Significant Change In Visual Acuity Research Articles

Methotrexate for the Treatment of Thyroid Eye Disease

Background/Aim. To evaluate the efficacy of methotrexate for the treatment of thyroid eye disease (TED). Methods. 36 consecutive patients with active TED, previously treated with corticosteroids but stopped due to the occurrence of side effects, were commenced on methotrexate therapy. Two different weekly doses were administered depending on the weight of the patient (7.5 mg or 10 mg). Clinical activity score (7-CAS), visual acuity (VA), ocular motility, exophthalmos, and eyelid position were retrospectively evaluated at 3, 6, and 12 months and compared with baseline data. Results. There was a statistically significant improvement in 7-CAS at 3, 6, and 12 months after treatment (P < 0.0001). There was no significant change in visual acuity. Ocular motility disturbances improved at 6 and 12 months (P < 0.001). There was no significant change in exophthalmos (mean 24 mm, SD 3 mm) or eyelid position (marginal reflex distance mean 6 mm, SD 1.5 mm) during the follow-up period. No side effects were registered. Conclusions. Methotrexate therapy is effective in reducing CAS and ocular motility disturbances. No significant improvement in proptosis or eyelid retraction should be expected from this treatment. Eventually, it might be considered a suitable alternative treatment in TED for patients who cannot tolerate steroids.

Efficacy of perceptual vision therapy in enhancing visual acuity and contrast sensitivity function in adult hypermetropic anisometropic amblyopia

BackgroundThe purpose of this study was to evaluate the efficacy of neural vision therapy, also termed perceptual vision therapy, in enhancing best corrected visual acuity (BCVA) and contrast sensitivity function in amblyopic patients.MethodsThis prospective study enrolled 99 subjects previously diagnosed with unilateral hypermetropic amblyopia aged 9–50 years. The subjects were divided into two groups, with 53 subjects (53 eyes) in the perceptual vision therapy group and 46 subjects (46 eyes) in the control group. Because the nature of the treatment demands hard work and strict compliance, we enrolled the minimal number of subjects required to achieve statistically significant results. Informed consent was obtained from all subjects. Study phases included a baseline screening, a series of 45 training sessions with perceptual vision therapy, and an end-of-treatment examination. BCVA and contrast sensitivity function at 1.5, 3, 6, 12, and 18 cycles per degree spatial frequencies were obtained for statistical analysis in both groups. All subjects had follow-up examinations within 4–8 months. With the exception of one subject from the study group and two subjects from the control group, all subjects had occlusion during childhood. The study was not masked.ResultsThe results for the study group demonstrated a mean improvement of 2.6 logarithm of the minimum angle of resolution (logMAR) lines in visual acuity (from 0.42 to 0.16 logMAR). Contrast sensitivity function improved at 1.5, 3, 6, 12, and 18 cycles per degree spatial frequencies. The control group did not show any significant change in visual acuity or contrast sensitivity function. None of the treated eyes showed a drop in visual acuity. Manifest refractions remained unchanged during the study.ConclusionThe results of our study demonstrate the efficacy of perceptual vision therapy in improving visual acuity. The 2.6 logMAR lines improvement in visual acuity is encouraging, and is consistent with the results of previous studies. However, long-term follow-up and further studies are needed.

Long-term Follow-up of Tacrolimus Ointment for Treatment of Atopic Keratoconjunctivitis

To evaluate the long-term clinical outcomes of 0.1% tacrolimus dermatologic ointment (Protopic) in cases of refractory atopic keratoconjunctivitis (AKC). Prospective, nonrandomized, noncontrolled case series. Twenty-two eyes from 11 patients with severe AKC who were treated with 0.1% tacrolimus ointment were followed prospectively. The mean age of the patients was 32.27 ± 12.7 years (range, 19-61 years). Each patient completed a follow-up period of at least 48 months, during which the signs and symptoms of AKC were assessed. Changes in the total scores of signs and symptoms from baseline were recorded at each visit, and the main outcome measure was the clinical response to topical tacrolimus treatment. Dramatic improvements in clinical signs and symptoms were achieved 1 week after starting topical tacrolimus treatment, and complete clinical resolution was observed in almost all patients 6 weeks after starting treatment. Treatment was gradually reduced, with increasing intervals between applications. Eight patients remained asymptomatic for up to 3 years, although recurrence occurred in 3 patients who attempted to discontinue treatment. All patients complained of a mild burning sensation upon application of the ointment. No additional medications were required to provide relief, and no patient discontinued treatment because of adverse drug effects. No drug-related ocular complications were encountered, and no significant changes in visual acuity or refraction were documented. Tacrolimus dermatologic ointment is a potentially safe and effective treatment for AKC cases refractory to standard treatment and may substitute for steroid treatments aimed at controlling disease activity.

