Visual outcomes in idiopathic intracranial hypertension in children

ObjectiveThe purpose of this study was to report the clinical characteristics and long-term visual outcomes in a cohort of children with idiopathic intracranial hypertension (IIH).DesignRetrospective, observational cohort study.ParticipantsConsecutive children who met the diagnostic criteria for definite IIH at a tertiary care pediatric hospital between 2009 and 2020.MethodsThe charts of pediatric patients with IIH were reviewed. The main outcome measure was long-term visual impairment, with an analysis of clinical features by age and risk factors for a poor visual outcome.ResultsThere were 110 children (75 females) with IIH. At presentation, younger children with IIH were less likely to present with headaches (p = 0.01) and more likely to be asymptomatic (p = 0.03). There was a strong association with female sex (p < 0.001) and higher body mass index (p < 0.001) in adolescents in comparison to younger children. Of the 90 patients with long-term visual outcome data, only 8 (9%) had evidence of mild visual impairment (1 loss of visual acuity, 7 loss of visual field) with no cases of severe visual impairment. On risk factor analysis, the only variable associated with a poor visual outcome was greater severity of papilledema at diagnosis.ConclusionsIn this large series of pediatric IIH, the long-term visual outcomes were favourable, with evidence of mild visual impairment in less than 10% of patients.     

Status of eye health among tribal school children in South India

Purpose:Global trends show a high prevalence of refractive errors among children. The prevalence of vision impairment due to uncorrected refractive errors among school children is increasing and the need for management of other ocular conditions is also reported. This study presents the status of eye health and pattern of daily activities among the school children of a tribal location in Tamil Nadu, South India.Methods:A cross-sectional study was conducted in 13 schools of Karumandurai cluster, Salem district in Tamil Nadu, India. A three-phased comprehensive school screening protocol was conducted to understand the prevalence of vision impairment, refractive error, and other ocular conditions along with a survey about the daily activities of the children at school and home.Results:Among the 3655 children screened, the prevalence of vision impairment was found to be 0.62% (n = 23, 95% confidence interval [CI] 0.42–0.94) and prevalence of refractive error was 0.30% (n = 11, 95%CI 0.17–0.54), among which 0.11% (n = 4) were already wearing spectacles. A total of 44 children (1.20%; 95%CI 0.90–1.61) were found to have other ocular problems and among them, 14 (0.38%) had visual acuity less than 20/30 (6/9). Almost 84% of children required surgical or specialty eye care services. Vision impairment was more in children with other ocular conditions compared to refractive errors (P < 0.001).Conclusion:The prevalence of vision impairment and refractive errors in this tribal area was less. Ocular conditions were more prevalent than refractive errors in this tribal region with the majority of children needing specialty or surgical eye care services. This implies the need for access to secondary or tertiary eye care centers.     

Philadelphia glaucoma detection and treatment project: ocular outcomes and adherence to follow-up at a single health centre

ObjectivesTo determine ocular outcomes and factors associated with adherence to ophthalmic follow-up in a medically underserved population at a single health centre in Philadelphia.DesignRetrospective chart review.ParticipantsPatients from a community glaucoma screening program.MethodsChart review was conducted for participants who received a complete eye examination at the Philadelphia District Health Center 5 between January 1, 2012 and May 31, 2014 within the Philadelphia Glaucoma Detection and Treatment Project. Multivariate logistic regression was used to determine factors related to ophthalmic follow-up adherence.ResultsA total of 249 participants completed an eye examination (mean age = 57.7 ± 6.9 years). Most were African American (n = 220; 88.4%); female (n = 129; 51.8%). Forty-seven participants (18.9%) received glaucoma-related diagnoses, 20 (8.0%) were prescribed ocular medication, and 26 (10.4%) underwent laser therapy. Ninety (36.1%) attended their recommended follow-up eye examination at the health centre. Glaucoma-related diagnosis (p ≤ 0.001), recommendation of a 4- to 6-week follow-up period (p < 0.001), prescribed eye drops (p < 0.001), or received laser therapy (p = 0.047) were factors most predictive of ophthalmic follow-up adherence.ConclusionsThe collaborative effort of eye care providers and health centres offers an important opportunity to detect, treat, and manage glaucoma and other ocular pathology in medically underserved communities. Having a glaucoma-related diagnosis, initiating treatment, and scheduling regular follow-up visits are the most important factors influencing adherence to follow-up eye appointments.     

