IBRUTINIB FOR CONTROL OF CHOROIDAL AND ORBITAL METASTASIS FROM CHRONIC LYMPHOCYTIC LEUKEMIA.

PURPOSE: To describe a case of choroidal and orbital metastasis of chronic lymphocytic leukemia controlled with ibrutinib monotherapy, an oral tyrosine kinase inhibitor. METHODS: Single case report. RESULTS: A 69-year-old man with a past medical history of chronic lymphocytic leukemia diagnosed 1 year previously was referred with a foveal lesion in the right eye and was found to have hyperopic shift in the right eye. Optical coherence tomography demonstrated choroidal infiltration in the right eye, and computed tomography of the orbits demonstrated a left orbital mass. Biopsy of the left orbital mass confirmed chronic lymphocytic leukemia/small lymphocytic leukemia. Oral ibrutinib monotherapy of 140 mg three times daily was initiated for treatment of these choroidal and orbital metastases, and at 6 months, there was clinical resolution of disease. Cessation of ibrutinib monotherapy was followed 7 months later by recurrence of choroidal disease. Reinitiation of ibrutinib monotherapy 140 mg three times daily led again to clinical disease resolution, and durable remission has been attained on a well-tolerated low maintenance dose of ibrutinib 140 mg two times daily. CONCLUSION: This is the first reported case of control of choroidal and orbital metastasis of chronic lymphocytic leukemia with ibrutinib monotherapy, confirmed with choroidal recurrence on drug cessation and clinical resolution of disease on re-treatment.

Prevalence of asteroid hyalosis and systemic risk factors in United States adults.

BACKGROUND/OBJECTIVE: Asteroid hyalosis (AH) is an uncommon clinical entity of unknown aetiology that is associated with older age. Previous epidemiologic studies have reported various systemic and demographic risk factors for AH but remain limited due to regional constraints of their study populations. Additionally, Hispanic and Non-Hispanic black populations remain under sampled. The aim of this study is to examine the prevalence of asteroid hyalosis in the United States and identify associated factors at a national level. SUBJECTS/METHODS: This is a population-based, cross-sectional study of 5578 subjects aged 40 and older from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES). The primary outcome measured was asteroid hyalosis on retinal imaging in any eye. Evaluated risk factors included patient demographics, medical history, body measures, serum markers, and fundus photography findings. RESULTS: Prevalence of asteroid hyalosis was 0.86% overall, 0.86% in Caucasians, 0.79% in African-Americans, and 0.88% in Hispanics. Asteroid hyalosis was associated with older age (p < 0.0001, 95% confidence interval [CI], 0.06-0.12; odds ratio [OR], 1.09) but not ethnicity or sex. After adjusting for age, greater bodyweight (p = 0.049; 95% CI, 0.001-0.04; OR, 1.02), and history of myocardial infarction (p = 0.022; 95% CI, 0.07-1.55; OR, 2.36) were also found to be significant risk factors. CONCLUSION: Asteroid hyalosis is a rare entity in the US associated with older age, greater body weight, and prior history of MI. A potential relationship between AH and cardiovascular disease remains plausible.

Intraocular lens correction of presbyopia.

The continued development of intraocular lens (IOL) technology has led to a dramatic improvement in refractive outcomes. New and innovative ways of achieving the desired postoperative refractive goals continue to be developed. This article aims to review the currently available IOL modalities for correction of presbyopia at the time of cataract surgery, including reference to high-quality comparative studies, where available, and discussion of strengths as well as limitations of the currently available IOL technologies. It has been shown that multifocal compared to monofocal IOL was associated with higher rates of spectacle independence, but higher rates and severity of symptomatic glare as well as reduced contrast sensitivity. Within multifocal IOLs, diffractive compared to refractive IOLs tended to have better near vision and a lower rate of symptomatic glare. Extended depth-of-focus IOLs compared to diffractive multifocal IOL demonstrated equal or superior intermediate visual acuity, with less than or equal rates of glare. Accommodative IOLs represent a broad range of technologies that continue to develop, and new technologies offering opportunities for postoperative adjustment of refractive outcome are emerging.