Topical Ranibizumab as a Treatment of Corneal Neovascularization

To examine the effect of topical ranibizumab on clinically stable corneal neovascularization (NV). This was a prospective, open-label, monocentric, uncontrolled noncomparative study. Ten eyes of 9 patients with corneal NV received topical ranibizumab (1%) 4 times a day for 3 weeks with a follow-up period of 16 weeks. The main corneal NV outcome measures were: neovascular area, the area occupied by the corneal neovessels; vessel caliber (VC), the mean diameter of the corneal neovessels; and invasion area (IA), the fraction of the total cornea area covered by the vessels. This study was conducted at the Massachusetts Eye and Ear Infirmary, Boston, MA. Statistically significant decreases in neovascular area (55.3%, P < 0.001), which lasted through 16 weeks, and VC (59%, P < 0.001), which continued to improve up to week 16, were observed after treatment. No significant decrease was observed in IA (12.3%, P = 0.49). There was no statistically significant change in visual acuity or intraocular pressure. No adverse events ascribed to the treatment were noted. Topical application of ranibizumab is effective in reducing the severity of corneal NV in the context of established corneal NV, mostly through decrease in VC rather than IA.

Aflibercept Therapy for Exudative Age-related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

To evaluate the outcome of intravitreal injection of aflibercept in cases with exudative age-related macular degeneration, (AMD) resistant to injections of bevacizumab or ranibizumab. Retrospective observational case series. A retrospective chart review at a single institution was conducted to identify patients with exudative AMD and choroidal neovascularization (CNV) in 1 or both eyes resistant to treatment with ranibizumab or bevacizumab who were switched to treatment with at least 3monthly injections of aflibercept. In total, 36 eyes from 31 patients were included. The demographic data, visual acuities, central macular thickness on optical coherence tomography (OCT), complications, and number of injections were reviewed. The mean patient age was 79 years (range 60-88). There were 13 male and 18 female patients. The number of prior injections with either bevacizumab or ranibizumab ranged from 6-74. After 3monthly injections of aflibercept, there was a reduction of either subretinal or intraretinal fluid in 18 of 36 (50.0%) of the treated eyes; the amount of fluid remained stable in 15 eyes (41.7%) and worsened in 3 eyes (8.3%). A significant average decrease was observed for the central macular thickness after 3 injections of 65μm (P= 2.9× 10(-6)), with no significant change in visual acuity. Aflibercept therapy appears to be beneficial in a subset of patients with neovascular age-related macular degeneration who exhibit recurrent or resistant intraretinal or subretinal fluid following multiple injections with either bevacizumab or ranibizumab.

Lutein Supplementation over a One-Year Period in Early AMD Might Have a Mild Beneficial Effect on Visual Acuity: The CLEAR Study

We investigated the effect of daily supplementation with lutein (L) capsules on macular pigment optical density (MPOD) and visual acuity (VA) in patients with early age-related macular degeneration (AMD). A randomized, double-blind, placebo-controlled, two-center investigation of the effects of L supplementation in early AMD was conducted. The duration of the trial was 12 months. The centers were Manchester, United Kingdom and Maastricht, the Netherlands. L capsules (10 mg Ester) or a placebo (P) were taken daily. There were 72 patients (mean age 70.5 ± 8.7) assigned randomly to either L (n = 36) or P (n = 36) groups. MPOD using a flicker-based technique (MPS9000) and best corrected VA (LogMAR) were measured at the beginning and at 4-month intervals over the duration of the 12-month supplementation period. Blood serum samples were collected to monitor compliance. At the end of the trial, an overall increase in the mean MPOD level was found for the L group from 0.38 ± 0.19 to 0.53 ± 0.22 optical density (OD) units. According to a mixed design ANOVA, this was statistically significant (P < 0.001). No change in MPOD was found for the P group. There was no significant change in VA in the L group (n = 36). The P group (n = 36) showed a statistically significant deterioration from 0.05 ± 0.13 to 0.09 ± 0.13 (P < 0.05). When comparing the change in VA over the supplementation period, there was a significant difference between the two groups (P < 0.05). To avoid ceiling effects, 2 subgroups of patients with VA worse than 0.06 at baseline were reanalyzed. In the L subgroup (n = 19) a mean improvement in VA from 0.23 ± 0.12 at baseline to 0.16 ± 0.10 at visit 4 was observed (P < 0.05). In the P subgroup (n = 14), there was a small deterioration from 0.18 ± 0.13 to 0.19 ± 0.12 (P = 0.70). The improvement in VA in the L subgroup was compared to the deterioration in VA in the P group and this effect reached statistical significance (P < 0.05). L supplementation increases MPOD levels in early stage AMD patients. According to the VA measurements, the progress of the disease might be slowed in some patients with augmented levels of MP. (ClinicalTrials.gov number NCT01042860.).

