Long Term Visual Outcomes of an Extended Macular Vision IOL in Eyes with Macular Disease and Visually Insignificant Cataract.

Purpose: To determine long-term efficacy and safety of an extended macular vision intraocular lens (IOL) implanted in patients with dry age-related macular degeneration (AMD) and visually insignificant cataracts. Design: Retrospective observational case series. Setting: MicroChirurgia Oculare, Italy. Methods: A retrospective case series of patients with dry AMD and visually insignificant cataracts undergoing phacoemulsification and implantation of an extended macular vision IOL designed to optimize image quality up to 10° from the foveal center (EyeMax Mono, Sharpview Ophthalmology, London, UK). Criteria for implantation were visually insignificant cataract (NC1 according to LOCS III classification) with dry age-related macular degeneration. Hypermetropia was targeted in most eyes to provide magnification when corrected with spectacles. Primary outcome measures were changes in corrected distant and secondary outcome measures included near visual acuity (CDVA and CNVA, respectively) between baseline and latest follow-up and safety outcomes. Results: 113 eyes of 86 patients (mean age 70.3±7.9 years) were included (mean follow-up: 48.3±25.1 months). Mean CDVA improved by 0.22 logMAR (11 ETDRS letters), from 0.53±0.4 to 0.31±0.3 (n=113, p<0.001). Similarly, mean CNVA improved by 0.08 logMAR (4 ETDRS letters), from 0.45±0.2 to 0.37±0.2 (n=77, p<0.001). Eleven eyes had AMD with extensive atrophy, and their mean CDVA improved by 0.32 logMAR (16 ETDRS letters). Three eyes (2.7%) experienced loss of more than one line in logMAR CDVA and four eyes (5.2%) experienced loss of more than one line in logMAR CNVA. No complications or instances of IOL exchange were reported. Conclusion: Visual improvement in eyes with visually insignificant cataract and AMD who underwent phacoemulsification and were implanted with EyeMax Mono IOL appears to be influenced by the IOL optical design. Vision enhancement in eyes with visually insignificant cataracts underscores the IOL's ability to optimize use of healthy retinal areas. Prospective studies with control groups are needed to confirm these findings.

Glaucoma risk and the consumption of fruits and vegetables among older women in the study of osteoporotic fractures.

PURPOSE: To explore the association between the consumption of fruits and vegetables and the presence of glaucoma. DESIGN: Cross-sectional cohort study. METHODS: In a sample of 1,155 women located in multiple centers in the United States, glaucoma specialists diagnosed glaucoma in at least one eye by assessing optic nerve head photographs and 76-point suprathreshold screening visual fields. Consumption of fruits and vegetables was assessed using the Block Food Frequency Questionnaire. The relationship between selected fruit and vegetable consumption and glaucoma was investigated using adjusted logistic regression models. RESULTS: Among 1,155 women, 95 (8.2%) were diagnosed with glaucoma. In adjusted analysis, the odds of glaucoma risk were decreased by 69% (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.11 to 0.91) in women who consumed at least one serving per month of green collards and kale compared with those who consumed fewer than one serving per month, by 64% (OR, 0.36; 95% CI, 0.17 to 0.77) in women who consumed more than two servings per week of carrots compared with those who consumed fewer than one serving per week, and by 47% (OR, 0.53; 95% CI, 0.29 to 0.97) in women who consumed at least one serving per week of canned or dried peaches compared with those who consumed fewer than one serving per month. CONCLUSIONS: A higher intake of certain fruits and vegetables may be associated with a decreased risk of glaucoma. More studies are needed to investigate this relationship.

The treatment of branch retinal vein occlusion with bevacizumab.

PURPOSE OF REVIEW: New treatment modalities for branch retinal vein occlusion have recently been introduced. The role of intravitreal bevacizumab injections will be discussed and compared with laser photocoagulation and other novel intravitreal pharmacotherapies. RECENT FINDINGS: Argon laser photocoagulation is the single treatment for branch retinal vein occlusion that has been shown to reduce vision loss in a randomized controlled clinical trial. The effectiveness of this treatment is limited though. Currently, increasing data support the role of intravitreal bevacizumab as an effective treatment for patients with macular edema secondary to branch retinal vein occlusion. Multiple injections seem to be necessary in order to achieve visual stabilization, favorable and durable macular changes. The effect of a single injection seems to last 6-8 weeks. The most common treatment protocol is two to three injections over the first 5-6 months. Patients who had minimal or no response to laser therapy appeared to benefit from bevacizumab. No significant complications have been associated with its use but only short-term data are available. SUMMARY: Intravitreal bevacizumab appears to be a safe and effective treatment for macular edema associated with branch retinal vein occlusion, at least in the short term. Further randomized, controlled investigations are needed to assess long-term safety and efficacy of intravitreal bevacizumab.

Optic disk and nerve fiber layer imaging to detect glaucoma.

