Incidence Of Visual Loss Research Articles

An out-of-season cold: filler-induced vascular occlusion of the columellar artery causing necrosis of the cartilaginous anterior nasal septum case report and a literature review

In their recent publication, George Kroumpouzos et al. provided a comprehensive update on the complications caused by filler procedures in the lips and perioral area. These injections have been associated with various arterial accidents and an incidence of vision loss mainly when such procedures are performed at the level of the central facial massif. Among the various cases of vascular involvement reported in the literature, we have found what we believe to be a rare occurrence of columellar artery occlusion with a noteworthy discrepancy between the expected symptoms and the actual described vascular effects. The necrosis of the columellar artery following hyaluronic acid injections showed some peculiarities: its frequency is unknown, and recognition can be troublesome due to the presentation of subtle symptoms. We want to exemplify these characteristics in this case, which, fortunately, optimally resolved itself, underscoring its unique nature.

The Royal College of Ophthalmologists' National Ophthalmology Database Study of Cataract Surgery: Report 12, Risk factors for suprachoroidal haemorrhage during cataract surgery.

To establish the incidence of acute intraoperative suprachoroidal haemorrhage (AISH) during cataract surgery and identify the risk factors for this complication. Data from the Royal College of Ophthalmologists' National Ophthalmology Database was analysed. During the 11-year study period, from 01/04/2010 to 31/03/2021, 709 083 operations performed on 498 170 patients from 65 centres were eligible for inclusion. AISH occurred in 0.03% (204/709 083, approximately 1 in 3 500) of eligible cataract operations performed during the study period. Posterior capsule rupture was the risk factor most strongly associated with AISH (OR: 17.6, 95% CI: 12.4-24.9, p < 0.001). Other ocular risk factors identified were raised intraocular pressure (IOP) preoperatively (OR: 3.7, 95% CI: 2.5-5.5, p < 0.001), glaucoma (OR: 1.7, 95% CI: 1.2-2.4, p = 0.004). Risk increased with age and patients aged over 90 years were at greatest risk (OR: 6.7, 95% CI: 3.5-12.8, p < 0.001). The addition of intracameral anaesthetic when performing surgery under topical anaesthetic appears to be protective (OR: 0.5, 95% CI: 0.3-0.8, p = 0.003), compared to topical anaesthetic alone. There was a 16-fold increase in the incidence of vision loss when AISH occurred. The risk of AISH during modern cataract surgery is approximately 1 in 3 500 and is associated with a significant increase in the risk of vision loss should it occur. Posterior capsule rupture is the risk factor most strongly associated with AISH. Preoperative IOP control is a modifiable risk factor. The use of intracameral anaesthesia may reduce the risk of AISH.

Was gibt es Neues in der AMD-Landschaft?

As society ages, the importance of age-related eye diseases such as age-related macular degeneration (AMD) increases. The intravitreal treatment of neovascular AMD (nAMD), which accounts for about 10% of all AMD cases, revolutionized the world of ophthalmology about 15 years ago. This form of therapy, which can be used to treat - in addition to nAMD - other vascular retinal diseases, has led to a significant reduction in the incidence of vision loss and blindness caused by AMD and diabetes worldwide. Current developments in ophthalmology may shape the future of AMD treatment and include advancements in home-monitoring technologies like simpler, more cost-effective optical coherence tomography (OCT) devices, application of artificial intelligence for more detailed OCT, development and approval of novel therapeutics with longer-lasting effects on the eye or new mechanisms of action as well as new application systems using nanotechnological “Sustained-Delivery Systems” or suprachoroidal treatment with viral vectors for gene therapy. Overall, these exciting ongoing developments will change the treatment landscape in AMD and pave the way to increased quality of life for our elderly patients. Moreover, home monitoring technologies will ease the burden on our healthcare systems. At the same time, novel therapeutic options that require intravitreal surgical interventions may increase it.

Incidence, causes and risk factors of vision loss in rural Southern China: 6-year follow-up of the Yangxi Eye Study

PurposeTo report the 6-year incidence, causes and risk factors for vision loss (visual impairment (VI) and blindness), among elderly adults in rural southern China.MethodsPopulation-based, cohort study. Initiated in 2014, the...