Photorefractive Keratectomy Modification of Postkeratoplasty Anisometropic Refractive Errors

To evaluate the efficacy, refractive predictability and stability, and complications of photorefractive keratectomy (PRK) with adjunctive mitomycin C (MMC) in patients with postkeratoplasty anisometropia. A retrospective review was carried out of all cases of PRK performed for postkeratoplasty anisometropia with the VISX Star S4 excimer laser with MMC between January 1, 2004, and December 31, 2008. The main outcome measures were best spectacle-corrected distance visual acuity (CDVA) and patient tolerance of full spectacle refractive correction. Secondary outcome measures were uncorrected distance visual acuity (UDVA), refractive accuracy and stability, and complications. Twenty cases met the inclusion criteria. At 6 months, the spectacle CDVA had improved from a preoperative mean of 20/50 to 20/30 (P = 0.01). Ten eyes (50%) gained 2 or more lines of CDVA. Eighteen eyes (90%) had a CDVA of 20/40 or better. All 20 patients (100%) were subjectively satisfied with full binocular spectacle correction. There was an improvement in UDVA from a preoperative mean of 20/282 to 20/52 (P < 0.001). Thirteen patients (65%) had an UDVA of 20/40 or better. There was a reduction in the mean refractive spherical equivalent from -5.2 to -0.9 diopters (D), in myopia from -7.6 to -1.8 D, and in astigmatism from 4.9 to 2.0 D. No significant change in visual acuity or refractive error occurred between 3 and 12 months. No sight-threatening complications occurred. One eye (5%) lost 2 lines of CDVA. PRK with adjunctive MMC is an effective method of reducing postkeratoplasty anisometropia and providing satisfactory spectacle rehabilitation.

Electroretinographic Effects of Omega-3 Fatty Acid Supplementation on Dry Age-Related Macular Degeneration

To evaluate the effects of high-dose oral omega-3 fatty acid supplementation on electroretinography and omega-3 index in patients with dry age-related macular degeneration. Single institution, prospective, nonrandomized, noncomparative interventional case series comprising 34 eyes of 17 patients older than 50 years of age with early to intermediate age-related macular degeneration. Patients received oral supplementation with 4 g of omega-3 fatty acids daily (840 mg eicosapentaenoic acid/2520 mg docosahexaenoic acid) for 6 months. The main outcome measures included Early Treatment Diabetic Retinopathy Study best-corrected visual acuity, change in N1 and P1 peak amplitudes on multifocal electroretinographic testing, and change in serum omega-3 index. Mean baseline Early Treatment Diabetic Retinopathy Study best-corrected visual acuity letter score was 77 letters (Snellen equivalent of 20/32). There were no statistically significant changes in visual acuity (P = .12) or retinal function by multifocal electroretinographic testing. Serum omega-3 index increased by an average of 7.6% during the course of the study (P < .001). Study limitations included the relatively short duration of the study and small number of participants. Short-term supplementation with high doses of omega-3 fatty acids does not result in any measurable changes in visual acuity or retinal function by multifocal electroretinographic testing. Dietary supplementation with 4 g of omega-3 fatty acids results in a significant increase in serum omega-3 index in patients with dry age-related macular degeneration and may provide a useful clinical measure for future studies. clinicaltrials.gov Identifier: NCT01258335.