Circumscribed choroidal hemangioma: Clinical features and outcomes by age category in 458 cases

PurposeTo investigate features and outcomes of circumscribed choroidal hemangioma by patient age.MethodsRetrospective review of circumscribed choroidal hemangioma from 3/29/1967–6/4/2018 based on age at presentation (≤20 vs. >20–50 vs. >50 years).ResultsThere were 458 circumscribed choroidal hemangiomas diagnosed at mean age (13 vs. 41 vs. 64 years, p < 0.001). The youngest age group had worse presenting visual acuity (20/400 vs. 20/150 vs. 20/100, p < 0.001), larger tumor basal diameter (13.5 vs. 6.6 vs. 6.2, p < 0.001), greater tumor thickness (5.8 vs. 3.1 vs. 2.9, p < 0.001), closer distance to foveola (0.5 vs. 1.4 vs. 1.2, p = 0.03), and greater extent of subretinal fluid (4 quadrants, 26% vs. 8% vs. 2%, p < 0.001). The youngest patients were less likely to be treated with primary observation (39% vs. 39% vs. 56%) or photodynamic therapy (10% vs. 27% vs. 22%) and more likely to be treated with plaque radiotherapy (26% vs. 6% vs. 3%) or external beam radiotherapy (13% vs. 1% vs. 0%) (p < 0.001). The youngest patients required greater total number of treatments (mean 4 vs. 2 vs. 1, p < 0.001). At mean follow-up (44 vs. 68 vs. 60 months, p = 0.37), the youngest patients had worse visual acuity (20/400 vs. 20/200 vs. 20/100, p = 0.03), but no difference in visual acuity loss of 3 or more Snellen lines (27% vs. 13% vs. 16%, p = 0.55).ConclusionYounger patients (≤20 years) with circumscribed choroidal hemangioma present with worse visual acuity and larger, more posterior tumors. Future studies are needed to improve early detection and treatment for this subgroup of patients.     

Profile of ocular conditions from school eye screening in Southern India

Purpose:To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu.Methods:The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6–17 years) between July 2016 and June 2019. The study followed a three-phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented.Results:Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22–2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21–1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10–8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37–6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12–6.23 P < 0.001) was common among males.Conclusion:The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow-up after school eye screening would safeguard the visual development of these children.     

Rationale,Design, and Demographic Characteristics of the Handan Offspring Myopia Study

Abstract

Purpose: The Handan Offspring Myopia Study (HOMS) aims to investigate the familial associations of myopia between parents and their offspring.

Methods: Children aged 6–18 years, residing in 6 villages where all people aged ≥30 years had participated in The Handan Eye Study in 2006–2007, were selected for the current eye study between March and June 2010. A mobile clinic was set up in the 6 villages for comprehensive eye examinations, including visual acuity, ocular biometry, cycloplegic autorefraction and retinal photography.

Results: Of 1238 eligible individuals, 878 children (70.2%; 52.6% male) from 541 families were recruited. Mean age of the children was 10.5?±?2.5 years. The prevalence of myopia (spherical equivalent refraction <?0.5 diopter) was 23.5% (males 16.8%, females 30.8%). The prevalence of low vision (presenting visual acuity ≥20/400 but <20/60) in the better eye was 7.1%. A higher number of females had low vision at the time of presentation (9.2%) compared to males (5.2%, p?=?0.02). The prevalence of low vision in the worse eye was 10.6% (males 6.7%, females 14.9%, p?<?0.001). The majority of visual impairment in the better-seeing (56/62, 90.3%) as well as the worse-seeing (84/93, 90.3%) eye was correctable.

Conclusions: The HOMS examined about 70% of eligible Han Chinese offspring of Handan Eye Study participants in a rural region of northern China. Results from the HOMS will provide key information about the prevalence of refractive errors and eye diseases in rural Chinese children.     

