Visual Impairment and Suicide Risk: A Systematic Review and Meta-Analysis.

Importance: Suicide is a substantial public health concern that involves various recognized contributing factors. Sensory impairments, specifically visual impairment, are deemed potential risk factors. Nonetheless, comprehensive information about associated risk levels and underlying determinants remains limited. Objective: To investigate the association between visual impairment and different aspects of suicide, including the assessment of risk levels and exploration of potential contributing factors. Data Sources: An electronic search was performed in the PubMed, EMBASE, Scopus, and Cochrane Library databases from their inception to February 8, 2024. Study Selection: All published studies were considered without restrictions on study design, publication date, or language. Data Extraction and Synthesis: Two independent reviewers extracted the published data using a standardized procedure in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Random-effects meta-analyses were used to estimate pooled effect sizes. Multiple meta-regression analyses were conducted to identify potential factors contributing to the association between visual impairment and the risk of suicide. Main Outcomes and Measures: The primary outcome measure was the odds ratio (OR) of suicidal behavior (including suicide attempt and suicide death) for individuals with visual impairment compared with those without. The secondary outcome measures were the pooled ORs of suicidal ideation and suicide death, respectively. Results: A total of 31 population-based studies with 5 692 769 unique individuals (mean [SD] age, 48.4 [8.5] years; 2 965 933 females [52%]) were included. For 17 studies (5 602 285 individuals) that evaluated suicidal behavior, the pooled OR was 2.49 (95% CI, 1.71-3.63). For 21 studies (611 899 individuals) that assessed suicidal ideation, the pooled OR was 2.01 (95% CI, 1.62-2.50). For 8 studies (5 067 113 individuals) investigating the association between visual impairment and suicide death, the pooled OR was 1.89 (95% CI, 1.32-2.71). The multiple meta-regression model identified age group as a predictive factor associated with suicidal behavior, with the studies included suggesting that adolescents were at the highest risk. While this analysis showed moderate heterogeneity for suicide death, high heterogeneity was observed for suicidal behavior and suicidal ideation. Conclusions and Relevance: The findings of this systematic review and meta-analysis support the association between visual impairment and increased risk of suicidal tendencies. The risk differed by age group, with a pronounced risk observed among adolescents.

Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens.

INTRODUCTION: The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). METHODS: This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. RESULTS: There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). CONCLUSIONS: In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.

Nighttime Outdoor Artificial Light and Risk of Age-Related Macular Degeneration.

Importance: Light pollution's impact on human health is increasingly recognized, but its link to exudative age-related macular degeneration (EAMD) remains unclear. Objective: To investigate the association between exposure to outdoor artificial light at night (OALAN) and the risk of incident EAMD. Design, Setting, and Participants: In this nationwide population-based case-control study, all individuals 50 years or older with newly diagnosed EAMD between January 1, 2010, and December 31, 2011, were identified with reference to the Korean National Health Insurance Service registration program database for rare and intractable diseases. Birth year- and sex-matched controls (with no EAMD diagnosis until 2020) were selected at a 1:30 ratio. Data were acquired from May 1 to December 31, 2021, and analyzed from June 1 to November 30, 2022. Exposures: Mean levels of OALAN at participants' residential addresses during 2008 and 2009 were estimated using time-varying satellite data for a composite view of persistent nighttime illumination at an approximate scale of 1 km2. Main Outcomes and Measures: The hazard ratios (HRs) and 95% CIs of the association between residential OALAN and risk of incident EAMD were determined based on maximum likelihood estimation after adjusting for sociodemographic characteristics, comorbidities, and area-level risk factors (ie, nighttime traffic noise and particulate matter of aerodynamic diameter ≤10 µm in each participant's administrative district of residence). Results: A total of 126 418 participants were included in the analysis (mean [SD] age, 66.0 [7.9] years; 78 244 men [61.9%]). Of these, 4078 were patients with newly diagnosed EAMD and 122 340 were EAMD-free matched controls. In fully adjusted models, an IQR (55.8 nW/cm2/sr) increase in OALAN level was associated with an HR of 1.67 (95% CI, 1.56-1.78) for incident EAMD. The exposure-response curve demonstrated a nonlinear, concave upward slope becoming more pronounced at higher levels of light exposure (ie, at approximately 110 nW/cm2/sr). In a subgroup analysis, an IQR increase in OALAN was associated with increased risk of incident EAMD in urban areas (HR, 1.46 [95% CI, 1.33-1.61]) but not in rural areas (HR, 1.01 [95% CI, 0.84-1.22]). Conclusions and Relevance: In this nationwide population-based case-control study, higher levels of residential OALAN were associated with an increased risk of incident EAMD. Future studies with more detailed information on exposure, individual adaptive behaviors, and potential mediators are warranted.

