Eye Clinic Research Articles

Clinical outcome of organ‐cultured preloaded DMEK compared to standard DMEK ‐ A single center study

The use of ready‐to‐use grafts from specialized eye banks might provide a number of benefits, including graft quality control, assured availability at a certain operation time, a decreased likelihood of case cancellation, and a shorter and less sophisticated DMEK surgery, with a resulting lower risk of graft damage. However, it is critical to thoroughly establish the clinical safety of employing these preloaded tissues. Especially since most of the studies were prepared and stored under hypothermic conditions. There are only a few studies on preprepared tissues in organ culture, which are partly controversial.In this prospective study we included patients who received DMEK surgery at the Knappschaft Eye Clinic Sulzbach between 05/2021–12/2022. Patients received either a preloaded DMEK (pDMEK), prepared 5 days before surgery in the eye bank, or a conventional, directly before surgery, surgeon‐prepared DMEK (sDMEK).The preliminary data shows that preloaded DMEK is a safe procedure, but there is a trend towards more frequent rebubbling in the pDMEK group and a statistically non‐significant lower postoperative endothelial cell count compared to the sDMEK group. However, visual acuity and corneal thickness reduction were similar in both groups.

ZEISS VISULAS green SLT in primary open‐angle glaucoma and ocular hypertension: 6 month follow up in a real‐world setting

Aims/Purpose: The aim of this study is to report preliminary data of efficacy and safety of ZEISS VISULAS® green Selective Laser Trabeculoplasty (SLT) in primary open‐angle glaucoma (POAG) and ocular hypertension (OHT) in a real‐life clinical setting.Methods: We prospectively collected data of 34 treated eyes in 17 patients during 2022. Patients followed a regular clinical management in our center (San Giuseppe Hospital, University Eye Clinic, IRCCS Multimedica, Milan, Italy). Follow up was of 6 months. Inclusion criteria were adult patients, diagnosis of POAG or OHT. Exclusion criteria were previous laser trabeculoplasty (LT), filtration surgery, and cyclophotocoagulation procedures. Main outcome was ≥20% intraocular pressure (IOP) reduction at 6 months. All the procedures were performed by two doctors (CB, DT). Adverse events were recorded.Results: We included 34 eyes of 17 patients. Mean age was 67.4 ± 11.5 years. Patients were 88.2% Caucasian, 47.1% females, with a diagnosis of OHT (64.7%), mild POAG (29.4%), or moderate POAG (5.9%). The mean IOP was significantly decreased from baseline to 6 months (21.5 ± 2.1 vs 18.0 ± 2.6 mmHg, p < 0.05). Primary outcome (≥ 20% IOP reduction at 6 months) was reached in 52.9% cases. There was no significant increase in glaucoma medical therapy at 6 months (1.1 ± 1.0 vs 1.4 ± 1.0 medication per eye, p = 0.23). No patient received a second SLT treatment or underwent filtration surgery or cyclophotocoagulation procedures during the follow‐up. No major ocular or systemic side effects were found. The most common adverse event was ocular discomfort in 10 cases (29.4%), always mild and transient. SLT treatment was performed with an average of 100.2 ± 6.7 spots, 27.4 ± 4.7 μJ energy, and a 360° distribution for 32 of 34 eyes (2 eyes treated at 270°).Conclusions: We reported the preliminary short‐term data of efficacy and safety of ZEISS VISULAS® green SLT treatment in POAG and OHT. To the best of our knowledge, this is the first report of ZEISS VISULAS® green SLT in a real‐life clinical setting. This technology has been shown to be effective and safe in lowering IOP at 6 months after the treatment. Limits of this study were the small sample size and the short follow‐up time.

Associations between dry eye disease and sleep quality: a cross-sectional analysis

Background/aimsTo investigate relationships between dry eye (DE) disease and sleep quality, with a focus on which aspects of sleep most closely relate to DE.Methods141 veterans (mean age: 56±5) seen at...

