Lenticular Imaging: A New Experimental and Quantitative Analysis of Capsular Dynamics, "Choi-Apple View".

PURPOSE: Development of a means for quantitative estimation of lenticular and zonular dynamics by using real-time imaging of human autopsy eyes during implantation of different intraocular lens (IOL) models. METHODS: Isolated lenticular structures from human autopsy eyes were prepared in vitro. The following IOLs were implanted: a one-piece C-loop haptic IOL, a three-piece C-loop haptic IOL, and a one-piece plate-type IOL. The amount of deformation of lenticular structures during implantation was calculated and the movements visualized with two cameras. The results were transformed to two-dimensional graphs using a newly developed image-processing algorithm. RESULTS: For both one-piece plate-type and one-piece C-loop haptic IOLs, the amount of capsular bag deformation from its initial shape was greater in the direction of posterior center of the capsule, as detected by side camera, than in the direction of the equator (or periphery), as detected by front camera. The mean peak deformation values were 51% and 36% (as measured by side and front cameras, respectively) for one-piece plate-type IOL and 25% and 20% for one-piece C-loop haptic IOL. For three-piece C-loop haptic IOL, the capsular bag distention was almost equal in both posterior and peripheral directions, with mean peak deformation values reaching 39% and 38%. CONCLUSIONS: The new experimental means of lenticular imaging and quantified dynamics from two different angles allowed three-dimensional understanding of specific behavior of each IOL. Our model not only exposes the capsular bag for recording during implantation, but also objectively compares the individual movement values and reveals different zonular and capsular stress patterns, depending on IOL model. TRANSLATIONAL RELEVANCE: The novel "Choi-Apple View" allows a three-dimensional quantitative analysis of capsular dynamics and IOL implantation behavior.

Sex-specific age threshold for increased risk of retinal vein occlusion in Koreans.

PURPOSE: Retinal vein occlusion (RVO) is one of most common retinal vascular disorders. It can lead to visual impairment and subsequent socioeconomic loss among the working population. RVO peak incidence is known to occur in the fifth and sixth decades of life, and is more predominant in males. To date, there has been no consensus regarding the optimal screening age for individuals at high risk for RVO, or whether sex-dependent cut-offs may be appropriate. Therefore, the purpose of this study was to predict the sex-specific age threshold for increased risk of RVO in Koreans. METHODS: The analysis was based on data from the Korean National Health Insurance Database from 2013. Patients diagnosed with new cases of RVO from January 2013 to December 2013 were included. Individuals younger than 20 years of age and those with other retinal diseases were excluded. Multivariate logistic regression analysis and odds ratios with 95% confidence intervals were conducted to identify the age-related risk factors for RVO. A receiver operating characteristic (ROC) curve for RVO incidence was constructed. RESULTS: Among the 754,749 individuals included in the study, 623 (0.08%) developed RVO. The optimal cut-off age for increased risk of RVO was 54 years overall, (sensitivity 0.78, specificity 0.70), 48 years in males (sensitivity 0.90, specificity 0.58), and 54 years in females (sensitivity 0.80, specificity 0.68). The incidence of RVO in females over 50 years of age was 3 times higher than that in females under the age of 50 after adjusting for confounding factors, and these differences tended to increase with age. The area under the ROC curve was 0.80 (95% CI; 0.79-0.82) overall, 0.81 (95% CI; 0.79-0.83) in males, and 0.79 (95% CI; 0.78-0.81) in females. CONCLUSION: RVO incidence was higher in females, and increased more rapidly with age. The incidence of RVO more than doubled after 50 years of age for both sexes after adjusting for confounding factors. Females had an older age cut-off for RVO than males. However, the clinical impact of the use of sex-specific age cut-offs for RVO would benefit from additional validation from further studies.

Evaluation of Clinical Efficacy and Safety of a Novel Cyclosporin A Nanoemulsion in the Treatment of Dry Eye Syndrome.

PURPOSE: Topical administration of the anti-inflammatory agent cyclosporin A (CsA) is recommended for long-term management of dry eye syndrome (DES), yet standard ophthalmic CsA preparations have been reported to be unstable. In this trial, the efficacy and safety of Clacier™ (based on a phase 3 study developed by Huons Co. Ltd.), a novel 0.05% CsA nanoemulsion formulation, are compared with those of the conventional Restasis® emulsion. METHODS: Patients with moderate-to-severe DES were randomly assigned to receive topical 0.05% CsA in the form of Clacier or Restasis, to be administered twice daily for 12 weeks. The primary efficacy outcome was the change from baseline in corneal fluorescein staining scores at week 12; changes at weeks 4 and 8 were secondary endpoints. Additional endpoints included score changes from baseline in nonanesthetic Schirmer's test I, tear breakup time, ocular surface disease index, and conjunctival staining. RESULTS: At week 12, corneal staining scores were improved in patients treated with Clacier and Restasis, with no significant difference between treatments (P = 0.41). Temporal conjunctival surface damage was significantly more ameliorated with Clacier treatment than with Restasis treatment (P = 0.034). Notably, tear film stability was improved more rapidly in Clacier patients at week 4 (P = 0.005) than in Restasis patients (P = 0.36). Improvements in tear production were comparable with both Clacier and Restasis treatments. Clacier did not increase the risk of adverse events as compared with Restasis. CONCLUSION: Treatment with Clacier alleviated clinical signs and symptoms of DES comparably to the commercially available Restasis, resulting in improved quality of life for patients. Clacier is an effective and safe therapeutic agent for DES.