Association between subconjunctival hemorrhage and hemorrhagic disorders: a nationwide population-based study.

Subconjunctival hemorrhage (SCH) is a benign eye condition that is often noticeable and leads to medical attention. Despite previous studies investigating the relationship between SCH and cardiovascular diseases, the relationship between SCH and bleeding disorders remains controversial. In order to gain further insight into this association, a nationwide cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort version 2.0 from 2006 to 2015. The study defined SCH using a diagnostic code and compared the incidence and risk factors of intracerebral hemorrhage (ICH) and gastrointestinal (GI) bleeding in 36,772 SCH individuals and 147,088 propensity score (PS)-matched controls without SCH. The results showed that SCH was associated with a lower risk of ICH (HR = 0.76, 95% CI = 0.622-0.894, p = 0.002) and GI bleeding (HR = 0.816, 95% CI = 0.690-0.965, p = 0.018) when compared to the PS-matched control group. This reduced risk was more pronounced in females and in the older age group (≥ 50 years), but not observed in males or younger age groups. In conclusion, SCH dose not increase the risk of ICH and major GI bleeding and is associated with a decreased incidence in females and individuals aged ≥ 50 years.

Improved Intermediate Visual Function with New Monofocal Intraocular Lens in Combined Cataract and Vitrectomy Surgery for Retinal Disease.

PURPOSE: To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients with various retinal diseases who underwent combined cataract and pars plana vitrectomy surgery. METHODS: This prospective observational study included 33 patients with various retinal diseases. Monocular best-corrected distance visual acuity (BCDVA), uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), and contrast sensitivity were measured and compared with 40 age-matched patients in the standard monofocal IOL. RESULTS: The Eyhance IOL group demonstrated significantly better UCIVA at 6 months follow-up compared to the standard monofocal IOL group. No significant differences were observed between the two groups in contrast sensitivity, BCDVA, UCDVA, or UCNVA. The regression analysis showed a significant association between preoperative corrected distance visual acuity and improved UCIVA in the Eyhance IOL group. CONCLUSIONS: The Eyhance ICB00 IOL proved to be a valuable option for patients with retinal diseases undergoing combined cataract surgery and vitrectomy. It effectively improved intermediate vision without compromising contrast sensitivity or distance visual acuity.

In Vivo Electroporation Improves Retinal Delivery of Intravitreally Injected Exosomes.

Purpose: Mesenchymal stem cell (MSC)-derived exosomes are promising therapeutic agents and natural nanoscale delivery platforms for treating degenerative retinal diseases. This study investigated the effect of electroporation on the retinal delivery of intravitreally administered MSC-derived exosomes in a murine model. Methods: Exosomes isolated from adipose tissue-derived MSCs were stained with ExoGlow exosome-specific dye and administered to the right eyes of 40 Sprague-Dawley rats. Electroporation was performed in 20 rats immediately after intravitreal injection (electroporation group); 5 square pulses of 40 V/cm for 50 ms each with 950-ms intervals were administered. The remaining 20 rats were assigned to the no-electroporation group. The eyeballs were harvested 24 h later for evaluation. The total number of fluorescent particles per hyperfield was counted from the retinal flat mounts to quantify the retinal delivery of exosomes. Tissue damage after electroporation was evaluated using retinal histological sections and a terminal deoxynucleotidyl transferase-mediated deoxyuridine nick end labeling (TUNEL) assay. Results: A significantly higher number of fluorescent particles per hyperfield were observed in the retinal flat mounts of the electroporation group compared with that in the no-electroporation group (599.0 ± 307.5 vs. 376.9 ± 175.4; P = 0.013). Retinal histological sections and TUNEL assays showed no signs of tissue damage after electroporation. Conclusions: In vivo electroporation can improve the retinal delivery of intravitreally injected exosomes.