Management of severe delirium with dexmedetomidine in a palliative care patient—a case report

Dexmedetomidine is used as an adjunct to anaesthesia or as a stand-alone agent for conscious sedation. It is a potent α2-adrenergic receptor agonist, with a fast onset of action and peak effects in 30 minutes to 1 hour after application, depending on the route of administration. It is metabolized in the liver and excreted in urine as a glucuronide. It potentiates analgesia and is effective in opioid sparing. Clinical trials show its efficacy in the treatment of Intensive Care Unit (ICU) delirium with an effect comparable to antipsychotics and benzodiazepines. It has also been used at the Eye Clinic of the University Medical Centre Ljubljana to sedate patients undergoing intraocular surgery. It proved to be an excellent alternative to other sedatives and analgesics, such as midazolam and remifentanil. The aim of this paper is to review the pharmacokinetics and pharmacodynamics of dexmedetomidine and to investigate its potential use in the palliative care population, particularly in the management of delirium. This area of application is still largely unexplored and opens up a new field of application. At the Institute of Oncology (IO) Ljubljana, we have used it with success in several palliative patients with delirium, when all other modalities were failing. At the IO Ljubljana, anaesthesiologists are involved in the palliative management of patients, especially in pain management, but also in sedation and delirium treatment. Given its favourable pharmacokinetic and pharmacodynamic effects, dexmedetomidine could be used more frequently and perhaps alternative and less complex routes of administration, such as intranasal administration, could be explored. In this paper, we present a case of a palliative care patient in whom dexmedetomidine was used successfully.

The outstanding Russian ophthalmologist Alexey Nikolaevich Maklakov

The conducted archival research and analysis of literary publications allowed us to supplement the biography and creative path in science, clinical and social activities of the outstanding Russian ophthalmologist A.N. Maklakov. This article emphasizes the urgency of the problem of teaching in medical universities, and gives special attention to the thoughts of the scientist about providing clarity in the process of teaching students. The article notes his role in the arrangement and equipment of the new eye clinic of the Moscow University, and presents fragments of memoirs of his student and mentee, another famous Russian ophthalmologist S.S. Golovin. A remark is made about the need to clarify the terms traditionally accepted in the history of medicine in relation to surgery and ophthalmology. An assessment is given on the contribution of A.N. Maklakov to the establishment of the Moscow Ophthalmological Circle, his efforts to unite doctors, and the development of the statutory documents of the All-Russian Society of Eye Doctors.

Research on Nourishing Yin Moisturizing Eye and Eyes Tea in the Treatment of Liver and Kidney Yin Deficiency and Dry Eye Clinical

Research on Nourishing Yin Moisturizing Eye and Eyes Tea in the Treatment of Liver and Kidney Yin Deficiency and Dry Eye Clinical

Knowledge of refractive errors and barriers to spectacle lens utilisation among patients attending selected eye clinics in tertiary hospitals in Bauchi State, Nigeria

Knowledge of refractive errors and barriers to spectacle lens utilisation among patients attending selected eye clinics in tertiary hospitals in Bauchi State, Nigeria

Ramón Castroviejo (1904–1987): The father of the modern corneal transplantation

Ramón Castroviejo Briones was born in 1904 in Logroño, Spain. He received his medical education at the University of Madrid, where he graduated in 1927. In 1929, he received a fellowship to work as assistant in the Ear, Nose, and Throat Hospital and College of Chicago. In 1930, he passed his American Board Examination and returned to Europe to visit the centers where keratoplasty was a fact. He visited the University eye clinics of Madrid, Paris, Vienna, Berlin, and Prague. When he returned to the United States, Castroviejo had a clear idea of what was being done in Europe and what he hoped to achieve. William L. Benedict had offered him a research fellowship at the Mayo Clinic, in Rochester, Minnesota, which Castroviejo accepted. In 1932, Dr. Maynard C. Wheeler granted Castroviejo a Research Fellowship at the new Eye Institute of the College of Physicians and Surgeons of Columbia University. He moved to New York, where he continued his research in animals in the Eye Institute of the Columbia Presbyterian Medical Center, and was an early developer of techniques for transplanting corneal tissue from the eyes of those who had just died to damaged eyes of the living. While not being the first to successfully graft human cornea, he improved the technique of the operation in the 1930s and 1940s, prompting the worldwide adoption of corneal transplantation as a standard way to deal with severe corneal pathology. His keratoplasty technique, creating a rectangular rather than circular “window” in the cornea, was the secret to his successful transplants, and remained standard until more efficient suture materials became available. The surgeon described this technique in 1937 to the American College of Surgeons. He contended that rectangular windows gave better results than the circular ones that had been tried earlier, since their edges could be fitted better to merge with and become a living part of the rest of the eye. Although the medical community was slow to recognize his successes, Castroviejo was eventually lauded for his sight‐saving corneal tissue transplant techniques, which he continued to refine and teach for many years. Castroviejo also promoted the donation of corneal tissue in the United States and designed numerous ophthalmic instruments, including the Castroviejo needle holder ‐an instrument used in eye, dental and other forms of microsurgery‐ Castroviejo callipers and corneal scissors. He became the director of Ophthalmology at St. Vincent's Hospital before he opened his own hospital when he bought the Hammond House in New York. After closing his private hospital he retired as clinical professor of the University of New York and moved permanently to Madrid, where he founded the Instituto Castroviejo, at the Complutense University of Madrid, and organized the Spanish Eye Bank, maintaining extensive clinical activity whenever his health permitted. Ramón Castroviejo died in 1987, at the age of 82, and is widely recognized as one of the 10 most influential people in ophthalmology of the 20th century.

