In-Depth Analysis of Preoperative OCT Markers as Prognostic Factors for Lamellar Macular Holes and Epiretinal Membrane Foveoschisis.

OBJECTIVE: To identify preoperative OCT markers that correlate with postoperative visual acuity (VA) changes in eyes with lamellar macular hole (LMH) and epiretinal membrane foveoschisis (ERMF) after pars plana vitrectomy (PPV). DESIGN: Cross-sectional retrospective study. SUBJECTS: Patients seen at the Wilmer Eye Institute between 2011 and 2021 with an International Classification of Diseases, Ninth Revision, or International Classification of Diseases, 10th Revision, code for "macular hole" that underwent PPV, and demonstrated all OCT criteria present for either LMH or ERMF based on the Hubschman et al (2020) classification. METHODS: Optical coherence tomography markers including hole dimensions, retinal layer continuity, and ellipsoid zone (EZ) convexity and pixelated intensity were quantified. Visual acuity immediately before PPV and at the last follow-up date available were both recorded. MAIN OUTCOME MEASURES: Preoperative OCT variables that are correlated with postoperative changes in VA. RESULTS: Forty-two eyes from 42 patients with LMH (n = 11) and ERMF (n = 31) that underwent PPV were identified. Visual acuity in the ERMF cohort significantly improved at last follow-up compared with preoperative VA (P < 0.001), whereas VA in the LMH cohort did not (P = 0.14). In the LMH cohort, retinal layer continuity at the hole edge was positively correlated with change in VA at final follow-up, whereas hole height was negatively correlated with VA. In the ERMF cohort, preoperative VA was negatively correlated with change in VA at final follow-up. CONCLUSIONS: Retinal layer continuity at the hole and hole height are novel preoperative markers that predict postoperative VA change in LMH. After identifying the type of macular lesion, surgeons should consider using these preoperative OCT markers when counseling patients on potential postoperative VA outcomes and when managing patient expectations. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

Using the language of surgery to enhance ophthalmology surgical education.

Background: Currently, surgical education utilizes a combination of the apprentice model, wet-lab training, and simulation, but due to reliance on subjective data, the quality of teaching and assessment can be variable. The "language of surgery," an established concept in engineering literature whose incorporation into surgical education has been limited, is defined as the description of each surgical maneuver using quantifiable metrics. This concept is different from the traditional notion of surgical language, generally thought of as the qualitative definitions and terminology used by surgeons. Methods: A literature search was conducted through April 2023 using MEDLINE/PubMed using search terms to investigate wet-lab, virtual simulators, and robotics in ophthalmology, along with the language of surgery and surgical education. Articles published before 2005 were mostly excluded, although a few were included on a case-by-case basis. Results: Surgical maneuvers can be quantified by leveraging technological advances in virtual simulators, video recordings, and surgical robots to create a language of surgery. By measuring and describing maneuver metrics, the learning surgeon can adjust surgical movements in an appropriately graded fashion that is based on objective and standardized data. The main contribution is outlining a structured education framework that details how surgical education could be improved by incorporating the language of surgery, using ophthalmology surgical education as an example. Conclusion: By describing each surgical maneuver in quantifiable, objective, and standardized terminology, a language of surgery can be created that can be used to learn, teach, and assess surgical technical skill with an approach that minimizes bias. Key message: The "language of surgery," defined as the quantification of each surgical movement's characteristics, is an established concept in the engineering literature. Using ophthalmology surgical education as an example, we describe a structured education framework based on the language of surgery to improve surgical education. Classifications: Surgical education, robotic surgery, ophthalmology, education standardization, computerized assessment, simulations in teaching. Competencies: Practice-Based Learning and Improvement.

Associations of Midlife and Late-Life Blood Pressure Status With Late-Life Retinal OCT Measures.