Timing of antiretroviral therapy for HIV-infected patients with cytomegalovirus retinitis: study protocol of a multi-center prospective randomized controlled trial

BackgroundCytomegalovirus retinitis (CMVR) is an important opportunistic infection (OI) occurring mainly in patients with acquired immunodeficiency syndrome (AIDS) and has the potential to cause severe visual impairment and blindness among AIDS patients. Subsequent to the adoption and implementation of widespread antiretroviral therapy (ART), the prognosis of AIDS-associated CMVR has been substantially improved. Nevertheless, the equivocal clinical evidence as regards the optimal timing for ART initiation in patients with an established CMVR diagnosis is required. We therefore designed the present study in order to investigate the optimal timing for ART initiation in AIDS/CMVR patients.MethodsThis will be a prospective, randomized controlled trial to be performed at 17 hospitals in mainland China. A total of 300 participants with CMVR will be randomly assigned to an early ART initiation group (ART initiation within 2 weeks after anti-CMV therapy), or a deferred ART initiation group (initiation of ART more than 2 weeks after anti-CMV therapy) at a 1:1 ratio. All participants will receive 48 weeks of follow-up after anti-CMV therapy initiation. Our primary outcome will be the incidence of visual loss (to a visual acuity worse than 20/40 or 20/200) in the two groups during the 48-week follow-up period. Secondary outcomes will include changes in HIV virological suppression and serum CD4+ T-cell counts, the incidence of mortality, retinitis progression (movement of the peripheral border of a CMV lesion ≥ ½ disc diameter, or occurrence of a new CMV lesion), retinal detachment, immune recovery uveitis (IRU), and other OIs and adverse events between the two study groups during the 48 weeks of follow-up.DiscussionThe study aims to investigate the optimal timing for ART initiation in AIDS/CMVR patients. We hope to be able to extract robust clinical evidence for use in optimal AIDS/CMVR management should our trial be successful.Trial registrationThis research was registered as one of the twelve clinical trials under the name of a general project “A study for precision diagnosing and treatment strategies in difficult-to-treat AIDS cases and HIV-infected patients with highly fatal or highly disabling opportunistic infections”, ChiCTR1900021195. Registered on 1 February 2019, http://www.chictr.org.cn/showproj.aspx?proj=35362.

P188 Tocilizumab for giant cell arteritis: real world experience in a single UK centre

Abstract Background Tocilizumab was approved for the treatment of giant cell arteritis (GCA) by NICE in April 2018. This decision followed the GiACTA (Giant Cell Arteritis Actemra) study, a randomised control trial that demonstrated a beneficial effect of tocilizumab in reducing the frequency of disease flare and overall prednisolone requirements. However, as noted in the NICE appraisal, the extent to which the patient population in the GiACTA study reflects the population it is eventually used for in UK clinical practice is not clear. To address this, we analysed the records of all patients started on tocilizumab treatment for GCA in a single centre since its approval. Methods We performed a retrospective analysis of the clinical records of all patients started on tocilizumab for GCA at the Freeman Hospital in Newcastle. All patients are discussed in a regional connective tissue disease MDT prior to the initiation of therapy to ensure they fulfil NICE guidelines. At each subsequent visit adverse events related to both tocilizumab and corticosteroids and any flares of GCA or ischaemic events are recorded. Results In total 14 patients started tocilizumab since June 2018, with a cumulative exposure of 8 patient-years. The mean age was 74 years, slightly older than the average age in the GiACTA trial (69 years). In contrast to GiACTA where 48% of patients were newly diagnosed, all our patients had established disease. In our cohort 36% of patients had CT PET evidence of large vessel vasculitis, similar to the rate in GiACTA (40%) but higher than the national average of around 5%. Incidence of visual loss in our treated patients was higher at 29% than recorded in the general GCA population in the DC-VAS study (7.9%). In those treated for relapsing disease around half (56%) had recorded previous significant adverse events with steroids, including heart failure, hypertension and mood changes. Five patients had infections requiring antibiotics (cellulitis/ulcer in three, chest infection in one, urinary tract infections in two), with two serious infections requiring hospital admission (both urinary tract infections). No patients had further ischaemic events while on treatment. All patients were on a lower dose of prednisolone following treatment with an average of a 63% reduction in steroid dose. Conclusion The modest number of patients receiving tocilizumab for GCA suggests we are not treating everyone at first relapse. The higher rates of large vessel vasculitis, visual loss and previous steroid-induced complications suggest a preference for saving tocilizumab for a more severely affected subset of patients. In this preliminary data there were reassuringly no recorded ischaemic events following treatment and steroid doses were successfully reduced in all patients. Disclosures G. Reynolds None. B. Griffiths None. K. Houghton None. B. Thompson None. A.R. Lorenzi None. J. Heaney None.