Risk Factors for Strabismus and Amblyopia in Young Singapore Chinese Children

Abstract

Purpose: To determine the risk factors for strabismus and amblyopia in young Singapore Chinese children.

Methods: A total of 3009 children were recruited for the population-based cross-sectional Strabismus, Amblyopia and Refractive Error in Singaporean Preschoolers Study (STARS). Strabismus was defined as any tropia identified on cover test. Visual acuity was measured in children aged 30–72 months with a logMAR chart where possible and the Sheridan-Gardiner test if not. Amblyopia was defined based on visual acuity and refractive error or presence of strabismus or past/present visual axis obstruction. Parents completed questionnaires on family, prenatal and birth histories.

Results: Our study showed that 24 children aged 6–72 months (1.2%) had strabismus (20 with exotropia), and 20 children aged 30–72 months (0.8%) were amblyopic. After multivariate analysis, strabismus was associated with astigmatism ≥1.00 diopter (D; p?=?0.03), amblyopia (p?=?0.003), a sibling with strabismus (p?<?0.001), and families with lower parental education (p?=?0.04). In addition to strabismus, amblyopia was associated with anisometropia ≥1.00 D (p?<?0.001) and astigmatism ≥1.00 D (p?<?0.001). No association was noted between either strabismus or amblyopia and prematurity, maternal age or smoking.

Conclusion: This study highlights the importance of family history in strabismus, and the close associations between refractive error and strabismus with amblyopia. These factors play a more important role in young Singapore Chinese children.     

Visual and autorefraction outcomes following toric intraocular lens insertion without calculation of posterior corneal astigmatism in the UK National Health Service

ObjectiveTo ascertain visual and refractive outcomes following toric intraocular lens (IOL) implantation in the UK National Health Service (NHS) without posterior corneal astigmatism calculation, with multiple surgeons of different grades, pooled input and output pathways and autorefraction as the refractive outcome measure.MethodsPreoperative and 1-month post-operative data were analysed retrospectively in 114 eyes (95 patients) receiving a toric IOL between 2014 and 2016 at Imperial College NHS Trust. Preoperative keratometric astigmatism was ≥2 dioptres (D).ResultsMean preoperative best-corrected visual acuity (BCVA) was 0.50 logMAR (±0.46), improving to a mean uncorrected VA (UCVA) of 0.35 logMAR (±0.36) postoperatively (p < 0.001) with 65% of eyes attaining a UCVA ≤ 0.30 logMAR. Excluding 33 eyes with pre-existing visual comorbidities and one targeting monovision, mean post-operative UCVA was 0.24 logMAR (±0.29) (p < 0.001), and 85% had UCVA ≤ 0.30 logMAR, 62% UCVA ≤ 0.20 logMAR. Mean refractive astigmatism improved from 3.04 D (±1.46) to 1.36 D (±1.13) (p < 0.001). In total, 52% of eyes had post-operative refractive astigmatism ≤1.00 D. The Alpins correction index was 1.05 (±0.22), indicating a tendency to overcorrect. Toric IOL misalignment was noted in two eyes, and two cases of posterior capsule rupture were converted to a non-toric IOL.ConclusionsVisual outcomes of toric IOL implantation in our pooled pathway are comparable to single-surgeon case series where posterior corneal astigmatism has not been accounted for. However, with 1-month post-operative autorefraction, only 52% of eyes had ≤1 D refractive astigmatism, which is lower than previously published series, but may be standard for 1-month autorefraction outcomes.Subject terms: Outcomes research, Health services     

Factors Affecting Long-term Myopic Regression after Laser In Situ Keratomileusis and Laser-assisted Subepithelial Keratectomy for Moderate Myopia

