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:

Highlights from this issue
Okada et al (see page 406)

The clinical features of Japanese children and adolescents presenting with uveitis to a tertiary centre were investigated. The majority of patients had bilateral disease and no systemic disease associations. Most eyes had a good visual outcome.

Uji et al (see page 411)

Swept-source optical coherence tomography showed that episclera was remarkably swollen in the eyes with diffuse scleritis. On the other hand, scleral stroma was not definitely swollen in eyes with diffuse scleritis compared with normal eyes.

Gabison et al (see page 418)

Rituximab is an alternative to cyclophosphamide to treat Mooren’s ulcer refractory to local and systemic corticosteroids.

Singh et al (see page 423)

A clinical trial evaluating nepafenac for the prevention of macular oedema showed fewer patients with diabetic retinopathy developed macular oedema following treatment with...

Author: Barton, K., Chodosh, J., Jonas, J. B.
Posted: March 22, 2017, 12:00 am
Case-control study of risk factors for acute corneal hydrops in keratoconus
Purpose

To determine risk factors for the development of acute corneal hydrops in keratoconus in the UK in a case-controlled study.

Methods

Between November 2009 and December 2010, we prospectively identified 73 individuals who developed acute corneal hydrops. We then identified 174 controls from nine regions in the UK with keratoconus who had not had hydrops. For cases and controls we recorded demographics and clinical features. Univariate and multivariable logistic regressions were performed to identify risk factors.

Results

Univariate analysis suggested strong associations between the odds of hydrops and each of vernal keratoconjunctivitis (OR 4.08, 95% CI 1.45 to 11.49, p=0.008), asthma (OR 2.70, CI 1.34 to 5.47, p=0.006), atopic dermatitis (OR 3.13, CI 1.50 to 6.56, p=0.002), learning difficulties (OR 7.84, CI 2.86 to 21.46, p<0.001), previous hydrops (OR 40.2; CI 6.2 to , p<0.001), black ethnicity (OR 2.98, CI 0.98 to 8.99; p=0.05), visual acuity in the worse eye (OR 8.76 CI 3.86 to 19.88; p<0.001) and minimum keratometry of ≥48 D prior to the hydrops (OR 4.91, CI 1.07 to 22.6, p=0.041). The use of a contact lens correction was also found to be associated with the odds of hydrops (OR 0.08; CI 0.03 to 0.19, p<0.001). Multiple variable regression indicated that having vernal keratoconjunctivitis (adjusted OR (AOR) 15, 95% CI 1.30 to 173.7; p=0.03), asthma (AOR 4.92, CI 1.22 to 19.78; p=0.025), visual acuity in worse eye (AOR 4.11, CI 1.18 to 14.32; p=0.026) and a high keratometry value (AOR 4.44, CI 0.85 to 23.18; p=0.077) were independently associated with the odds of hydrops in subjects with keratoconus.

Conclusion

Some individuals with keratoconus are at high risk of developing acute corneal hydrops. These patients could be managed more aggressively to reduce their risk of developing this complication of their disease.

Author: Barsam, A., Brennan, N., Petrushkin, H., Xing, W., Quartilho, A., Bunce, C., Foot, B., Cartwright, N. K., Haridas, A., Agrawal, P., Suleman, H., Ahmad, S., MacDonald, E., Johnston, J., Tuft, S.
Posted: March 22, 2017, 12:00 am
European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition: Part 1: Foreword; Introduction; Glossary; Chapter 1 Patient Examination
Foreword

It gives me pleasure to introduce the 4th edition of the EGS Guidelines. The Third edition proved to be extremely successful, being translated into 7 languages with over 70000 copies being distributed across Europe; it has been downloadable, free, as a pdf file for the past 4 years. As one of the main objectives of the European Glaucoma Society has been to both educate and standardize glaucoma practice within the EU, these guidelines were structured so as to play their part.

Glaucoma is a living specialty, with new ideas on causation, mechanisms and treatments constantly appearing. As a number of years have passed since the publication of the last edition, changes in some if not all of these ideas would be expected.

For this new edition of the guidelines a number of editorial teams were created, each with responsibility for an area within the specialty; updating where necessary, introducing new diagrams and Flowcharts and ensuring that references were up to date. Each team had writers previously involved with the last edition as well as newer and younger members being co-opted.

As soon as specific sections were completed they had further editorial comment to ensure cross referencing and style continuity with other sections.

Overall guidance was the responsibility of Anders Heijl and Carlo Traverso. Tribute must be made to the Task Force whose efforts made the timely publication of the new edition possible.