Long-term Reliability of Diurnal Intraocular Pressure Patterns in Healthy Asians.

PURPOSE: To determine the long-term repeatability of diurnal intraocular pressure (IOP) patterns in healthy Asian subjects without glaucoma. METHODS: Twenty-three eyes in 23 healthy Asian subjects without glaucoma underwent diurnal IOP measurements using Goldmann applanation tonometry every 2 hours from 9 AM to 11 PM during two visits that were 8 weeks apart. To validate repeatability between visits, we calculated intra-class correlation coefficients (ICCs) mean IOP, peak IOP, minimum IOP, and IOP fluctuation at each time point and expressed the results as the difference between peak IOP and minimum IOP or as the standard deviation of all diurnal IOP values in the diurnal IOP curve. RESULTS: IOP repeatability was excellent at all time points, with ICCs ranging from 0.812 to 0.946 (p < 0.001). The 9 AM IOP showed the best repeatability between visits (ICCs, 0.946). Repeatability of mean IOP, peak IOP, and minimum IOP was also excellent (ICCs ranging from 0.899 to 0.929). However, IOP fluctuations showed poor repeatability, with an ICC lower than 0.15. CONCLUSIONS: Long-term repeatability of diurnal IOP patterns in healthy Asian subjects was excellent. These findings suggest that IOP measurements at standardized times of the day will be useful for assessing the effectiveness of glaucoma therapy.

Risk Prediction Model for Progression of Age-Related Macular Degeneration.

AIMS: The aim of this paper was to develop a risk prediction model for the progression of age-related macular degeneration (AMD) in Koreans using systemic and environmental factors. METHODS: The study sample included 10,890 individuals 50 years of age or older; 318 (2.92%) presented with early AMD findings in baseline examinations. Re-examinations were performed in 157 (49.37%) who were followed up for 4.4 years. The multivariate analysis of covariates included demographic and environmental factors. After using these data to develop a risk prediction model, the individual algorithm was made, and receiver operating characteristic curves were calculated to assess the predictive ability of the risk model for AMD progression. RESULTS: The individual algorithm to predict the AMD progression risk based on systemic and ocular factors was as follows: Y = -9.565 + 1.709 (drusen locationcenter) + 0.795 (drusen locationparacentral) + 1.074 (both eyes) + 0.094 (drusen sizeintermediate) + 0.034 (drusen sizelarge) + 0.614 (drusen number10-20) + 2.278 (drusen number>20) + 0.577 (hyperpigmentation) + 0.725 (hypopigmentation) + 0.079 (male) - 0.025 (age) - 0.921 (SMKex) + 1.574 (SMKcurrent) + 0.363 (total protein) + 1.626 (globulin), where SMK means smoking status. The C statistics for the model was 0.84 (0.75-0.92) indicating a good predictive power. CONCLUSION: A comprehensive risk prediction model for AMD progression was made to calculate the individual AMD progression risk using personal systemic and environmental factors.

Association Between Platelet Function and Disc Hemorrhage in Patients With Normal-Tension Glaucoma: A Prospective Cross-Sectional Study.

PURPOSE: To evaluate the association between platelet function and disc hemorrhage in patients with normal-tension glaucoma. DESIGN: Prospective, cross-sectional study. METHODS: Study involved a total of 315 subjects, including patients with normal-tension glaucoma and disc hemorrhage (n = 120), patients with normal-tension glaucoma without disc hemorrhage (n = 75), and healthy individuals (control group, n = 120). A detailed eye examination including visual field testing, color disc photography, optical coherence tomography scanning, and measurement of collagen/epinephrine closure time using a platelet function analyzer were performed for all subjects. RESULTS: The collagen/epinephrine closure time (s) as measured by the platelet function analyzer was approximately 14%-24% longer in the normal-tension glaucoma and disc hemorrhage group compared with the other groups (141.92 ± 53.44 [with normal-tension glaucoma and disc hemorrhage] vs 124.60 ± 46.72 [with normal-tension glaucoma without disc hemorrhage] vs 114.84 ± 34.84 [healthy individuals], 1-way analysis of variance test, P < .001). The activated partial thromboplastin time (s) value of the normal-tension glaucoma with disc hemorrhage group was also higher than the control group. Stepwise multiple logistic regression analysis revealed that only a longer collagen/epinephrine closure time (OR adjusted for age, sex, prothrombin time, activated partial thromboplastin time, diabetes mellitus, hypertension, hypotension, heart disease, hypothyroidism, migraine, stroke, hypercholesterolemia: 2.94; 95% CI: 1.40-6.17) was independently associated with disc hemorrhage. A similar trend was observed when platelet function was compared among the 3 groups with respect to age. CONCLUSIONS: Our results suggest that platelet function is significantly associated with disc hemorrhage in patients with normal-tension glaucoma. Delayed absorption resulted from prolonged bleeding due to delayed platelet aggregation may have an effect on the detectability of disc hemorrhage in patients with normal-tension glaucoma.