PurposeHigh myopia is known to be a risk factor for long-term regression after laser refractive surgery. There have been few studies about the correction of moderate myopias that did not need retreatment after long-term follow-up. We evaluated 10 years of change in visual acuity and refractive power in eyes with moderate myopia after laser refractive surgery.MethodsWe included patients that had undergone laser in situ keratomileusis (LASIK) or laser-assisted subepithelial keratectomy (LASEK) to correct their myopia and that had at least 10 years of follow-up. We evaluated the stability of visual acuity in terms of safety, efficacy, and refractive changes at examinations 6 months and 1, 2, 5, 7, and 10 years after surgery.ResultsThe study evaluated 62 eyes (36 eyes in LASIK patients and 26 eyes in LASEK patients). In both groups, the efficacy index tended to decrease, and it was consistently higher in the LASEK group compared to the LASIK group over the 10 years of follow-up. The safety index improved over 10 years and was always higher than 0.9 in both groups. The difference between the spherical equivalent at 6 months postoperatively and later periods was statistically significant after 5, 7, and 10 years in both groups (LASIK, p = 0.036, p = 0.003, and p < 0.001, respectively; LASEK, p = 0.006, p = 0.002, and p = 0.001, respectively). Ten years after surgery,26 eyes (66.7%) in the LASIK group and 19 eyes (73.1%) in the LASEK group had myopia greater than 1 diopter. In comparison with the thickness at 6 months postoperatively, central corneal thickness was significantly increased after 5, 7, and 10 years in both LASIK and LASEK groups (LASIK, p < 0.001, p < 0.001, and p < 0.001, respectively; LASEK, p = 0.01, p < 0.001, and p < 0.001, respectively).ConclusionsModerately myopic eyes showed progressive myopic shifting and corneal thickening after LASIK and LASEK during 10 years of follow-up. We also found that early refractive regression may indicate the long-term refractive outcome.     

Refractive and visual outcomes of small incision lenticule extraction (SMILE) in eyes with thin corneas

ObjectivesTo report the refractive and visual outcomes of small incision lenticule extraction (SMILE) with the thinnest corneal thickness (CCT) of less than 500 µm and evaluate it in terms of safety and efficacy.SettingRefractive Surgery Clinic of University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey.DesignRetrospective case series.MethodsThe pre-and-postoperative examinations of all patients with thin corneas (preoperative CCT <500 µm) who underwent the SMILE procedure and had a minimum of 24 months of follow-up records were reviewed from medical files. The main outcome measures of the refractive and visual outcomes and the effect on corneal high order aberrations (HOAs) were evaluated.ResultsThe study included 55 eyes of 39 patients. The mean preoperative uncorrected visual acuity (UDVA) was 1.3 ± 1.5 logMAR, and the mean postoperative UDVA was significantly improved to 0.05 ± 0.80 logMAR at the last visit (p < 0.001). At the last follow-up, 84% of the eyes were within ± 0.50D, and 96% of the eyes were within ±1.00D of attempted SE refraction. The HOAs of coma (p < 0.001), secondary astigmatism (p = 0.015), spherical aberration (p < 0.001), and RMS (p < 0.001) aberrations increased significantly from the baseline to the postoperative last visit. The increase in trefoil was not significant (p = 0.32). No sight threatening complications or ectasia were observed during the follow-up time.ConclusionSMILE is a safe and effective technique with long-term stability for treatment of myopia in eyes with a thin cornea, and satisfactory results can be obtained if candidates for surgery are selected carefully with particular emphasis on normal preoperative corneal topography.Subject terms: Outcomes research, Refractive errors     

Social Determinants and Their Impact on Visual Impairment in Southern Mexico

Abstract

Purpose: Visual impairment in disadvantaged populations in Mexico has been scarcely reported. We compared the prevalence of visual impairment and its associated risk factors in populations in rural compared to urban areas of the Mexican southern state of Chiapas.

Methods: In a population-based study, the prevalence of visual impairment in rural and urban areas of Comitan, Chiapas, was estimated. All eligible individuals aged ≥20 years living in rural areas were invited to participate; persons from urban areas were chosen randomly. Individuals were considered of indigenous (IND) origin either by self-report or if they spoke an IND language. Visual acuity (VA) and pinhole VA were measured using a tumbling E chart. VA was defined as normal (better than or equal to 20/60), moderate impairment (worse than 20/60 but better than or equal to 20/200), severe impairment (worse than 20/200 but better than or equal to 20/400), or blindness (worse than 20/400).