Roger Hitchings

Chairman of the EGS Foundation

www.eugs.org

The Guidelines Writers and Contributors 

Augusto Azuara Blanco

Luca Bagnasco

Alessandro Bagnis

Keith Barton

Christoph Baudouin

Boel Bengtsson

Alain Bron

Francesca Cordeiro

Barbara Cvenkel

Philippe Denis

Christoph Faschinger

Panayiota Founti

Stefano Gandolfi

David Garway Heath

Francisco Goni

Franz Grehn

Anders Heijl

Roger Hitchings

Gabor Hollo

Tony Hommer

Michele Iester

Jost Jonas

Yves Lachkar

Giorgio Marchini

Frances Meier Gibbons

Stefano Miglior

Marta Misiuk-Hojo

Maria Musolino

Jean Philippe Nordmann

Norbert Pfeiffer

Luis Abegao Pinto

Luca Rossetti

John Salmon

Leo Schmetterer

Riccardo Scotto

Tarek Shaarawy

Ingeborg Stalmans

Gordana Sunaric Megevand

Ernst Tamm

John Thygesen

Fotis Topouzis

Carlo Enrico Traverso

Anja Tuulonen

Ananth Viswanathan

Thierry Zeyen

The Guidelines Task Force 

Luca Bagnasco

Anders Heijl

Carlo Enrico Traverso

Augusto Azuara Blanco

Alessandro Bagnis

David Garway Heath

Michele Iester

Yves Lachkar

Ingeborg Stalmans

Gordana Sunaric Mégevand

Fotis Topouzis

Anja Tuulonen

Ananth Viswanathan

The EGS Executive Committee 

Carlo Enrico Traverso (President)

Anja Tuulonen (Vice President)

Roger Hitchings (Past President)

Anton Hommer (Treasurer)

Barbara Cvenkel

Julian Garcia Feijoo

David Garway Heath

Norbert Pfeiffer

Ingeborg Stalmans

The Board of the European Glaucoma Society Foundation 

Roger Hitchings (Chair)

Carlo E. Traverso (Vice Chair)

Franz Grehn

Anders Heijl

John Thygesen

Fotis Topouzis

Thierry Zeyen

The EGS Committees 

CME and Certification 

Gordana Sunaric Mégevand (Chair)

Carlo Enrico Traverso (Co-chair)

Delivery of Care 

Anton Hommer (Chair)

EU Action 

Thierry Zeyen (Chair)

Carlo E. Traverso (Co-chair)

Education 

John Thygesen (Chair)

Fotis Topouzis (Co-chair)

Glaucogene 

Ananth Viswanathan (Chair)

Fotis Topouzis (Co-chair)

Industry Liaison 

Roger Hitchings (Chair)

Information Technology 

Ingeborg Stalmans (Chair)

Carlo E. Traverso (Co-chair)

National Society Liaison 

Anders Heijl (Chair)

Program Planning 

Fotis Topouzis (Chair)

Ingeborg Stalmans (Co-chair)

Quality and Outcomes 

Anja Tuulonen (Chair)

Augusto Azuara Blanco (Co-chair)

Scientific 

Franz Grehn (Chair)

David Garway Heath (Co-chair)

Posted: March 22, 2017, 12:00 am
Validation of an instrument to assess visual ability in children with visual impairment in China
Objective

To validate a visual ability instrument for school-aged children with visual impairment in China by translating, culturally adopting and Rasch scaling the Cardiff Visual Ability Questionnaire for Children (CVAQC).

Methods

The 25-item CVAQC was translated into Mandarin using a standard protocol. The translated version (CVAQC-CN) was subjected to cognitive testing to ensure a proper cultural adaptation of its content. Then, the CVAQC-CN was interviewer-administered to 114 school-aged children and young people with visual impairment. Rasch analysis was carried out to assess its psychometric properties. The correlation between the CVAQC-CN visual ability scores and clinical measure of vision (visual acuity; VA and contrast sensitivity, CS) were assessed using Spearman's r.

Results

Based on cultural adaptation exercise, cognitive testing, missing data and Rasch metrics-based iterative item removal, three items were removed from the original 25. The 22-item CVAQC-CN demonstrated excellent measurement precision (person separation index, 3.08), content validity (item separation, 10.09) and item reliability (0.99). Moreover, the CVAQC-CN was unidimensional and had no item bias. The person–item map indicated good targeting of item difficulty to person ability. The CVAQC-CN had moderate correlations between CS (–0.53, p<0.00001) and VA (0.726, p<0.00001), respectively, indicating its validity.

Conclusions

The 22-item CVAQC-CN is a psychometrically robust and valid instrument to measure visual ability in children with visual impairment in China. The instrument can be used as a clinical and research outcome measure to assess the change in visual ability after low vision rehabilitation intervention.