Purpose: To explore the relationship of long-term blood pressure (BP) patterns with late-life optical coherence tomography (OCT) structural measures reflecting optic nerve health. Methods: Participants in this community-based cohort study of black and white individuals were part of the Atherosclerosis Risk in Communities study and the nested Eye Determinants of Cognition (EyeDOC) study. Participants had BP measured six times from 1987 to 2017 and were categorized into five BP patterns: sustained normotension; midlife normotension, late-life hypertension (systolic BP [SBP] >140 mmHg or diastolic BP [DBP] >90 mmHg or antihypertensive medication use); sustained hypertension; midlife normotension, late-life hypotension (SBP <90 mmHg or DBP <60 mmHg); and midlife hypertension, late-life hypotension. Multivariable linear regression modeling was used to evaluate associations between BP patterns and late-life OCT ganglion cell complex (GCC) and peripapillary retinal nerve fiber layer (RNFL) thickness. Results: In total, 931 eyes of 931 participants (mean age at EyeDOC visit = 80 years; 63% female; 45% black) were included. Mean GCC and RNFL thicknesses in the sustained normotension pattern were 90.8 ± 10.3 µm and 89.9 ± 11.2 µm versus 89.4 ± 11.9 µm and 90.1 ± 12.2 µm in the sustained hypertension pattern (P > 0.05). Compared to the sustained normotension pattern, no significant differences in GCC or RNFL thickness were found for any anomalous BP pattern. Conclusions: Assessment of long-term BP status showed no significant associations with late-life OCT structural measures. Translational Relevance: OCT imaging results in our population-based sample suggest that neither hypertension, even when present in midlife, nor late-life hypotension are significant risk factors for late-life optic nerve damage.

Doxycycline vs Placebo at 12 Weeks in Patients With Mild Thyroid-Associated Ophthalmopathy: A Randomized Clinical Trial.

Importance: Mild thyroid-associated ophthalmopathy (TAO) negatively impacts quality of life, yet no clinical guidelines for its treatment are available. Existing evidence supports the use of doxycycline in treating mild TAO. Objective: To evaluate the short-term (12 weeks) efficacy of doxycycline in treating mild TAO. Design, Setting, and Participants: In this placebo-controlled multicenter randomized double-masked trial, 148 patients were assessed for eligibility. After exclusions (patients who were pregnant or lactating, had an allergy to tetracyclines, or had uncontrolled systematic diseases), 100 patients with mild TAO (orbital soft tissue affected mildly) at 5 centers in China were enrolled from July 2013 to December 2019 and monitored for 12 weeks. Interventions: Participants were randomly assigned 1:1 to receive doxycycline (50 mg) or placebo once daily for 12 weeks. Main Outcomes and Measures: The primary outcome was the rate of improvement at 12 weeks compared with baseline assessed by a composite indicator of eyelid aperture (reduction ≥2 mm), proptosis (reduction ≥2 mm), ocular motility (increase ≥8°), and Graves ophthalmopathy-specific quality-of-life (GO-QOL) scale score (increase ≥6 points). Adverse events were recorded. Results: A total of 50 participants were assigned to doxycycline and 50 to placebo. The mean (SD) age was 36.7 (9.1) years; 75 participants (75.0%) were female and 100 (100.0%) were Asian. Medication compliance was checked during participant interviews and by counting excess tablets. At week 12, the improvement rate was 38.0% (19 of 50) in the doxycycline group and 16.0% (8 of 50) in the placebo group (difference, 22.0%; 95% CI, 5.0-39.0; P = .01) in the intention-to-treat population. The per-protocol sensitivity analysis showed similar results (39.6% [19 of 48] vs 16.0% [8 of 50]; difference, 23.6%; 95% CI, 6.4-40.8; P = .009). No adverse events other than 1 case of mild gastric acid regurgitation was recorded in either group. Conclusions and Relevance: The results of this study indicate that oral doxycycline, 50 mg daily, resulted in greater improvement of TAO-related symptoms at 12 weeks compared with placebo in patients with mild TAO. These findings support the consideration of doxycycline for mild TAO but should be tempered by recognizing the relatively short follow-up and the size of the cohort. Trial Registration: ClinicalTrials.gov Identifier: NCT02203682.

Association of Optical Coherence Tomography and Optical Coherence Tomography Angiography Retinal Features With Visual Function in Older Adults.

