Vision-Related Quality of Life Among Healthy, Preperimetric Glaucoma, and Perimetric Glaucoma Patients.

PURPOSE: To investigate the association of vision-related quality of life (VRQOL) with the central visual field and macular ganglion cell complex (GCC) thickness in healthy control participants, patients with preperimetric glaucoma, and patients with perimetric glaucoma. DESIGN: Retrospective cross-sectional study. METHODS: A total of 39 healthy, 34 preperimetric glaucoma, and 145 perimetric glaucoma patients completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ). A linear mixed-effect models was used to investigate the association between the glaucoma stage as measured by binocular 10-2 visual field mean sensitivity (VFMS) and GCC thickness with the Rasch-calibrated NEI-VFQ score. RESULTS: A total of 436 eyes from 218 participants (mean age = 67.2 [95% CI = 65.1 to 69.2] years) were enrolled. VRQOL calculated by the NEI-VFQ Rasch-calibrated score was worst for patients with perimetric glaucoma (50.7 [95% CI = 47.2 to 54.2]), followed by patients with preperimetric glaucoma (41.2 [95% CI = 34.5 to 47.9]) and healthy controls (29.3 [95% CI = 24.0 to 34.7]. Worse VRQOL had a moderate association with a worse global binocular 10-2 VFMS (-3.4 [95% CI = -5.0 to -1.9] dB per 1 score; P < .001; adjusted R2 = 0.27), but not with a thinner global GCC in the better eye (-0.1 [95% CI = -0.2 to 0.1] µm per 1 score; P =.0485; adjusted R2 = 0.17). CONCLUSIONS: These findings suggest that patients with perimetric and preperimetric glaucoma have worse VRQOL than patients with healthy eyes. As compared to macular thickness measurements, the central visual field is more strongly associated with VRQOL and may better help to identify patients in need of intervention.

Association Between Ganglion Cell Complex Thinning and Vision-Related Quality of Life in Glaucoma.

Importance: Faster structural changes may be associated with worse vision-related quality of life in patients with glaucoma. Objectives: To evaluate the association between the rate of ganglion cell complex thinning and the Vision Function Questionnaire in glaucoma. Design, Setting, and Participants: This retrospective analysis of a longitudinal cohort was designed in October 2021. Patients were enrolled from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Two hundred thirty-six eyes of 118 patients with diagnosed or suspected glaucoma were followed up with imaging for a mean of 4.1 years from September 2014 to March 2020. Main Outcomes and Measures: The Vision Function Questionnaire was evaluated using the 25-item National Eye Institute Visual Function at the last follow-up visit. Ganglion cell complex thickness was derived from macular optical coherence tomography scans and averaged within 3 circular areas (3.4°, 5.6°, and 6.8° from the fovea) and superior and inferior hemiregions. Linear mixed-effects models were used to investigate the association between the rate of ganglion cell complex thinning and Rasch-calibrated Vision Function Questionnaire score. Results: The mean (SD) age was 73.2 (8.7) years, 65 participants (55.1%) were female, and 53 participants (44.9%) were African American. Race was self-reported by the participants. Mean composite Rasch-calibrated National Eye Institute Visual Function Questionnaire score was 50.3 (95% CI, 45.9-54.6). A faster annual rate of global ganglion cell complex thinning in the better eye was associated with a higher disability reflected by the composite National Eye Institute Visual Function Questionnaire score (-15.0 [95% CI, -28.4 to -1.7] per 1 µm faster; P = .03). When stratified by degrees from the fovea, the 5.6° and 6.8° areas were associated with the composite National Eye Institute Visual Function Questionnaire Rasch-calibrated score (-14.5 [95% CI, -27.0 to -2.0] per 1 µm faster; R2 = 0.201; P = .03; and -23.7 [95% CI, -45.5 to -1.9] per 1 µm faster; R2 = 0.196; P = .02, respectively), and -8.0 (95% CI, -16.8 to 0.8) per 1 µm faster for the 3.4° area (R2 = 0.184; P = .07) after adjusting for confounding factors. Conclusions and Relevance: These findings suggest that faster and sectoral central location of ganglion cell complex thinning provides useful information in determining the risk of vision-related quality of life in glaucoma. Monitoring macular structure may be useful for determining the risk of functional impairment in glaucoma.

