Incidence and Mimickers of Acute Idiopathic Optic Neuritis: Analysis of 291 Consecutive Patients from Southern Finland

Purpose: To estimate the population-based incidence of acute idiopathic optic neuritis (ON) and analyse its differential diagnosis in patients referred with symptoms suggestive of ON.

Methods: Patients with suspected ON referred to the Helsinki University Hospital, serving a population of 1.5 million in Southern Finland, were reviewed between 1st May 2008 and 14th April 2012. Brain and optic nerve magnetic resonance imaging (MRI) was performed within 24 hours in 83% of patients.

Results: Of 291 referred patients, 184 (63%; 95% confidence interval [CI], 57–69%) were diagnosed with ON whereas 107 (37%) had another condition. The estimated crude incidence of ON in Southern Finland was 3.0 (95% CI 2.8–3.3) per 100,000 (females, 4.6 and males, 1.4). Mean age was 34 years (range 15–61), 76% were female. Two (1%) were diagnosed with neuromyelitis optica. ON as the first demyelinative episode was diagnosed in 108 (59%) patients, and MRI showed demyelinating lesions (MRI+) in 82% (95% CI, 75–89) of them. MRI+ predicted the development of multiple sclerosis (MS): 54% of MRI+ vs. 5% MRI? patients were diagnosed as MS during a mean follow-up of 7.7 years. The most common differential diagnosis was non-arteritic anterior ischemic optic neuropathy (12%). Six (2%) intracranial compressive lesions were found upon MRI scan.

Conclusions: More than a third of patients with symptoms suggestive of ON had another condition. Demyelinative lesions on MRI indicated higher risk of developing MS. We recommend the use of MRI to improve the differential diagnostic accuracy of ON and to identify patients with high risk of MS.     

Retinoblastoma y realce del nervio óptico en la resonancia magnética cerebral: ¿es siempre una metástasis?

Case report

The case is presented on a girl with a unilateral retinoblastoma that required treatment with intra-arterial chemotherapy. In the nuclear magnetic resonance imaging of the brain performed 1 month after intra-arterial chemotherapy treatment, post-laminar optic nerve (ON) enhancement was observed, leading to the suspicion of an ON tumour infiltration. Additional examinations were requested by which a probable optic neuropathy was diagnosed.

Regional optic nerve blood flow and its autoregulation

An autoradiographic method (14C-iodoantipyrine autoradiography) was used to measure regional optic nerve blood flow (ONBF) under basal conditions in 11 adult female cats. Flow was measured in six regions of the optic nerve: (1) prelaminar, (2) laminar, (3) 1 mm post-laminar, (4) 4 mm post-laminar, (5) 6 mm post-laminar, and (6) intracranial optic nerve and chiasm. A gradient of flow rates was found with relatively high flow in the prelaminar, laminar, and 1-mm post-laminar optic nerve, and significantly lower flow in the 4- and 6-mm post-laminar nerve and in the intracranial optic nerve and chiasm. Blood flow in the 4- and 6-mm post-laminar nerve and in the intracranial nerve and chiasm was comparable to previously reported values for cerebral white matter in the cat. With alteration of mean arterial blood pressure (MABP), optic nerve blood flow demonstrated autoregulatory compensation in all areas.     

Validation of a portable,non-mydriatic fundus camera compared to gold standard dilated fundus examination using slit lamp biomicroscopy for assessing the optic disc for glaucoma