Intraocular lens power calculation formulas: a scientometric analysis.

The most accurate method of intraocular lens (IOL) power calculation in cataract surgery has not been determined, and further studies are needed to reach a consensus. The aim of this study was to assess publications related to IOL power calculation formulas, mapping their yearly trends, most productive authors, top publishing countries and institutions, and areas of specialization for IOL power formulas. We conducted a comprehensive analysis of research articles published on the topic of IOL power calculation formulas. Using PubMed, we employed appropriate search terms and filtered the results for the period of January 1, 1946, to June 28, 2023. Data were analyzed using CiteSpace, VOSviewer, and Microsoft Excel programs. The visual representations of the collected data through the use of figures was provided to demonstrate the aspects of IOL power calculation research. We retrieved 5475 documents in the initial search. Analysis of these documents revealed an increase in the number of publications, from one publication in 1946 to 201 publications in 2023. The top three countries contributing to these publications were the United States, China, and Japan, collectively accounting for over 27% of the total articles. However, the two institutions with the highest contributions were located in the United Kingdom and Hungary, neither of which was among the top 10 countries in overall contributions. Overall 15 326 authors contributed to publications pertaining to IOL power calculation formulas. Among these authors, the most prolific contributors included Achim Langenbucher from Saarland University (Germany), Giacomo Savini from G.B. Bietti Foundation I.R.C.C.S. (Italy), and Kenneth J Hoffer from the University of California (United States). Saarland University emerged as the most productive institution, contributing equally to two distinct departments: the Dr. Rolf M. Schwiete Center for Limbal Stem Cell Research and Congenital Aniridia, as well as the Department of Experimental Ophthalmology. The School of Physical Science at the Open University in the United Kingdom engaged in partnership with various institutions including Eye & Laser Clinic Castrop Rauxel in Germany and Johannes Kepler University Linz in Austria. Among the top 10 keywords found in the publications were "cataract", "cataract surgery", and "intraocular lens". This study represents the first scientometric analysis of publications related to IOL power calculation formulas. The study offers valuable insights into the geographic distribution, contributing authors, and emphasis of research on the IOL power calculation formulas. Further cooperation is essential to pinpoint the most suitable formula and to address gaps in our current understanding.

Clinical manifestation and long-term follow-up of presumed ocular tuberculosis in China

BackgroundThis study aimed to report the clinical manifestations of presumed ocular tuberculosis (OTB) and the treatment response after anti-tuberculosis therapy (ATT) in a Chinese population. MethodsClinical data, including general characteristics, ocular lesions, visual acuity at baseline, and final follow-up of patients with presumed OTB from 2006 to 2022 in two eye clinics in China, were retrospectively analyzed. ResultsThe study included 84 eyes of 52 patients. The following ocular manifestations were observed: anterior uveitis (4.8%), posterior uveitis (34.5%), panuveitis (11.9%), retinal vasculitis (40.5%) and optic neuropathy (8.3%). After ATT, the vision improved by varying degrees in 48 eyes (57.1%), remained stable in 34 eyes (40.5%) and decreased in 2 eyes (2.4%). ConclusionsOTB is likely to be misdiagnosed as other infectious uveitis and optic neuropathy. Clinical features must be interpreted in conjunction with topical and general laboratory findings and in collaboration with other subspecialties to make a final diagnosis.

