AJO International最新文献

Purpose

Describe real-world characteristics and outcomes in patients undergoing Food and Drug Administration (FDA) approved/cleared ab interno Minimally Invasive Glaucoma Surgery (MIGS) combined with cataract surgery or cataract surgery alone.

Design

An observational, retrospective study of glaucomatous disease treated with MIGS (OMNI® Surgical System, Hydrus®, iStent Inject®) combined with cataract surgery or cataract surgery alone, documented in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight).

Methods

The study period was between 07/01/2017 and 12/31/2022. Eligible patients were identified via Current Procedural Terminology (CPT) codes coupled with electronic health records. Outcomes included intraocular pressure (IOP) and IOP-lowering medication class usage over 24 months stratified by baseline IOP (≤18 and >18 mmHg). Bonferroni testing (p < 0.0125) were applied.

Results

Glaucomatous disease was identified for 77,391 (OMNI: 428, Hydrus: 1,435, iStent Inject: 4,769, cataract surgery alone: 70,759) patients (109,745 eyes). For patients with a baseline IOP >18 mmHg, significant (p < 0.001) change in IOP (OMNI −6.64 [SD 7.59], Hydrus −5.71 [6.30], iStent Inject −4.96 [7.30], cataract surgery alone −5.55 [6.41]) and medication usage (OMNI −1.34 [1.48], Hydrus −1.20 [1.18], iStent Inject −0.86 [1.10], cataract surgery alone −0.67 [1.10]) were observed at 24 months. In the baseline IOP ≤18 mmHg subgroup, all cohorts showed significant medication reductions (p < 0.001), with no change in IOP.

Conclusions

MIGS combined with cataract surgery and cataract surgery alone resulted in significant and sustained IOP (baseline IOP >18 mmHg) and medication reductions (both IOP subgroups). As MIGS procedures lead to non-equivalent results, further research will define the role of each in patient subpopulations.

Purpose

This study evaluates the influence of various lifestyle factors, such as screen time, physical inactivity, dietary habits, and psychological stress, on the development and progression of myopia in comparison to genetic predisposition. It underscores the critical role of adopting healthier lifestyles to minimize the risk of myopia, especially in genetically susceptible individuals.

Design

This study integrates a systematic review of existing literature with empirical data to assess the relationship between lifestyle habits and myopia, providing a nuanced understanding of its multifaceted etiology.

Methods setting

Comprehensive literature review and analysis of data from multiple institutional and clinical studies.

Patient or study population

The study includes research on individuals across the myopia spectrum, examining genetic factors in addition to lifestyle influences.

Intervention or observation procedure(s)

Analysis focused on lifestyle behaviors, including digital device use, physical activity, dietary patterns, and sleep quality in relation to myopia.

Main outcome measure(s)

Correlation of myopia prevalence with lifestyle choices and genetic susceptibility.

Results

The results highlight a strong association between lifestyle behaviors and myopia, with genetic predispositions exacerbating the effects of detrimental lifestyle habits. In particular, proactive lifestyle modifications, especially increasing outdoor activity, appear to be effective in preventing myopia.

Conclusion

This study supports an integrative approach to myopia management, emphasizing lifestyle modifications in conjunction with genetic awareness. It calls for comprehensive public health strategies to address the increase in myopia, advocating a balanced interplay between maintaining physical health, engaging in outdoor activities, and promoting mental wellness to counteract the multifactorial risks associated with myopia development.

Objective

To better understand the burnout rates among ophthalmologists before and after the start of COVID-19 in the United States.

Design

Retrospective observational study integrating cross-sectional data from annual faculty surveys conducted in 2018, 2021, and 2022, plus a separate, single-item burnout survey administered prospectively in 2022 and repeated six months later to faculty members, trainees, and staff members.

Subjects

University of Michigan faculty, trainees, and staff at a tertiary eye care center (Kellogg Eye Center), and Women in Ophthalmology (WIO) members.

Methods

A validated, single-item burnout assessment on a 5-point scale was electronically distributed to WIO and Kellogg physicians and staff in late 2022. Links to wellness resources were provided at submission. The survey was redistributed after six months, with an added question on resource utilization. Responses were compared to Kellogg's Annual Faculty Survey in 2018, 2021, and 2022, which included the same single-item burnout measure. All responses to the single-item scale were dichotomized based on presence of burnout. Self-reported wellness resource utilization was also assessed.

Outcomes

Self-reported measures of burnout.

Results

A total of 73, 91, and 81 ophthalmologists on faculty completed the Annual Faculty Survey in 2018, 2021 and 2022, representing a response rate of 64 %, 79 %, and 69 %. The response rate for the single-item survey sent to Kellogg among ophthalmologists in 2022 was 43 %. The Kellogg ophthalmologist burnout rate in 2018 was 39.7 % and was significantly higher in 2021 at 70.3 % (p = 0.0001), and in 2022 at 70.4 %. Burnout rates amongst WIO members and Kellogg ophthalmologists were similar. While no respondents to the single-item survey in 2018 reported the most severe burnout score, in 2021, responses shifted to include the most severe answers. Some respondents reported utilizing wellness resources, follow-up results did not demonstrate significantly decreased burnout in any group.

