Ocular Exam Research Articles

Analysis of factors leading to lid wiper epitheliopathy.

Lid wiper epitheliopathy (LWE) has received more attention during the diagnosis and treatment of the dry eye. However, its causes and pathogenesis remain unclear. We aimed to explore the etiology of LWE by analyzing the association between the severity of LWE and different anatomical and tissue morphological examination characteristics using confocal microscopy on eyes with dry eye syndrome. We recruited 350 patients with LWE and dry eye syndrome (350 eyes). We examined the eyes with lid-wiper staining, conjunctival staining, a comprehensive ocular surface exam using the OCULUS keratography 5M, conjunctival impression cytology, and confocal microscopy observations. We analyzed the associations between each indicator and the LWE staining score. According to the Spearman's analysis, the LWE staining score was weakly associated with thickness of the lipid layer (r=0.1737, p=0.0005) and severity of Meibomian gland dysfunction (r=0.2026, p<0.0001); and strongly associated with staging of conjunctival impression cytology (r= -0.7694, p<0.0001). Pearson's correlation analysis indicated that, LWE staining score was moderately associated with age (r=0.4165, p<0.0001), tear meniscus height (r=0 -0.4019, p<0.0001), and NIKBUT-first (noninvasive keratography tear film breakup time) (r= -0.5108, p<0.0001); and strongly associated with NIKBUT-average (r= -0.7820, p<0.0001) and ocular staining score (r=0.6113, p<0.00001). Some patients presented abnormal blinking. We observed deeper lesion depths and more holes and fissures in the lid wipers of patients with more severe LWE than in patients with milder LWE. Abnormal friction factors caused by insufficient lubrication between the lid wiper area and the ocular surface seem to influence the development and/or the severity of LWE. Aggravation of LWE further increases the frictional damage between the lid wiper and the ocular surface.

Rare Presentation of Bilateral Central Retinal Vein Occlusion and Leukemic Retinopathy in a Young Adult Diagnosed with T-cell Acute Lymphoblastic Leukemia

Simultaneous bilateral central retinal vein occlusion (CRVO) is a rare presentation that warrants consideration of an underlying hyperviscosity state. Increased serum viscosity can lead to the hematologic emergency of leukostasis with resultant vascular obstruction and hypoxic tissue damage. The following case demonstrates the first case of bilateral CRVO in a young adult secondary to acute lymphoblastic leukemia (ALL). A 23-year-old female presented to the emergency department (ED) with two days of worsening bilateral blurry vision and bitemporal headache. Her ocular exam was significant for bilateral intraretinal hemorrhages consistent with CRVO with chest radiograph demonstrating widened mediastinum with perihilar lymphadenopathy and serologic testing revealing ALL with blast crisis. The patient was subsequently admitted to the oncology service for induction chemotherapy. Patients with new headache and bilateral vision changes should prompt a thorough neurological and ophthalmologic exam to assess for underlying systemic pathologies. Concurrent bilateral CRVO is a rare but specific finding for systemic hyperviscosity syndrome, blood dyscrasia, polycythemia, or other serious illness. Early recognition and treatment of the underlying condition can prevent further vision loss and overall morbidity and mortality.

Removal of an Impaled Intraocular Hair Comb Following Self-inflicted Trauma

Ocular trauma is one of the most common and vision-threatening ophthalmic presentations with a wide spectrum of complications, such as bleeding, infection, vision loss, and enucleation. A 64-year-old-male presented to the emergency department (ED) with a self-inflicted orbital penetrating injury with a hair comb. Computed tomography showed the comb traversed the medial orbit inferior to the medial rectus but did not damage the optic nerve; there were no globe or orbital wall fractures. His ocular exam was significant for a right eye afferent pupillary defect and decreased visual acuity 20/800, consistent with optic neuropathy. Primary concerns were stabilizing and removing the foreign body without causing further damage in the setting of an uncooperative patient. The comb was removed with the aid of local and systemic analgesia using gentle traction and normal saline irrigation. The patient was admitted for systemic and topical antibiotics and showed improvement in visual acuity and resolution of his optic neuropathy. This case illustrates the importance of rapid ED assessment and management of complex penetrating ocular trauma. Examination should specifically look for signs of globe rupture and optic nerve injury. Expedited foreign body removal should be managed together with an ophthalmologist with procedural sedation and broad-spectrum antibiotics to avoid further visual and infectious complications.