Incidence and progression of diabetic retinopathy in Sub-Saharan Africa: A five year cohort study

AimsTo describe the incidence and progression of retinopathy in people with diabetes in Southern Malawi over 5 years. To document visual loss in a setting where laser treatment is not available.MethodsSubjects from a cohort sampled from a hospital-based, primary-care diabetes clinic in 2007 were traced in 2012. Laser treatment was not available. Modified Wisconsin grading of retinopathy was performed using slit lamp biomicroscopy by a single ophthalmologist in 2007 and using four-field mydriatic fundus photographs at an accredited reading centre in 2012. Visual acuity was measured by Snellen chart in 2007 and by ‘Early Treatment of Diabetic Retinopathy Study’ chart in 2012. HbA1c, blood pressure, HIV status, urine albumin–creatinine ratio, haemoglobin and lipids were measured.ResultsOf 281 subjects recruited in 2007, 135 (48%) were traced and assessed, 15 were confirmed dead. At follow-up (median 5.3 years) ≥2 step retinopathy progression was observed in 48 subjects (36.4%; 95% CI 28.2–44.6). Incidence of sight threatening diabetic retinopathy for those with level 10 (no retinopathy) and level 20 (background) retinopathy at baseline, was 19.4% (11.3–27.4) and 81.3% (62.1–100), respectively. In multivariate analysis 2 step progression was associated with HbA1c (OR 1.2495%CI 1.04–1.48), and haemoglobin level (0.77, 0.62–0.98). 25 subjects (18.8%) lost ≥5 letters, 7 (5.3%) lost ≥15 letters.ConclusionsProgression to sight threatening diabetic retinopathy from no retinopathy and background retinopathy was approximately 5 and 3 times that reported in recent European studies, respectively. Incidence of visual loss was high in a location where treatment was not available.

Acute Retinal Necrosis: Presenting Characteristics and Clinical Outcomes in a Cohort of Polymerase Chain Reaction–Positive Patients

To identify determinants of adverse outcomes in acute retinal necrosis (ARN), presenting characteristics and incidence rates of vision loss and ocular complications in a cohort of polymerase chain reaction (PCR)-positive eyes were analyzed. Retrospective observational cohort study. Forty-one eyes of 36 patients with clinically diagnosed ARN, PCR-positive for herpes simplex virus or varicella zoster virus and evaluated between January 2002 and June 2013, were included. Main outcome measures included incidence rates of vision loss and retinal detachment (RD). Presenting visual acuity was generally poor (20/50 to >20/200 in 27%; 20/200 or worse in 56%). The incidence rate of ≤20/200 was 0.66/eye-year (EY), (95% confidence interval [CI], 0.32/EY to 1.22/EY); the rate of light perception or no light perception vision was 0.07/EY (95% CI, 0.02/EY to 0.16/EY). During follow-up, 59% of eyes developed at least 1 RD (rate=0.40/EY, 95% CI, 0.19/EY to 0.58/EY). Eyes with retinitis involving ≥25% of the retina at presentation detached at nearly 12 times the rate, as compared to those with <25% retinal involvement (0.70/EY vs 0.06/EY; P= .001). Development of an RD was the greatest determinant of adverse visual outcomes, with 4% of eyes, that had experienced at least 1 RD, achieving a best-corrected visual acuity of ≥20/40 compared to 53% of eyes that never detached (P= .0003). Poor outcomes in ARN were common in this cohort. RD confers the greatest risk of incident vision loss, and once 25% or more of the retina is involvedthe risk of RD and visual loss increases significantly.

The incidence of unexplained visual loss following removal of silicone oil.