Conclusions

In 2018, ophthalmologists’ burnout rates at this academic eye center were in line with national averages. However, a significant increase in burnout was seen in 2021 onwards, with a shift towards more severe burnout responses. Though numerous factors may account for these changes, COVID-19 may be a significant contributor. Future work may focus on specific contributors to increased rates of burnout amongst ophthalmologists.

Purpose

We report a case of a 69-year-old woman with a history of tamoxifen and anastrozole use, as well as prior retinal detachment, presenting with cruciform crystals in the anterior and posterior chamber.

Design

Retrospective case review.

Methods

Our patient underwent workup including a slit lamp exam, funduscopy, OCT, and cytologic analysis of aqueous aspirate.

Results

The patient initially presented with decreased visual acuity in the left eye to 20/40 with an intraocular pressure of 15 mmHg. Examination revealed anterior segment inflammation with white refractile deposits dusting the corneal endothelium, iris, intraocular lens implant, and vitreous skirt. Cytologic analysis of aqueous aspirate revealed non-polarizable, variably sized cruciform crystals.

Conclusion

Although retinopathy is associated with tamoxifen and anastrozole usage, such crystals have not been described within the aqueous or vitreous. While the etiology in our patient remains unclear, tamoxifen has been previously detected within intraocular fluids and may have precipitated crystal formation. Deposits from Fuchs uveitis or occult infection-related deposition as seen in crystalline keratopathy are also possible.

Purpose

To investigate potential risk factors associated with retinal vein occlusion (RVO) in a Greek population.

Design

Case-control study

Methods

Participants in this study were 106 patients diagnosed with RVO, either central (CRVO) or branch (BRVO), and 76 healthy controls matched for sex and age. Demographic data were collected. All participants underwent complete ophthalmological examination. Blood samples were taken to evaluate full blood count and biochemical parameters. Univariate and multivariate analysis were performed to identify risk factors for CRVO and BRVO.

Results

63 patients with CRVO and 43 with BRVO, and 76 healthy controls were included in our analysis. The mean age of patients with BRVO, CRVO and healthy controls was 67.8 ± 9.1 years, 68.4 ± 9.2 years and 67.8 ± 9.1 years respectively. Univariate analysis showed that hypertension (p < 0.001), diabetes (p = 0.006), neutrophil-to-lymphocyte ratio (NLR, p < 0.001), triglycerides (p < 0.001) and homocysteine (p < 0.001) were associated with CRVO, while diabetes (p = 0.034), NLR (p = 0.031), triglycerides (p < 0.001) and homocysteine (p = 0.007) were associated with BRVO. In multivariate analysis, hypertension (OR=1.92; 95 % CI= 1.16–5.97, p = 0.032), NLR (OR=2.08; 95 % CI=1.24–3.52, p = 0.006), triglycerides ≥150 mg/dl (OR=2.96; 95 % CI=1.08–7.86, p = 0.034) and homocysteine levels (OR=1.23; 95 % CI=1.12–1.36, p < 0.001) were independently associated with CRVO, while triglycerides ≥150 mg/dl (OR=4.04; 95 % CI=1.16–11.33, p = 0.041) and homocysteine levels (OR=1.12, 95 % CI=1.08–1.24, p = 0.036) were independently associated with BRVO.

Conclusion

This is a first case-control study in a Greek population with RVO. It is important to recognize various risk factors for RVO, which may help to elucidate the pathogenesis of the disease and also identify vulnerable populations for this condition. Prompt referral and multidisciplinary approach is often needed in patients who have suffered an RVO.

Introduction: Paralysis of gaze, Pseudo-Argyll Robertson pupils, convergence-retraction nystagmus and eyelid retraction (Collier's sign) are typical signs of a dorsal midbrain syndrome (also known as Parinaud syndrome). The dorsal midbrain syndrome is caused by a damage to certain mesencephalic nuclei. Case Description: We present a case of dorsal midbrain syndrome with typical clinic and radiological findings. Discussion: This case shows that careful examination of eyes and good neuroanatomical knowledge are sufficient for localization of damage.

Purpose

To present a case of dramatic retinal reperfusion in bilateral idiopathic occlusive retinal vasculitis after aggressive treatment with adalimumab, high-dose prednisolone and methotrexate.

Design & methods

Retrospective case review

Results

A 29-year-old male pilot with bilateral idiopathic occlusive retinal vasculitis developed a worsening right central scotoma while on methotrexate and prednisolone. Fundoscopy and fluorescein angiography (FFA) showed complete occlusion of the right inferotemporal retinal arteriole. High-dose prednisolone was commenced, and adalimumab introduced 4 weeks later. After 12 weeks of this aggressive treatment, repeat multimodal imaging revealed almost complete reperfusion of the previously affected arterial and venous systems. Clinically, the scotoma remained stable.