Evaluation of a New Monofocal Intraocular Lens in Patients Undergoing Cataract and Vitrectomy Surgery for Idiopathic Macular Hole.

PURPOSE: To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients who underwent combined cataract and pars plana vitrectomy (PPV) surgery for idiopathic macular hole (MH). METHODS: A prospective study was conducted on 89 eyes of 89 patients who underwent combined cataract and PPV surgery for MH. The patients were divided into two groups: Eyhance ICB00 and Tecnis ZCB00. Pre-operative characteristics, post-operative visual outcomes, contrast sensitivity, and complications were compared between the two groups. A univariate regression analysis was performed to identify the factors that may affect the postoperative visual outcomes. RESULTS: Both groups showed significant improvement in mean corrected distance visual acuity (CDVA) six months post-operation (p < 0.001). There was no significant difference in pre-operative characteristics or complications between the two groups. However, the Eyhance ICB00 group showed a significantly higher uncorrected intermediate visual acuity (UCIVA) value at 6 months after surgery than the Tecnis ZCB00 group (p = 0.014). Contrast sensitivity values were not significantly different between the two groups. The univariate regression analysis revealed a significant correlation between preoperative CDVA and minimum linear diameter of MH with postoperative UCIVA in the Eyhance ICB00 group. CONCLUSIONS: The newly generated Eyhance ICB00 IOL showed promising results in terms of post-operative UCIVA, with no significant difference in complications or contrast sensitivity values compared to the Tecnis ZCB00 IOL. These findings suggest that the Eyhance ICB00 IOL may be a useful option for patients who undergo combined cataract and PPV surgery for idiopathic MH, particularly for those who require intermediate visual acuity.

Volumetric fluid analysis of fixed monthly anti-VEGF treatment in patients with neovascular age-related macular degeneration.

AIM: To evaluate visual outcomes and changes in fluid after administering monthly anti-vascular endothelial growth factor (VEGF) injections to treat neovascular age-related macular degeneration (nAMD) with subretinal fluid (SRF) and pigment epithelial detachment (PED). METHODS: This prospective study included eyes with nAMD previously treated with as-needed anti-VEGF injections. The patients were treated with six monthly intravitreal injections of ranibizumab. Quantitative volumetric segmentation analyses of the SRF and PED were performed. The main outcome measures included best-corrected visual acuity (BCVA), and SRF and PED volumes. RESULTS: Twenty eyes of 20 patients were included in this study. At the 6-month follow-up, BCVA and PED volume did not change significantly (P=0.110 and 0.999, respectively) but the mean SRF volume decreased from 0.53±0.82 mm3 at baseline to 0.08±0.23 mm3 (P=0.002). The absorption rate of the SRF volume was negatively correlated with the duration of previous anti-VEGF treatment (P=0.029). Seven of the 20 eyes (35%) showed a fluid-free macula and significant improvement in BCVA (P=0.036) by month 6. CONCLUSION: Quantifying the SRF can precisely determine the patient's responsiveness to anti-VEGF treatment of nAMD.

Multifocal Electroretinography Changes over 12 Months after Resolution of Central Serous Chorioretinopathy: Prospective Observational Study.

INTRODUCTION: This prospective observational study aimed to evaluate the changes in retinal function after the anatomical resolution of central serous chorioretinopathy by multifocal electroretinography. METHODS: Thirty-two eyes of 32 patients with unilaterally resolved central serous chorioretinopathy were prospectively studied. Serial multifocal electroretinography examinations were performed at the initial visit for active central serous chorioretinopathy, the time of anatomical resolution (resolved central serous chorioretinopathy), and 3, 6, and 12 months after resolution. The peak amplitudes of the first kernel responses were analysed and compared with those in 27 age-matched normal controls. RESULTS: Compared with controls, the N1 amplitudes of rings 1-4 and P1 amplitudes of rings 1-3 showed statistically significant reductions at 12 months after the resolution of central serous chorioretinopathy (p < 0.05). The multifocal electroretinography amplitude substantially increased at the time of resolution and gradually improved until 3 months after the resolution of central serous chorioretinopathy. CONCLUSION: Serial examinations with multifocal electroretinography showed that retinal responses increased mostly after the resolution of central serous chorioretinopathy, and this improvement slowly progressed until 3 months; however, the multifocal electroretinography amplitudes remained statistically reduced 12 months after the anatomical resolution of central serous chorioretinopathy, indicating the residual functional deficits detected by multifocal electroretinography.