Korelasi Disparitas Tenaga Kesehatan Puskesmas Terhadap Pelayanan Kesehatan Primer Peserta Jaminan Kesehatan Nasional Kabupaten Poso

Poso Regency is one of the regions that has achieved universal health coverage. However, based on the data from BPJS Kesehatan in 2022, the percentage of participants referred with non-specialistic diagnoses from Primary Health Care Facilities (FKTP) is still significant. This is related to the role of FKTP as a gatekeeper in primary care services. This research aims to describe the performance of Puskesmas as gatekeepers in controlling referrals by linking the availability of healthcare personnel to referral rates. This research is a quantitative approach with secondary data sourced from BPJS Kesehatan. It was found that the p-value for the ratio of doctor is very borderline (0.05) concerning the number of referrals. Additionally, there were 586 referrals with specialized diagnoses that were eventually coded as non-specialistic diagnoses in hospitals, with 210 of them coded as H.521, which should have been managed at the Puskesmas. It is recommended that the central government consider the distribution of healthcare personnel from outside the region through temporary work agreements. Furthermore, based on the significant number of non-specialistic referrals, particular attention should be given to referrals to the eye clinic (Poli mata), which may be indicative of eyeglass services. Therefore, it is advisable to consider policy changes so that participants seeking eyeglasses can undergo examinations at the community health centers according to the standard competency of doctors, supplemented by supporting training to ensure certified practitioners conduct the examinations.

A case series study: Corneal lesions and subsequent needs for Corneal Grafting

Background: Corneal lesions handicap all age groups and corneal grafts, provided by do-nors, treat most of the isolated corneal lesions that has wide diverse etiologies. Methods and patients: This study analyzed corneal lesion etiologies and determined the percentage of candidates that required corneal grafts. This study was conducted in Al-Thawra Modern General hospital (ATGMH) in 2004. We enrolled all new patients with cor-neal lesions attending the clinic during the study period. The corneal lesions were either isolated or combined with other eye lesions. We determined the demography, etiology, and visual acuity by Snellen's E- chart, slit lamp, ultrasound, and accordingly documented the plan of treatment. Those that had trauma and/or inflammation were treated with followed up for two months to plan their potential need for corneal graft. Results: From 1440 ophthalmic patients visiting the eye clinic in 2004, the incidence rates of eyes affected by corneal lesions were 9.41% (N=135). Among the causes requiring primary and secondary level intervention were trauma (61) 4.236% and inflammation (18) 1.25%. Among the treated suffers, 15% obtained visual acuity 6/36 and better. Tertiary intervention by corneal graft was required among degenerative lesions (9) 0.625%, keratoconus (12) 0.833%, edema (12) 0.833%, dryness (7) 0.278%, dystrophy (6) 0.416%. Meanwhile, the fourth level required cosmetic treatment and rehabilitation. The lesions were bilateral in (27) 20%, congenital in (6) 0.416% and tumors found in (2) 0.138%. Conclusion: The incidence of corneal lesions was high (9.4%) among our patients, 63.94% were due to preventable trauma and inflammation and 69% were candidates for corneal graft.

Pseudoexfoliative Syndrome in Cataract Surgery-A Quality Register Study and Health Economic Analysis in the Split-Dalmatia County, Croatia.