To assess the incidence and clinical features of unexpected visual loss after removal of silicone oil (ROSO). A retrospective cross-sectional observational study of 421 consecutive eyes, which underwent silicone oil removal at one institution over a 2-year period. Fourteen (3.3%) patients, (12 male, mean age of 53.1 years) suffered unexplained visual loss. In these eyes, the mean duration of silicone oil fill was 141 days (range 76-218). The mean loss of visual acuity was 3.7 (range 2-6) Snellen lines (SL) at 1 month, 3.5 (2-6) SL at 3 months and 2.91 (0-6) SL at 6 months. The change from preoperative visual acuity was statistically significant at all visits (P=0.02). Subgroup analysis of 20 fovea-sparing giant retinal tear (GRT) detachments, observed 10 (50%) cases of visual loss after ROSO. Electrodiagnostic testing suggested predominantly macular dysfunction, with optic nerve involvement in one case. Five of the 14 cases had variable recovery of vision. There is a 3.3% overall incidence of visual loss following ROSO with a high rate (50%) observed in maculae on GRT detachments. Although recovery of visual acuity is seen in a minority of cases, visual loss after ROSO remains a serious and unexplained concern for vitreoretinal surgeons.

The Impact of Lack of Government-Insured Routine Eye Examinations on the Incidence of Self-Reported Glaucoma, Cataracts, and Vision Loss

We determined the impact of lack of government insured routine eye examinations on the incidence of self-reported glaucoma, cataracts and vision loss. We analyzed data from the Canadian longitudinal National Population Health Survey (1994-2011). White respondents aged 65+ in 1994/1995 were included (n = 2618). Three cohorts were established at baseline: those free of glaucoma, cataracts, and vision loss (i.e., unable to see close or distance when wearing glasses or contact lenses). Incident cases were identified through self-reporting of these conditions during the follow-up period. The incidence (per 1000 person-years) of glaucoma was lower in uninsured provinces (8.1; 95% confidence interval [CI], 5.5-10.7) than in insured provinces (12.8; 95% CI, 10.5-15.1). The incidence of cataracts was also lower in the uninsured (67.2; 95% CI, 55.7-78.6) versus insured provinces (75.7; 95% CI, 69.2-82.2). The incidence of vision loss was higher in the uninsured (26.6; 95% CI, 20.2-33.0) versus insured provinces (22.5; 95% CI, 20.0-25.5). Adjusting for confounders, seniors in insured provinces had a 59% increased risk of glaucoma (incidence rate ratio [IRR], 1.59; 95% CI, 1.07-2.37), a 13% greater risk of cataracts (IRR, 1.13; 95% CI, 0.93-1.37), and a 12% reduced risk of vision loss (IRR, 0.88; 95% CI, 0.67-1.16). Lack of government-funded routine eye examinations is associated with a reduced incidence of self-reported glaucoma and cataracts, likely due to reduced detection. Lack of insurance also is associated with a higher incidence of self-reported vision loss, likely due to poorer access to eye care and late treatment.

Sensitivity of diabetic retinopathy associated vision loss to screening interval in an agent-based/discrete event simulation model

ObjectiveTo examine the effect of changes to screening interval on the incidence of vision loss in a simulated cohort of Veterans with diabetic retinopathy (DR). This simulation allows us to examine potential interventions without putting patients at risk. MethodsSimulated randomized controlled trial. We develop a hybrid agent-based/discrete event simulation which incorporates a population of simulated Veterans – using abstracted data from a retrospective cohort of real-world diabetic Veterans – with a discrete event simulation (DES) eye clinic at which it seeks treatment for DR. We compare vision loss under varying screening policies, in a simulated population of 5000 Veterans over 50 independent ten-year simulation runs for each group. ResultsDiabetic Retinopathy associated vision loss increased as the screening interval was extended from one to five years (p<0.0001). This increase was concentrated in the third year of the screening interval (p<0.01). There was no increase in vision loss associated with increasing the screening interval from one year to two years (p=0.98). ConclusionsIncreasing the screening interval for diabetic patients who have not yet developed diabetic retinopathy from 1 to 2 years appears safe, while increasing the interval to 3 years heightens risk for vision loss.