PurposeTo evaluate the sensitivity and specificity of a portable non-mydriatic fundus camera to assess the optic disc for glaucoma.MethodsWe conducted a single-site, cross-sectional, observational, instrument validation study. Non-mydriatic fundus photographs centred at the optic disc were obtained from 276 eyes of 68 glaucoma and 70 normal patients, using a portable fundus camera (Smartscope, Optomed, Oulu, Finland). A senior Glaucoma consultant, masked to the patient’s study participation, performed a gold standard dilated fundus examination to make the diagnosis of glaucoma. Following this, a mydriatic photograph was taken by a standard table-top fundus camera. All the images were digitalized and de-identified by an independent investigator and presented to two remote graders, masked to the patients, their diagnoses, and photographic modality. Based on individual disc characteristics, a diagnosis of screening positive or negative for glaucoma was made. In the end, the independent investigator re-identified the images. Sensitivity and specificity to detect glaucoma with the undilated Smartscope camera was calculated compared to dilated fundus examination.ResultsGrading remote images taken with the portable non-mydriatic fundus camera showed a sensitivity of 96.3% (95% confidence interval (CI): 91.6–98.8%) and 94.8% (95% CI: 89.7–97.9%) and a specificity of 98.5% (95% CI: 94.9–99.8%) and 97.8% (95% CI: 93.9–99.6%) for the two graders respectively as compared to gold standard dilated fundus examination.ConclusionThe non-mydriatic Smartscope fundus images have high sensitivity and specificity for diagnosing glaucoma remotely and thus may be an effective tool for use in community outreach programs.Subject terms: Optic nerve diseases, Diagnosis     

Multicenter prospective validation study for international chronic ocular graft-versus-host disease consensus diagnostic criteria

PurposeTo validate the international chronic ocular graft-versus-host disease (GVHD) diagnostic criteria (ICCGVHD) compared to the National Institute of Health diagnostic criteria 2014 (NIH2014) for chronic ocular GVHD.MethodsBetween 2013 and 2019, the study enrolled 233 patients with or without chronic ocular GVHD combined with the presence or absence of systemic chronic GVHD in an internationally prospective multicenter and observational cohort from 9 institutions. All patients were evaluated for four clinical parameters of ICCGVHD.ResultsThe relation between the ICCGVHD score (0-11) and NIH2014 eye score (0–4) was relatively high (r = 0.708, 95% CI: 0.637–0.767, p < 0.001). The sensitivity and specificity of ICCGVHD for NIH 2014 for 233 patients were 94.3% (95% CI: 89.6%–98.1%) and 71.7% (95% CI: 63.0–79.5%), respectively (cutoff value of the ICCGVHD score = 6). The positive predictive value was 77.1% (95% CI: 71.1%–82.1%), and the negative predictive value was 87.0% (95% CI:81.6–92.5%). For the patients with systemic GVHD (n = 171), the sensitivity and specificity were 94.2% and 67.2%, respectively (ICCGVHD-score cutoff value = 6). By receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was 0.903 (95% CI: 0.859–0.948). For patients without systemic GVHD (n = 62), the sensitivity and specificity were 100% and 76.7%, respectively (ICCGVHD-score cutoff value = 6). The AUC was 0.891 (95% CI 0.673–1.000).ConclusionsGood sensitivity, specificity, predictive value and correlation were found between ICCGVHD and NIH2014. ICCGVHD scores ≥6 can be useful to diagnose ocular GVHD with or without systemic GVHD for clinical research.     