Safety and Visual Outcome of Visian Toric ICL Implantation After Corneal Collagen Cross-linking in Keratoconus

To evaluate the safety and clinical outcome of phakic Visian toric implantable collamer lens (ICL) (STAAR Surgical, Monrovia, CA) insertion after corneal collagen cross-linking (CXL) in progressive keratoconus. A retrospective study examined the results of the two-step CXL and Visian toric ICL implantation in 16 eyes of 10 patients with keratoconus. The two procedures were done at an interval of 6 months. Data were collected preoperatively, at the 6-month follow-up visit after CXL, and at the 6-month follow-up visit after ICL implantation. CXL induced a statistically significant decrease in steep keratometry (50.02 ± 4.07 at baseline to 48.74 ± 4.05 at 6 months after CXL, P = .001) without any significant change in visual acuity or refraction. At 6-month follow-up after ICL implantation, mean K (max) was 50.49 ± 4.07 versus 52.29 ± 4.79 D at baseline (P = .001). Mean uncorrected distance visual acuity improved from 1.67 ± 0.49 to 0.17 ± 0.06 logMAR (P = .001) and mean corrected distance visual acuity improved from 0.15 ± 0.06 to 0.12 ± 0.04 logMAR (P = .023). Mean spherical equivalent decreased from -7.24 ± 3.53 to -0.89 ± 0.76 D (P = .001) and mean cylinder decreased from 2.64 ± 1.28 to 1.16 ± 0.64 D (P = .001). The safety and efficacy indices were 1.08 ± 0.13 and 0.97 ± 0.08, respectively. No intraoperative or postoperative complications occurred. Implantation of the Visian toric ICL following CXL is an effective option for improving visual acuity in patients with keratoconus.

Pilot randomised clinical trial of Pascal TargETEd Retinal versus variable fluence PANretinal 20 ms laser in diabetic retinopathy: PETER PAN study

PurposeTo investigate the short-term effects of high-density 20-ms laser on macular thickness using Pascal-targeted retinal photocoagulation (TRP) and reduced fluence/minimally-traumatic panretinal photocoagulation (MT-PRP) compared to standard-intensity PRP (SI-PRP) in proliferative...

Ahmed glaucoma valve implantation for refractory glaucoma

Objective To evaluate the efficacy of Ahmed valve implantation for refractory glaucoma and discuss the postoperative complications and management.Methods A retrospective study was conducted to documents of 23 eyes with refractory glaucoma from 21patients who undergone Ahmed valve implantation.The subject had a minimum 6 months of follow-up after surgery.Results The follow-up ranged from 6 to 24months (mean 20.1 ±7.2months).There was no significant change in visual acuity during follow-up.Intraocular pressure was reduced from a preoperative mean of (45.70 ± 11.44) mmHg(1 mmHg =0.133 kPa)to a postoperative mean of(26.28 ± 12.02) mmHg( P ＜ 0.01 ) . The cumulative probabilities of success at 1and 2 years were 40％ and 16.7％ and of total success at 1 and 2 years were 70％ and 50％ respectively.The postoperative complications occurred in 19eyes( 82.6％ )include 13 eyes within 1 week after surgery and 6 eyes during 6 to 24 months follow - up. Conclusion Ahmed valve implantation is effective method in the management of refractory glaucoma in spite of its unnegligible complications. Key words: Glaucoma, refractory; Ahmed valve; Surgery; Complications

Visual acuity in children with low grade gliomas of the visual pathway: implications for patient care and clinical research

Low grade gliomas affecting the visual pathway, commonly referred to as optic pathway gliomas (OPGs), have a relatively high survival rate but can cause significant vision loss. While previous treatment outcomes for tumors of the central nervous system have focused primarily on changes in tumor size or patient survival, more recently preservation of vision has also become a primary objective when treating these tumors. Visual acuity (VA) is the most testable and reliable visual parameter in young children with OPGs. Unfortunately, standardized VA assessments have neither been employed to make treatment decisions nor used as primary outcomes in clinical trials. The lack of a standardized VA assessment has also hindered the ability to interpret and compare results between studies. It is essential that all members of the multidisciplinary care team (i.e., pediatric neuro-oncologist, neurologist, neurosurgeon, and ophthalmologist) can accurately interpret VA results and properly use them to guide management decisions. Specifically, determining what constitutes a significant change in VA and the factors that may influence these results should be incorporated into collective team recommendations. This review describes the VA assessment in children with OPGs and proposes a standardized VA testing protocol for future pediatric OPG clinical treatment trials.