To investigate the impact of pseudoexfoliation (PEX) syndrome on intraoperative phacoemulsification (PHACO) parameters and assess the economic cost of PHACO surgery for cataracts in patients with and without PEX syndrome. This was a retrospective quality register study on 5889 patients (6236 eyes) who underwent PHACO cataract surgery in the Eye Clinic, Clinical Hospital Centre Split, Croatia, over a 7-year period (May 2015 to December 2022), in accordance with the Guidelines of the Helsinki Declaration and approval from the Research Ethics Committee of the University Hospital Centre Split, Croatia. Inclusion criteria were patients with either presenile or senile cataract or cataract related to PEX syndrome who undertook PHACO procedure by the same experienced surgeon using the same PHACO device (Infiniti Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA). Eyes were categorized according to PEX presence- (PEX group) or absence (Group without PEX). The following recorded data about intraoperative PHACO parameters were collected: Cumulative Dissipated Energy (CDE), Ultrasound total time, PHACO time, torsional time, aspiration time, estimated fluid used, and duration of the surgical procedure. In the economic analysis, all PHACO parameters were considered, with a specific focus on the duration of the surgical procedure, costs associated with additional medical materials and devices, complications during surgery, and surgery procedure Diagnosis-Related Group (DRG) codes. A total of 4535 cases were eligible for inclusion in the study, 278 (6.13%) were diagnosed with PEX and 4257 (93.87%) had no PEX. Significantly higher PHACO parameters were observed in the PEX group. Similarly, a statistically significant increase in the values of all PHACO parameters was observed with the increase in nuclear lens density. Intraoperative complications were more frequent in the PEX group. Zonular weakness requiring the use of a capsular tension ring (CTR) and posterior capsular rupture occurred 30 and 13 times more often, respectively, in the PEX group. The expected cost of the PHACO procedure was found to be 1.4 times higher in patients with PEX, compared to those without PEX, for all types of nuclear cataract. All PHACO parameters are significantly higher in patients with PEX. The costs associated with PHACO surgery for cataracts are greater for patients with PEX and are not covered by the present DRG codes, which highlights the need to accordingly adjust the DRGs for PHACO procedures in PEX patients, in order to maintain the quality of healthcare provided for these vulnerable patients.

Selective Laser Trabeculoplasty – The First-line Treatment For Open-Aangle Glaucoma?!

The purpose of this nonrandomized study conducted at the Eye Clinic "Akhali Mzera" between October 2011 and November 2022 was to evaluate the intraocular pressure (IOP) reduction and side effects following selective laser trabeculoplasty (SLT). A total of 867 eyes of 558 patients with early to moderate primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PXG) phakic and pseudophakic were included in the study. The patients were treated with laser as primary therapy or adjunct laser with medication. The mean age of the study participants was 54.3 ± 5.2 years (range, 40 to 78 years) and 362 (64.9%) were males. The glaucoma diagnosis was POAG in 726 (83.7%) eyes and PXG in 141 (16.3%) eyes. Diabetes mellitus in 8% and systemic hypertension in 30% were noted. 736 eyes (84.9%) were on medications, and 130 (14.9%) eyes were treated with laser as primary therapy. Overall, the mean IOP after SLT was 17.8 ± 3.2mmHg, 18.8 ± 2.3 mmHg, and 23.4 ± 2.5 mmHg in the 12th month, 24th month, and 36th month respectively. About 20% of patients with POAG lost efficacy in 18 months post-treatment and in these eyes, the second SLT procedure was more effective than the first one. The number of drugs reduced from an average of 1.3 to an average of 1.0 was statistically significant with the inter-eye correlation. Those patients who were treated with laser as primary therapy with a baseline IOP of 25.4 mmHg ±2.9 mmHg had IOP reduction of 7.5 ± 3.1 mmHg at the last visit, and those who were on antiglaucoma medication with baseline IOP 23.9 ± 2.2 mmHg had IOP reduction of 4.8 ± 2.8 mmHg. IOP reduction at the last visit between POAG, and PXG was 6.5 mmHg and 7.9 mmHg, respectively. It was concluded that SLT is a safe and innovative technology that uses lasers to target only certain cells of the trabecular meshwork of the eye.

SDE

Early screening for dry eye disease (DED) is crucial to identify and provide timely intervention to high-risk susceptible populations. Currently, clinical methods for diagnosing DED include the tear break-up time test, meibomian gland analysis, tear osmolarity test, and tear river height test, which require in-hospital detection. Unfortunately, there is no convenient way to screen for DED yet. In this paper, we propose SDE, a contactless, convenient, and ubiquitous DED screening system based on RF signals. To extract biomarkers for early screening of DED from RF signals, we construct frame chirps variance and extract fine-grained spontaneous blinking action. SDE is carefully designed to remove interference in RF signals and refine the characterization of biomarkers that denote the symptoms of DED. To endow SDE with the ability to adapt to new users, we develop a deep learning-based model of unsupervised domain adaptation to remove the influence of different users and environments in local and global two-level feature spaces. We conduct extensive experiments to evaluate SDE with 54 volunteers in 4 scenes. The experimental results confirm that SDE can accurately screen for DED in a new user in real environments such as eye examination rooms, clinics, offices, and homes.