Neuro-ophthalmic Sarcoidosis: The University of Iowa Experience

Purpose: To report a case series of neuro-ophthalmic sarcoidosis manifestations from a predominantly Caucasian Midwest population. Design: Retrospective non-comparative case series and literature review. Participants: Twenty patients with biopsy proven sarcoidosis cases and neuro-ophthalmic manifestations. Methods: We reviewed 67 consecutive charts with the clinical diagnosis of neurosarcoidosis at the University of Iowa Hospital and Clinics (UIHC) Department of Ophthalmology database in Iowa City, Iowa, seen from 1984 to 2006. Main Outcome Measures: Charts were reviewed for the following: 1) demographic information; 2) neuro-ophthalmic findings; 3) biopsy location and results; 4) pre-existing sarcoidosis; 5) neuroimaging studies (e.g., cranial magnetic resonance imaging and computed tomography scans); 6) cerebrospinal fluid results; 7) sarcoid related testing (serum angiotensin converting enzyme, chest radiograph, chest computed tomography scans, Gallium scan, bronchoalveolar lavage, pulmonary function testing); 8) treatment; and 9) course of disease. Results: Twenty of the 67 charts (30%) had biopsy proven sarcoidosis and neuro-ophthalmic manifestations. Of the 20 included cases, 4 (20%) were men and 16 (80%) were women. Six (30%) patients were African-American and 14 (70%) were Caucasian. The average age at diagnosis was 43.1 years with a standard deviation of 14.1 and a range of 22 to 80 years. Neuro-ophthalmic manifestations included optic neuropathy (14), cranial neuropathy (4), Horner's Syndrome (1), tonic pupil (1), and optic tract involvement (1). Of the 14 patients presenting with optic neuropathy, 8 had optic disc edema, 5 had optic disc pallor and 1 had an optic disc granuloma. Contrast cranial magnetic resonance imaging (MRI) showed pathologic contrast enhancement (16 of 19 cases) involving optic nerve (9), optic chiasm (1), optic radiations (1), cavernous sinus (1), leptomeninges (3), and cerebral parenchyma (3). Chest imaging was abnormal in the course of disease for 12 of 18 and serum angiotensin-converting enzyme was only elevated in 5 of 15 patients tested. All 20 patients were treated with corticosteroids but five required additional immunosuppressive therapy to control disease activity. The neuro-ophthalmic course was relapsing and remitting in 8 cases, stable or resolved in 7, and chronic in 5 patients. After treatment of patients with optic neuropathy, visual acuity at last follow-up visit was improved in 5, worsened in 5, and stable (i.e., within one Snellen acuity line of baseline) in 4. Conclusion: In our Midwest retrospective case series of biopsy proven neuro-ophthalmic sarcoidosis, patients were predominately white females with a wide age range. Consideration for the diagnosis of neurosarcoidosis should therefore not be limited by age, gender, or race. Optic neuropathy was the most common manifestation, typically presenting with optic disc edema and severe visual loss. No light perception vision was relatively common and should be considered a “red flag” for the diagnosis. Contrast cranial MRI frequently shows pathologic enhancement of the visual pathway. Serum angiotensin converting enzyme and chest radiography had relatively poor sensitivity for detecting biopsy proven disease in our study and therefore additional testing for tissue diagnosis might still be necessary for extrapulmonary neuro-ophthalmic sarcoidosis. Corticosteroids are the mainstay of therapy but some patients may require additional immunosuppressive therapy.     

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     

视网膜母细胞瘤眼球摘除术后病理与预后分析

目的　分析视网膜母细胞瘤（ｒｅｔｉｎｏｂｌａｓｔｏｍａ,Ｒｂ）侵犯眼球部位与患者预后之间的关系,为病情的预测和治疗提供依据。方法　回顾性分析２００３年１月至２０１１年２月于中山大学中山眼科中心行眼球摘除术的单眼Ｒｂ患者。记录术后肿瘤侵犯的部位、治疗情况和生存情况并评估患者的５ａ生存率（５ｙｅａｒｐｒｏｂａｂｉｌｉｔｙｅｖｅｎｔ-ｆｒｅｅｓｕｒｖｉｖａｌ,５-ＰＥＦＳ）。随访以患者死亡或至２０１２年２月截止,随访时间为（４６．３±２９．２）个月。结果　共有２０２例２０２眼患者纳入研究,其中筛板及筛板前侵犯所占比例最大（４０．６％）,５-ＰＥＦＳ也最高（９６．１％）;筛板后视神经侵犯和视神经断端侵犯者５-ＰＥＦＳ分别是８２．５％和４０．０％,三者比较差异有显著统计学意义（Ｐ＜０．０１）。筛板后视神经侵犯接受治疗的患者５-ＰＥＦＳ（９１．６％）有高于未治疗者（６６．７％）的趋势（Ｐ＝０．０９）;视神经断端侵犯者接受治疗与未治疗的５-ＰＥＦＳ分别是５０．０％和０（Ｐ＜０．０１）,单纯脉络膜侵犯患者５-ＰＥＦＳ是９３．８％,巩膜侵犯患者接受和未接受辅助化疗的５-ＰＥＦＳ分别是５７．１％ 和７７．８％（Ｐ＞０．０５）。２例眼眶侵犯患者均死亡,４例患者眼球摘除术后眼眶复发,从眼球摘除术到眼眶复发的时间是５～１５个月,平均为９．８个月。结论　Ｒｂ眼球摘除术后病理检查对患者预后的预测和辅助治疗有指导意义;眼球摘除术后２ａ,尤其１ａ内是Ｒｂ复发的高发期,这期间所有患者需要密切随诊。     

Prevalence and Visual Risk Factors for Falls in Bilateral Cataract Patients in Ho Chi Minh City,Vietnam

Abstract

Purpose: To determine the prevalence of falls in the 12 months prior to cataract surgery and examine the associations between visual and other risk factors and falls among older bilateral cataract patients in Vietnam.