Incidence and Prevalence of Pediatric Noninfectious Uveitis in Korea: A Population-Based Study.

BACKGROUND: Uveitis is less common in children than in adults; however, pediatric uveitis has a relatively severe disease course that affects the quality of life. Although it is important to understand the epidemiological characteristics of pediatric uveitis, few studies have been conducted in large populations without referral bias. This study investigated the nationwide incidence and prevalence of pediatric uveitis in South Korea according to period, age, anatomic type, and systemic associations. METHODS: This nationwide population-based cohort study used data from the Korean National Health Insurance Service from 2002 to 2018. This study included patients younger than 19 years of age with noninfectious uveitis with at least three claims of diagnostic codes of uveitis on separate days with at least once claim of prescription codes of steroid and immunosuppressive agents. All the cases were classified as anterior or non-anterior uveitis, and the overall incidence and prevalence were estimated by age, sex, and period. Patients with noninfectious uveitis were categorized by the presence of associated systemic conditions. RESULTS: A total of 10,862,616 patients over 128,688,078 person-years were evaluated from 2005 to 2016. Overall, 5,368 cases of anterior uveitis and 604 cases of non-anterior uveitis were identified. The incidence and prevalence of pediatric noninfectious uveitis were 4.64 per 100,000 person-years (95% confidence interval [CI], 4.52-4.76) and 8.25 per 100,000 persons (95% CI, 8.09-8.41). Both the incidence and prevalence of pediatric uveitis increased with age. Anterior uveitis accounted for 84.7% of pediatric noninfectious uveitis prevalent cases (6.99 per 100,000 persons). Cases of juvenile idiopathic arthritis (JIA)-associated uveitis accounted for 8.7% (926 cases) of pediatric noninfectious uveitis cases with a prevalence of 0.72 per 100,000 (95% CI, 0.67-0.77). The proportion of systemic associations was higher and JIA-related uveitis accounted for 11.2% (803 cases) of recurrent or chronic noninfectious uveitis cases with a prevalence of 0.62 per 100,000. CONCLUSION: This is the first population-based study investigating the largest population of pediatric patients with uveitis in Korea. The nationwide incidence and prevalence of pediatric noninfectious uveitis in 2005-2016 were 4.64 per 100,000 person-years and 8.25 per 100,000, respectively. The proportion of JIA in pediatric noninfectious uveitis was 8.7%. These population-based study findings provide a better understanding of the public health burden and aid in the planning of health-care strategies for pediatric patients with uveitis.

Molecular Epidemiology of Adenoviral Keratoconjunctivitis in Korea.

Human adenoviruses (HAdVs) are a major cause of epidemic keratoconjunctivitis. We investigated the types of adenoviruses responsible for the recent epidemic of keratoconjunctivitis in Korea. From January to November 2019, 218 conjunctival swab samples were collected from patients clinically suspected as having adenoviral keratoconjunctivitis. Genotyping targeting of adenovirus capsid hexon genes was performed using PCR and sequencing. Of the 218 samples collected, 128 (58.7%) were positive for the adenovirus genes by PCR, and 126 samples were successfully genotyped. Adenovirus type 8 (HAdV-D8) was the most common type (67.5%), followed by HAdV-D64 (11.1%), HAdV-D37 (9.5%), HAdV-B3 (5.6%), HAdV-D53 (4.0%), HAdV-E4 (1.6%), and HAdV-D56 (0.8%). Adenoviral keratoconjunctivitis cases were the most frequent in July and August 2019, which were mainly caused by type 8. Phylogenetic analyses revealed little genetic distance among adenoviruses of the same type detected in our study. Our results provide basic data for further studies of adenoviral keratoconjunctivitis.