Review of the Disparities in Access to Pediatric Eye Care Among Low Socioeconomic Status and Underrepresented Racial Minority Groups Exacerbated by the Economic Downturn in Pediatric Ophthalmology.

To explore the association between race and socioeconomic status on health disparities in pediatric eye care, characterize the status of diversity within the pediatric ophthalmology workforce, and propose potential solutions to improve access to vision care, particularly for children from vulnerable populations. The major studies examining the socioeconomic and racial disparities in visual outcomes and the impact of diversity in the ophthalmology workforce were reviewed. Currently, the pediatric ophthalmology workforce has limited racial diversity, and increasing the number of underrepresented in medicine providers has potential to improve access to pediatric eye care, particularly for underserved populations. Mobile eye clinics, school-based vision programs, and health literacy initiatives may engage communities to bring eye care directly to children and enhance follow-up. Families with lower socioeconomic status may represent a vulnerable population facing significant access to pediatric eye care barriers, particularly for asymptomatic pediatric eye conditions. Emphasis on strategies that directly engage communities and bring free vision care to families should be given to improve disparities in visual health outcomes. Ophthalmologists and pediatric ophthalmologists should be aware of the current racial underrepresentation within the pediatric ophthalmology workforce, and the importance of workforce diversity in accelerating physician-patient concordance and access to eye care. [J Pediatr Ophthalmol Strabismus. 2024;61(3):172-178.].

Epidemiology of eye diseases: outcomes from a free provincial eye clinic in Papua New Guinea.

To ascertain the prevalence and pattern of eye problems in Madang Province, Papua New Guinea. A six-month retrospective study was performed at Madang Provincial Hospital Eye Clinic. Convenience sampling was used in this study and all patient records from January to June 2020 were included. Data was extracted using Microsoft Excel and the data included gender, age, occupation, district where the patient lived, presenting visual acuity, and diagnosis. It was then analyzed using International Business Machines Corporation's Statistical Package for the Social Sciences version 26. A p-value of ≤0.05 was considered statistically significant. A total of 1,715 patients received services at the eye clinic between January and June 2020, and 1,664 were included in this study. The mean age of the patients was 39.3 ± 20.3 years. There were slightly more males (50.4%) than females. The overall leading ocular morbidities were corneal ulcers and keratitis (20.7%), refractive errors (17.4%), and cataracts (16.8%). More than half of the patients (56.2%) were either visually impaired or blind. Nearly half of the patients (41.8%) traveled long distances to seek services at the eye clinic. There was a significant association between demographic characteristics, diagnosis, and level of visual impairment. There is a high prevalence of potential causes of visual impairment and blindness in Madang Province and these conditions affect all age groups and genders. It is essential to increase accessibility to eye care services in the country.

Quantification and Predictors of Visual Field Variability in Healthy, Glaucoma Suspect, and Glaucomatous Eyes Using SITA-Faster