Ocular motor manifestations of movement disorders

Impaired eye movements are frequently seen in ophthalmic and neurologic clinical practice, especially in individuals with movement disorders. Identification of the abnormal movement can aid initial diagnosis and improve understanding of the underlying disease pathophysiology. The present article reviews the ocular motor manifestations and recent research on them in common movement disorders. Ocular motor manifestations and their pathophysiologic correlates are being defined. In particular, study of eye movements can help clarify the changing clinicopathologic spectrum of atypical parkinsonian disorders. The pathophysiology and natural history of blepharospasm are being elucidated. Recent research focuses on high-resolution imaging and other technological advances to improve the sensitivity of the ocular motility exam. Eye movements are being studied as biomarkers for diagnosis and progression in clinical care and trials. The current review summarizes ocular motor manifestations in common movement disorders, and presents recent research investigating their cause and treatment.

Pediatric retinal damage due to soccer-ball-related injury: Results from the last decade.

To outline the incidence of posterior segment injuries related to soccer-ball blunt trauma in children. Retrospective search of the computerized hospital medical database between the years 2007 and 2017. All pediatric trauma cases were reviewed and cases with blunt trauma related to direct orbital/ocular hit from a soccer-ball were included. Cases were divided into two groups (non-severe and severe) based on the presence of sight-threatening findings on presentation (e.g. retinal tear, vitreous hemorrhage, retinal detachment, and macular edema). Out of 343 pediatric patients with relevant diagnoses, 14 (4.1%) were treated for injuries related to soccer-ball trauma. All patients were males at their early-to-mid teens (14.3 ± 2.1 years). The most common funduscopic finding was peripheral commotio retina (13, 93%). There was equal distribution between the two groups (seven each). Retinal injury in the severe group included retinal tear (3), vitreous hemorrhage (4), retinal detachment (1), and macular hole (1). Five patients in this group presented with visual acuity of 20/25 or better. Rate of external signs of injury were similar in both groups. Soccer-ball blunt trauma in children can cause significant posterior segment injuries regardless of the presence of external injury or ocular complaints. A thorough ocular exam is mandatory in all cases for the detection of vision-threatening retinal injuries.

Central retinal artery occlusion after Descemet membrane reposition by intracameral air: A case report

To report a case of central retinal artery occlusion after Descemet membrane reposition by intracameral air. An otherwise healthy 60-year-old woman presented with white mature cataract in her left eye. Ocular exam of both eyes was within normal limits. After an uneventful topical phacoemulsification, a moderate-grade striate keratopathy and non-planar Descemet membrane detachment was noted on first postoperative day, which was confirmed on anterior segment optical coherence tomography. The Descemet membrane was repositioned within 24 h of cataract extraction by intracameral air tamponade (pneumatic descematopexy) under topical anesthesia, and partial air release was done after 2 h. The patient was evaluated for decreased immediate postoperative vision of perception of light. After pneumatic descematopexy, the stromal edema relatively cleared. The intraocular pressure before releasing the intracameral air was 38 mmHg and antiglaucoma medication was started. Dilated fundus exam showed retinal pallor and a cherry-red spot over the macula. A diagnosis of central retinal artery occlusion was confirmed, and thorough systemic workup was done. Systemic investigations were within normal limits. The patient was managed conservatively, but the final visual acuity remained at 1/60. Central retinal artery occlusion is not a reported complication after pneumatic descematopexy for Descemet membrane detachment management. The possible mechanism could be sudden increase in intraocular pressure due to pupil block by air, and thus, ocular surgeries with use of intracameral air for prolonged duration warrants close monitoring of intraocular pressure and its subsequent management.

