Disparities in Visual Field Testing Frequency Among Subjects With Glaucoma.

Purpose: Prior evidence suggests racial disparities in the utilization of visual field testing (VFT) for the diagnosis and monitoring of glaucoma. In this study, we considered the effect of baseline glaucoma severity and socioeconomic disadvantage along with other potential confounders such as test reliability, ancillary tests, and glaucoma surgeries on racial disparity in the frequency of VFT. Methods: The records of all subjects with a diagnosis of glaucoma who received VFT at an academic, tertiary care facility from January 2018 to December 2021 were accessed. Analysis was performed to compare VFT frequency, the total number of office visits (DoS), and the ratio of VFT frequency to DoS (VFT/DoS) across self-reported races while controlling for sex, age, socioeconomic disadvantage (Area Deprivation Index), VF reliability indicators and baseline mean deviation, optical coherence tomography frequency, and glaucoma surgeries. Results: Among the 2654 subjects (1515 White, 782 Black, and 357 Asian) included in this study, Black subjects had the worst socioeconomic status and disease severity at baseline. They also experienced a 3% lower VFT/DoS ratio compared to White subjects (P = 0.031). Asian subjects had a 5% lower VFT/DoS ratio compared to White subjects (P = 0.015). Discussion: We identified racial disparity in performing VFT in subjects with glaucoma even when multiple confounders were considered. Further investigation is necessary to identify other race-associated factors to work toward reducing racial disparities in VFT. Translational Relevance: Black and Asian subjects with glaucoma receive fewer VFT per visit compared to White subjects even when considering socioeconomic disadvantage and disease severity.

Difficult decisions, filtration surgery, and the heartbreak of the numerator.

A 70-year-old man had progressive and severe glaucoma in each eye. He was intolerant to dorzolamide, brimonidine, and netarsudil. Each eye had prior selective laser trabeculoplasty (SLT) as well as phacoemulsification plus minimally invasive glaucoma surgery (MIGS) 6 years before current presentation (iStent [Glaukos Corp.] in the right eye and Cypass [Alcon Laboratories, Inc.] in the left eye). Postoperative acuities were 20/20 and 20/25 in the right and left eyes, respectively. When his left eye progressed with loss of central acuity despite peak intraocular pressures (IOPs) in the middle to upper teens, neuro-ophthalmology consultation was obtained (Figure 1JOURNAL/jcrs/04.03/02158034-202401000-00017/figure1/v/2023-12-22T124801Z/r/image-tiff). That workup included magnetic resonance imaging scan and hematologic screening, but all results were negative, and the neuro-ophthalmic consultant concluded that the vision loss was likely on the basis of glaucoma. Accordingly, a trabeculectomy was performed in the left eye achieving consistent IOPs in the range of 7 to 10 mm Hg without medications, rending the left eye stable since the filtration surgery nearly 2 years previously. The right eye continued to progress both subjectively and objectively, and on recent examination, the IOP measured 20 mm Hg and 09 mm Hg in the right and left eyes, respectively (Figure 2JOURNAL/jcrs/04.03/02158034-202401000-00017/figure2/v/2023-12-22T124801Z/r/image-tiff). Medications included timolol and latanoprostene bunod in the right eye only. Central corneal thickness was 526 µm and 527 µm in the right and left eyes, respectively. The visual acuity now measured 20/25 in the right eye and 20/250 in the left eye. The vertical cup-to-disc ratio was 0.9 in the right eye and 1.0 in the left eye. Gonioscopy revealed a wide open angle in each eye with a patent sclerostomy superiorly in the left eye. The conjunctiva and sclera were healthy and without scarring in the right eye. The bleb in the left eye was diffuse, lightly vascularized, and seidel negative. Axial length (AL) was 26.88 µm in the right eye and 26.77 µm in the left eye. The patient was in good health and was not anticoagulated. An extensive discussion ensued about the best course of action for the right eye. How would you proceed in managing definite progression in this individual's right eye, knowing that he had lost fixation in his left eye at similar pressures?

The role of sphingolipids in meibomian gland dysfunction and ocular surface inflammation.