Methods: Data collected from 413 patients in the week before scheduled cataract surgery included a questionnaire and three objective visual tests.

Results: The outcome of interest was self-reported falls in the previous 12 months. A total of 13% (n?=?53) of bilateral cataract patients reported 60 falls within the previous 12 months. After adjusting for age, sex, race, employment status, comorbidities, medication usage, refractive management, living status and the three objective visual tests in the worse eye, women (odds ratio, OR, 4.64, 95% confidence interval, CI, 1.85–11.66), and those who lived alone (OR 4.51, 95% CI 1.44–14.14) were at increased risk of a fall. Those who reported a comorbidity were at decreased risk of a fall (OR 0.43, 95% CI 0.19–0.95). Contrast sensitivity (OR 0.31, 95% CI 0.10–0.95) was the only significant visual test associated with a fall. These results were similar for the better eye, except the presence of a comorbidity was not significant (OR 0.45, 95% CI 0.20–1.02). Again, contrast sensitivity was the only significant visual factor associated with a fall (OR 0.15, 95% CI 0.04–0.53).

Conclusion: Bilateral cataract patients in Vietnam are potentially at high risk of falls and in need of falls prevention interventions. It may also be important for ophthalmologists and health professionals to consider contrast sensitivity measures when prioritizing cataract patients for surgery and assessing their risk of falls.     

Validación de la escala de graduación del color en la fotografía del nervio óptico,una alternativa para la clasificación cualitativa

BackgroundTo validate objectively the proposed Teherán-Morales's color grading scale, comparing to the subjective readings of specialists in optic nerve photography.MethodsConcordance study and diagnostic tests, in which 150 photographs of the optic nerve were evaluated, from three groups, glaucomatous neuropathy, neuropathy of other origin and control group with the Teherán-Morales's color scale and the analysis of three experts in optic nerve. Spearman's Rho correlation was performed between both analysis methods.ResultsIn the analysis of all the photographs using Spearman's Rho, we found moderate correlations that were statistically significant P < .0001, the highest was in the temporal quadrant by observer 1 (r = 0.650 95% CI 0.546 to 0.733). In photographs of optic neuropathy, the correlations become moderately high, and statistically significant P < .0001, the highest correlation was for the temporal quadrant by observer 1 (r = 0.772 95% CI 0.626 to 0.865). In the glaucoma and normal eyes groups, there were moderate to low correlations with statistical significance P < .05.ConclusionsThe Teherán-Morales's scale, for color grading, is useful in detecting color, correlates moderately with the subjective assessment of experts in the optic nerve having its best performance in optic neuropathy with very pale discs. However, in normal or glaucomatous optic discs, it has a low correlation, compared to the subjective clinical assessment.     

The prevalence and determinants of glaucoma among 40 years and older Saudi residents in the Riyadh Governorate (except the Capital) – A community based survey

PurposeTo evaluate the prevalence of glaucoma and its determinants among adult Saudi Residents aged 40 years and older in the Riyadh Governorate (except the Capital).MethodsA cluster-based sample of randomly selected citizens from six primary health center catchment areas were examined between 2014 and 2015. Data were collected on their glaucoma management. Assessment included measurement of intraocular pressure, optic nerve head evaluation and gonioscopy. Glaucoma suspects were referred for visual field testing.ResultA total of 940 citizens were examined and 124 had glaucoma. The prevalence of glaucoma was 5.6% [95% Confidence interval (CI): 5.43–5.75] with an estimated 3758 cases of glaucoma in study area. Males had a significantly higher prevalence (7.62%) than females (3.48%). Glaucoma was not significantly associated to diabetes [Odds ratio (OR) = 1.1; (95% CI: 0.8–1.7); P = 0.5]. The variation in the prevalence of glaucoma by age group was not significant (P = 0.2). Open angle of anterior chamber was in 78% of glaucoma cases. The coverage of glaucoma management was 27.8%. Among known glaucoma patients were 69% were treatment-complaint. Of 124 glaucoma patients, 29 (23.5%) were aware of their diagnosis. Mild and moderate visual impairment was in 67% and 8 (6.5%) glaucoma patients while one (0.8%) patient was bilateral blind.ConclusionThe prevalence of glaucoma was high. Identified determinants should be noted and accordingly a public health approach for early detection and adequate management is recommended.     

