Opthamologists and opometrists

Ophthalmology Journal News

Welcome to the Ophthalmology Journal News page! This page will showcase the latest news from the world of Ophthalmology, as published by The British Journal of Ophthalmology (BMJ).

For the British Ophthalmology Journal Archives, please visit http://bjo.bmj.com/ .

These news items are mainly specific study results that are relevant to the layman.

We have also added another news page with more ‘general’ Opthalmogy news here: Opthamologist News.

Furthermore, we have added a page with general news articles about Eye Health here:  Eye Problems Articles  , which is a good read for both patients and Ophthalmologists alike.

Enjoy!

Ophthalmology Journal News:

Comparison of choroidal thicknesses using swept source and spectral domain optical coherence tomography in diseased and normal eyes
Background/aims

Choroidal thickness measurements are reported to differ between swept source optical coherence tomography (SS-OCT) and spectral domain OCT (SD-OCT). This study aimed to assess the comparability of choroidal thickness measurements using SS-OCT and SD-OCT devices among patients with retinal diseases and normal participants.

Methods

In a prospective cohort study of 100 subjects, comprising patients with retinal disease and normal volunteers, OCT scans were performed sequentially with the DRI OCT-1 and Spectralis OCT using standardised imaging protocols. Subfoveal choroidal thicknesses were independently measured by masked reading-centre certified graders. Paired t tests and intraclass correlation coefficients (ICCs) were used to compare the measurements.

Results

Among all 100 participants, mean subfoveal choroidal thickness was 264.3 µm and 272.4 µm for DRI OCT-1 and Spectralis OCT respectively (p=0.001), with ICC of 0.989. The mean difference in choroidal thickness between OCT devices was larger among eyes with retinal diseases compared with normal eyes (8.4 µm vs 7.3 µm). Eyes with choroidal thickness ≤200 µm had smaller differences between OCT devices compared with those with thicker choroids (mean 3.6 µm vs 10.0 µm, p=0.021).

Conclusions

Subfoveal choroidal thickness measurements are comparable between DRI OCT-1 and Spectralis OCT. The presence of retinal disease increases the variability of choroidal thickness measurements between OCT devices.

Author: Tan, C. S. H., Ngo, W. K., Cheong, K. X.
Posted: February 18, 2015, 2:18 pm
Rate and timing of spontaneous resolution in a vitreomacular traction group: Should the role of watchful waiting be re-evaluated as an alternative to Ocriplasmin therapy?
Introduction

The incidence of spontaneous resolution of vitreomacular traction (VMT) is low in studies of Ocriplasmin that have had a limited follow-up. Previous studies did not look for morphological parameters in the natural history using spectral-domain ocular coherence tomography (SD-OCT) imaging. The purpose of this study was to investigate how often and when spontaneous VMT resolution occurs in candidates for Ocriplasmin therapy.

Methods

The study is a retrospective chart review of patients who would have high chances of a benefit by an Ocriplasmin injection, without epiretinal membrane or vitreomacular adhesion of 1500 µm or more on SD-OCT. Main outcome measures were the frequency of complete VMT resolution and the best corrected visual acuity seen in the natural history.

Results

Out of the 46 patients that were included after screening 889 SD-OCT images, 20 were found to exhibit spontaneous resolution during the follow-up period (median: 594 days, 95% CI 567 to 719 days), the majority after 6–12 months of observation (95% CI 266 to 617 days). The group with spontaneous VMT resolution and a mean improvement of one line in best corrected visual acuity included a few patients losing vision by macular hole formation. In the absence of resolution, patients lost on average one early treatment diabetic retinopathy study letter per year. Younger age was found to increase the chance of spontaneous resolution.

Conclusions

A shorter follow-up might underestimate the incidence of spontaneous VMT resolution as the functional outcome of watchful waiting. The likelihood of resolution does not seem to decrease after 12 months.

Author: Dimopoulos, S., Bartz-Schmidt, K.-U., Gelisken, F., Januschowski, K., Ziemssen, F.
Posted: February 18, 2015, 2:18 pm
Morphological characteristics of conjunctival squamous papillomas in relation to human papillomavirus infection
Objective

To determine the prevalence of a broad spectrum of human papillomavirus (HPV) types in conjunctival papillomas and a possible difference in clinical and histopathological presentation of HPV-positive and HPV-negative papillomas.