Surgical Reduction of Ocular Pigmentation in Patients With Oculodermal Melanocytosis

To show the outcomes of surgical reduction of ocular pigmentation in patients with oculodermal melanocytosis. Surgical reduction of ocular pigmentation was performed in 49 patients with oculodermal melanocytosis at the Asan Medical Center, Seoul, Republic of Korea, between January 2005 and January 2009. In all patients, ocular pigmentation was cosmetically reduced, and most patients were satisfied with the results of surgery. Preoperative and postoperative visual acuities, intraocular pressure (IOP), keratometry, and refractive outcomes did not differ significantly. During the follow-ups, 14 patients showed transient IOP elevation and 4 patients showed conjunctival neovascularization. Surgical reduction of oculodermal melanocytosis seemed to be cosmetically satisfactory and did not cause significant changes in visual acuity, refraction, or keratometry, although 28.6% (14 of 49) of patients showed transient IOP elevation.

Comparing Treatment of Neovascular Age-related Macular Degeneration with Sequential Intravitreal Avastin and Macugen Versus Intravitreal Mono-therapy–A Pilot Study

Purpose: To examine if the sequential treatment of Avastin and Macugen is safe and more efficient than the mono-therapies in a prospective randomized masked pilot study.Materials and Methods: Subjects with exudative age-related macular degeneration were randomized to receive three intravitreal injections of either 1 mg of Avastin, 0.3 mg Macugen, or first 1 mg Avastin followed by retreatment of 0.3 mg Macugen. Follow-up examinations were performed after 1, 6, 12 weeks, and 6 months.Results: Forty-eight subjects were included (13:18:17). Avastin resulted in lasting significant changes in visual acuity at 6 weeks, increase in contrast sensitivity at 6 weeks, and a significant decrease in macular thickness after 6 and 12 weeks. Macugen showed a significant decrease in retinal thickness after 6 weeks, but a significant decrease in visual acuity after 6 months, and a significant decrease in contrast sensitivity after 12 weeks and 6 months. The sequential treatment showed a decrease in retinal thickness after 1 and 12 weeks.Conclusion: Avastin alone is more effective in increasing visual acuity and contrast sensitivity and decreasing retinal thickness, than Macugen or the sequential treatment. We conclude that the sequential treatment of Avastin with Macugen is safe, but the single treatment of Avastin is more efficient.

Anatomic and functional outcome after surgical removal of idiopathic macular epiretinal membrane

The purpose of this study is to investigate the functional and structural outcomes of surgical treatment of eyes with idiopathic macular epiretinal membrane (ERM). Clinical records of 21 patients (22 eyes) who underwent macular ERM removal with at least 6 months of postoperative follow-up period were reviewed retrospectively. All patients were treated with pars plana vitrectomy and ERM peeling surgery. Fourteen patients also underwent cataract surgery at the same time. Pre- and postoperative visual acuity (VA), intraocular pressure (IOP), and macular thickness along with postoperative adverse events were all recorded. The mean follow-up was 8.5 ± 3.2 months. Three eyes were pseudophakic and 19 eyes were phakic preoperatively. Five phakic eyes undergoing simple ERM peeling surgery had worsened cataracts, and vision was recovered after subsequent cataract extraction surgery. Mean preoperative IOP was 13.1 ± 4.2 mmHg, which did not differ significantly postoperatively ( p = 0.228). One patient had increased IOP postoperatively and needed topical antiglaucoma treatment. Thirteen eyes showed visual improvement, and six eyes became worse during the follow-up. Mean preoperative best-corrected VA was 0.36 decimal equivalent, which was then converted to logarithm of the minimum angle of resolution (logMAR 0.502 ± 0.259) for statistical analysis; this had improved to a mean of 0.536 decimal equivalent (logMAR 0.38 ± 0.35) at the final follow-up. Mean central macular thickness (CMT) also significantly declined ( p < 0.0001). From an analysis of dividing patients into two subgroups according to clinical severity [macular pucker (MP) and cellophane maculopathy (CM)], measured mean CMT of both groups demonstrated significant reduction at final follow-up (MP, p < 0.0001; CM, p = 0.005). Mean final best-corrected VA also reached significant improvement in MP group ( p = 0.008). However, in the CM group, no significant change in VA was observed ( p = 0.52). Besides, VA measurements in the MP group had improved significantly to that of CM ( p = 0.037). The measured CMTs of the MP group had also reduced significantly ( p = 0.046) compared with those of the CM group. In conclusion, membrane peeling surgery can lead to a significant reduction of macular edema in patients with idiopathic macular ERM. The advantages of combined peeling and cataract surgery will achieve maximum positive visual outcome.