Population-Based Trachoma Mapping in Six Evaluation Units of Papua New Guinea

ABSTRACT

Purpose: We sought to determine the prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years, and trachomatous trichiasis (TT) in those aged ≥15 years, in suspected trachoma-endemic areas of Papua New Guinea (PNG).

Methods: We carried out six population-based prevalence surveys using the protocol developed as part of the Global Trachoma Mapping Project.

Results: A total of 19,013 individuals were sampled for inclusion, with 15,641 (82.3%) consenting to participate. Four evaluation units had prevalences of TF in children ≥10%, above which threshold the World Health Organization (WHO) recommends mass drug administration (MDA) of azithromycin for at least three years; Western Province (South Fly/Daru) 11.2% (95% confidence interval, CI, 6.9–17.0%), Southern Highlands (East) 12.2% (95% CI 9.6–15.0%), Southern Highlands (West) 11.7% (95% CI 8.5–15.3%), and West New Britain 11.4% (95% CI 8.7–13.9%). TF prevalence was 5.0–9.9% in Madang (9.4%, 95% CI 6.1–13.0%) and National Capital District (6.0%. 95% CI 3.2–9.1%) where consideration of a single round of MDA is warranted. Cases of TT were not found outside West New Britain, in which four cases were seen, generating an estimated population-level prevalence of TT in adults of 0.10% (95% CI 0.00–0.40%) for West New Britain, below the WHO elimination threshold of 0.2% of those aged ≥15 years.

Conclusion: Trachoma is a public health issue in PNG. However, other than in West New Britain, there are few data to support the idea that trachoma is a cause of blindness in PNG. Further research is needed to understand the stimulus for the active trachoma phenotype in these populations.     

Accommodation in pseudophakic eyes

PurposeToday, many patients who have undergone cataract surgery want to enjoy good non-spectacle corrected distant vision and nonspectacle corrected near vision with glasses independence. According to the literature, the implantation of an accommodative intraocular lens (AIOLs) can achieve the level of vision after cataract surgery. However, there is a debate regarding the true accommodative capability of the AIOLs (i.e., whether the IOLs can move forward when attempting to accommodate like the natural crystalline lens of a phakic eye). This review aims to answer the following questions: (1) Can pseudophakic eye accommodate? (2) If pseudophakic eyes can accommodate, how long does this accommodation last? (3) Is there pseudoaccommodation?MethodsThis is a systematic review of randomized and nonrandomized controlled trials that have compared different IOLs in accommodation using subjective and objective methods of testing accommodation. All peer reviewed randomized and nonrandomized controlled trials that compared different IOLs in accommodation were included.ResultsThere was evidence of pseudophakic accommodation up to 12 months postoperatively for AIOLs (mostly 1CU): subjective accommodation [95% confidence interval (CI), 0.36–0.98], objective optic shift (95% CI, 0.12–0.76). However, accommodation decreased at 12 months postoperatively (95% CI, 0.55–1.00). In addition, several papers have reported evidence of pseudoaccommodation.ConclusionThere is pseudophakic accommodation up to 1 year post cataract surgery, mostly 1CU AIOL. Pseudoaccommodation may coexist.     