Author: Huang, J., Khadka, J., Gao, R., Zhang, S., Dong, W., Bao, F., Chen, H., Wang, Q., Chen, H., Pesudovs, K.
Posted: March 22, 2017, 12:00 am
Inequality in cataract blindness and services: moving beyond unidimensional analyses of social position
Objective

Inequalities in cataract blindness are well known, but data are rarely disaggregated to explore the combined effects of a range of axes describing social disadvantage. We examined inequalities in cataract blindness and services at the intersection of three social axes.

Methods

Three dichotomous social variables (sex (male/female); place of residence (urban/rural); literacy (literate/illiterate)) from cross-sectional national blindness surveys in Pakistan (2001–2004; n=16 507) and Nigeria (2005–2007; n=13 591) were used to construct eight subgroups, with disadvantaged subgroups selected a priori (ie, women, rural dwellers, illiterate). In each data set, the social distribution of cataract blindness, cataract surgical coverage (CSC) and effective cataract surgical coverage (eCSC) were examined. Inequalities were assessed comparing the best-off and worst-off subgroups using rate differences and rate ratios (RRs). Logistic regression was used to assess cumulative effects of multiple disadvantage.

Results

Disadvantaged subgroups experienced higher prevalence of cataract blindness, lower CSC and lower eCSC in both countries. A social gradient was present for CSC and eCSC, with coverage increasing as social position improved. Relative inequality in eCSC was approximately twice as high as CSC (Pakistan: eCSC RR 2.7 vs CSC RR 1.3; Nigeria: eCSC RR 8.7 vs CSC RR 4.1). Cumulative disadvantage was observed for all outcomes, deteriorating further with each additional axis along which disadvantage was experienced.

Conclusions

Each outcome tended to be worse with the addition of each layer of social disadvantage. Illiterate, rural women fared worst in both settings. Moving beyond unidimensional analyses of social position identified subgroups in most need; this permits a more nuanced response to addressing the inequitable distribution of cataract blindness.

Author: Ramke, J., Zwi, A. B., Lee, A. C., Blignault, I., Gilbert, C. E.
Posted: March 22, 2017, 12:00 am
Aquaporin expression in the lacrimal sac of patients with primary and functional nasolacrimal duct obstruction
Purpose

To compare the expression profile of aquaporins (AQPs), a family of membrane proteins that function as selective pores in the epithelium of the lacrimal sac in patients with primary or functional nasolacrimal duct obstruction.

Methods

Forty lacrimal sacs were obtained from 20 patients with primary nasolacrimal duct obstruction (group 1) and 20 patients with functional nasolacrimal duct obstruction (group 2) during endoscopic endonasal dacryocystorhinostomy. Western blot and immunohistochemical analyses were performed to determine the presence and distribution of AQPs in the epithelium and subepithelial glands of the nasolacrimal ducts.

Results

AQP 1, 2, 3, 4 and 5 were identified by western blot analysis. Quantified AQP levels were higher in group 2 than in group 1, although this was not statistically significant (p=0.857 for AQP 1, p=0.370 for AQP 2, p=0.813 for AQP 3, p=0.766 for AQP 4 and p=0.429 for AQP 5 by Mann-Whitney U test). Immunohistochemical analyses revealed AQPs 1, 3, 5, 7 and 10. Expression of AQP 1, 3, 5, 7 and 10 was statistically significantly greater in group 2 than in group 1 (p=0.022 for AQP 1, p=0.028 for AQP 3, p=0.002 for AQP 5, p=0.041 for AQP 7 and p=0.001 for AQP 10 by Mann-Whitney U test).

Conclusions

AQP expression in functional nasolacrimal duct obstruction had a tendency towards being higher than in primary nasolacrimal duct obstruction, although this was only statistically significant on immunohistochemistry.

Author: Park, J., Kim, J., Kim, M., Baek, S.
Posted: March 22, 2017, 12:00 am
Detection of mild papilloedema in posterior uveitis using spectral domain optical coherence tomography
Objective

To compare two methods for diagnosing mild papilloedema (PO) using peripapillary total retinal (PTR) and retinal nerve fibre layer (RNFL) thickness measurement by spectral domain optical coherence tomography (OCT) in patients suffering from posterior uveitis.

Methods

17 eyes in 17 patients with PO caused by posterior uveitis, 15 eyes in 15 patients with uveitis but with no PO based on slit lamp analysis were studied. High-quality OCT fundus images were analysed and graded by three masked observers using the Modified Frisén Scale. Eyes with PO were divided into two subgroups: mild (n=15) and moderate–severe PO (n=2). Two measurement methods were evaluated and compared: RNFL and PTR thickness measurements centred on the optic disc. Thickness values were calculated overall and for each quadrant and compared between groups. The main outcome measures were RNFL and PTR thickness, and thickness variation between control and affected patients for both protocols.