Results: Data on VA were obtained from 969 persons (610 rural, 359 urban) whose mean age was 43.3 years (standard deviation 15.6 years). Prevalence of moderate visual impairment was higher in rural (10.2%, 95% confidence interval, CI, 7.2–14.2%) than urban (3.9%, 95% CI 1.9–7.9%) areas (p?<?0.001). Persons with moderate visual impairment were older and less educated (both p?<?0.001). Rural individuals aged 50 years and older had 4.4 times (95% CI 1.8–11.3, p?=?0.002) the likelihood of having moderate visual impairment compared with urban persons.

Conclusion: Unfavorable socioeconomic conditions were associated with higher prevalence of moderate visual impairment in rural compared with urban populations in Mexico.     

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

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

Binocularity outcomes following treatment for retinopathy of prematurity

ObjectiveRetinopathy of prematurity (ROP) is a leading cause of childhood visual impairment. Treatment options for severe ROP include laser and/or anti–vascular endothelial growth factor (anti-VEGF) injections. Previous studies have compared the 2 treatments for functional outcomes including visual acuity, amblyopia, and strabismus. The purpose of this study was to evaluate the influence of treatment on binocularity.MethodsIn this masked, cross-sectional study, binocularity was measured using Bagolini lenses and the Frisby stereotest in children aged 3–8 years with a history of ROP treatment in 2 Canadian centres. Events associated with disruption of binocularity including amblyopia, anisometropia, and strabismus, were recorded and analyzed as secondary outcomes.ResultsA total of 42 children were recruited: 19 were treated with laser and 23 with an anti-VEGF agent. The mean age at the time of assessment in the laser group was 81.2 (6.8 years) ± 16.2 months versus 63 (5.25 years) ± 15.7 months in the anti-VEGF group (p < 0.001). No statistically significant difference in rates of binocularity was detected (68% laser vs 82% anti-VEGF, p = 0.27). Laser-treated participants experienced a greater number of cumulative insults to binocularity (p = 0.01).ConclusionsPatients with a history of ROP treated with laser or anti-VEGF agents require long-term follow-up to address binocularity-disrupting factors. Although we did not detect a difference in rates and level of binocularity between treatment groups, we did find an increased rate of cumulative binocularity disrupting events in the laser-treated group.     

Macular thickness fluctuation in neovascular age-related macular degeneration treated with anti-vascular endothelial growth factor

ObjectiveTo establish whether increased variability in macular thickness in neovascular age-related macular degeneration (nAMD) patients affects visual outcomes in clinical practiceDesignRetrospective cohort studyParticipantsTreatment-naive nAMD patients studied over 24 monthsMethodsCentral subfield thickness (CST) values from optical coherence tomography were collected quarterly from baseline to 24 months, and standard deviations (SDs) were calculated. The relationship was modeled with mixed-effects regression between CST SD and 24-month change in visual acuity (VA). Linear regression modeling determined predictors of CST SD.ResultsA total of 422 eyes with nAMD were studied. Baseline and 24-month CST values (mean ± SD) were 331.2 ± 97.6 and 253.4 ± 53.6 μm (Δ = –77.8 ± 104.7 μm, p < 0.001), with CST SD across 24 months of 42.0 ± 32.8 μm. Baseline and 24-month VA were 58.8 ± 19.2 and 62.4 ± 20.6 Early Treatment of Diabetic Retinopathy Study letters (Δ = +3.7 ± 20.8 letters, p = 0.008). CST SD over 24 months was a statistically significant negative predictor of 24-month change in VA (–15.41 [–20.98, –9.83] letters per 100 μm, p < 0.001). Quartile analysis of 24-month VA by CST SD showed a +11.2-letter difference between the first and last quartiles (p < 0.001). Baseline CST was a predictor of 24-month CST SD (24.88 [22.69, 27.06] μm per 100 μm, p < 0.001).ConclusionsHigher macular thickness fluctuations are related to poorer visual outcomes at 24 months in patients with nAMD treated with anti-vascular endothelial growth factor injections. Macular thickness variability may be an important prognostic factor of visual outcomes in nAMD eyes.     

