Risk Factors For Visual Acuity Research Articles

Clinical Features and Vitreous Biomarkers of Early-Onset Type 2 Diabetes Mellitus Complicated with Proliferative Diabetic Retinopathy.

PurposeTo compare the clinical features and vitreous biomarkers of proliferative diabetic retinopathy (PDR) between patients with early-onset and late-onset type 2 diabetes mellitus (T2DM).Materials and MethodsThis case-control study analyzed the clinical data of 74 patients with PDR who underwent vitrectomy. The patients were divided into the early-onset (T2DM diagnosis age ≤ 40 years, n = 39) and late-onset (T2DM diagnosis age > 40 years, n = 35) groups. Thirty-six specimens were collected, and the liquid chip technology was used to detect the content of 27 types of cytokines in the vitreous. Differences in clinical features and cytokine levels between the two groups were evaluated. Bonferroni correction was applied for multiple comparisons.ResultsCompared with the late-onset group, the levels of hemoglobin A1c (HbA1c) and total cholesterol were significantly higher in the early-onset group (P < 0.001 and P = 0.009, respectively). Patients with early-onset T2DM PDR had worse visual prognoses and a higher rate of postoperative recurrent vitreous hemorrhage. The results of cytokine detection showed that the levels of interleukin-4 (IL-4), IL-6, IL-8, IL-9, granulocyte colony-stimulating factor, interferon-γ, interferon-inducible 10 kDa, monocyte chemotactic protein 1, macrophage inflammatory protein (MIP)-1α, and MIP-1β in the early-onset group were significantly higher than those in the late-onset group (p < 0.0026). Age at diabetes diagnosis and HbA1c, IL-4, and regulated upon activation, normal T cell expressed and secreted levels were independent risk factors for visual acuity after undergoing vitrectomy.ConclusionEarly-onset T2DM PDR patients had poor blood glucose and lipid metabolism, higher levels of inflammatory factors, and worse visual prognosis. Stricter metabolic management and earlier anti-inflammatory interventions may be required for patients with early-onset T2DM.

Characteristics and Visual Prognosis of Pediatric Open Globe Injury in Shanghai, China

Introduction: The aim of the study was to describe the characteristics of open globe injury (OGI) and the relationship between the complications and visual outcomes in children with this type of injury. Methods: This was a retrospective chart review of 1,664 children, under the age of 16 years, who were hospitalized for OGI between January 1, 2007, and December 31, 2015. Each patient’s age, sex, cause and agent of injury, complications, visual acuity, and classification of ocular trauma were collected for review and analysis. Results: The mean age was 5.6 ± 3.4 years. Right eyes were particularly vulnerable to injury (right eye:left eye ratio = 1.2:1). Traumatic cataract was the most common complication. The average initial and final best corrected visual acuity were logarithm of the minimum angle of resolution (logMAR) 2.04 ± 0.78 and logMAR 1.74 ± 0.88, respectively. Logistic regression analysis showed that hyphema (odds ratio [OR] = 1.850), iris prolapse (OR = 1.702), vitreous hemorrhage (OR = 9.703), retinal detachment (OR = 11.938), endophthalmia (OR = 5.377), intraocular foreign body (OR = 3.346), and initial visual acuity <0.05 (OR = 9.017) were risk factors for visual acuity <0.05 at hospital discharge. Conclusion: OGI was most frequent in preschool children and boys. Right eyes were more vulnerable than left eyes. Poor visual outcomes were associated with hyphema, iris prolapse, vitreous hemorrhage, retinal detachment, endophthalmia, intraocular foreign body, and an initial visual acuity <0.05.

Contemporaneous Risk Factors for Visual Acuity in Non-Infectious Uveitis

ABSTRACT Introduction We evaluated the associations of clinical and demographic characteristics with visual acuity (VA) with over 5 years in a subspecialty noninfectious uveitis population. Methods Retrospective data from 5,530 noninfectious uveitis patients were abstracted by expert reviewers, and contemporaneous associations of VA with demographic and clinical factors were modeled. Results Patients were a median of 41 years old, 65% female, and 73% white. Eyes diagnosed ≥5 years prior to cohort entry had worse VA (−1.2 lines) than those diagnosed <6 months prior, and eyes with cataract surgery performed prior to entry had worse VA (−5.9 lines) than those performed during follow-up. Vitreous haze (−4.2 lines for 3+ vs quiet), hypotony (−2.5 lines for ≤5 mm Hg vs 6–23 mm Hg), and CNV (−1.8 lines) all were strongly associated with reduced VA. Conclusion Factors associated with reduced VA included well-known structural complications, and lack of subspecialty care during cataract surgery.