Inflammation occurs in response to tissue injury and invasion of microorganisms and is carried out by the innate and adaptive immune systems, which are regulated by numerous chemokines, cytokines, and lipid mediators. There are four major families of bioactive lipid mediators that play an integral role in inflammation - eicosanoids, sphingolipids (SPL), specialized pro-resolving mediators (SPM), and endocannabinoids. SPL have been historically recognized as important structural components of cellular membranes; their roles as bioactive lipids and inflammatory mediators are recent additions. Major SPL metabolites, including sphingomyelin, ceramide, ceramide 1-phosphate (C1P), sphingosine, sphingosine 1-phosphate (S1P), and their respective enzymes have been studied extensively, primarily in cell-culture and animal models, for their roles in cellular signaling and regulating inflammation and apoptosis. Less focus has been given to the involvement of SPL in eye diseases. As such, the aim of this review was to examine relationships between the SPL family and ocular surface diseases, focusing on their role in disease pathophysiology and discussing the potential of therapeutics that disrupt SPL pathways.

Refractive Outcomes in Fuchs' Endothelial Corneal Dystrophy: Conventional and Femtosecond Laser-Assisted Cataract Surgery.

PURPOSE: To investigate the refractive outcomes of eyes with Fuchs' endothelial corneal dystrophy (FECD) following phacoemulsification. METHODS: This is a retrospective chart review of patients with FECD who underwent phacoemulsification. Manifest refraction at the early postoperative period (1-6 weeks) and late postoperative period (3-12 months) was collected. The spherical equivalent (SE) and variance of SE from target in diopters (D) were analyzed. RESULTS: A total of 219 eyes from 175 FECD patients (73 FLACS, 146 conventional phacoemulsification) were included. In the early postoperative period, when comparing variance from intended target, 62% (n=126) had a SE variance of ≤0.5 D, 22% (n=44) >0.5 D and ≤1 D, and 17% (n=34) >1 D. In the late postoperative period, 62% (n=85) had a SE variance of ≤0.5 D, 19% (n=26) >0.5 D and ≤1 D, and 20% (n=27) >1 D. There was no difference in the variance of SE comparing FLACS versus conventional phacoemulsification in either the early postoperative period (p=0.78) or the late postoperative period (p=0.29). CONCLUSION: Patients with mild-to-moderate FECD had favorable refractive outcomes with phacoemulsification. There was no difference in refractive outcomes in eyes with FECD between the group that underwent FLACS versus the group that underwent conventional phacoemulsification.

Salzmann nodular degeneration: prevalence, impact, and management strategies.

PURPOSE: This review will summarize the clinical and histological presentation of Salzmann nodular degeneration (SND), its prevalence and risk factors, potential underlying mechanisms, diagnostic tools, management options, and impact on cataract surgery and co-morbid ocular surface diseases. METHOD: PubMed review of 44 articles published between 1976 and 2018. RESULTS: SND is a corneal disease characterized by whitish gray or bluish nodules on the peripheral or central cornea. The clinical presentation of SND is variable and the nodules can be asymptomatic or cause foreign body sensation and/or blurred vision. Histologically, SND appears as subepithelial nodules with thin overlying epithelium, disrupted or absent Bowman's layer, and activated fibroblasts within the nodule. SND pathogenesis is not fully understood but is thought to involve poor epithelial protection and disruption of the epithelial-stromal interface, allowing for penetration of epithelially derived growth factors into the stroma and subsequent activation of stromal fibroblasts, eventually leading to sub-epithelial deposition of disorganized extracellular membrane components. SND most commonly occurs in Caucasian females in a bimodal distribution, occurring in the fifth or eighth and ninth decades of life. Risk factors for SND include ocular surface diseases and surgery. Surgical intervention is recommended in individuals with symptomatic nodules - primarily superficial keratectomy performed with or without intraoperative mitomycin C, photokeratectomy, and/or amniotic membrane transplantation. These procedures have been successful in removing the lesion and reducing corneal irregularity, but have variable recurrence rates (0-31%). CONCLUSION: The pathogenesis of SND is complex and multifactorial. Advances in diagnostic and treatment modalities have allowed for earlier and more accurate diagnosis and effective treatment of SND.

