To evaluate axial length (AL) alterations in patients with macular disease over the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.
In this prospective, ...comparative study, 33 patients with macular edema underwent unilaterally intravitreal anti-VEGF therapy and were followed for two months; the contralateral eyes were considered as controls. Central retinal thickness (CRT) was measured with spectral-domain optical coherence tomography and AL with an IOL-Master optical biometer.
CRT of the treated eyes decreased by 35.33 ± 65.59 μm (range, -222.00-67 μm), while AL increased by 0.008 ± 0.062 mm (range, -0.11-0.18 mm). CRT of the control group decreased by 9.82 ± 65.40 μm (range, -203-182 μm), and AL increased by 0.011 ± 0.129 mm (range, -0.20-0.67 mm). No significant correlation was detected between CRT and AL parameters (rhos=0.026, P=0.882).
Anti-VEGF administration has no significant impact on optical biometry-derived AL measurements.
The purpose of this study was to investigate the existence of pseudoexfoliation syndrome (PXF) as a risk factor for the development of central retinal vein occlusion (CRVO).
This was a retrospective, ...comparative study of the prevalence of pseudoexfoliation in three groups of patients: 48 patients with CRVO, 164 patients with branch retinal vein occlusion (BRVO), and 70 control patients (70 eyes). All patients were phakic and had no previous diagnosis of glaucoma. Patients were matched in terms of age and systemic hypertension. All patients had normal intraocular pressure (IOP) at presentation (defined as less than or equal to 21 mmHg).
In the CRVO group, 14 out of 48 patients were diagnosed as having PXF (29.17%). In the BRVO group, 14 out of 164 patients had PXF (8.5%), and in the control group, six out of 70 patients had PXF (8.6%). Differences of percentage between groups were statistically significant (P<0.001, χ(2) test). When comparing patient subgroup with ischemic CRVO with subgroup with non-ischemic CRVO, we found that in the ischemic CRVO group, 13 out of 27 patients were diagnosed as having PXF (48.15%), and in the non-ischemic CRVO group, one out of 21 patients was diagnosed as having PXF (4.7%; P<0.001, χ(2) test). The relative odds of having CRVO in patients with PXF versus patients without PXF were 4.406 (confidence interval CI, 2.03-9.54).
PXF and CRVO, especially ischemic, are strongly associated in our study. Our results indicate that PXF might be an independent factor for CRVO, as it is related with CRVO independently from glaucoma.
Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative ...contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error.
We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals UIs) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older.
Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% 95% UI −1·5 to 1·0; 2019 prevalence 9·58 cases per 1000 people 95% IU 8·51 to 10·8, 2010 prevalence 96·0 cases per 1000 people 86·0 to 107·0). Age-standardised prevalence of avoidable blindness decreased by −15·4% –16·8 to −14·3, while avoidable MSVI showed no change (0·5% –0·8 to 1·6). However, the number of cases increased for both avoidable blindness (10·8% 8·9 to 12·4) and MSVI (31·5% 30·0 to 33·1). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases 9% IU 12·7–18·0), followed by glaucoma (3·6 million cases 2·8–4·4), undercorrected refractive error (2·3 million cases 1·8–2·8), age-related macular degeneration (1·8 million cases 1·3–2·4), and diabetic retinopathy (0·86 million cases 0·59–1·23). Leading causes of MSVI were undercorrected refractive error (86·1 million cases 74·2–101·0) and cataract (78·8 million cases 67·2–91·4).
Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached.
Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg.
Purpose. To evaluate the anatomical and functional outcome of repeated surgeries for recurrent retinal detachment. Methods. We retrospectively reviewed 70 cases with refractory retinal detachment of ...various etiologies that required multiple operations. Anatomical success (attached retina) or failure (totally/partially-detached retina) was assessed biomicroscopically. The BCVA was used for the evaluation of the functional outcome, at presentation and at the end of follow-up. Various pre-, intra-, and postoperative factors were associated with anatomical success or failure as well as with final functionality. Results. The mean number of surgeries was 4 (range: 2 to 10). The anatomical success rate was 80% (56 attached cases, 14 detached cases). 29% of the attached cases had a BCVA better than 20/40 (Snellen chart). The number of operations doesn’t seem to affect significantly the final visual acuity. The PVR was found to affect both the anatomical and functional outcome (P=0.014 & P=0.002, respectively). Conclusions. In the present study, it is suggested that multiple operations for refractory retinal detachment may result in successful anatomic results, with a fare functional outcome at the same time. Eventually, we verified that the existence of PVR worsens the prognosis.
Purpose
It is widely accepted that monocular deprivation results in improved visual performance in the non‐pathological eye. The current study investigates the effect of deprivation due to severe ...impairment in one eye during late childhood or adulthood, on the spatial performance of the fellow ‘good’ eye.