Twelve per cent of 6142 eyes treated for neovascular age-related macular degeneration (nAMD) presented with low visual outcome within 2years. Analysis from the Swedish Macula Registry (SMR).

PurposeTo analyse characteristics from the SMR to explore the risk factors for visual acuity (VA) below ≤ 35 letters of the Early Treatment Diabetic Retinopathy Study (ETDRS) due to nAMD during a two‐year follow‐up.MethodsThis study evaluates 6142 treatment‐naïve eyes, with focus on a subgroup of 780 eyes with final VA outcome of ≤ 35 letters, regarding differences of baseline characteristics, change of VA, number of injections and choice of drug to predict visual outcome.ResultsPatients with final VA ≤ 35 letters were older; p < 0.0001, and received fewer injections, 6.2 ± 3.8 vs. 8.7 ± 5.4; p < 0.00001. Only 4% of all patients with ≥ 70 letters baseline VA decreased to a final VA of ≤ 35 letters. The two groups with a final VA of ≤ 35 letters and VA > 35 letters presented the following baseline lesion locations; p = 0.001; 61% vs. 57% subfoveal, 18% vs. 21% juxtafoveal and 4% vs. 6% extrafoveal. Lesion size, in the group with final VA ≤ 35 letters, was 2805 ± 2093 μm vs. 2440 ± 1637 μm in the group with a VA of > 35 letters; p = 0.005. A logistic regression analysis including baseline VA, best‐ or worse‐seeing eye, age, membrane size, membrane location, symptom duration showed VA; p = < 0.0001, best‐ or worse‐seeing eye; p = 0.026, age; p = < 0.0001, and membrane size; p = 0.002 to predict a decline of VA within 2 years.ConclusionsIn eyes treated for wet AMD and studied for 2 years, 12.7% of eyes declined to a final VA of ≤ 35 letters. Visual acuity, worse‐seeing eye treated, age and membrane size turned out as the baseline characteristics that had significantly influenced visual decline to ≤ 35 letters during the two‐year follow‐up.

Intraocular Foreign Body Trauma in Operation Iraqi Freedom and Operation Enduring Freedom: 2001 to 2011

We update the incidence of intraocular foreign bodies (IOFB) in soldiers admitted to Walter Reed Army Medical Center from 2001 to 2011 after sustaining combat injuries in Operation Iraqi Freedom and Operation Enduring Freedom. This consecutive retrospective case series included 890 eyes of 652 patients. Data were collected in the Walter Reed Ocular Trauma Database. Inclusion criteria were any American soldier or Department of Defense civilian with an IOFB injured in Operation Iraqi Freedom/Operation Enduring Freedom. Closed globe injuries with orbital foreign bodies, injury outside of a combat zone, or non-Department of Defense civilian trauma were the exclusion criteria. Primary outcome measures were final visual outcome and the number, size, and location of IOFBs. Secondary outcome measures included surgical procedures, use of eye protection, associated complications, source of injury and Ocular Trauma Score. There were 890 eye injuries in 652 patients evacuated to Walter Reed Army Medical Center between2001 and 2011. IOFBs were found in 166 eyes of 149 patients (18.6%; 95% confidence interval [CI], 16.2%-21.3%). Most patients had a single IOFB (80.7%). An IOFB was positively associated with Ocular Trauma Score grade 1 or 2 (0-65) injuries (odds ratio [OR], 1.58; 95% CI, 1.07-2.38; P= 0.01). There were 130 eyes (78.33%) that had recorded time from initial visual acuity to final visual acuity and it ranged from 8 to 2421 days (mean, 433.24 days). Thirty-eight (25.16%; 95% CI, 18.89%-32.67%) eyes had no change in visual acuity, 98 (64.90%; 95% CI, 57.00%-72.07%) had improved visual acuity, and 15 (9.93%; 95% CI, 6.01%-15.84%) had decreased visual acuity. IOFB was not found to predict final visual acuity of <20/200 in multivariate analysis when other injury features were known (P= 0.1). Pars plana vitrectomy was completed on 124 eyes (74.70%). Removal of IOFB was performed in 118 eyes (71.08%; average of 31.67 days after initial injury) with a delayed procedure occurring after primary closure and antibiotics owing to a lack of surgical capacity in Iraq and Afghanistan. Retinal detachment occurred in 48 eyes (28.92%) and proliferative vitreoretinopathy in 44 eyes (26.5%). IOFBs occur frequently in combat ocular trauma and are significantly associated with moresevereinjuries. However, IOFBs were not found to be a significant risk factor for visual acuity of <20/200.