PURPOSE: To compare optic disk and retinal nerve fiber layer (RNFL) imaging methods to discriminate eyes with early glaucoma from normal eyes. DESIGN: Retrospective, cross-sectional study. METHODS: In a tertiary care academic glaucoma center, 92 eyes of 92 subjects (46 with early perimetric open-angle glaucoma and 46 controls) were studied. Diagnostic performance of optical coherence tomography (StratusOCT; Carl Zeiss Meditec, Dublin, California, USA), scanning laser polarimetry (GDx VCC; Laser Diagnostic Technologies, San Diego, California, USA), confocal laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] III; Heidelberg Engineering GmbH, Heidelberg, Germany), and qualitative assessment of stereoscopic optic disk photographs were compared. Outcome measures were areas under receiver operator characteristic curves (AUCs) and sensitivities at fixed specificities. Classification and regression tree (CART) analysis was used to evaluate combinations of quantitative parameters. RESULTS: The average (+/- standard deviation) visual field mean deviation for glaucomatous eyes was -4.0 +/- 2.5 dB (decibels). Parameters with largest AUCs (+/- standard error) were: average RNFL thickness for StratusOCT (0.96 +/- 0.02), nerve fiber indicator for GDx VCC (0.92 +/- 0.03), Frederick S. Mikelberg (FSM) discriminant function for HRT III (0.91 +/- 0.03), and 0.97 +/- 0.02 for disk photograph evaluation. At 95% specificity, sensitivity of disk photograph evaluation (90%) was greater than GDx VCC (P = .05) and HRT III (P = .002) results, but not significantly different than those of StratusOCT (P > .05). The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area with CART produced a sensitivity of 91% and specificity of 96%. CONCLUSIONS: StratusOCT, GDx VCC, and HRT III performed as well as, but not better than, qualitative evaluation of optic disk stereophotographs for detection of early perimetric glaucoma. The combination of StratusOCT average RNFL thickness and HRT III cup-to-disk area ratio provided a high diagnostic precision.

Effect of topical 0.1% indomethacin solution versus 0.1% fluorometholon acetate on ocular surface and pain control following laser subepithelial keratomileusis (LASEK).

PURPOSE: To compare the effect of topical 0.1% indomethacin solution versus 0.1% fluorometholon acetate in the early postoperative period after LASEK treatment. METHODS: One hundred thirty-five patients undergoing LASEK, having been randomized in a double-masked manner into 2 groups (1 receiving indomethacin and 1 fluorometholon), were evaluated 2-4 days before and 4 days after treatment. We examined corneal fluorescein staining and corneal esthesiometry; the level of pain experienced was reported by the patient on a visual pain scale. In addition, haze was evaluated at 14 +/- 1 weeks after surgery. RESULTS: The pain level and corneal fluorescein staining were significantly less in the indomethacin group. Corneal esthesiometry was reduced to the same extent in the 2 groups. There were no statistically significant differences in haze presentation between the 2 groups. CONCLUSION: Our study highlights the efficacy of indomethacin solution compared with fluorometholon as a pain reducer after LASEK treatment and suggests that indomethacin is associated with a faster epithelial healing process.

Optic disc imaging in perimetrically normal eyes of glaucoma patients with unilateral field loss.

PURPOSE: To compare the ability of optic disc and retinal nerve fiber layer (RNFL) imaging to discriminate perimetrically unaffected eyes of glaucoma patients from normal eyes. METHODS: Forty-six primary open-angle glaucoma patients with glaucomatous visual field loss with achromatic perimetry in one eye and a normal visual field in the fellow eye and 46 normal controls were selected. Receiver operator characteristic (ROC) curves and sensitivities at fixed specificities were used to compare the performance of StratusOCT (Fast RNFL algorithm), GDx-VCC, HRT II, and clinical evaluation of optic disc photographs to distinguish perimetrically unaffected eyes of glaucoma patients from normal eyes. RESULTS: The parameters with the largest area under the ROC curves (AUC) were as follows: inferior average RNFL thickness (0.92 +/- 0.03) for StratusOCT; linear cup-to-disc ratio (0.82 +/- 0.05) for HRT II; and nerve fiber layer index (0.69 +/- 0.06) for GDx-VCC. Clinical evaluation of stereoscopic disc photographs resulted in AUCs ranging between 0.80 and 0.85. The P values for pairwise comparisons of the AUCs of OCT's best parameter with those of HRT, GDx, and disc photographs were .06, < .001, and .17, respectively. The sensitivities at 95% specificity for the best parameters from StratusOCT (inferior average), HRT II (cup volume), GDx-VCC (temporal-superior-nasal-inferior-temporal average), and clinical evaluation of disc photographs were 61%, 39%, 37%, and 28%, respectively. OCT identified more perimetrically normal glaucomatous eyes as having abnormalities, compared to normals, than did HRT (P = .001), GDx (P = .001), or clinical evaluation of disc photographs (P < .001). CONCLUSION: Optical coherence tomography (StratusOCT) may detect evidence of glaucomatous damage earlier than other imaging techniques and clinical evaluation of optic disc photographs in perimetrically unaffected eyes of primary open-angle glaucoma patients.