Burden of ocular morbidities and color blindness among school-attending children in a foothill town of Uttarakhand State

Purpose:To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India.Methods:A cross-sectional study was conducted among school-going children of age group 6–16 years of standard I–XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value <0.05.Results:In total, 13,492 students (mean age 10.9 ± 2.7 years) with almost equal male to female ratio were screened. Overall prevalence of ocular morbidity was 23.2%, with refractive error (18.5%) on top, followed by color blindness (2.2%). The later was observed more among males (3.0%) as compared to females (1.4%) with significantly higher odds, OR = 2.3 (1.7–2.9) (P < 0.001).Conclusion:Refractive error has been the most common ocular morbidity, followed by color blindness. Earliest detection can prevent permanent disability and disappointment among youngsters when rejected from entering certain professions due to color vision defect.     

Phenotypic Consequences of the GJD2 Risk Genotype in Myopia Development

PurposeTo study the relatively high effect of the refractive error gene GJD2 in human myopia, and to assess its relationship with refractive error, ocular biometry and lifestyle in various age groups.MethodsThe population-based Rotterdam Study (RS), high myopia case-control study MYopia STudy, and the birth-cohort study Generation R were included in this study. Spherical equivalent (SER), axial length (AL), axial length/corneal radius (AL/CR), vitreous depth (VD), and anterior chamber depth (ACD) were measured using standard ophthalmologic procedures. Biometric measurements were compared between GJD2 (rs524952) genotype groups; education and environmental risk score (ERS) were calculated to estimate gene-environment interaction effects, using the Synergy index (SI).ResultsRS adults carrying two risk alleles had a lower SER and longer AL, ACD and VD (AA versus TT, 0.23D vs. 0.70D; 23.79 mm vs. 23.52 mm; 2.72 mm vs. 2.65 mm; 16.12 mm vs. 15.87 mm; all P < 0.001). Children carrying two risk alleles had larger AL/CR at ages 6 and 9 years (2.88 vs. 2.87 and 3.00 vs. 2.96; all P < 0.001). Education and ERS both negatively influenced myopia and the biometric outcomes, but gene-environment interactions did not reach statistical significance (SI 1.25 [95% confidence interval {CI}, 0.85–1.85] and 1.17 [95% CI, 0.55–2.50] in adults and children).ConclusionsThe elongation of the eye caused by the GJD2 risk genotype follows a dose-response pattern already visible at the age of 6 years. These early effects are an example of how a common myopia gene may drive myopia.     

Visual and anatomic outcomes of cataract surgery with intraoperative or postoperative complications in a teaching institution

ObjectiveTo review visual and anatomic outcomes after cataract surgery with complications in a teaching institution.MethodsConsecutive case series. A chart review was conducted of patients who underwent phacoemulsification with intraoperative or postoperative complications, performed by ophthalmology residents under direct supervision of experienced ophthalmology attending physicians. Best corrected visual acuity (BCVA), OCT parameters, and postoperative treatments were reviewed at 1, 3, 6, and 12 months postoperatively.ResultsOne hundred thirty-three eyes were analyzed. Mean BCVA was 50 ± 23 approximate Early Treatment Diabetic Retinopathy Study letters at the preoperative visit and improved by a mean of 8 letters (n = 128; p = 0.001), 16 letters (n = 117; p < 0.001), 14 letters (n = 79; p < 0.001), and 4 letters (n = 34; p = 0.37) at 1, 3, 6, and 12 months. The mean OCT central subfoveal thickness increased by less than 50 μm at all time points and this change was not statistically significant at 12 months. BCVA increased by 3 lines in 41%, 56%, 57%, and 44% of eyes at 1, 3, 6, and 12 months. Median BCVA was 20/40 or better at each follow-up period. Fifty-three (40%) eyes required a secondary surgical procedure due to intraoperative or postoperative complication. A significant proportion of eyes received anti-inflammatory drops through 1 year.ConclusionsAfter cataract surgery with intraoperative or postoperative complications, a majority of eyes experienced substantial visual gains and only mild retinal thickening while being managed with long-term anti-inflammatory drops and additional surgical procedures.