Frequency and severity of diabetic retinopathy in patients with type 2 diabetes mellitus at the Regional Institute of Ophthalmology

In order to determine the frequency and severity of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (MD), a cross-sectional descriptive study was conducted in 3,239 patients of the Regional Institute of Ophthalmology in the city of Trujillo, La Libertad region, Peru. After pupil dilation, trained personnel took two photographs of each eye, centered on macula and optic nerve. The frequency of DR was 25.9%, with a higher proportion in men with DR (28.2%) and in those with more than 10 years of MD disease (49.0%). Most patients had mild to moderate non-proliferative diabetic retinopathy (NPDR) (79.3%); 10.1% had severe NPDR, and 9.7% had proliferative DR. We conclude that DR occurs in one in four patients and about 20% in advanced degrees. There is a need to expand screening coverage from the time of diagnosis of DM and to implement preventive measures such as metabolic control and periodic ocular fundus exam.

After Lightening Strikes: A Case Of Anoxic Encephalopathy In A 30 Year Old Soccer Player

HISTORY: A 30 year old male with a past medical history of hypothyroidism was out playing soccer when he was struck by lightening. After the lightening strike, the patient experienced cardiac arrest, and CPR was performed. Spontaneous circulation was achieved after a 17 minutes of CPR, and the patient was admitted to a burn unit for partial thickness burns of his left anterior chest, abdomen, and right medial lower calf. During the patient’s stay on the burn unit, he was noted to have severe cognitive deficits secondary to an anoxic brain injury sustained during his cardiac arrest, and also had a PEG tube placed after developing aspiration pneumonia. Following the burn unit, the patient was transferred to an acute rehab facility to address the severe cognitive deficits he had developed. Upon arrival at the acute rehabilitation facility, the patient was a Rancho Los Amigos level three. PHYSICAL EXAM: The patient was lying comfortably in bed. He was able to mimic behavior, but was unable to follow commands consistently. On ocular exam, the patient had a left pupil that was fixed and dilated, and sub-conjunctival hemorrhages. Abdominal exam was significant for an in-place PEG tube. Integumentary was significant for partial thickness wounds on his anterior chest and right lower extremity. The patient demonstrated full active range of motion of his upper and lower extremities. DIFFERENTIAL DIAGNOSIS: Anoxic encephalopathy Encephalopathy secondary to electrocution Toxic metabolic encephalopathy TESTS AND RESULTS: -Labs on admission were significant for the following: White blood cell count of 5.0; hemoglobin of 10.3; blood urea nitrogen of 55; AST of 42 and ALT of 70. -CT head on admission showed no evidence of intracranial hemorrhage, lobar infarct, hydrocephalus, or midline shift. FINAL DIAGNOSIS: Anoxic encephalopathy secondary to lightening strike TREATMENT AND OUTCOMES: The patient was started on amantadine to stimulate increased attention and wakefulness, and seroquel and trazadone to help address the patients nocturnal agitation and promote sleep. At the end of his 5 week stay on the acute rehabilitation unit, the patient had advanced to a Ranchos Los Amigos level eight. He was fully oriented to his environment, tolerating an oral diet, engaging in appropriate conversation, and ambulating with a walker.