Vision-related Performance and Quality of Life of Patients With Rapid Glaucoma Progression.

PURPOSE: The purpose of this study was to determine how clinical measures, performance-based measures and subjective assessments of vision-related quality of life (VRQoL) are affected in patients with rapid glaucoma progression. METHODS: Prospective longitudinal study that included 153 patients diagnosed with moderate glaucoma. A subset of patients that presented with rapid glaucoma progression (n=22), defined as visual field (VF) mean deviation (MD) loss >2.0 dB/y, were compared with patients with nonrapid progression (n=131). Groups were compared using t tests, χ, or Fisher exact test. Main outcome measures were visual acuity (VA), VF MD, retinal nerve fiber layer thickness (RNFL), contrast sensitivity (CS), Compressed Assessment of Ability Related to Vision (CAARV), and Rasch calibrated National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) scores. RESULTS: At baseline, patients who progressed rapidly had lower measurements of VA (P=0.041), VF MD (P<0.001), Pelli-Robson score (P=0.004), Spaeth/Richman Contrast Sensitivity (SPARCS) score (P=0.001), RNFL thickness (P=0.009), CAARV total score (P<0.001), and NEI-VFQ-25 composite score (P=0.03). A multivariable logistic regression was performed and showed VF MD to be the only baseline independent predictor of rapid progression. After 1 year, patients who progressed rapidly also had a significant decrease in SPARCS score (P=0.04). CONCLUSIONS: Factors associated with rapid glaucoma progression included worse VF MD decreased scores of performance-based measures and subjectively worse VRQoL. After 1 year, rapid progressors had a significant reduction in contrast sensitivity as measured by SPARCS.

Aspartame and Risk of Cancer: A Meta-analytic Review.

Aspartame (APM) is the most commonly used artificial sweetener and flavor enhancer in the world. There is a rise in concern that APM is carcinogenic due to a variation in the findings of the previous APM carcinogenic bioassays. This article conducts a meta-analytic review of all previous APM carcinogenic bioassays on rodents that were conducted before 31 December 2012. The search yielded 10 original APM carcinogenic bioassays on rodents. The aggregate effect sizes suggest that APM consumption has no significant carcinogenic effect in rodents.

Sex Differences in the Relationship Between Obesity and Choroidal Nevus in US Adults.

PURPOSE: To investigate sex differences and the effect of other variables on the association between obesity and choroidal nevus in the US adult population. METHODS: The study population of this cross-sectional study included 5575 subjects aged ≥40 years from the 2005 to 2008 National Health and Nutrition Examination Survey (NHANES) who underwent retinal imaging. Primary predictor variables were body mass index (BMI) when the subject was 25 years old ("former BMI") and BMI at time of NHANES participation ("current BMI"). Body mass index was classified "elevated" (≥25 kg/m2) versus "normal" (<25 kg/m2). The main outcome measure was choroidal nevus in either eye on retinal imaging. Subgroup analysis was stratified by sex and race. RESULTS: The mean age of the study population was 56.4 years, with 47.3% male and 52.7% female subjects. The prevalence of choroidal nevus was 4.7% overall. Former elevated BMI was associated with choroidal nevus in the overall population (odds ratio [OR]: 1.35, 95% confidence interval [CI]: 1.06-1.71, P = 0.01) and males (OR: 1.43, CI: 1.03-1.99, P = 0.03). Current elevated BMI was associated with choroidal nevus in the overall population (OR: 1.37, CI: 1.02-1.85, P = 0.04); females (OR: 1.72, CI: 1.11-2.68, P = 0.02), and postmenopausal females (OR: 1.94, CI: 1.23-3.06, P = 0.006). CONCLUSIONS: Choroidal nevus is associated with former and current obesity. Sex and postmenopausal status differences in this association could provide insight into the demographics of patients at risk for developing choroidal nevus.