Longitudinal Study of Cone Photoreceptors during Retinal Degeneration and in Response to Ciliary Neurotrophic Factor Treatment

To study cone photoreceptor structure and function in patients with inherited retinal degenerations treated with sustained-release ciliary neurotrophic factor (CNTF). Two patients with retinitis pigmentosa and one with Usher syndrome type 2 who participated in a phase 2 clinical trial received CNTF delivered by an encapsulated cell technology implant in one eye and sham surgery in the contralateral eye. Patients were followed longitudinally over 30 to 35 months. Adaptive optics scanning laser ophthalmoscopy (AOSLO) provided high-resolution images at baseline and at 3, 6, 12, 18, and 24 months. AOSLO measures of cone spacing and density and optical coherence tomography measures of retinal thickness were correlated with visual function, including visual acuity (VA), visual field sensitivity, and full-field electroretinography (ERG). No significant changes in VA, visual field sensitivity, or ERG responses were observed in either eye of the three patients over 24 months. Outer retinal layers were significantly thicker in CNTF-treated eyes than in sham-treated eyes (P < 0.005). Cone spacing increased by 2.9% more per year in sham-treated eyes than in CNTF-treated eyes (P < 0.001, linear mixed model), and cone density decreased by 9.1%, or 223 cones/degree(2) more per year in sham-treated than in CNTF-treated eyes (P = 0.002, linear mixed model). AOSLO images provided a sensitive measure of disease progression and treatment response in patients with inherited retinal degenerations. Larger studies of cone structure using high-resolution imaging techniques are urgently needed to evaluate the effect of CNTF treatment in patients with inherited retinal degenerations.

Visual Acuity Development of Children with Infantile Nystagmus Syndrome

Infantile nystagmus syndrome (INS) can be idiopathic or associated with ocular or systemic disease. The ocular oscillation of INS directly contributes to loss of visual acuity. In this study, visual acuity development in patients with INS was examined. Children with INS were classified as having idiopathic INS (n = 84) or INS with an associated sensory deficit: INS and albinism (n = 71), bilateral optic nerve hypoplasia (ONH; n = 23), or congenital retinal disorder (n = 36). Visual acuity was assessed with Teller cards and/or optotypes, and the data were analyzed for three age groups (<24 months, 24-48 months, and >48 months). Patients with idiopathic INS showed mildly reduced visual acuity early in life and gradual maturation with age that paralleled a normative curve. Patients with albinism also showed a mild visual deficit early in life but failed to keep pace with the normative curve, showing a gradual increase in visual acuity deficit. Patients with ONH and congenital retinal disorders exhibited more severe visual acuity deficits during infancy. The ONH group displayed slow improvement of visual acuity with a plateau at 24 months through >48 months, with a small increase in visual acuity deficit. The congenital retinal disorder group had no significant change in visual acuity across age and had a rapid increase in visual acuity deficit. The pattern of visual acuity development differs among children with INS, depending on the presence or absence of associated sensory system deficits. Careful characterization of visual system differences in patients with INS is important if visual acuity is an outcome in clinical trials.

Thirty-Year Follow-up of an African American Family with Macular Dystrophy of the Retina, Locus 1 (North Carolina Macular Dystrophy)

To describe clinical characteristics, including visual acuity (VA), genetic analysis, and management of complications, over a 30-year period in an African American family with macular dystrophy of the retina, locus 1 (MCDR1), commonly referred to as "North Carolina macular dystrophy." Observational, cohort study. Twelve family members from a 4-generation pedigree. A total of 12 African American patients in an affected family were examined. Clinical examination was documented during 2 different follow-up periods from 1979 to 1982 in 10 patients and from 2005 to 2009 in 11 patients. Genetic analysis was performed in 4 affected members during this time. Foveal microperimetry, fundus autofluorescence, and spectral domain optical coherence tomography (OCT) data were also obtained. Change in VA of 8 members followed over 3 decades and clinical data and management of complications for all patients. Nine of 11 living family members had classic findings ranging from disease grade 2 (confluent foveal drusen, 8 eyes) to grade 3 (central coloboma-like lesion, 10 eyes). Two members developed choroidal neovascularization (CNV) requiring laser ablation, and 1 member developed non-clearing vitreous hemorrhage and underwent 25-gauge pars plana vitrectomy. Another family member developed exotropia and amblyopia in 1 eye by age 7 years. Those without CNV had no significant change in VA over 30 years. Linkage studies of 4 affected family members showed the same short tandem repeats on markers spanning D6S249 and D6S283 within the MCDR1 region of chromosome 6q16. Microperimetry analysis of an affected member with grade 3 MCDR1 revealed absent function in the region of the central coloboma-like lesions, corresponding to photoreceptor absence on OCT, although there were preserved foveal function and intact photoreceptors adjacent to the lesion. This African American family shares similar clinical findings as other MCDR1 pedigrees and the same haplotype as the originally described family from North Carolina. Clinical characteristics, including retinal features and stable VA in the absence of amblyopia and CNV, are similar to those in other reports. Eccentric viewing around impaired photoreceptors may explain good VA in patients with clinically severe-appearing macular lesions. Sequencing of the MCDR1 interval may help identify a protein responsible for early macular development. Proprietary or commercial disclosure may be found after the references.