Evaluation of incomplete blinking as a measurement of dry eye disease

PurposeTo investigate the association between partial blinking during spontaneous blinking as measured by interferometry and ocular exams for the assessment of dry eye disease (DED). MethodsThis retrospective study included 58 eyes of patients previously diagnosed with DED. Ocular surface assessment included ocular surface disease index (OSDI) score, tear film osmolarity, tear breakup time (TBUT), grading of corneal fluorescein staining, Schirmer I test, and dry eye parameters by the LipiView™ interferometer (TearScience, Morrisville, NC, USA), including lipid layer thickness of the tear film (LLT), meibomian gland dropout (MGd), number of incomplete and complete blinks per 20 s and the partial blinking rate (PBR). Generalized estimation equations (GEE) were used for association testing between each variable of interest. The working correlation for each GEE model was selected using the Corrected Quasi-likelihood under the Independence Model Criterion. ResultsThe number of incomplete blinks was significantly associated with TBUT (P = 0.006), OSDI (P = 0.000) and MGd (P = 0.000). PBR was significantly associated with OSDI (P = 0.032) and MGd (P = 0.000). The number of complete blinks was significantly associated with TBUT (P = 0.032), but not with other ocular surface parameters. MGd was significantly associated with TBUT (P = 0.002) and OSDI (P = 0.001). LLT was significantly associated with tear film osmolarity (P = 0.007), and tear film osmolarity was significantly associated with LLT (P = 0.000). ConclusionsIncomplete blinking is associated with decreased TBUT, increased OSDI, and increased MGd possibly through its contribution to meibomian gland obstruction and subsequent loss of tear film homeostasis. It may, therefore, be considered an additive measure for mild-to-moderate DED assessment.

Differences in Anterior Chamber Angle Assessments Between Gonioscopy, EyeCam, and Anterior Segment OCT: The Chinese American Eye Study.

PurposeTo quantify interquadrant differences in anterior chamber angle (ACA) configuration assessed on gonioscopy, EyeCam, and anterior segment optical coherence tomography (AS-OCT) in a cohort of Chinese Americans.MethodsSubjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES), a population-based epidemiologic study in Los Angeles, CA. Each subject underwent a complete ocular exam, including gonioscopy, EyeCam, and AS-OCT, under dark ambient lighting. Gonioscopy and AS-OCT imaging and EyeCam image grading were performed by trained ophthalmologists.ResultsSeven hundred nine eyes from 709 subjects were analyzed. Less anatomic variation among the quadrants was detected on gonioscopy and EyeCam compared with AS-OCT (P < 0.05). The mean gonioscopy grade, EyeCam grade, and AS-OCT measurement for each quadrant varied by up to 10.3%, 6.4%, and 46.2% of the superior quadrant value, respectively. There were significant interquadrant differences (P < 0.05) among mean AOD750 measurements when grouping by quadrant and gonioscopy or EyeCam grade. Mean AOD750 measurements were smallest for the superior quadrant by between 14.3% and 38.1% and 17.4% and 37.9% on gonioscopy and EyeCam, respectively, compared with other quadrants.ConclusionsGonioscopy and EyeCam significantly underrepresent anatomic variations of the ACA compared with AS-OCT. Gonioscopy or EyeCam grades from different quadrants do not appear to be comparable or interchangeable, which supports reconsideration of current definitions and methods used to diagnose and manage primary angle closure disease.Translational RelevanceAS-OCT imaging raises concerns about current clinical definitions and methods that rely gonioscopy or EyeCam to assess the ACA.

Hyperautofluorescent Dots are Characteristic in Ceramide Kinase Like-associated Retinal Degeneration

There is a lack of studies which seek to discern disease expression in patients with mutations that alter retinal ceramide metabolism, specifically in the ceramide kinase like (CERKL) gene. This cross-sectional case series reports a novel phenotypic manifestation of CERKL-associated retinopathy. Four unrelated patients with homozygous CERKL mutations underwent a complete ocular exam, spectral-domain optical coherence tomography, short-wavelength fundus autofluorescence (SW-AF), quantitative autofluorescence (qAF), and full-field electroretinogram (ffERG). Decreased visual acuity and early-onset maculopathy were present in all patients. All four patients had extensive hyperautofluorescent foci surrounding an area of central atrophy on SW-AF imaging, which has not been previously characterized. An abnormal spatial distribution of qAF signal was seen in one patient, and abnormally elevated qAF8 signal in another patient. FfERG recordings showed markedly attenuated rod and cone response in all patients. We conclude that these patients exhibit several features that, collectively, may warrant screening of CERKL as a first candidate: early-onset maculopathy, severe generalized retinal dysfunction, peripheral lacunae, intraretinal pigment migration, and hyperautofluorescent foci on SW-AF.