The First Epiretinal Implant for Hereditary Blindness in the Asia-Pacific Region.

In February 2013, the Argus® II Retinal Prosthesis System (Second Sight Medical Products, Inc., Sylmar, CA, US) became the first "bionic eye" approved by the FDA to restore useful vision in patients previously blinded by end-stage retinitis pigmentosa, a hereditary, progressive degeneration of the outer retinal photoreceptor cells. The system captures and converts an external optical input into an electrical signal that activates an epiretinal electrode array on the inner surface of the retina. This signal bypasses dysfunctional photoreceptors and directly stimulates the functional inner retina, thus transmitting information to the visual cortex and creating artificial vision. This article describes the first implantation of the Argus II Retinal Prosthesis System in the Asia-Pacific region, which occurred in a deaf and blind 72-year-old Japanese American woman with Usher syndrome. At 57 months after her operation, the patient uses the device daily to perform visual tasks, and the microelectrode array remains in the proper position on the macula. This case demonstrates the long-term safety and efficacy of the Argus II epiretinal implant, which allowed a functionally blind patient to gain meaningful vision.

Differentiating Exudative Macular Degeneration and Polypoidal Choroidal Vasculopathy Using OCT B-Scan.

PURPOSE: Although polypoidal choroidal vasculopathy (PCV) is best diagnosed with indocyanine green angiography (ICGA), ICGA is often unavailable or not ordered. OCT is widely available, and OCT B-scan can visualize polypoidal lesions diagnostic of PCV as inverted U-shaped elevations of the retinal pigment epithelium (RPE) with heterogeneous reflectivity and sometimes ring-shaped lesions within the polypoidal lesion. This study aims to differentiate findings between eyes diagnosed with PCV or typical exudative age-related macular degeneration (AMD) using ICGA and then compares findings noted on the OCT B-scan line scan in each group. DESIGN: Retrospective, chart review. METHODS: Clinical features of eyes with PCV and typical exudative AMD were compared by using ICGA. Eyes with PCV were evaluated for inverted U-shaped polypoidal lesions, which are the main differentiating finding of PCV from typical exudative AMD. Data collected included presence of subretinal fluid (SRF), macular edema or intraretinal edema, subretinal hyperreflective material (SHRM), and retinal pigment epithelial detachment (RPED). These findings were evaluated in 2 parts: baseline and after 6 to 9 months of antiangiogenic therapy. Additionally, analysis was performed for the presence of polypoidal lesions before and after treatment. MAIN OUTCOME MEASURES: Presence of inverted U-shaped lesions on OCT B-scan following treatment. RESULTS: A total of 112 eyes of 106 patients were included. A total of 69 eyes were diagnosed with PCV, and 43 eyes were diagnosed with typical exudative AMD. Compared with AMD eyes, PCV eyes had an increased prevalence of SRF at baseline and after 6 to 9 months of treatment, but the prevalence of macular edema, SHRM, and RPED was similar at baseline and at 6 to 9 months after treatment. In PCV eyes, the presence of visible polypoidal lesions decreased from 56.5% to 24.6% after treatment. CONCLUSIONS: If PCV is suspected in an anti-vascular endothelial growth factor (VEGF)-resistant case of exudative AMD, in the absence of ICGA availability, it is important to look at the baseline OCT B-scan before therapy for evidence of polypoidal lesions. The characteristic inverted U-shaped elevation was present in more than half of PCV eyes on OCT B-scan at baseline but disappeared after antiangiogenic therapy in 56.4% of cases in which this was initially identified. Subretinal fluid was more prevalent in PCV eyes than non-PCV AMD eyes.

Introducing the 24-2C Visual Field Test in Neuro-Ophthalmology.