Optic neuritis: correlation of pain and magnetic resonance imaging

PURPOSE: To demonstrate whether the magnetic resonance imaging (MRI) localization of the abnormal enhancement of the optic nerve can be related to the pain or pattern of visual field loss associated with acute optic neuritis. DESIGN: Retrospective observational series and MRI review from a referral neuro-ophthalmology service. PARTICIPANTS: Seventy-three women and 23 men with acute optic neuritis who had high resolution gadolinium-enhanced fat-suppressed MRI within twenty days of the onset of visual loss. METHODS: The presence of eye or other fifth cranial nerve (V(1)) pain, and pain with eye movement ipsilateral to the affected optic nerve or no eye pain was recorded. The neuroradiologist reviewed the MRI, masked to the affected eye, and recorded the length and segment (orbital, canalicular, intracranial, or combination of segments) of abnormal optic nerve enhancement. The presenting visual field defects were characterized as diffuse, central, arcuate, nasal or temporal. MAIN OUTCOME MEASURES: The types of pain and patterns of field loss were correlated with the segments of optic nerve enhancement in the affected eye. RESULTS: Five patients had nerves that did not enhance and were excluded from the outcome analysis. In the 91 patients with abnormal enhancement, 70 experienced eye/V(1) pain, 67 had pain with eye movement and 17 patients had no pain. Enhancement of the orbital optic nerve occurred in 66 patients, 93.9% who had eye/V(1) pain and 92.4% who had pain with eye movement. In the 25 patients with enhancement of the canalicular, intracranial or both segments, without orbital involvement, 32% had eye/V(1) pain and 24% had pain with eye movement. No pain occurred in 3% with enhancement of the orbital segment and in 60% with enhancement of the other optic nerve segments. The length of enhancement moderately correlated with eye/V(1) pain (r = 0.49, P = 0.01) and pain with eye movement (r = 0.37, P = 0.01). Patients with enhancement longer than 10 mm had pain five times (P = 0.004) more frequent than did those with enhancement 相似文献   

Interactions among different genetic loci in age-related macular degeneration

Purpose: To evaluate the possible synergistic effect of at risk genotypes of ARMS2/LOC387715 (A69S), DNA repair SMUG1 rs3087404, CCL2–2518, C3 (R102G), CFH Y402H, complement factor B (L9H), and complement factor I (CFI) (G119R) in advanced age-related macular degeneration compared to those of healthy controls. Elucidation of synergistic effects between different genetic loci may clarify their pathogenetic pathways.

Methods: We calculated relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (S) to estimate the additive or supra-additive effects of the mentioned genotypes.

Results: ARMS2-CFH [RERI = 4.78 (95% CI 2.17–10.61), AP = 0.65 (95% CI 0.33–0.83), S = 4.11 (95% CI 1.40–12.06)], and CFH-C3 combinations [RERI = 2.71 (95% CI 0.04–7.01) AP = 0.47 (95% CI ?0.03–0.7) S = 2.30 (95%CI 0.97–5.45)] have the most significant levels of synergism and C3-CFI combination [RERI = ?1.65 (95%CI ?4.34–0.06), AP = ?0.92(95%CI ?3.09 – ?0.09), S = 0.32 (95%CI 0.09 = 1.20)] has the most significant level of antagonism.

Conclusion: Among different genotype combinations ARMS2-CFH and CFH-C3 combinations have the most significant levels of synergism and C3-CFI combination has the most significant level of antagonism in AMD patients.     

Stereometrische Parameter der Papillentopographie

Background

The Heidelberg retina tomograph (HRTIII, Heidelberg Engineering, Germany) in conjunction with the Moorfields regression analysis (MRA) allows monitoring for the progression of early damage to the optic nerve suspicious of early stage glaucoma. The confocal scanning laser ophthalmoscope provides clinicians with an objective and reproducible analysis of morphological parameters of the optic disc. Margins of the optic disc are approximated with a contour line to calculate the stereometric parameters leading to interobserver and intraobserver variability of the MRA. New devices enabling 3D fundus photography might be an alternative to the established HRT. It was the goal of this study to compare the methods by assessing the differences in the topographic parameters obtained by the HRT and the Kowa nonmyd WX 3D (2D/3D non-mydriatic retinal camera, Kowa, Japan) in a representative sample.

Methods

This retrospective study included 45 eyes of normal patients, 40 eyes of patients with macropapillae and 45 eyes of glaucoma patients. Each patient underwent an HRT examination and fundus photography with the Kowa nonmyd WX 3D on the same day. Excluded from the study were eyes with hazy media (cornea, lens, vitreous) or refractive anomalies higher than >4 dpt or astigmatisms >2 dpt. Eyes with previous refractive surgery history or other retinal diseases affecting the optic nerve were also excluded from the study. Bland-Altman plots were used for statistical evaluation. Distribution of parameters was described by 95% confidence intervals (CI).

