A Novel Method of Quantifying the Choriocapillaris in Normal and Post-inflammatory Eyes.

OBJECTIVE: To assess the reliability and validity of gray level co-occurrence matrices (GLCM) in the quantification of choriocapillaris and describe GLCM features in normal and eyes with resolved acute posterior multifocal placoid pigment epitheliopathy (APMPPE) and serpiginous choroiditis (SC). METHODS: In this, multicenter, reliability, validity and comparative study; OCTA was performed on eyes with resolved APMPPE and SC and normal individuals. CC texture classification, low flow area measurements and GLCM feature extraction were performed. RESULTS: A total of 13 normal, 8 APMPPE and 15 SC eyes were analyzed. All GLCM parameters demonstrated an excellent reliability. GLCM parameters were differently distributed across the three groups. Decision-tree based on the random forest predictive model provided an overall accuracy of 86% in classifying the three groups using GLCM features. CONCLUSION: These data demonstrated an excellent reliability and validity of GLCM features in quantifying the choriocapillaris in healthy and diseased eyes.

Textural Properties of Choriocapillaris on OCTA in Healed Inflammatory Choriocapillaropathies.

BACKGROUND AND OBJECTIVE: To evaluate the flow characteristics and textural properties of choriocapillaris (CC) on optical coherence tomography angiography in eyes with resolved inflammatory choriocapillaropathies and Vogt-Koyanagi-Harada (VKH) disease. PATIENTS AND METHODS: A cohort of eyes with healed acute posterior multifocal placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis (SC), and VKH disease were included. A 3 mm × 3 mm OCT angiogram of CC was acquired and graded for flow characteristics and textural properties. RESULTS: This study included 16 patients. Texture was heterogeneous in all eyes in the SC and VKH groups, and in four eyes (40%) in the APMPPE group. Most of the eyes with VKH disease had severe low flow, whereas most of the SC and APMPPE eyes demonstrated mild low flow. Heal duration had a strong negative correlation with severity of CC low flow and a weak, statistically nonsignificant correlation with texture heterogeneity. CONCLUSION: Despite the resolution of active inflammation, partial CC hypoperfusion and texture disruptions persist for longer durations and may resolve in a time dependent manner. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:566-572.].

PREVALENCE OF VITREOMACULAR ADHESION IN PATIENTS WITHOUT MACULOPATHY OLDER THAN 40 YEARS.

PURPOSE: To determine the prevalence and factors influencing vitreomacular adhesion (VMA) or vitreomacular traction (VMT) in subjects without maculopathy older than age 40 years. METHODS: In a prospective cross-sectional study, 1,950 eyes in 1,090 participants aged 40 to 89 years representing various ethnic groups from 14 centers in the United States underwent a comprehensive eye examination, including spectral domain optical coherence tomography. A team of independent, masked readers classified the presence or absence of VMA/VMT on spectral domain optical coherence tomography based on the International Vitreomacular Traction Study Group rubric. RESULTS: Across all eyes, the prevalence of VMA or VMT was 39% or 1%, respectively. For every 1-year increase in age, there was a statistically significant 7% decreased odds of having VMA or VMT (95% confidence interval [CI]: 0.89-0.96; P < 0.001), whereas African Americans had 55% significantly reduced odds of having VMA or VMT when than whites (95% CI: 0.23-0.90; P = 0.025). Vitreomacular adhesion >1,500 µm was significantly more likely than VMA <1,500 µm in younger adults (95% CI: 0.70-0.86; P < 0.001), hyperopes versus emmetropes (95% CI: 1.49-35.9; P = 0.01), primary eye care versus tertiary practices (95% CI: 0.03-0.92; P = 0.04), and patients without hyperlipidemia (95% CI: 0.04-0.83; P = 0.03). CONCLUSION: Vitreomacular adhesion is highly prevalent among middle-aged adults. Diagnostic screening with spectral domain optical coherence tomography may help to accurately detect VMA or VMT, prompting routine monitoring and timely therapeutic intervention.

Electrooculography and optical coherence tomography reveal late-onset Best disease.