Clinical signs of meibomian gland dysfunction (MGD) are associated with changes in meibum sphingolipid composition.

PURPOSE: Sphingolipids (SPL) play roles in cell signaling, inflammation, and apoptosis. Changes in SPL composition have been reported in individuals with MGD, but associations between clinical signs of MGD and compositional changes in meibum SPLs have not been examined. METHODS: Forty-three individuals underwent a tear film assessment. Groups were split into those with good or poor quality meibum. Meibum was collected then analyzed with liquid chromatography-mass spectroscopy to quantify SPL classes. Relative composition of SPL and major classes, Ceramide (Cer), Hexosyl-Ceramide (Hex-Cer), Sphingomyelin (SM), Sphingosine (Sph) and Sphingosine 1-phosphate (S1P) was calculated via mole percent. RESULTS: 22 and 21 individuals were characterized with good and poor quality meibum, respectively. Individuals with poor quality were older (60 ±â€¯8 vs 51 ±â€¯16 years) and more likely to be male (90% vs 64%). Relative composition analysis revealed that individuals with poor meibum quality had SPL composed of less Cer (33.36% vs 49.49%, p < 0.01), Hex-Cer (4.88% vs 9.15%, p < 0.01), and S1P (0.16% vs 0.31%, p = 0.05), and more SM (58.67% vs 38.18%, p < 0.01) and Sph (2.92% vs 2.87%, p = 0.97) compared to individuals with good quality meibum. Assessment of the ratio of Cer (pro-apoptotic) to S1P (pro-survival) showed that individuals with poor meibum quality had a relative increase in Cer (495.23 vs 282.69, p = 0.07). CONCLUSION: Meibum quality, a clinically graded marker of MGD, is associated with compositional changes in meibum sphingolipids. Further investigation of the structural and bioactive roles of sphingolipids in MGD may provide future targets for therapy.

Analysis of bisphenol A diglycidyl ether (BADGE) and its hydrolytic metabolites in biological specimens by high-performance liquid chromatography and tandem mass spectrometry.

Due to its cytotoxicity, genotoxicity, and adipogenicity observed in in vitro studies, bisphenol A diglycidyl ether (BADGE) may pose a health risk to humans. Quantifying BADGE exposure is an essential step to assess potential health risks associated with this ubiquitous compound widely used in certain plastic products. Due to the lack of endogenous sources for BADGE, bio-monitoring of BADGE and/or its hydrolytic metabolites (BADGE·H2O and BADGE·2H2O) can be a useful means to measure exposure. In this study, we developed a highly specific and sensitive method to measure BADGE, BADGE·H2O and BADGE·2H2O in plasma and urine, using a fast liquid-liquid extraction technique followed by a high-performance liquid chromatography and positive electrospray tandem mass spectrometry (LC-ESI-MS/MS) method. The method can quantify BADGE, BADGE·H2O and BADGE·2H2O with lower limits of quantification (LLOQ) of 0.05, 0.05 and 0.2 ng/ml, respectively. The percentage deviation of mean calculated concentrations from target concentrations was within 20%, variations across repeated analyses were within 15%, and mean extraction recovery was higher than 51.4% for all the three analytes in both plasma and urine matrices. The method has been applied to venous blood samples, cord blood samples, and urine samples collected from 9 to 14 adult volunteers. Results showed that concentrations of BADGE were lower than LLOQ in all of these samples except one urine sample. Low levels of BADGE·H2O from 0.108 to 0.222 ng/ml were observed in four venous blood samples and one urine sample (0.187 ng/ml). In contrast, concentrations of BADGE·2H2O were higher than LLOQ, varying from 0.660 to 303.593 ng/ml, in all the 10 venous blood samples and 1 cord blood sample (0.592 ng/ml) and two urine samples (0.200 and 0.306 ng/ml). The results suggest that bio-monitoring of blood and urine for BADGE exposure should focus on the hydrolysis derivatives of BADGE, mainly in the form of BADGE·2H2O.