PURPOSE: The Humphrey 24-2C visual field test is a modified 24-2 visual field test that incorporates 10 additional test points in the central 10° of vision. This study compares the new 24-2C test to the standard Humphrey 10-2 visual field test in patients presenting for neuro-ophthalmology evaluation to evaluate its ability to detect central visual field defects. METHODS: Twenty-five neuro-ophthalmology patients (42 eyes) underwent both 24-2C and 10-2 visual field testing using the Humphrey perimeter. The number of flagged total deviation (TD) and pattern deviation (PD) points of the 10 added test points of the 24-2C were compared with the corresponding 10-2 fields at the P < 5%, P < 2%, and P < 1% significance levels. The total number of flagged TD points were further analyzed by diagnosis. An experienced neuro-ophthalmologist evaluated all visual fields, commenting on the added value for clinical practice. RESULTS: There was no significant difference between the number of flagged TD and PD points of the 10 extra 24-2C points and corresponding 10-2 points at all significance levels. When analyzed by diagnosis, there was no significant difference in the number of flagged TD points in patients with optic neuritis, ischemic optic neuropathy, optic atrophy, and no neuro-ophthalmic disease. The added 24-2C points aided in identifying visual field defects and areas of spared central vision and had similar diagnostic value as the 10-2. CONCLUSIONS: The 24-2C is able to detect visual field loss in the central 10° that corroborates with loss detected in the 10-2 pattern. The 24-2C exhibits potential to be used as a hybrid between the 24-2 and 10-2 to better evaluate visual field defects.

Correlating Ophthalmology Exposure in Medical School to Applying and Matching Into an Ophthalmology Residency.

PURPOSE: To correlate ophthalmology curricular exposure in medical school to the number of students who applied and matched into ophthalmology residency programs. Given the high curricular burden placed on medical schools, the authors sought to better characterize existing ophthalmology curricula and to delineate which offerings are closely related to high numbers of students applying and matching into ophthalmology residencies. METHOD: The authors reviewed the extent of ophthalmology curricula between 2007 and 2017 via a survey administered in 2018 to all U.S. Association of American Medical Colleges (AAMC)-affiliated medical schools. They obtained residency application and match data with permission from the Association of University Professors of Ophthalmology. The authors compared metrics of ophthalmology exposure with the number of students who applied and matched into ophthalmology during the corresponding year using mixed-effects Poisson regression analysis. RESULTS: This study includes 49 U.S. AAMC-affiliated medical schools. When adjusted for the number of applicants per year, the following were significantly (P < .05) associated with matching into an ophthalmology residency: the presence of an ophthalmology department, an ophthalmology residency program, an ophthalmology interest group, ophthalmologists on faculty, ophthalmology content in the preclinical curriculum, preclinical lectures taught by ophthalmologists, and the availability of an optional fourth-year ophthalmology elective. Multivariable analysis indicated both that the presence of an ophthalmology residency program was the only independent predictor of matching into an ophthalmology residency and that the presence of an ophthalmology residency program, ophthalmology content in the preclinical curriculum, and preclinical lectures taught by ophthalmologists are independent predictors for applying. CONCLUSIONS: A foundation in ophthalmology is crucial for all physicians, especially those who may encounter patients with eye problems in emergency or primary care settings. However, for those students considering a career in ophthalmology, choosing a medical school with an ophthalmology department and residency program is particularly important.

Two differing presentations of periocular dermatitis as a side effect of dupilumab for atopic dermatitis.

Dupilumab is a monoclonal antibody used to treat atopic dermatitis. Worsening of atopic dermatitis and conjunctivitis following dupilumab use are reported adverse effects; however, there is little reported on the nature and mechanism of these complications. Here, we describe two patients with chronic atopic dermatitis who developed new or severely worsened periocular dermatitis, believed to be a side effect of dupilumab injections, and resolution after its discontinuation. We explore the possibility of dupilumab-induced suppression of Th2 mediated inflammation and upregulation of Th1 and IFNγ mediated inflammation as a possible mechanism.