PURPOSE: Best vitelliform macular dystrophy, also known as Best disease, is a macular dystrophy characterized by bilateral yellowish egg yolk-like lesion(s) present within the maculae. It is a slowly progressive disease that usually presents at childhood. Best vitelliform macular dystrophy frequently proceeds through stages, beginning with a classic presentation described as vitelliform. A similar condition, known as adult-onset foveomacular vitelliform dystrophy, has been described among adult patients. Although the two maculopathies may look similar, they are considered two separate entities, because of the age of onset and overall clinical presentation. CASE REPORT: A 54-year-old man presented with gradual-onset blurred near vision in each eye. Previous records showed a history of unremarkable dilated fundus examinations for the past 8 years. Best-corrected distance acuities measured 20/20 OD and 20/20 OS. Amsler grid testing revealed a mild metamorphopsia OD and OS. Dilated fundoscopy revealed macular pseudohypopyon in each eye. In vivo imaging of the maculae was obtained with spectral-domain optical coherence tomography findings. Electrooculography findings were consistent with Best vitelliform macular dystrophy of atypical, late onset. CONCLUSIONS: Best vitelliform macular dystrophy may vary in its presentation. Electrooculography and spectral-domain optical coherence tomography can aid in establishing the definitive diagnosis.

The "double-layer sign": in vivo imaging of polypoidal choroidal vasculopathy.

PURPOSE: Polypoidal choroidal vasculopathy (PCV), a disease of the choroidal vascular network, presents clinically with polyp-like reddish orange lesions, as well as retinal pigment epithelial (RPE) and/or neurosensory retinal detachments. Optical coherence tomography (OCT) is a useful diagnostic tool that provides cross-sectional and volumetric imaging of posterior segment microstructure. Typical OCT findings in PCV may reveal a classic hyperreflectivity in the choroidal layers known as the "double-layer" sign. This sign is indicative of an abnormal choroidal vascular network. Indocyanine green angiography is also useful for the diagnosis of PCV and clearly identifies the polyp-like lesions arising from the choroidal vasculature. CASE REPORT: A 53-year-old African American woman presented with complaints of gradually decreasing vision in the left eye (OS). Clinical examination revealed moderately reduced acuity OS with a small central scotoma found on Amsler grid testing. Dilated fundus examination revealed a hemorrhagic RPE detachment with suspicion of a choroidal neovascular membrane in the foveal region of the OS. Exudative leakage appeared circumferentially around the macula OS. Optical coherence tomography of the OS also revealed two highly reflective layers: one at the level of the RPE and another beneath the RPE ("double-layer" sign). The patient was referred to a retina subspecialist for angiography and treatment consideration. CONCLUSIONS: It is important to distinguish PCV from other variants of choroidal neovascularization. The polyp-like lesions found in the PCV are a unique and classic characteristic. Proper diagnostic workup includes stereoscopic posterior fundus evaluation and imaging studies, including OCT and indocyanine green angiography.

Central corneal thickness measurements obtained with anterior segment spectral domain optical coherence tomography compared to ultrasound pachymetry in healthy subjects.

INTRODUCTION: Central corneal thickness (CCT) imparts information about an individual's risk of conversion to glaucoma from ocular hypertension, progression of established glaucoma, and the likelihood of developing structural and functional abnormalities in patients with ocular hypertension. Most typically, CCT is measured through ultrasound (US) pachymetry. Currently, optical coherence tomography (OCT) has the ability to image the anterior segment, cornea, and anterior chamber angle. With this ability comes the option of determining CCT. The purpose of this study is to ascertain any significant difference in CCT measurement results as well as quantify the reproducibility of measurements of the two technologies. In addition, by measuring CCT both with traditional US pachymetry as well as spectral domain (SD) OCT technology, we sought to determine if CCT measurement by SD-OCT is an accurate, comparable and viable option; METHODS: Eighty eyes of forty healthy volunteers were used to determine CCT with both SD-OCT and US pachymetry. Three consecutive measurements were collected with each method on every eye. RESULTS: CCT measurements made by US pachymetry and SD-OCT were similar and consistent (r=0.99 for both methods). CCT measurements made by SD-OCT were consistently thinner by approximately 12 micrometers than measurements made by US pachymetry. Repeated measurements of CCT obtained by SD-OCT were more reproducible and had less variability than measurements obtained by US pachymetry. The mean within-subject standard deviation among SDOCT was significantly smaller than that in US pachymetry (1.92 in SD-OCT vs. 2.04 in US pachymetry, p=0.036); CONCLUSIONS: Measurement of CCT by SD-OCT compares favorably with and is at least as accurate as measurements made by US pachymetry. Repeat measurements of CCT by SD-OCT have less variability than those obtained by US pachymetry, are more reproducible, possibly more reliable, and may better represent actual CCT.