Results

In normal eyes (n=45) a mean difference in the disc area of 0.33?mm² was found (95?% confidence interval CI: 0.22?C0.43), in the cup-disc ratio (CDR) of 0.02 (95% CI: -0.06?C0.14), in the cup volume of 0.03?mm³ (95% CI: -0.04?C0.01), in the rim volume of 0.04?mm³ (95%-CI: -0.04?C0.13) and in the maximum cup depth of 0.28?mm (95?%-CI: 0.34?C0.23). All differences, except for the rim volume, were statistically significant (p<0.05). Patients exhibiting a macropapilla (n=40) displayed a mean difference of 0.03?mm² (95?% CI: -0.18?C0.11) for the disc area, a difference in CDR of 0.09 (95% CI: -0.05?C0.13), a difference in maximum cup depth of 0.28?mm (95% CI: 0.23?C0.34) and a cup volume of 0.14?mm³ (95%-CI: 0.10?C0.18). In addition, there were no significant differences in rim volume (difference: -0.02?mm³, 95% CI: -0.07?C0.12) or in disc area. In glaucomatous eyes (n=45), the mean difference for cup area was 0.33?mm² (95% CI: 0.22?C0.43), an area of 0.09?mm² (95% CI: 0.06?C0.13) for the CDR, -0.03?mm³ (95?% CI: -0.09?C0.02) for the cup volume and 0.08?mm³ (95% CI: 0.03?C0.13) for the rim volume. Mean maximum cup depth difference was 0.25?mm (95% CI: 0.20?C0.31). Mean differences in CDR, maximum cup depth and cup area were all statistically significant. The mean differences did not exceed the interobserver and intraobserver variability found in HRT measurements of other studies.

Conclusions

To the best of our knowledge this study is the first comparing optic disc parameters of HRT and 3D photography. Mean differences in stereometric parameters did not exceed the known interobserver and intraobserver variability. The combination of non-mydriatic fundus photography and optic disc analysis is a very attractive and time-saving method. However, before progression of early glaucoma can be monitored or suspected glaucoma can be appraised over longer time periods, further studies are needed to clarify test and retest variability.     

Novel use of 3T MRI in assessment of optic nerve volume in glaucoma

Purpose

To measure optic nerve (ON) volume using 3 T magnetic resonance imaging (MRI), to correlate ON volume with retinal nerve fiber layer (RNFL) thickness, and to determine the viability of MRI as an objective tool in distinguishing glaucoma severity.

Methods

In this cross-sectional study, 30 severe glaucoma patients, 30 mild glaucoma patients and 30 age-matched controls were recruited. All subjects underwent standard automated perimetry, RNFL analysis and 3 T MRI examinations. Glaucoma patients were classified according to the Hodapp–Anderson–Parish classification. Pearson’s correlation coefficient was used to correlate ON volume with RNFL, and receiver operating curve (ROC) analysis was performed to determine the sensitivity and specificity of ON volume in detecting glaucoma severity.

Results

Optic nerve volume was significantly lower in both the left and right eyes of the severe glaucoma group (168.70?±?46.28 mm³; 167.40?±?45.36 mm³) than in the mild glaucoma group (264.03?±?78.53 mm³; 264.76?±?78.88 mm³) and the control group (297.80?±?71.45 mm³; 296.56?±?71.02 mm³). Moderate correlation was observed between: RNFL thickness and ON volume (r?=?0.51, p <0.001), and in mean deviation of visual field and optic nerve volume (r?=?0.60, p?<?0.001). ON volume below 236 mm³ was 96 % sensitive and 80 % specific for the detection of severe glaucoma.

Conclusions

MRI measured optic nerve volume is a reliable method of assessing glaucomatous damage beyond the optic nerve head. A value of 236 mm³ and below can be used to define severe glaucoma.     

Factors Associated with Visual Impairment in Chinese American Adults: The Chinese American Eye Study

Purpose: To assess associations between multiple factors comprising a conceptual model of visual impairment (VI) in a population of Chinese Americans (CAs), and identify independent VI risk factors.

Methods: A population-based study of 4582 CAs aged 50 years and older residing in Monterey Park, California. A comprehensive eye examination was performed. VI was defined as best-corrected visual acuity <20/40 (US definition) in the better-seeing eye.

