 15–49 years in Bangladesh is estimated to be 3,493,980 people (95% CI 2,899,260–4,088,700), of whom 3,029,280 people do not use any spectacles.

Conclusion : The burden of RE and presbyopia is substantial in Bangladesh. Improving awareness and availability of refraction services is required to correct REs and presbyopia in Bangladesh.