Methods

Formalin-fixed, paraffin-embedded papilloma tissue specimens obtained from 25 patients were analysed using six different PCR-based methods targeting 87 HPV types from four different papillomavirus (PV) genera: α-PV, β-PV, -PV and µ-PV, and in situ hybridisation for HPV-6/HPV-11. Slides were reviewed for pedunculated or sessile growth, the presence of goblet cells, keratinising or non-keratinising epithelium, elastosis, atypia and koilocytes.

Results

α-PV types HPV-6 and HPV-11 were detected in 19/25 (76%) conjunctival papilloma tissue specimens, 9 (47%) of which were also HPV-6/HPV-11 positive with in situ hybridisation. Six different β-PV types—HPV-9, HPV-12, HPV-20, HPV-21, HPV-22, HPV-24—were additionally detected in four cases, all of which were also HPV-6/HPV-11 positive. No -PVs or µ-PVs were found in any of the tested tissues samples. Extralimbal location (p=0.021), presence of goblet cells (p=0.005), non-keratinising squamous epithelium (p=0.005), and absence of elastosis (p=0.005) were associated with the presence of HPV-6/HPV-11.

Conclusions

We demonstrated that certain clinical and histological features are more frequently associated with HPV infection and that HPV genera other than α-PV are most probably not significant factors in conjunctival papilloma occurrence.

Author: Mlakar, J., Kocjan, B. J., Hosnjak, L., Pizem, J., Beltram, M., Gale, N., Drnovsek-Olup, B., Poljak, M.
Posted: February 18, 2015, 2:18 pm
Mutation spectrum of CYP1B1 in Chinese patients with primary open-angle glaucoma
Purpose

The CYP1B1 gene has been shown to be related to primary open-angle glaucoma (POAG). This study aimed to identify the mutation profile of CYP1B1 in Chinese individuals with POAG.

Methods

The study included 416 unrelated cases diagnosed as POAG by standard ophthalmological examinations, and 657 unrelated healthy controls in a Chinese population. Genomic DNA was collected from peripheral blood of all the participants. The coding sequence of CYP1B1 was amplified by PCR from genomic DNA, followed by direct DNA sequencing.

Results

Among 416 patients with POAG, 13 missense mutations, including nine reported mutations and four novel mutations (p.P93S, p.R259C, p.A295T, p.L475P), were detected in 25 patients. All these mutations were found as heterozygotes and the reported mutations have been previously found in primary congenital glaucoma and/or POAG patients. Three of them (p.L107V, p.E229K, p.V320L) were also found in healthy controls. In addition, six previously reported single nucleotide polymorphisms (p.R48G, p.A119S, p.V243V, p.V432L, p.D449D, p.N453S) were also observed in POAG patients and controls, and they showed no obvious frequency difference between patients and controls.

Conclusions

This study provides a mutation spectrum of CYP1B1 resulting in POAG development in a Chinese population, which may demonstrate an involvement of the gene in a proportion of subjects with POAG and help to improve our understanding of the pathogenesis of CYP1B1-associated POAG.

Author: Gong, B., Qu, C., Li, X., Shi, Y., Lin, Y., Zhou, Y., Shuai, P., Yang, Y., Liu, X., Zhang, D., Yang, Z.
Posted: February 18, 2015, 2:18 pm
Structural and functional outcomes of anaesthetic cornea in children
Aim

To present visual and structural outcomes from the largest series to date of children with absent corneal sensation, and contribute recommendations for management.

Methods

A two-centre retrospective cohort of 33 eyes of 26 children was studied. Data regarding cause of corneal anaesthesia (CA), visual acuity (VA), complications and management were recorded.

Results

The most common underlying causes of CA were posterior fossa tumours (8), CA with somitic abnormalities (5), cerebellar hypoplasia (3), severe head trauma (3) and isolated CA (3). Median follow-up was 361/2 months. Coexisting facial palsy was prevalent with 18 patients (69%) being affected. At final follow-up, 4/27 eyes (15%) with VA measures had VA 0.3 logMAR or better; 15/27 (56%) had VA 0.3–1.0 logMAR; and 8/27 (30%) had VA worse than 1.0 logMAR. Seven of eight eyes with final VA worse than 1.0 logMAR had coexisting facial palsy. Only one of these eyes with facial palsy had a permanent tarsorrhaphy before VA fell below 1.0 logMAR. Also, of the nine eyes with facial palsy and a best-recorded VA better than 1.0 logMAR at final follow-up, five had a permanent tarsorrhaphy. Corneal scarring was present in 24/33 (73%) of eyes by final follow-up. 15/33 (45%) had at least one episode of microbial keratitis. The first presentation was with this complication in 9/26 (35%) children.