Results: Of five independent risk factors identified, age and self-reported history of ocular disease were most strongly associated with VI. Participants 70 years and older were 10.0 times as likely to have VI compared to those in their 50s (95% confidence interval (CI) 4.0–25.0), while those with a history of ocular disease were 4.2 times as likely to have VI (95% CI 2.2–7.8). Additional risk factors included low education (OR 2.8, 95% CI 1.7–4.8), low acculturation (OR 5.9, 95% CI 2.0–17.3) and self-reported history of diabetes (OR 2.0, 95% CI 1.2–3.2). A comparison to data previously described from the Los Angeles Latino Eye Study indicated that four of the factors that predict VI risk in CAs also represent clinically relevant risk factors for VI in Latinos.

Conclusions: Screening programs for individuals with advanced age and a history of ocular disease have the potential to reduce the burden of VI in CAs, as do educational programs for those with fewer years in school, a history of diabetes, and low acculturation.     

Mapping Trachoma in the Solomon Islands: Results of Three Baseline Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project

ABSTRACT

Purpose: We sought to complete the baseline trachoma map of the Solomon Islands by establishing prevalences of active trachoma and trichiasis in the provinces of Choiseul, Western, Rennell-Bellona, and Temotu.

Methods: Using the standardized methodology developed for the Global Trachoma Mapping Project, we conducted cross-sectional community-based surveys from September to November 2013. Choiseul and Western provinces were each mapped as separate evaluation units (EUs); Rennell-Bellona and Temotu were combined to form a third EU.

Results: A total of 9819 individuals were sampled for inclusion, with 9224 (93.3%) consenting to examination, of whom 4587 (46.3%) were female. Survey teams visited 82 villages, and surveyed 2448 households. Two EUs had prevalences of trachomatous inflammation – follicular (TF) in 1–9-year-olds over the 10% threshold at which WHO recommends mass distribution of azithromycin for at least 3 years (Western 20.4%, 95% confidence interval, CI 15.6–26.3%; Rennell-Bellona/Temotu 22.0%, 95% CI 18.5–26.0%). Choiseul had a TF prevalence of 6.1% (95% CI 4.1–8.6%), and met the criterion for a single round of mass antibiotic distribution before re-survey. The adjusted prevalences of trichiasis in those aged 15+ years were 0.0% (95% CI 0.0–0.2%) in Choiseul, 0.16% (95% CI 0.0–0.5%) in Western, and 0.10% (95% CI 0–0.3%) in Rennell-Bellona/Temotu provinces. All three EUs require implementation of the facial cleanliness and environmental improvement components of the trachoma elimination strategy.

Conclusion: Active trachoma is prevalent in the Solomon Islands. However, there is little evidence of the blinding complications of trachoma being a public health problem there. Further research into the explanation for this phenomenon is warranted.     

Use of offline artificial intelligence in a smartphone-based fundus camera for community screening of diabetic retinopathy

Purpose:The aim of the study was to analyse the reliability of an offline artificial intelligence (AI) algorithm for community screening of diabetic retinopathy.Methods:A total of 1378 patients with diabetes visiting public dispensaries under the administration of the Municipal Corporation of Greater Mumbai between August 2018 and September 2019 were enrolled for the study. Fundus images were captured by non-specialist operators using a smartphone-based camera covering the posterior pole, including the disc and macula, and the nasal and temporal fields. The offline AI algorithm on the smartphone marked the images as referable diabetic retinopathy (RDR) or non-RDR, which were then compared against the grading by two vitreoretinal surgeons to derive upon the sensitivity and specificity of the algorithm.Results:Out of 1378 patients, gradable fundus images were obtained and analysed for 1294 patients. The sensitivity and specificity of diagnosing RDR were 100% (95% CI: 94.72–100.00%) and 89.55% (95% CI: 87.76–91.16%), respectively; the same values for any diabetic retinopathy (DR) were 89.13% (95% CI: 82.71–93.79%) and 94.43% (95% CI: 91.89–94.74%), respectively, with no false-negative results.Conclusion:The robustness of the offline AI algorithm was established in this study making it a reliable tool for community-based DR screening.