Incidence Rates and Risk Factors for Vision Loss among AIDS-Related Cytomegalovirus Retinitis Patients in Southern Thailand

ABSTRACTPurpose: To describe the incidence of and risk factors for visual acuity (VA) loss in patients with AIDS and cytomegalovirus (CMV) retinitis.Methods: A total of 132 patients were included. The main outcome measurements were the incidences of VA loss to ≤20/50 and ≤20/200.Results: The incidences of VA loss to ≤20/50 and ≤20/200 were 0.22/eye-year (EY) and 0.12/EY, respectively. Risk factors for the incidence of VA loss to ≤20/50 were low nadir CD4+ T-cell count (adjusted hazard ratio [aHR], 3.1), large area of retinitis (aHR, 3.7), and no immune recovery (IR) (aHR, 13.9). Risk factors for the incidence of VA loss to ≤20/200 were not receiving highly active antiretroviral therapy (HAART) (aHR, 4.4) and large retinitis area (aHR, 2.1).Conclusions: The incidence of VA loss in eyes affected by CMV retinitis was high. The use of HAART, particularly with subsequent immune recovery, substantially reduced the incidence of VA loss.

Risk Factors for Loss of Visual Acuity among Patients with Uveitis Associated with Juvenile Idiopathic Arthritis: The Systemic Immunosuppressive Therapy for Eye Diseases Study

To describe the incidence of and risk factors for visual acuity (VA) loss and ocular complications in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. Multicenter retrospective cohort study. A total of 327 patients (596 affected eyes) with JIA-associated uveitis managed at 5 tertiary uveitis clinics in the United States. Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) cohort study. Demographic and clinical characteristics were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Loss of VA to 20/50 or to 20/200 or worse thresholds and the development of ocular complications. At presentation, 240 eyes (40.3%) had a VA of ≤20/50, 144 eyes (24.2%) had a VA of ≤20/200, and 359 eyes (60.2%) had at least 1 ocular complication. The incidences of VA loss to the ≤20/50 and ≤20/200 thresholds were 0.18 and 0.09 per eye-year (EY), respectively; the incidence of developing at least 1 new ocular complication over follow-up was 0.15/EY (95% confidence interval [CI], 0.13-0.17). However, among eyes with uveitis that had no complications at presentation, the rate of developing at least 1 ocular complication during follow-up was lower (0.04/EY; 95% CI, 0.02-0.06). Posterior synechiae, active uveitis, and prior intraocular surgery were statistically significantly associated with VA to the ≤20/50 and ≤20/200 thresholds both at presentation and during follow-up. Increasing (time-updated) anterior chamber cell grade was associated with increased rates of visual loss in a dose-dependent fashion. Use of immunosuppressive drugs was associated with a reduced risk of visual loss, particularly for the ≤20/50 outcome (hazard ratio, 0.40; 95% CI, 0.21-0.75; P<0.01). Ocular complications and vision loss were common in our cohort. Increasing uveitis activity was associated with increased risk of vision loss, and use of immunosuppressive drugs was associated with reduced risk of vision loss, suggesting that control of inflammation and use of immunosuppression may be critical aspects in improving the outcomes of patients with JIA-related uveitis. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

The Cataract National Dataset electronic multi-centre audit of 55 567 operations: risk indicators for monocular visual acuity outcomes

To report risk factors for visual acuity (VA) improvement and harm following cataract surgery using electronically collected multi-centre data conforming to the Cataract National Dataset (CND). Routinely collected anonymised data were remotely extracted from the electronic patient record systems of 12 participating NHS Trusts undertaking cataract surgery. Following data checks and cleaning, analyses were performed to identify risk indicators for: (1) a good acuity outcome (VA 6/12 or better), (2) the pre- to postoperative change in VA, and (3) VA loss (doubling or worse of the visual angle). In all, 406 surgeons from 12 NHS Trusts submitted data on 55,567 cataract operations. Preoperative VA was known for 55,528 (99.9%) and postoperative VA outcome for 40,758 (73.3%) operations. Important adverse preoperative risk indicators found in at least 2 of the 3 analyses included older age (3), short axial length (3), any ocular comorbidity (3), age-related macular degeneration (2), diabetic retinopathy (3), amblyopia (2), corneal pathology (2), previous vitrectomy (2), and posterior capsule rupture (PCR) during surgery (3). PCR was the only potentially modifiable adverse risk indicator and was powerfully associated with VA loss (OR=5.74). Routinely collected electronic data conforming to the CND provide sufficient detail for identification and quantification of preoperative risk indicators for VA outcomes of cataract surgery. The majority of risk indicators are intrinsic to the patient or their eye, with a notable exception being PCR during surgery.