PurposeThe newly released SITA-Faster (SFR) has significantly shorter testing durations compared to older SITA algorithms, but its variability is uncertain. This study quantifies and establishes threshold limits of intra-subject test-retest variability among normal subjects, glaucoma suspects and manifest glaucoma patients across the 24-2 test grid using SFR. DesignCross-sectional study with prospective longitudinal arm Subjects1426 eyes of 787 patients with normal, suspect, or manifest glaucoma from hospital-based and university-based eye clinics. MethodsTwo SFR tests (T1, T2) per eye at a baseline visit and at two follow up visits. Main outcome measuresPointwise variability measured by test-retest difference in pointwise sensitivity between test 1 and test 2, mean global variability (test-retest variance) measured by average of pointwise variability for each subject, global sensitivity, and reliability indices of each eye. ResultsOf the 1426 eyes, 540 (37.9%) had a diagnosis of glaucoma, 753 (52.8%) were glaucoma suspects and the remaining 133 eyes (9.3%) were healthy. Of 74,152 pointwise sensitivities obtained, the mean test-retest difference was 2.17 ± 2.9 dB while the mean test-retest variance for each subject was 2.17 ± 1.2 dB. Pointwise and global variability increased with worsening threshold sensitivity and MD respectively and was greater for peripheral compared to central test locations. In the longitudinal cohort, there was no significant difference in mean test-retest variance across the three visits (mean variability 2.10 vs 2.16 vs 2.16 dB at visits F0 vs F1 vs F2, repeated measures ANOVA, p = 0.53). Baseline MD (-0.19dB; 95% CI -0.22—0.16; p < 0.0001) and abnormally high sensitivity on glaucoma hemifield test (1.14dB; 95% CI 0.78-1.51; p < 0.0001) were significantly associated with increased variability. Finally, test-retest MD showed minimal change around the recommended 15% false positive cut off threshold. ConclusionThe variability of SFR increases with worsening threshold sensitivity, is stable over time and is greater for peripheral compared to central test locations. Worse baseline MD and abnormally high sensitivity are significant predictors of increased variability. A cut-off value of 15% in false positives may be inappropriate as a threshold for judging test reliability in SFR.

Subclinical hypothyroidism and anti-thyroid peroxidase antibodies in primary open-angle glaucoma: A case-control study.

To evaluate the association among subclinical hypothyroidism, anti-thyroid peroxidase (anti-TPO) antibody, and primary open-angle glaucoma (POAG). Case-control study. The cases consisted of patients with POAG and controls were age- and sex-matched patients from the general eye clinic with no history of glaucoma. Blood samples were taken from the participants' antecubital veins and sent for measurement of thyroid stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), and anti-thyroid peroxidase (anti-TPO) antibody. Data was analyzed using the Mann-Whitney U test and the Chi-square test. Odds ratio with 95% confidence interval (CI) was calculated. A two-tailed P value less than 0.05 was considered for statistical significance. There were a total of 63 cases and 63 controls. Subclinical hypothyroidism was present in 20.6% of patients in the glaucoma group and 4.8% of patients in the control group ( P < 0.01). The odds of subclinical hypothyroidism in patients with POAG compared to controls was 5.2 (95% CI 1.7-22). Anti-TPO antibody positivity was higher in the glaucoma group (22.2%) than in the control group (14.3%), but this did not reach statistical significance ( P = 0.25). This study suggests an association between POAG and subclinical hypothyroidism. Further research is needed to establish the cause-and-effect relationship between these two conditions.

FL-41 Tint Reduces Activation of Neural Pathways of Photophobia in Patients with Chronic Ocular Pain

To assess the therapeutic effect of tinted lenses (FL-41) on photophobia and light-evoked brain activity using functional magnetic resonance imaging (fMRI) in individuals with chronic ocular surface pain. Prospective case series. 25 subjects from the Miami veterans affairs (VA) eye clinic were recruited based on the presence of chronic ocular pain, dry eye symptoms, and photophobia. Using a 3T MRI scanner, subjects underwent 2 fMRI scans using an event-related design based on light stimuli: one scan while wearing FL-41 lenses and one without. Unpleasantness ratings evoked by the light stimuli were collected after each scan. With FL-41 lenses, subjects reported decreased (n = 19), maintained (n = 2), or increased (n = 4) light-evoked unpleasantness ratings. Group analysis at baseline (no lens) revealed significant light evoked responses in bilateral primary somatosensory (S1), bilateral secondary somatosensory (S2), bilateral insula, bilateral frontal pole, visual, precuneus, paracingulate, and anterior cingulate cortices (ACC) as well as cerebellar vermis, bilateral cerebellar hemispheric lobule VI, and bilateral cerebellar crus I and II. With FL-41 lenses, light-evoked responses were significantly decreased in bilateral S1, bilateral S2, bilateral insular, right temporal pole, precuneus, ACC, and paracingulate cortices as well as bilateral cerebellar hemispheric lobule VI. FL-41 lenses modulated photophobia symptoms in some individuals with chronic ocular pain. In conjunction, FL-41 lenses decreased activation in cortical areas involved in processing affective and sensory-discriminative dimensions of pain. Further research into these relationships will advance the ability to provide precision therapy for individuals with ocular pain.