Serpiginous choroiditis in a herpes-positive patient.

BACKGROUND: Viruses are one of the most common causes of infections involving the posterior segment of the eye. Viral infections can be congenital or acquired and can affect the retina, choroid, or optic nerve. Herpes simplex virus has been implicated in a number of posterior segment conditions, including serpiginous choroiditis (SC), which has generally been described as idiopathic. CASE REPORT: A 57-year-old black female presented with decreased and distorted vision in both eyes, of 10 months duration. Funduscopy revealed radial, deep grayish lesions emanating off of the optic disc in a peripapillary fashion. The clinical appearance was suggestive of SC, which was confirmed by fluorescein angiography. Serologic testing was positive for herpes simplex virus and thus may suggest a causative link between the virus and the choroiditis. CONCLUSIONS: SC has been historically cited as an idiopathic process. There have been only rare reports linking this process with a viral etiology. Laboratory testing and clinical work-up needs to be obtained in any patient suspected of having SC, to detect a viral etiology. Treatment of an underlying condition may lead to optimum resolution in these patients.

Cystoid macular edema as a result of immune-recovery uveitis.

BACKGROUND: Potent antiretroviral therapy can lead to improved immunity in patients with acquired immune deficiency syndrome. However, ocular inflammation can occur in predisposed individuals. This inflammation is referred to as immune-recovery uveitis. Cystoid macular edema (CME) is a complication that can result from this inflammation and is emerging as a major cause of visual loss in human immunodeficiency virus (HIV)-infected patients. CASE REPORT: A 52-year-old man presented with complaints of intermittent decreased vision that had coincided with the initiation of antiviral treatment. He also reported metamorphopsia and floaters in both eyes of several years duration. He had a history of HIV for 20 years and was only recently started on Highly Active Antiretroviral Therapy (HAART). He reported a vague history of ocular problems involving his retina. Retinal examination revealed bilateral areas of peripheral scarring from presumed past ocular inflammation and thickening and irregularity at each macula. Ancillary testing was performed, and CME was diagnosed. CONCLUSIONS: Immune-recovery uveitis is a leading cause of visual disturbance in HIV-infected patients with a history of cytomegalovirus (CMV) retinitis on HAART. Although the immune recovery associated with the advent of HAART has decreased the need for potent CMV medications, the heightened immune response can be associated with sight-threatening inflammation.

Eye on diabetes: a multidisciplinary patient education intervention.

PURPOSE: The purpose of this study is to compare the efficacy of usual care to an intervention emphasizing patient education targeted at a multicultural adult patient population with diabetes seeking eye care in an academic health center. METHODS: Ninety patients were randomized to usual care or to the intervention. All patients received a comprehensive eye health and vision examination and completed a demographic survey, a patient satisfaction survey, and a diabetes eye health pretest and posttest administered by a masked examiner at 1 week and 3 months. A multidisciplinary (optometry, pharmacy, endocrinology) patient education curriculum was developed for patients randomized to the intervention. Because the dependent variable was measured at 3 points on a nominal scale, a binary generalized estimating equation was employed. RESULTS: The assessment of patient knowledge at baseline revealed misconceptions about diabetic eye disease. While most patients recognized that people with diabetes should have regularly scheduled eye examinations through dilated pupils (90.0%), most patients incorrectly reported that diabetic eye disease usually has early warning signs (75.6%). While controlling for age, gender, race, education, and HbA1c level, subjects who participated in the intervention were 2 times more likely to score higher on the posttest (chi(2) = 45.51, P > .00). No differences between pretest and posttest scores were found for patients who did not participate in the intervention (chi(2) = 11.67, P > .11). CONCLUSIONS: Patients who participated in the educational intervention demonstrated an increase in knowledge across time. Patients may benefit from education emphasizing the importance of dilated eye examinations in the absence of ocular symptoms.