Discussion

CA in children is a vision-threatening problem, which has a particularly poor prognosis when associated with facial nerve palsy. Earlier tarsorrhaphy should be considered to help preserve vision in eyes with CA and coexisting facial palsy.

Author: Lambley, R. G., Pereyra-Munoz, N., Parulekar, M., Mireskandari, K., Ali, A.
Posted: February 18, 2015, 2:18 pm
Does cognitive impairment influence outcomes from cataract surgery? Results from a 1-year follow-up cohort study
Background/aims

To assess the impact of impaired cognition on visual outcomes 1 year following cataract surgery in a cohort of older people.

Methods

Participants aged 75 years or more with bilateral cataract and scheduled for cataract surgery were recruited consecutively. Cognition was assessed using the revised Addenbrooke's cognitive examination (ACE-R). Participants were divided into two groups: normal (ACE-R ≥88) and impaired cognition (ACE-R <88). Visual quality of life (VQOL) and logarithm of minimum angle of resolution visual acuity (VA) were assessed at baseline and 1 year following cataract surgery.

Results

Of 112 participants, 48 (43%) had normal cognition and 64 (57%) had impaired cognition. One year following cataract surgery participants in both groups had significant improvements in VQOL and VA. Visual outcomes at 1 year were significantly better in participants with normal cognition than in those with impaired cognition (95% CIs for difference 0.4–7.0 and 0.02–0.1, for VQOL and VA, respectively). Regression analyses correcting for potential confounders showed a relationship between baseline cognition and VA at 1 year (R2=0.30, p=0.001) and a possible relationship between baseline cognition and VQOL at 1 year (R2=0.41, p=0.01, this became insignificant after removal of outliers).

Conclusions

Patients with impaired cognition benefit from cataract surgery, but not to the same extent as patients with normal cognition.

Author: Jefferis, J. M., Taylor, J.-P., Clarke, M. P.
Posted: February 18, 2015, 2:18 pm
Clinical outcomes and surgeon assessment after implantation of a new diffractive multifocal toric intraocular lens
Purpose

To evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL).

Methods

Prospective, non-randomised multicentre clinical study including 57 eyes of 38 consecutive patients with an age between 37 and 84 years that underwent cataract surgery with implantation of the toric multifocal IOL Tecnis ZMT (Abbott Medical Optics, Santa Ana, California, USA). Changes in uncorrected and corrected logMAR distance, intermediate and near visual acuity ((uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), corrected near visual acuity) and manifest refraction were evaluated during a 2–4 month follow-up. Additionally, patients were asked about photic phenomena and spectacle dependence. The surgeons subjectively assessed various aspects of the surgery.

Results

A significant improvement in CDVA was observed postoperatively (p<0.01), with a significant reduction in manifest cylinder (p<0.01). Mean postoperative binocular UDVA and UNVA were 0.04±0.10 and 0.06±0.12, respectively. Monocular UDVA and UNVA was 0.20 or better in 85.4% and 87.0% of eyes, respectively. Mean binocular logMAR UIVA was 0.21±0.20. Only 10.5% of patients required postoperative correction for near or intermediate distance. The incidence of moderate to severe photic phenomena was limited. Surgeons defined the IOL implantation in most cases as easy or very easy, with a satisfaction rate with the procedure of 84%.

Conclusions

The implantation of the multifocal toric IOL is a safe procedure that provides a very good visual rehabilitation in eyes with corneal astigmatism.

Author: Kretz, F. T. A., Bastelica, A., Carreras, H., Ferreira, T., Muller, M., Gerl, M., Gerl, R., Saeed, M., Schmickler, S., Auffarth, G. U.
Posted: February 18, 2015, 2:18 pm
An evaluation of cataract surgery clinical practice guidelines
Purpose

This study used the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument to evaluate the methodological quality of clinical practice guidelines (CPG) published by the American Academy of Ophthalmology (AAO), Canadian Ophthalmological Society (COS) and Royal College of Ophthalmologists (RCO) for the management of cataract in adults.