Conclusions

Prompt and aggressive treatment of idiopathic occlusive retinal vasculitis can lead to retinal vascular reperfusion, potentially preventing VEGF-associated complications. However, a degree of visual impairment may remain permanent due to prolonged ischaemia.

Purpose

To assess feasibility of automatic segmentation of OCT biomarkers of visual acuity (VA) and the possibility of prediction of postoperative VA after successful reattachment in macula off rhegmatogenous retinal detachment (RRD) eyes using artificial intelligence (AI).

Design

retrospective case control study

Methods

Patients operated of pars plana vitrectomy (PPV) for macula-off non-traumatic RRD with available good quality OCT acquisitions were included. Ellipsoid zone(EZ) foveal damage and reflectivity, external limiting membrane(ELM) foveal damage, foveal flattening, outer nuclear layer(ONL) thickness and the presence of cysts and hyperreflective foci(HRFs) was assessed on preoperative OCT B scan images by both a trained segmenter and human graders. Different machine learning(ML)models were tested for detection of cases with VA>0.4 logMar at 6 months from surgery.Segmentation performance of the model was compared with ground truth segmentation provided by human graders. Postoperative VA prediction based on the segmented OCT biomarkers, preoperative VA and age was compared with actual postoperative VA to assess accuracy of the model.

Results

A total of 58 eyes of 58 patients were included. A significant difference in preoperative VA, foveal flattening, foveal EZ and ELM damage, EZ reflectivity and presence of HRF in the ONL was detected between groups(all p < 0.001).The segmenter showed good agreement with human assessment in both qualitative and quantitative variables. The Optimizable Naïve Bayes model was the best performing ML model and showed an accuracy of 86.2 % in detection of cases with postoperative VA>0.4 logMar.

Conclusions

The results confirm the prognostic relevance of EZ and ELM integrity and reflectivity, foveal flattening, ONL cysts and ONL HRF in macula off RRD, and, for the first time in literature, reports feasibility of the segmentation of these factors in preoperative OCT B scan images. We also report good classification performances of Naïve Bayes models based on OCT biomarkers, preoperative VA and age in distinguishing patients that should expect a postoperative VA>0.4 logMar at 6 months from surgery.

Purpose

On the frequency of glasses in the American Civil War.

Design and Methods

Evaluation of all available portrait photos of generals of the United States (US) and the Confederate States of America (CSA). Search for references to glasses in more than 100 group photos of soldiers (approx. 1000 Persons). Look for mention of glasses in several biographies and war reports.

Results

Only seven of 531 US generals and none of 353 CSA generals were photographed wearing glasses. No glasses could be found in the more than 100 group photos evaluated. There were no references to glasses in various biographies.

Conclusion

Ametropia and especially myopia were less common at the time of the American Civil War than they are today, and the absence of glasses in the photos does not necessarily mean that glasses were not worn. Nevertheless, it can be assumed that quite a few soldiers took part in the war without necessary correction and therefore with reduced visual acuity. The low, though slightly higher prevalence of glasses among US generals in the photos can best be explained by the better availability in the industrial north and the significantly better opportunities of import.

Purpose

To evaluate the effect of needle goniotomy during phacoemulsification cataract surgery on early IOP spikes in patients with glaucoma compared with phacoemulsification alone.

Design

Retrospective case control series

Methods

Cataract surgeries with concurrent goniotomy for glaucoma (n = 46) were compared with controls (n = 115) with and without glaucoma. IOP was measured prior to surgery and monitored through six months postoperatively. Between-group differences in IOP and postoperative IOP reduction were tested with ANOVA and Welch's 2-sided t-tests. Demographic, clinical, and intraoperative variables were also analyzed for significant association with postoperative IOP using univariate analysis. The incidence of IOP spike was evaluated according to two criteria: IOP > 30 mmHg or IOP > 10 mmHg above baseline.

Results

Phaco-goniotomy significantly lowered IOP at postoperative day one and month six. Following goniotomy, IOP was reduced on average 28 % (95 % CI [21, 36]) at month six compared with baseline, a mean reduction of -6.3 mmHg (95 % CI [-8.6, -4.0]), and a significantly greater reduction than in glaucoma controls (1 %, 95 % CI [-9, 7] and -0.3 mmHg, 95 % CI [-1.7, 1.1], p < 0.05). The average month six IOP following phaco-goniotomy was 12.9 mmHg (95 % CI [11.6, 14.1]), significantly lower than for glaucoma controls (15.6 mmHg, 95 % CI [14.0, 17.3], p < 0.05). The incidence of early IOP spike was significantly higher in glaucoma controls (23.1 %) than in the phaco-goniotomy cohort (6.0 %) (OR = 4.5, p < 0.05). There were no associations between CDE, ultrasound and aspiration time, or irrigation volumes on postoperative IOP. We showed that preoperative IOP was the only significant contributor to postoperative IOP reduction after phaco-goniotomy.

Conclusion

Incidence of early postoperative IOP elevation after phacoemulsification alone was 4.5 times higher than after phaco-goniotomy. Needle goniotomy may be a consideration for IOP lowering in glaucomatous eyes having cataract surgery.