Importance: Although there is abundant evidence relating neuronal and vascular optical coherence tomography (OCT) and OCT angiography (OCTA) measures to retinal disease, data on the normative distribution of retinal features and their associations with visual function in a healthy, older, community-based population are sparse. Objectives: To characterize the normative OCT and OCTA measures in older adults and describe their associations with visual function. Design, Setting, and Participants: This was a cross-sectional, observational study conducted from May 17, 2017, to May 31, 2019. The study included a community-based sample. Participants in the Atherosclerosis Risk in Communities study from Jackson, Mississippi (all self-reported Black participants), and Washington County, Maryland (all self-reported White participants), were recruited in the Eye Determinants of Cognition study (EyeDOC). Data analyses were conducted from June 14, 2020, to May 31, 2021. Main Outcomes and Measures: Retinal measurements, including retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, macular vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), and foveal avascular zone (FAZ) area, were captured with spectral-domain OCT and OCTA. Visual function, including presenting distance vision, corrected distance vision, near visual acuity (VA), and contrast sensitivity (CS), was assessed. Results: A total of 759 participants (mean [SD] age, 80 [4.2] years; 480 female participants [63%]; 352 Black participants [46%]) were included in the study. Mean (SD) GCC thickness (89.2 [9.3] µm vs 92.3 [8.5] µm) and mean (SD) FAZ (0.36 [0.16] mm2 vs 0.26 [0.12] mm2) differed between Jackson and Washington County participants, respectively. Mean (SD) RNFL thickness and mean (SD) VD in SCP and DCP were greater for participants 80 years or younger than for participants older than 80 years (RNFL: ≤80 years, 93.2 [10.5] µm; >80 years, 91.1 [11.6] µm; VD SCP, ≤80 years, 44.3% [3.5%]; >80 years, 43.5% [3.8%]; VD DCP, ≤80 years, 44.7% [4.9%]; >80 years, 43.7% [4.8%]). Linear regression showed each 10-µm increment in RNFL thickness and GCC thickness was positively associated with 0.016 higher logCS among all participants (RNFL: 95% CI, 0.005-0.027; P = .004; GCC: 95% CI, 0.003-0.029; P = .02), with stronger associations among Jackson participants. The associations of VA and structural measures were found only in Jackson participants, with coefficients per 10-µm increment of 0.012 logMAR VA (RNFL: 95% CI, 0.000-0.023; P = .049) and 0.020 logMAR VA (GCC: 95% CI, 0.004-0.034; P = .04). Conclusions and Relevance: In this cross-sectional study, better CS was associated with greater RNFL thickness and GCC thickness, but no visual measures were associated with angiographic features overall. These findings suggest that clinical application of normative references for OCT- and OCTA-based measures should consider demographic and community features.

The relationship between birth timing, circuit wiring, and physiological response properties of cerebellar granule cells.

Cerebellar granule cells (GrCs) are usually regarded as a uniform cell type that collectively expands the coding space of the cerebellum by integrating diverse combinations of mossy fiber inputs. Accordingly, stable molecularly or physiologically defined GrC subtypes within a single cerebellar region have not been reported. The only known cellular property that distinguishes otherwise homogeneous GrCs is the correspondence between GrC birth timing and the depth of the molecular layer to which their axons project. To determine the role birth timing plays in GrC wiring and function, we developed genetic strategies to access early- and late-born GrCs. We initiated retrograde monosynaptic rabies virus tracing from control (birth timing unrestricted), early-born, and late-born GrCs, revealing the different patterns of mossy fiber input to GrCs in vermis lobule 6 and simplex, as well as to early- and late-born GrCs of vermis lobule 6: sensory and motor nuclei provide more input to early-born GrCs, while basal pontine and cerebellar nuclei provide more input to late-born GrCs. In vivo multidepth two-photon Ca2+ imaging of axons of early- and late-born GrCs revealed representations of diverse task variables and stimuli by both populations, with modest differences in the proportions encoding movement, reward anticipation, and reward consumption. Our results suggest neither organized parallel processing nor completely random organization of mossy fiber→GrC circuitry but instead a moderate influence of birth timing on GrC wiring and encoding. Our imaging data also provide evidence that GrCs can represent generalized responses to aversive stimuli, in addition to recently described reward representations.