NIDEK MP1 IS ABLE TO DETECT SUBTLE DECLINE IN FUNCTION IN INHERITED AND AGE-RELATED ATROPHIC MACULAR DISEASE WITH STABLE VISUAL ACUITY

To investigate whether the Nidek MP1 microperimeter (NAVIS software Version 1.7; Nidek Technologies, Padua, Italy) can detect functional decline in progressive atrophic macular disease with stable visual acuity. Nine eyes of nine patients with stable acuity but progressive inherited or age-related atrophic macular disease evident on fundus autofluorescence imaging were reviewed. Each patient underwent 3 consecutive microperimetry tests at baseline, 6 months, and 12 months. Acuity, fixation, and microperimetry tests were performed at each visit. Changes in acuity, fixation stability, and macular sensitivity were analyzed. To detect regional change in retinal sensitivity, the test grid was divided into clusters based on either topographical or functional features. The mean sensitivities within each zone were also compared across the three visits. In this cohort, there was no significant change in visual acuity, fixation stability, and macular sensitivity over 1 year. However, significant decline in mean sensitivity within the central macula and test loci adjacent to dense scotoma was found (P = 0.004 and 0.002, respectively). In contrast, mean sensitivity elsewhere remained stable. The MP1 can detect significant change in regional retinal sensitivity within 12 months in patients with progressive atrophic macular disease and stable acuity. Individualized analysis of regional sensitivity may be a useful method for quantifying microperimetry.

One-year analysis of the iStent trabecular microbypass in secondary glaucoma

Purpose:To evaluate the midterm efficacy and safety of the iStent® glaucoma device in patients with secondary open-angle glaucoma.Patients and methods:A prospective, nonrandomized, interventional case series involving 10 patients with secondary open-angle glaucoma (traumatic, steroid, pseudoexfoliative, and pigmentary glaucoma) of recent onset who underwent ab interno implantation iStent. Patients were assessed following the procedure on days 1, 7, and 15 and months 1, 3, 6, and 12, and examinations included visual acuity, intraocular pressure (IOP) measurement using Goldmann tonometry, number of glaucoma medications, and complications. Wilcoxon rank-test for data with abnormal distribution was used for the analysis of IOP and glaucoma medications at baseline versus 3, 6, and 12 months following the procedure.Results:The mean baseline IOP was 26.5 ± 7.9 (range 18–40) mmHg, and significantly decreased in 10.4 ± 9.2 mmHg at three months (P < 0.05), in 7.4 ± 4.9 mmHg at six months (P < 0.05), and in 6.6 ± 5.4 mmHg at 12 months (P < 0.05) following iStent implantation. The mean number of hypotensive medications at baseline was 2.9 ± 0.7 (range 2–4). Statistically significant reductions in the number of medications of 1.1 ± 1.1 were observed at three months (P < 0.05), 1.0 ± 0.7 at six months (P < 0.05), and 1.1 ± 0.6 at 12 months (P < 0.05). No significant changes in visual acuity were noted. The most common complications comprised mild hyphema in seven eyes and transient IOP ≥30 mmHg in three eyes on postoperative day 1. Obstruction of the lumen of the stent with a blood clot was seen in three eyes, and all instances resolved spontaneously.Conclusion:The iStent is a safe and effective treatment option in patients with secondary open-angle glaucoma, and reduces the topical treatment burden in one hypotensive medication.