Clinically Relevant Immune-Cellular Metrics of Inflammation in Meibomian Gland Dysfunction.

PurposeTo determine the reliability and clinical relevance of in vivo confocal microscopy (IVCM)-based immune-cellular metrics of palpebral conjunctival inflammation in meibomian gland dysfunction (MGD).MethodsSixteen MGD patients and 13 reference controls included in this cross-sectional, retrospective study, had an ocular surface exam, symptom assessment (Ocular Surface Disease Index questionnaire [OSDI]), and palpebral conjunctival IVCM imaging. Bland-Altman analyses, intraclass correlation coefficient (ICCa), Lin's concordance correlation coefficient (ρc), receiver operating characteristic (ROC) analyses, and correlations were performed. Clinical outcome measures were symptom severity (OSDI scores), tear break-up time (TBUT), and corneal fluorescein staining (CFS grade).ResultsCompared to controls, patients with MGD had variable symptom severity (average OSDI score: 48.3 ± 7.6, P = 0.0008, range: 8.3–85.42), shorter TBUT (6.8 ± 0.9 seconds, P = 0.002), comparable corneal staining (0.31 ± 0.19, P = 0.20), and greater conjunctival inflammation (epithelial immune cells [EIC]: 477.8 ± 54.2 vs. 123.3 ± 17.2 cells/mm2, P < 0.0001; intraglandular immune cells [IGIC]: 41.9 ± 3.3% vs. 20.33 ± 7.3%, P < 0.01). Immune-cellular metrics had high inter- and intraobserver agreement (ρc: 0.86–0.94; ICCa and Cronbach's α: 0.85–0.97, P < 0.0001). EIC correlated positively with OSDI (rs: 0.49, P = 0.03), while both EIC and IGIC correlated inversely with TBUT (rs: −0.47, −0.45, P < 0.05), and had high accuracy in detecting inflammation (ROC area under the curve [AUC]: 0.97 and 0.89, P ≤ 0.001).ConclusionsEIC and IGIC are increased in highly symptomatic patients with MGD that have minimal corneal staining, and correlate with symptoms and clinical signs. EIC and IGIC may provide reliable and clinically relevant metrics of inflammation.

Quantitative Evaluation of Gonioscopic and EyeCam Assessments of Angle Dimensions Using Anterior Segment Optical Coherence Tomography.

PurposeTo evaluate the relationship between angle dimensions assessed by gonioscopy or EyeCam and anterior segment optical coherence tomography (AS-OCT).MethodsSubjects aged 50 years or older were recruited from the Chinese American Eye Study (CHES). Each subject underwent a complete ocular exam, including gonioscopy, AS-OCT, and EyeCam. Angle closure was defined as three or more quadrants in which pigmented trabecular meshwork could not be visualized. Angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA) were measured in each AS-OCT image.Results709 eyes (272 angle closure, 437 open angle) from 709 subjects were analyzed. Mean gonioscopy and EyeCam grades tended to increase as AS-OCT measurements increased. There were strong correlations overall between AS-OCT measurements and gonioscopy (r > 0.73) and EyeCam (r > 0.68) grades. However, correlations with AS-OCT measurements were weak for gonioscopy (r < 0.38) and EyeCam (r < to 0.27) among eyes with angle closure. Mean AS-OCT measurements differed for eyes with Shaffer grade 0 in all four quadrants among eyes with varying degrees of angle closure on gonioscopy (P < 0.01) but did not differ among eyes with varying degrees of angle closure on EyeCam (P > 0.27).ConclusionsAngle assessments by gonioscopy and EyeCam are weakly related to angle dimensions in eyes with angle closure.Translational RelevanceAS-OCT imaging raises concerns about current clinical methods that rely on direct visualization of ACA structures to assess the degree of angle closure.