Study design

An evaluation of the AAO, COS and RCO CPGs using a reliable and validated instrument.

Methods

Four evaluators independently appraised the three CPGs using the AGREE II Instrument, which covers six domains (Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability and Editorial Independence). The AGREE II includes an Overall Assessment summarising guideline methodological rigour across all domains, using a 7-point scale where perfect adherence equals a score of 7.

Results

Scores ranged from 36% to 75% for the AAO guideline; 45% to 94% for the COS guideline and 23% to 85% for the RCO guideline. Intraclass correlation coefficients for the reliability of mean scores for the AAO, COS, and RCO were 0.78, 0.74 and 0.80; 95% CIs (0.60 to 0.90), (0.45 to 0.88) and (0.53 to 0.91), respectively. The strongest domains were Scope and Purpose (COS, RCO), Clarity of Presentation (COS, RCO) and Editorial Independence (AAO, COS). The weakest were Stakeholder Involvement (AAO), Applicability (AAO, COS) and Editorial Independence (RCO).

Conclusions

Cataract surgery practice guidelines can be improved by targeting stakeholder involvement, applicability and editorial independence.

Author: Wu, C. M., Wu, A. M., Young, B. K., Wu, D., Chen, A., Margo, C. E., Greenberg, P. B.
Posted: February 18, 2015, 2:18 pm
Suction posterior capsulorhexis: an audit of 15 years' experience
Aims

To audit the results of 15 years’ experience of suction posterior capsulorhexis (SPC) during phacoemulsification and compare the outcomes with a recently published multicentre audit of cataract surgery, the Cataract National Dataset (CND).

Methods

Prospective cohort observational study.

Setting

Ophthalmology department of a district general hospital.

Results

Data collection ran from June 1998 to November 2013, and 866 eyes of 786 patients were included. The mean (SD) age was 70.7 (12.4) years with 62% women. Low levels of perioperative and postoperative complications were noted, and the visual outcomes at 2 weeks in this audit were significantly better than those of the CND, with 75.4% achieving a best-corrected vision of ≥6/6 and 87.3% ≥6/12, improving to 95.8% and 100%, respectively, for best-case analysis (p<0.001 for all comparisons). 99% achieved the same or a better postoperative visual acuity than preoperatively compared with 95% in the CND (p<0.001) and none lost two lines of Snellen acuity (versus 1.24%; p<0.001). Patients receiving one of the two designs of square-edged hydrophobic acrylic intraocular lenses used in this audit did not require later YAG laser treatment compared with 2.72% of those who had a polymethylmethacrylate intraocular lens (p<0.02). Biometry accuracy was within ±1.0 D of the predicted refraction in 89.3%.

Conclusions

SPC, when performed by an experienced surgeon, appears to achieve better visual outcomes than the CND without causing harm to patients nor adversely affecting biometry accuracy. Use of a hydrophobic acrylic intraocular lens with SPC may avoid the need for subsequent YAG laser therapy.

Author: Hugkulstone, C. E.
Posted: February 18, 2015, 2:18 pm
Comparison of conventional versus crossed monovision in pseudophakia
Aims

To compare the visual performances and patient satisfactions of conventional monovision, which corrects the dominant eye for distance vision, and crossed monovision, which corrects the non-dominant eye for distance vision in patients with pseudophakia.

Methods

This prospective randomised study was conducted in 59 patients who underwent implantation of different targets of monofocal intraocular lens for each eye at Konkuk University Medical Center between November 2009 and August 2012. The following were examined before bilateral cataract surgery and 2 months after the surgery: refractive error, binocular uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best corrected visual acuity (BCVA) and stereopsis. Questionnaires to evaluate postoperative spectacle dependence and patient satisfaction were completed by all patients.

Results

The conventional monovision group and the crossed monovision group were composed of 28 and 31 patients, respectively. There were no significant differences in postoperative UCDVA, UCNVA, BCVA and stereopsis between the two groups. In addition, patient satisfaction with near and distant vision and spectacle dependence were not significantly different in the two groups.

Conclusions

The clinical results of the crossed monovision were not significantly different from the results of conventional monovision. Therefore, crossed monovision can also be a valuable option for correcting postoperative presbyopia in patients considering bilateral cataract surgery.

Trial registration number

KCT0001065

Author: Kim, J., Shin, H. J., Kim, H. C., Shin, K. C.
Posted: February 18, 2015, 2:18 pm

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