Selective laser trabeculoplasty for intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

PURPOSE: Intravitreal injection of triamcinolone acetonide has increasingly become a therapeutic option for neovascular, inflammatory, and edematous intraocular diseases. A common side effect of this treatment is a steroid-induced elevation of intraocular pressure. In most of these patients, the rise in intraocular pressure can be treated topically. Those cases that cannot be treated medically have been treated with filtering surgery. This report presents a case of intraocular pressure elevation after intravitreal triamcinolone acetonide injection that was successfully treated with selective laser trabeculoplasty. CASE REPORT: A 63-year-old white man presented with brow ache on the right side approximately 3 months after undergoing intravitreal injection of triamcinolone acetonide for diabetic macular edema in the right eye. Applanation tonometry revealed an intraocular pressure of 45 mm Hg in the involved eye. After initial treatment with topical medications, the patient underwent selective laser trabeculoplasty. Now, 6 months postlaser treatment, the intraocular pressure in the involved eye is stable at 15 mm Hg without topical medications. CONCLUSIONS: A steroid-induced elevation of intraocular pressure is a common and widely reported side effect of treatment with intravitreal triamcinolone acetonide. This case report suggests that selective laser trabeculoplasty has potential as first- or second-line therapy for intraocular pressure elevation after intravitreal triamcinolone acetonide injection.

The eye in sleep apnea syndrome.

Sleep apnea syndrome (SAS) is a disease characterized by recurrent complete or partial upper airway obstructions during sleep. The majority of patients with SAS demonstrate this obstruction either at the nasopharynx or the oropharynx. Risk factors for SAS include obesity, male gender, upper airway abnormalities, alcohol use, snoring, and neck girth of more than 17 in. in men or 16 in. in women. Reported ophthalmic findings in patients with SAS include floppy eyelid syndrome (FES), glaucoma, and non-arteritic anterior ischemic optic neuropathy (NAION).

Central serous chorioretinopathy after epidural steroid injection.

Central serous chorioretinopathy (CSC) is a condition characterized by serous detachment of the neurosensory retina in the posterior pole. Corticosteroids administered by various routes is reported as a possible cause of CSC. We report the cases of two patients who developed CSC after receiving a corticosteroid injection in the epidural space for the treatment of back pain. In both patients, the accumulation of subretinal fluid spontaneously resolved within several weeks. Patients who develop CSC after epidural analgesia with corticosteroids should be alerted to the possible relationship between CSC and this treatment. Clinicians should advise all patients with CSC to avoid systemic corticosteroids administered by any route, unless they have a compelling medical indication. Pharmacists should advise patients to seek evaluation if visual changes occur during or after corticosteroid therapy.

Accommodative response to PRIO Computer Vision Tester versus printed text.

BACKGROUND: Video display terminals (VDTs) have Gaussian display characteristics. Research suggests that patients accommodate differently to Gaussian images. In the present study, we asked if the accommodative response to the PRIO Computer Vision Tester (a Gaussian image) is different than the accommodative response to a Monocular Estimation Method (MEM) printed text target. METHOD: A normally sighted prepresbyopic group of subjects (N = 60) was recruited from the student body of Nova Southeastern University. Low neutral retinoscopy was performed on each subject at a distance of 50 cm. using both the PRIO vision tester and an MEM target. RESULTS: The PRIO vision tester and the printed text provided essentially the same measures of accommodative response. In addition, the luminance of the PRIO dropped by nearly 40% over the course of 1 hour of intermittent use. CONCLUSION: The PRIO vision tester and traditional nearpoint retinoscopy provided essentially the same measures of accommodative response in prepresbyopic subjects. Further studies should be considered to evaluate whether the change in luminance of the PRIO system has any effect on the measurement of accommodative response.