Juvenile Idiopathic Arthritis-associated Uveitis at an Italian Tertiary Referral Center: Clinical Features and Complications

Purpose: To describe the frequencies and risk factors of ocular complications and poor visual outcomes in children with juvenile idiopathic arthritis (JIA).Methods: Retrospective cohort study, including 69 consecutive children (116 eyes) affected by JIA-associated uveitis managed at a tertiary uveitis clinic.Results: The incidence of visual loss to the 20/50 or worse threshold was 0.04/eye-year (EY) and to the 20/200 or worse threshold was 0.02/EY. The most common complications at baseline were posterior synechiae (52%), band keratopathy (38%), and cataract (12%). Risk factor for a visual acuity threshold of 20/50 or worse included hypotony (p = 0.01; hazard ratio [HR] 3.7; 95% CI 1.3–10.4); anterior chamber flare >1 (p = 0.04; HR 1.3; 95% CI 0.5–3.4); a positive antinuclear antibody (ANA) (p = 0.02; HR1.4; 95% CI 0.8–2.4). Hypotony and positive ANA are also associated to the 20/200 or worse threshold (p = 0.03; HR 5.1; 95% CI 1.1–23.9 and p = 0.04; HR 1.0; 95% CI 0.4–2.3; respectively). Use of immunosuppressive drugs was associated with a reduced risk of visual loss of 20/200 or worse (odds ratio 0.14, 95% CI, 0.02–1.29; p = 0.04).Conclusions: Loss of vision and ocular complications still occur among children with JIA-related uveitis. Prompt diagnosis and a strict follow up associated to immunosuppressive therapy may decrease the poor visual outcome.

Screening intervals for diabetic retinopathy and incidence of visual loss: a systematic review

Screening for diabetic retinopathy can help to prevent this complication, but evidence regarding frequency of screening is uncertain. This paper systematically reviews the published literature on the relationship between screening intervals for diabetic retinopathy and the incidence of visual loss. The PubMed and EMBASE databases were searched until December 2012. Twenty five studies fulfilled the inclusion criteria, as these assessed the incidence/prevalence of sight-threatening diabetic retinopathy in relation to screening frequency. The included studies comprised 15 evaluations of real-world screening programmes, three studies modelling the natural history of diabetic retinopathy and seven cost-effectiveness studies. In evaluations of diabetic retinopathy screening programmes, the appropriate screening interval ranged from one to four years, in people with no retinopathy at baseline. Despite study heterogeneity, the overall tendency observed in these programmes was that 2-year screening intervals among people with no diabetic retinopathy at diagnosis were not associated with high incidence of sight-threatening diabetic retinopathy. The modelling studies (non-economic and economic) assessed a range of screening intervals (1-5years). The aggregated evidence from both the natural history and cost-effectiveness models favors a screening interval >1year, but ≤2years. Such an interval would be appropriate, safe and cost-effective for people with no diabetic retinopathy at diagnosis, while screening intervals ≤1year would be preferable for people with pre-existing diabetic retinopathy. A 2-year screening interval for people with no sight threatening diabetic retinopathy at diagnosis may be safely adopted. For patients with pre-existing diabetic retinopathy, a shorter interval ≤1year is warranted.

Incidence of visual impairment and blindness in indigenous Australians within Central Australia: the Central Australian Ocular Health Study

To estimate the incidence and causes of visual impairment and blindness among indigenous Australians living in Central Australia. Clinic-based cohort study. A total of 1884 individuals aged ≥20 years living in one of 30 remote communities within the statistical local area of 'Central Australia'. From those initially recruited, 608 (32%) participants were reviewed again between 6 months and 3 years (median 2 years). Patients underwent Snellen visual acuity testing and subjective refraction. Following this, an assessment of their anterior and posterior segments was made. Baseline results were compared with those who were reviewed. The annual incidence rates and causes of bilateral visual impairment (vision worse than Snellen visual acuity 6/12 in the better eye) and bilateral blindness (Snellen visual acuity worse than 6/60 in the better eye). The annual incidence of bilateral visual impairment and blindness was 6.82% (8.12% for those aged ≥40 years) per year and 0.50% (0.62% for those aged ≥40 years) per year, respectively. Refractive error, followed by cataract and diabetic retinopathy, were the main causes for incident bilateral visual impairment and blindness. This study has demonstrated rates of incident bilateral blindness and visual impairment among the indigenous Australian population within Central Australia, which are substantially higher than those from the non-indigenous population. Services need to address the underlying causes of this incident vision loss to reduce visual morbidity in indigenous Australians living in central Australia.