Evaluation of Acute Central Serous Chorioretinopathy Using Enhanced Depth Imaging Optical Coherence Tomography and Multifocal Electroretinography.

INTRODUCTION: The aim of the study was to evaluate functional and structural abnormalities in patients with acute central serous chorioretinopathy (CSC) with multifocal electroretinography (mfERG) and enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: This prospective observational study included 57 patients with unilateral CSC. Both eyes underwent mfERG and EDI-OCT. Peak amplitudes and implicit times of the first kernel responses were analyzed and compared with those of 25 age-matched normal controls. Correlational analyses were performed between the mfERG results and EDI-OCT parameters. RESULTS: Compared with the normal controls, the amplitude and implicit time on mfERG were significantly impaired in the area with serous retinal detachment (SRD) and the area beyond the SRD. Eyes with a greater reduction in SRD had a less impaired mfERG response in fellow eyes than those whose retinal detachments were not spontaneously decreased by >90% after 3 months. Correlational analysis revealed that the subfoveal choroidal thickness was negatively correlated with the mfERG parameters. CONCLUSIONS: The findings of this study indicate diffuse functional impairment in acute CSC involving both eyes and areas beyond the SRD. The retinal response of the unaffected eye was associated with regression of SRD. Functional retinal abnormality was found to correlate with pathological changes in the choroid.

Analysis of treatment response about low-dose (0.01%) atropine eye-drops in myopic children.

INTRODUCTION: Myopia usually commences during primary school and progresses until the mean age of 16 years. Topical low-dose (0.01%) atropine eye-drop appears to be safe and efficacious for myopia control in children. However, in some cases, a higher concentration of atropine is required in some cases because low-dose atropine treatment is not effective. METHODS: This is a retrospective study among young myopic children between 5 and 15 years with myopia progression > 0.50 D/year. We selected patients treated with low-dose atropine (0.01%) eye-drops for 12 months and conducted a comparative analysis of the group with good responder and poor responder. Patients were classified as good responders if spherical equivalent refractive error (SE) progression was ⩽ 0.50 D after 12 months of treatment and poor responders if SE progression > 0.50 D. The prognostic factors before and after treatment were analyzed in two groups. RESULTS: A total of 68 eyes were included. Low-dose (0.01%) atropine eye-drops have a good treatment response in 54% of patients. In the good responder group (n = 37), the mean rate of myopia progression after 12 months of treatment (0.36 ± 0.17 D) was significantly slower compared with the baseline progression (p < 0.001). Good responders have smaller changes in axial length (AL) elongation and SE than poor responders (p < 0.001). The only adverse event was temporary near vision difficulty (10%), photophobia (10%), and mild pupil dilation (30%). DISCUSSION: The AL elongation is an important indicator for monitoring the treatment response. Children with a family history of myopia at a young age may not respond well to low-dose (0.01%) atropine eye-drops. In these cases, increasing the concentration of atropine eye-drops should be considered.

Choroidal Thickness Changes after Orthokeratology Lens Wearing in Young Adults with Myopia.

INTRODUCTION: Recently in South Korea, there are increasing number of young adults undergoing orthokeratology treatment for myopia control. They prefer orthokeratology treatment more than wearing spectacles or having a refractive surgery for several reasons. However, there is little research on the effect of orthokeratology treatment on choroids. OBJECTIVE: The aim of this study was to analyze the change in choroidal thickness (CT) in the horizontal axis in young myopic adults after orthokeratology treatment. METHODS: This was a retrospective research among young myopic patients (-1.0 to -5.0 diopters) aged 19-29 years (n = 36; 23.6 ± 2.5 years). We selected patients who were treated with orthokeratology for 12 months. CT values of the horizontal axis near the fovea before and after orthokeratology treatment were analyzed using optical coherence tomography. The value was measured at the beginning of treatment and at 3, 6, and 12 months after orthokeratology treatment. Three regional areas of choroid on the horizontal plane including fovea were analyzed. RESULT AND CONCLUSIONS: In the beginning of orthokeratology treatment, CT of the horizontal axis was 248.9 ± 45.7 µm in the temporal region, 259.9 ± 55.3 µm in the macular region, and 219.2 ± 46.4 µm in the nasal region. Three months after orthokeratology treatment, thickness values of choroids in the 3 divided areas increased significantly (p < 0.05). Mean CT at 6 or 12 months after orthokeratology treatment was greater than before ortho--keratology treatment. CT increased after 3 months of orthokeratology treatment in each regional area. In young myopic adults, CT in nasal area was thinner than that in foveal or temporal area before treatment. CT recovered to near baseline when it was observed for more than 6 months after orthokeratology treatment.