Evaluation of a Single Dose of Azithromycin for Trachoma in Low-Prevalence Communities

ABSTRACTPurpose: Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is the leading infectious cause of blindness worldwide and is targeted for elimination as a public health problem. We sought to determine whether a one-time azithromycin mass treatment would reduce trachomatous inflammation–follicular (TF) levels below the elimination threshold of 5% in communities with disease prevalence between 5 and 9.9%.Methods: The study was conducted in 96 sub-village units (balozis) in the Kongwa district of Tanzania which were predicted from prior prevalence surveys to have TF between 5 and 9.9%. Balozis were randomly assigned to the intervention and control arms. The intervention arm received a single mass drug administration of azithromycin. At baseline and 12-month follow-up, ocular exams for trachoma, ocular swabs for detection of chlamydial DNA, and finger prick blood for analysis of anti-chlamydial antibody were taken.Results: Comparison of baseline and 12-month follow-up showed no significant difference in the overall TF1-9 prevalence by balozi between control and treatment arms. In the treatment arm there was a significant reduction of ocular infection 12 months after treatment (p = 0.004) but no change in the control arm. No change in Pgp3-specific antibody responses were observed after treatment in the control or treatment arms. Anti-CT694 responses increased in both study arms (p = 0.009 for control arm and p = 0.04 for treatment arm).Conclusion: These data suggest that a single round of MDA may not be sufficient to decrease TF levels below 5% when TF1-9 is between 5 and 9.9% at baseline.

Low Vision and Blindness in Bulgarian Children with Developmental Delay

Introduction. Visual impairment and blindness are very common in children with developmental delay, seriously harming their intellectual, social, learning and even physical development. Most common reasons for mild visual impairment are refractive errors and amblyopia, while optic nerve atrophy, retinal diseases and central cortical impairment are the leading causes for low vision (moderate and severe visual impairment) and blindness. Visual and ocular problems in intellectually disabled children are often neglected and even treatable diseases are ignored. Purpose. The aim of our study was to determine the incidence and main reasons for low vision and blindness in Bulgarian children with mental retardation. Patients and Methods. A prospective study of ocular status of 403 children (0 – 18 years) with mental retardation was performed. All patients had detail ophthalmologic exam according to their age and intellectual disabilities. Results. A total of 403 patients – 241 (59.8%) males and 162 (40.2%) females were enrolled in the study. Binocular moderate to severe visual impairment and blindness were diagnosed in 42 (10.4%) children. Detected ocular pathologies were congenital nystagmus (3.2%), optic nerve atrophy (2.7%), retinopathy of prematurity (2.5%), central cortical blindness (1.2%) and congenital anomalies (0.7%). Conclusion. Children with mental retardation are risk group for ocular and visual pathologies, causing not just visual impairment but severe problems and blindness. And nevertheless, most cases of low vision and blindness are unavoidable, implementation of yearly screening ocular exams of mentally retarded children must be adopted on national level for encompassing the high rate of treatable or correctable visual problems.

Correlation between Intraocular Pressure and Angle Configuration Measured by OCT: The Chinese American Eye Study