Visual Loss After Blepharoplasty: Incidence, Management, and Preventive Measures

Although rare, instances of visual loss after cosmetic blepharoplasty have been previously reported in the literature. The goal of this study is to summarize the existing literature and report the results of a physician survey in order to provide appropriate guidelines for preventing, diagnosing, and treating this unfortunate complication. A 13-question survey was sent to all members of the American Society for Aesthetic Plastic Surgery (ASAPS) and the British Association of Aesthetic Plastic Surgery (BAAPS). Surgeons were queried about their number of years in surgical practice, their average annual caseload of blepharoplasties, and the number of cases of visual loss. The survey also contained questions about the type of anesthesia administered, surgical technique, the presence of risk factors or comorbidities in patients, symptoms, time of presentation, management, and final outcome. A total of 648 responses were received from ASAPS members and 72 from BAAPS members. The overall number of blepharoplasties reported by these respondents was 752,816. Thirty-nine cases of visual loss were reported: 25 permanent and 14 temporary. According to this, the overall incidence of visual loss following blepharoplasty was calculated at 0.0052% (five of 100,000 cases, or one in 20,000). Permanent visual loss was calculated at 0.0033% (three in 100,000, or one in 30,000) and temporary visual loss at 0.0019% (two in 100,000, or one in 50,000). The most common symptoms in affected patients were pain and pressure. Development of symptoms was reported to occur within the first 24 hours, with two peaks: intraoperative to one postoperative hour, and six to 12 postoperative hours. Hypertension was the most common risk factor for postoperative visual loss. Retrobulbar hemorrhage was reported to be the main cause of blindness. The most common management technique reported was orbital decompression, followed by steroids and canthotomy. According to this study, blindness after blepharoplasty is a rare event. However, every step should be taken to prevent it. Prevention should begin in the preoperative period and should continue intraoperatively and postoperatively. Once the diagnosis of impending visual loss is made, it should be treated as a true surgical emergency, since early treatment has proven beneficial.

The Incidence of Contact Lens–Related Microbial Keratitis in Australia

To establish the absolute risk of contact lens (CL)-related microbial keratitis, the incidence of vision loss and risk factors for disease. A prospective, 12-month, population-based surveillance study. New cases of CL-related microbial keratitis presenting in Australia over a 12-month period were identified through surveillance of all ophthalmic practitioners (numerator). Case detection was augmented by records' audits at major ophthalmic centers. The denominator (number of wearers of different CL types in the community) was established using a national telephone survey of 35,914 individuals. Cases and controls were interviewed by telephone to determine subject demographics and CL wear history. Visual outcomes were determined 6 months after the initial event. Annualized incidence and confidence intervals (CI) were estimated for different severities of disease and multivariable analysis was used in risk factor analysis. Annualized incidence (with CI) of disease and vision loss by CL type and wear modality and identification of independent risk factors. We identified 285 eligible cases of CL-related microbial keratitis and 1798 controls. In daily wear rigid gas-permeable CL wearers, the annualized incidence per 10,000 wearers was 1.2 (CI, 1.1-1.5); in daily wear soft CL wearers 1.9 (CI, 1.8-2.0); soft CL wearers (occasional overnight use) 2.2 (CI, 2.0-2.5); daily disposable CL wearers 2.0 (CI, 1.7-2.4); daily disposable CL wearers (occasional overnight use) 4.2 (CI, 3.1-6.6); daily wear silicone hydrogel CL wearers 11.9 (CI, 10.0-14.6); silicone hydrogel CL wearers (occasional overnight use) 5.5 (CI, 4.5-7.2); overnight wear soft CL wearers 19.5 (CI, 14.6-29.5) and in overnight wear of silicone hydrogel 25.4 (CI, 21.2-31.5). Loss of vision occurred in 0.6 per 10,000 wearers. Risk factors included overnight use, poor storage case hygiene, smoking, Internet purchase of CLs, <6 months wear experience, and higher socioeconomic class. Incidence estimates for soft CL use were similar to those previously reported. New lens types have not reduced the incidence of disease. Overnight use of any CL is associated with a higher risk than daily use.