Comparison of Scleral Buckling and Vitrectomy Using Wide Angle Viewing System for Rhegmatogenous Retinal Detachment.

Purpose: To compare the surgical results of pars plana vitrectomy (PPV) and scleral buckling (SB) using the same vitreoretinal viewing system for rhegmatogenous retinal detachment (RRD) Methods: The study was a retrospective analysis of the medical records of 52 eyes (52 patients) with uncomplicated RRD located in superior quadrants. Eyes with pseudophakia or complications were not included. Thirty-one eyes underwent PPV using a wide-angle viewing system (WAVS) and 21 eyes received SB using the same WAVS combined with a chandelier endoilluminator. The primary anatomical success rate was the main outcome, defined as the proportion of eyes with successful reattachment of the retina. Results: The primary anatomical success rate was 90.5% in the SB group and 90.3% in the PPV group. Both groups achieved 100% of the final success rate. Although no significant difference was observed between the two groups, temporary intraocular pressure elevation and post-operative cataract formation were more frequent in the PPV group. In patients under the age of 55, post-operative cataract formation was significantly less common in the SB group. (P = .045) Conclusions: Under the same vitreoretinal visualization techniques, both SB and PPV had similar anatomical success rates. Chandelier­assistance WAVS may increase the popularity of SB to treat primary RRD, allowing many patients to receive the benefits of SB surgery.

Macular Pigment Optical Density in the Korean Population: a Cross Sectional Study.

BACKGROUND: To evaluate the macular pigment optical density (MPOD) with age in the Korean population using the Macular Pigment Screener II (MPSII®). METHODS: One hundred and twenty-six eyes were retrospectively reviewed. MPOD was measured using MPSII®, which uses a heterochromatic flicker photometry method, and the estimated values were analyzed. Spearman's correlation test was used to evaluate correlations between MPOD and age. The association between MPOD and age was determined using a simple linear regression analysis. MPODs among the four groups were compared via the post hoc analysis with Bonferroni correction, MPODs between the age-related macular degeneration (AMD) group and aged-matched healthy subjects were compared via the Mann-Whitney U test. Other risk factors for AMD were identified via a logistic regression analysis. RESULTS: Estimated MPOD decreased significantly with increasing age in the general population. In the simple regression analysis, a statistically significant linear regression model was observed, and the estimated values of MPOD decreased by ?0.005 as age increased by 1 year. Aged (> 50 years) showed lower MPOD than younger (30-49 years) subjects. But, in the healthy population, the estimated MPOD values exhibited a decreasing trend with age, but there were no significant differences according to age, after excluding patients with AMD. MPOD was significantly lower in patients with AMD than in aged healthy controls. Furthermore, hypertension, dyslipidemia, and smoking were identified as risk factors for AMD. CONCLUSION: MPOD measured with MPSII® reflects the MP density in healthy individuals and patients with dry AMD. Aging was not significantly associated with low MPOD in healthy population, but the presence of dry AMD was significantly associated with low MPOD. Then, low MPOD may be a risk factor for development of dry AMD. Furthermore, routine screening with MPS II® for ages 50 and older is thought to help detect early low MPOD and identify individuals who should take supplements.

The effects of intravitreal triamcinolone acetonide in diabetic macular edema refractory to anti-VEGF treatment.