To characterize the relationship between angle configuration measured by anterior segment optical coherence tomography (AS-OCT) and intraocular pressure (IOP). Cross-sectional study. Subjects aged 50 years or older were identified from the Chinese American Eye Study (CHES), a population-based epidemiological study in Los Angeles, CA. Each subject underwent a complete ocular exam including Goldmann applanation tonometry, gonioscopy, and AS-OCT imaging. Four AS-OCT images were analyzed per eye and parameters describing angle configuration were measured, including angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), and scleral spur angle (SSA). The relationship between AS-OCT measurements and IOP was assessed using locally-weighted scatterplot smoothing (LOWESS) regression and change-point analyses. Correlation between AS-OCT measurements and IOP. 702 eyes (382 closed angle and 320 open angle) from 555 subjects were analyzed. Mean IOP for angle closure eyes was 16.3 ± 3.9 mmHg and open angle eyes was 15.3 ± 2.7 mmHg. Mean IOP increased as AS-OCT measurements decreased for all parameters except TIA750. Once measurement values dropped below parameter-specific threshold values, AS-OCT measurements and IOP were significantly correlated (p < 0.05) for AOD500 (r = -0.416), AOD750 (r = -0.213), ARA500 (r = -0.669), ARA750 (r = -0.680), TISA500 (r = -0.655), TISA750 (r = -0.641), SSA500 (r = -0.538), and SSA750 (r = -0.208). There was no correlation between AS-OCT measurements and IOP in open angle eyes (p > 0.40). There is an anatomic threshold for angle configuration below which IOP is strongly related to the degree of angle closure. This finding suggests reconsideration of current definitions of angle closure and may be relevant for developing new OCT-based methods to identify patients at higher risk for elevated IOP and glaucoma.

Refractive Error and Ocular Findings Among Infants and Young Children With Severe Problem Behavior and Developmental Disabilities

ABSTRACTThe prevalence of refractive error and ocular disorders among infants and young children with severe behavioral problems and developmental disorders is not well defined, particularly in developing countries. We performed a retrospective review of ophthalmic examinations performed during a National Institutes of Health–funded cohort study of very young children in Peru with behavioral problems and at risk for developmental disorders. Two-hundred twenty-two children between the ages of 0 and 4 years (mean 2.2 ± 0.9 years) were examined and 100 (45.0%) had an abnormal ocular exam. Overall, the prevalence of refractive error was 33.3%, nystagmus was 12.2%, and strabismus was 10.9%. Among children with Down syndrome, refractive error ranged from 46.2% at age 2 to 85.7% at age 4. Refractive error and ocular disorders are highly prevalent even at a young age in children with behavioral problems and developmental disorders. Much of the visual impairment in this population is treatable; early identification and intervention can have a lifelong positive impact on neurodevelopment.

Incorporation of Clinically‐Based Ultrasound Workshops in a 1st Year Medical Anatomy Course

Ultrasound (US) is quickly becoming an increasingly common tool in point‐of‐care medical practice (commonly called “the new stethoscope”). To better prepare our students for this environment, the Arizona College of Osteopathic Medicine (AZCOM) has developed and is implementing a 4‐year, longitudinal, integrated, US curricular experience. The initial phase (1st year courses) includes a major US component in gross anatomy. The gross anatomy series is two regional, dissection‐based courses with eight exam units (four per course) over two quarters. The US component to the gross courses includes increased use of US images in lectures as well as eight, clinically‐based, hands‐on US workshops; one for each exam unit. Modifications in the lecture schedule made inclusions of the workshops credit‐hour neutral. The exam units and associated US workshops (in italics) are: Back/Scapular—lumbar puncture; Upper Extremity—carpal tunnel syndrome; Thorax—4‐view cardiac assessment; Abdominal—biliary colic; Posterior Abdominal wall/Pelvis/Perineum—AAA, FAST; Lower Extremity—plantar fasciitis, calcaneal tendonitis, tarsal tunnel syndrome; Head and Neck I—ocular and thyroid exams; Head and Neck II—carotid stenosis. The US workshops are designed for students to visualize the relevant anatomy of a common, point‐of‐care clinical scenario on living subjects. Student assessment is in the form of oral “check‐out” quizzes in the workshops and US‐based questions in the written and practical portions of the unit exams. Overall performance on US questions in the first four exams was below the exam averages (77% v. 83%), but with a marked upward trajectory of the US question performance (69%, 62%, 76%, 89%). Practical exam questions showed a similar trajectory, but with lower averages. A Likert scale survey—first of a series as part of an ongoing four‐year study—was given at the end of the first quarter (4 exam units) to assess student opinions regarding US in the anatomy course. The non‐incentivized response rate was 146/279. Students overwhelmingly (90+%) feel US training is an important part of the curriculum that should begin as early as possible. For each workshop a strong majority agreed that it improved their comprehension of both the anatomy of the region scanned (87%, 92, 91, 92) and the regional clinical concerns (91%, 94, 93, 93). A majority of students also agreed that the US workshops led them to do some form of further research of the clinical concerns (65%, 64%, 74%, 71%). These preliminary results are very encouraging. Another survey will be taken at the end of the winter quarter, but current indications are that the utilization of US workshops in the AZCOM gross anatomy course has been a valuable addition.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Retinal Lesions and Renal Impairment Associated with Interferon β1α Therapy for Multiple Sclerosis: A Case Report