Methods
Twenty patients (age: 29 ± 9 years) with severe visual impairment in one eye (visual acuity equal or worse than count fingers at 1 m), for a period longer than 2 years, participated in the study. Only patients with an age less than 50 years and monocular deprivation onset greater than 9 years were included. On the basis of the time of deprivation the patients were categorised into two subgroups: (i) long‐past deprivation (N = 8, age 28 ± 8 years, 9–20 years of deprivation) and recent deprivation (N = 12, age 30 ± 11 years, 2–4 years of deprivation). Eighteen more participants (age: 28 ± 5 years) with normal binocular vision served as the control group. Best‐corrected contrast sensitivity was evaluated using reversing (2 Hz) vertical sinusoidal gratings. Seven spatial frequencies (1, 2, 4, 8, 12, 16 and 24 c/deg) were tested. Performance of the control group was tested both monocularly (dominant eye) and binocularly.
Results
In normal subjects, binocular viewing improved contrast sensitivity on average by 4.2 dB (corresponding to a 70% improvement in contrast threshold) compared to monocular recordings. Average contrast sensitivity in subjects with impaired vision in one eye was found to be higher by 5.0 dB (corresponding to an 83% improvement in contrast threshold) compared with the dominant eye of the control group. The increase in sensitivity was independent of spatial frequency. No differences were observed between the two subgroups with recent and long‐past deprivation.
Conclusions
Notable improvement in contrast sensitivity was found in the non‐pathological eye of patients with severe impairment in the other eye at an age after the “critical” period of visual development. These findings are consistent with growing evidence supporting functional changes as a result of altered experience or injury in the adult vision system.
Abstract
Purpose: To evaluate combination treatment with reduced-fluence photodynamic therapy (RDPDT) with Verteporfin and intravitreal bevacizumab, compared to bevacizumab alone, for choroidal ...neovascularization (CNV) in age-related macular degeneration. Methods: This was a prospective, randomized comparative study comprising 95 patients with CNV. 49 patients received RDPDT (25 J/cm2) followed by intravitreal bevacizumab 1.25 mg one hour later, while 46 received intravitreal bevacizumab alone. Patients were followed for 12 months at four-week intervals with visual acuity (VA) assessment and Optical Coherence Tomography (OCT) of the macula. Bevacizumab re-injections were performed as needed. Results: On average, patients were re-injected 4.45 times in the combination group and 6.96 times in the bavacizumab group (p < 0.001). At 12 months, VA improved by 8.64 letters in the bevacizumab group and by 8.37 letters in the combination group (p = 0.922). Conclusion: Adding a reduced-fluence PDT arm in combination with bevacizumab offers similar results to those of intravitreal bevacizumab alone with significantly reduced number of injection repetitions.
To compare visual acuity (VA) assessed in healthy eyes and eyes with diabetic retinopathy (DR) using three different logMAR charts: the Sloan letter European-wide chart, the tumbling E chart, and the ...Landolt C chart.
Measurements on one eye of 40 volunteers (aged 29 ± 4 years) without visual impairment and 31 DR patients (aged 70 ± 9 years) with mild/moderate visual impairment were included. Visual acuity was assessed, with habitual refractive correction, using each of the three charts. Bland-Altman charts were constructed, and 95% limits of agreement were calculated to measure agreement.
Mean VA in the group of young adults was -0.05 ± 0.10 (Sloan letter), -0.02 ± 0.13 (tumbling E), and 0.00 ± 0.12 (Landolt C) logMAR. Average VA estimates differed to a statistically significant extent between all charts. Mean VA in the DR group was 0.46 ± 0.25 (Sloan letter), 0.48 ± 0.26 (tumbling E), and 0.59 ± 0.28 (Landolt C). A statistically significant difference was observed for average Sloan letter versus Landolt C (p < 0.001) and tumbling E versus Landolt C (p < 0.001) acuities. Moreover, in healthy eyes, a moderate correlation (r = -0.38, p = 0.015) was found between the discrepancy in Sloan letter and Landolt C acuity and the mean VA estimate. The 95% limits of agreement were wide (more than approximately 0.2 logMAR for each comparison) and wider in the DR group chart comparisons than in healthy eyes.
Landolt C charts resulted in worse VA estimates compared with letter and tumbling E charts in both young adults and visually impaired subjects with DR. These differences seem more pronounced in DR patients who exhibit worse VAs. The specific study population must be considered in comparing outcomes from different clinical practices.
A 69-year-old male patient presented to our department with a 3-month history of nyctalopia. Reviewing of his general health revealed a history of gastrointestinal tumor treated with a modified ...WHIPPLE operation. Ocular findings at presentation included mild xerophthalmic features and nonspecific pigmentary retinal changes. A standard full-field electroretinogram (ERG) was obtained that showed normal photopic function and extinguished scotopic function. The ocular symptoms, the history and the ERG findings suggested vitamin A deficiency as a possible cause for his complaints. Serum vitamin A levels were subsequently requested, but the results were within normal limits. Despite the normal serum vitamin A levels, the patient was instructed to commence treatment with high doses of oral vitamin A supplements. One month after the onset of the treatment, the patient reported that his visual function has significantly improved, while repeat ERG testing revealed that scotopic function has improved to normal levels. This case highlights that in patients with acquired night blindness due to vitamin A deficiency, the ERG responses possibly represent a more sensitive marker compared to the serum levels of vitamin A.
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