Bilateral Sequential Vision Loss in a Patient Re-Challenged with Amiodarone

Optic neuropathy with vision loss is an uncommon but serious event currently considered a probable amiodarone-associated adverse drug reaction. We report a case of a 72-year-old woman with irreversible, bilateral, and sequential vision loss experienced while taking amiodarone. This case involves challenge, discontinuation and subsequent rechallenge with amiodarone. It provides evidence for reclassifying optic neuropathy as a certain adverse drug reaction. Despite relatively low incidence of vision loss in patients receiving amiodarone, we agree with recommendations of baseline and periodic ophthalmic examinations during therapy. Due to potentially irreversible vision loss, patients taking amiodarone should seek medical attention for visual changes.

Cytomegalovirus retinitis

Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection affecting patients with AIDS, despite the fact that the use of highly active antiretroviral therapy (HAART) has reduced its incidence by 80%. Treatment with HAART has decreased the risk of retinitis progression, retinal detachment and visual loss in patients with CMV retinitis. HAART-induced immune recovery has been associated with an approximately 50% reduction in the risk of visual loss in eyes of patients with CMV retinitis. However, immune recovery uveitis, an ocular complication seen in the era of HAART, may increase the risk of visual loss. Furthermore, among patients with AIDS and without CMV retinitis followed in the era of HAART, the development of CMV retinitis over time has been reported to account for approximately 40% of incident vision loss and, thus, continues to be the leading cause of visual loss among patients with AIDS.

Juvenile Idiopathic Arthritis-Associated Uveitis: Incidence of Ocular Complications and Visual Acuity Loss

To estimate the incidences of ocular complications and vision loss in patients with juvenile idiopathic arthritis (JIA)-associated uveitis, to describe risk factors for vision loss, and to describe the association between therapy and complications and vision loss. Retrospective cohort study. setting: Single-center, academic practice. study population: A total of 75 patients with JIA-associated uveitis evaluated between July 1984 and August 2005. procedures: Clinical data on these patients were analyzed. outcome measures: Occurrence of ocular complications and visions of 20/50 or worse and 20/200 or worse. Over a median follow-up of three years, the incidence of any ocular complication was 0.33/eye-year (EY). Rates of vision loss to 20/50 or worse and 20/200 or worse were 0.10/EY and 0.08/EY, respectively. Risk factors at presentation for incident vision loss included presence of posterior synechiae, anterior chamber flare > or = 1+, and abnormal intraocular pressure (IOP). During follow-up, ocular inflammation > or = 0.5+ cells was associated with an increased risk of visual impairment (relative risk [RR] = 2.02, P = .006) and of blindness (RR = 2.99, P = .03). Immunosuppressive drug therapy reduced the risk of hypotony by 74% (P = .002), epiretinal membrane formation by 86% (P = .05), and blindness in the better eye by 60% (P = .04). Incident vision loss and complications were common. Presence of posterior synechiae, anterior chamber flare > or = 1+, and abnormal IOP at presentation were associated with vision loss during follow-up. Use of immunosuppressive drugs reduced the risk of some ocular complications and of blindness in the better-seeing eye.

Effect of Cytomegalovirus Retinitis on the Risk of Visual Acuity Loss among Patients with AIDS

To describe the prevalence and incidence of reduced visual acuity in eyes of patients with AIDS and without cytomegalovirus (CMV) retinitis at enrollment and estimate the proportion of incident vision loss attributable to new-onset CMV retinitis in this cohort. Multicenter prospective observational study. Three thousand fourteen eyes of 1507 patients with AIDS and without CMV retinitis at enrollment. Medical history, ophthalmologic examination, and laboratory testing collected at enrollment and at follow-up visits every 6 months thereafter. Loss of visual acuity across the < or =20/50 and < or =20/200 thresholds and doubling of the visual angle; potential causes of this vision loss. For eyes of patients without CMV retinitis at enrollment, the proportions with best-corrected visual acuity of < or =20/50 and of < or =20/200 were 3.9% and 1.8%, respectively. The incidence rates of vision loss to < or =20/50, < or =20/200, and to a doubling of the visual angle were 1.5/100 eye-year (EY), 0.8/100 EY, and 2.1/100 EY, respectively. Approximately 40% of the incident vision loss was attributable to CMV retinitis diagnosed during the follow-up period, and approximately 25% was attributable to cataract. Although the development of CMV retinitis was the most common reason for visual acuity loss in eyes of our patients with AIDS, it accounted for less than half of the vision loss in our population (approximately 40%). Newly diagnosed cataract during the follow-up period accounted for a substantial amount of incident vision loss as well.