Background: Recombinant interferon β is now the mainstay of maintenance therapy for multiple sclerosis in many countries. Retinal lesions are rarely related with subcutaneous interferon β1α in multiple sclerosis. Interferon nephrotoxicity is also an extremely rare side effect. We report a case of interferon-associated retinopathy and nephropathy in a patient with multiple sclerosis receiving subcutaneous interferon β1α. Case report: A 42 years old Caucasian female with a history of multiple sclerosis on continuous treatment with interferon β1α, presented with anemia, thrombocytopenia, albuminouria, mild elevation of liver enzymes, renal impairment and sudden hypertension without visual disorders. Ocular fundus exam showed several retinal cotton wool spots indicating interferon-retinopathy and the drug was discontinued. Biochemical and immunological analyses were negative for autoimmune renal diseases. The retinopathy disappeared without specific therapy 2 months after discontinuing interferon β1α and kidney function restored. Interferon β1α resumed 16 weeks after stopping treatment due to multiple sclerosis relapse. On an iterative fundus exam 3 months after resumption of interferon β1α, no further cotton wool spots have recurred. 6 and 12 months later, with the patient on interferon β1α treatment, the ocular fundus was free of lesions and kidney function was within normal range. Conclusions: In our patient, both complications resolved after drug cessation and the diagnosis of interferon β1α retinopathy and nephropathy was retained due to the lack of any other etiology.

Ultrasound ciliary plasty to treat glaucoma: efficacy and safety results on 152 patients

PurposeTo evaluate the efficacy and safety of the Ultrasound Ciliary Plasty (UCP) procedure using Focused ultrasound with second generation probe on a consecutive series of 152 glaucoma patients.MethodsProspective clinical series of 169 eyes of 152 patients with primary and secondary open angle or angle closure glaucoma treated between April 2015 and September 2016 in 2 University Hospitals. Procedures were conducted with second generation therapy probe comprising 6 piezoelectric transducers, with 8 seconds exposure time per transducer (standard protocol). Complete ophthalmic examinations were performed before the procedure, and at 1 day, 1 week, 1, 3, 6 and 12 months after. Primary outcome was IOP reduction compared to baseline. Secondary outcomes were success rate (defined as IOP reduction from baseline ≥20% and IOP &gt;5 mmHg without adding medication compared to baseline), vision‐threatening complications, hypotensive medication use, complications, and re‐interventions.ResultsNo major intra‐ or post‐operative complications occurred. Ocular exam did not reveal lesions of ocular structures other than ciliary body and no or few signs of anterior chamber inflammation. Semi‐mydriasis was observed on fifteen eyes, reduced or resolved in a few weeks/months. Intraocular pressure was significantly reduced from a mean preoperative value of 27.1 ± 9.3 mmHg (3.1 hypotensive medications) to a mean value of 19.1 ± 7.6 mmHg (3.2 hypotensive medications) at last follow‐up, corresponding of a mean IOP reduction of 27%. Nineteen patients were re‐treated using focused ultrasound, 7 patients were considered as failure and treated by filtering surgery, and 8 patients with Diode laser cyclo‐destructive procedure.ConclusionsUltrasound Ciliary Plasty using High Intensity Focused Ultrasound is an effective method to reduce intraocular pressure in patients with glaucoma.