PURPOSE: To investigate the efficacy and safety of primary intravitreal triamcinolone acetonide (IVTA) in eyes affected by diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. STUDY DESIGN: Retrospective observational study METHODS: The medical records of patients who attended our clinic from March 2013 to September 2018 with refractory macular were reviewed. We included the patients who were injected at least one IVTA and completed 6 months of observation. Best-corrected Snellen visual acuity (VA), central macular thickness (CMT), intraocular pressure (IOP), and adverse events (AEs) were examined at baseline and at 1 month, 2 months, 3 months, and 6 months. RESULTS: Sixty-four eyes of 54 subjects were included. The mean VA was improved significantly at all time points compared to pre-treatment (P < 0.0001), with the greatest mean improvement at 1 month (0.3 logMAR). The reduction in mean CMT was also significant at all follow-up examinations compared to baseline (P < 0.0001), with the greatest decrease at 1 month (113.68 ± 53.78 µm). A poorer VA before injection was a factor that influenced visual gain 1 month post treatment (0.247 logMAR units/unit increase in baseline VA, P = 0.006). The most common AE associated with IVTA treatment was elevated IOP (11 eyes), observed significantly more often after IVTA injections containing a preservative (25.8%) than after those that were preservative-free (9.1%) (P = 0.033). CONCLUSION: IVTA injection can be an alternative steroid treatment for DME refractory to anti-VEGF therapy.

Quantitative physiological measurements to evaluate the response of antivascular endothelial growth factor treatment in patients with neovascular diseases.

Antivascular endothelial growth factor (VEGF) treatment is still used intravitreally worldwide for various neovascular diseases, despite other available, approved treatments. We performed a systematic search of the literature focused on visual physiology studies. We used the online biomedical search engine PubMed and searched key words including "M-chart," "Preferential Hyperacuity Perimetry," "microperimetry," (MP) "electroretinography," and "contrast sensitivity" to estimate treatment efficacy of anti-VEGF treatments in a quantitative manner. Many studies were identified which used a variety of methodologies, disease entities, injected agents, and patient populations, making it difficult to obtain a direct comparison of their results. However, favorable functional outcomes achieved using current quantitative methods would lend further confidence to the effectiveness of a treat-and-extend protocol using intravitreal anti-VEGF for the management of patients with neovascular diseases. Despite anti-VEGF's wide use, a well-designed longitudinal multicenter study to systematically evaluate and compare different physiological methods or parameters in patients with neovascular diseases is still lacking, though it would benefit therapeutic decisions.

Cone photoreceptor abnormalities correlate with vision loss in a case of acute posterior multifocal placoid pigment epitheliopathy.

The authors report adaptive optics scanning laser ophthalmoscopy (AO-SLO) findings in a case of acute posterior multifocal placoid pigment epitheliopathy. The right eye showed an island of coarse, hyperreflective speckles surrounded by a dark annulus lacking cone cells, which were associated with reduced MP1 sensitivity and abnormal findings in other imaging modalities. Although dark lesions were also detected in the left eye, the correlated spectral-domain optical coherence tomography images were normal. AO-SLO allowed for the direct observation of retinal disruptions and the ability of this technology to detect abnormalities in the left eye demonstrates a superior ability for in-depth retinal imaging.

Comparison of fundus autofluorescence between fundus camera and confocal scanning laser ophthalmoscope-based systems.

BACKGROUND AND OBJECTIVE: To compare fundus autofluorescence (FAF) imaging via fundus camera (FC) and confocal scanning laser ophthalmoscope (cSLO). PATIENTS AND METHODS: FAF images were obtained with a digital FC (530 to 580 nm excitation) and a cSLO (488 nm excitation). Two authors evaluated correlation of autofluorescence pattern, atrophic lesion size, and image quality between the two devices. RESULTS: In 120 eyes, the autofluorescence pattern correlated in 86% of lesions. By lesion subtype, correlation rates were 100% in hemorrhage, 97% in geographic atrophy, 82% in flecks, 75% in drusen, 70% in exudates, 67% in pigment epithelial detachment, 50% in fibrous scars, and 33% in macular hole. The mean lesion size in geographic atrophy was 4.57 ± 2.3 mm(2) via cSLO and 3.81 ± 1.94 mm(2) via FC (P < .0001). Image quality favored cSLO in 71 eyes. CONCLUSION: FAF images were highly correlated between the FC and cSLO. Differences between the two devices revealed contrasts. Multiple image capture and confocal optics yielded higher image contrast with the cSLO, although acquisition and exposure time was longer.