Results

Average RNFL and PTR thickness in the moderate–severe PO, mild PO and control groups were 274.5±54.45 µm, 134±31.69 µm, 97.4±14.43 µm and 722.25±29.34 µm, 437.53±84.47 µm, 327.8±25.92 µm, respectively. Mild PO differed from the control groups according to both the RNLF (p=0.0006) and the PTR (p=0.0002) measurements. The average thickness variation between control and mild PO was significantly different between RNFL and PTR measurements: 36.6 µm vs 109.73 µm (p<0.0001), respectively.

Conclusions

PTR thickness measurement increases the sensitivity of detection of mild PO and could be useful for diagnosing and monitoring papillitis. A new protocol should be developed to measure PTR in the same 3.5 mm disc as the RNFL measurement.

Author: Philiponnet, A., Vardanian, C., Malcles, A., Pochat, C., Sallit, R., Kodjikian, L.
Posted: March 22, 2017, 12:00 am
Strabismus in children with white matter damage of immaturity: MRI correlation
Background/aims

To investigate the correlation between strabismus and the severity of white matter damage of immaturity (WMDI), based on MRI findings. Although strabismus is commonly associated with WMDI, its clinical features are not well established.

Methods

This cross-sectional study involved 73 consecutive patients who visited the department of ophthalmology and were diagnosed with WMDI. The severity of WMDI was graded based on the MRI findings of the patients. All of the patients underwent complete ophthalmic examination, and strabismus was characterised in terms of direction, constancy, and angle of deviation. The prevalence and the characteristics of strabismus and their correlation with the grade of WMDI were investigated.

Results

The perinatal characteristics, age at MRI, and the number of MRIs per child did not differ between different grades of WMDI. Refractive errors, found in 56 (76.7%) patients, did not differ between the grades of WMDI either. Strabismus was observed in 38 (52.1%) patients, and its prevalence increased with the grade of the disorder; 20 patients had exotropia and 18 had esotropia. Constant strabismus was found more frequently in patients with higher grade WMDI. However, the direction and angle of deviation did not differ depending on the grade of WMDI.

Conclusions

The prevalence of strabismus increased with the severity of WMDI and was higher among patients with WMDI than among healthy individuals. The severity of WMDI might be related to the presence and constancy of strabismus.

Author: Jeon, H., Jung, J., Kim, H., Yeom, J. A., Choi, H.
Posted: March 22, 2017, 12:00 am
Clinical features of uveitis in children and adolescents at a tertiary referral centre in Tokyo
Objectives

To analyse clinical features, systemic associations, treatment and visual outcomes of uveitis in children and adolescents at a tertiary centre in Tokyo.

Methods

Clinical records of 64 patients under the age of 20 years who presented between 2001 and 2013 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo were reviewed retrospectively.

Results

Of the 64 patients, there was a predominance of girls (70%) and bilateral disease (81%). Mean age at presentation was 12.9 years (4–19 years). Mean follow-up was 46 months (3–144 months). Anterior uveitis was present in 56.3% of patients, panuveitis in 28.1% and posterior uveitis in 15.6%. No patients had intermediate uveitis. The most common diagnostic designation was unclassified uveitis (57.8%). Systemic associations were observed in 10.9% and no patients were diagnosed with juvenile idiopathic arthritis. Ocular complications were observed in 71.9% of patients, including optic disc hyperemia/oedema (40.6%), vitreous opacification (23.4%), posterior synechia (18.7%), increased intraocular pressure (17.1%) and cataract (14.1%). Six patients underwent intraocular surgery, five for cataract extraction and two for glaucoma control. Twelve patients (18.7%) received some form of systemic therapy either corticosteroids, immunosuppressive drugs or biologic agents. The percentage of eyes with a visual acuity of 1.0 or better was 87.1% at baseline, 91.3% at 6 months, 89.6% at 12 months and 87.5% at 36 months.

Conclusions

The majority of children and adolescents who presented to us with uveitis had bilateral disease and no systemic disease associations. Only one-fifth of patients required systemic therapy to control their ocular inflammation, and most eyes had a good visual outcome.

Author: Keino, H., Watanabe, T., Taki, W., Nakayama, M., Nakamura, T., Yan, K., Okada, A. A.
Posted: March 22, 2017, 12:00 am
Safety and efficacy of a hydroxypropyl guar/polyethylene glycol/propylene glycol-based lubricant eye-drop in patients with dry eye
Aims

To demonstrate non-inferiority of a hydroxypropyl guar/polyethylene glycol/propylene glycol lubricating eye-drop (HPG/PEG/PG) compared with an osmoprotective carboxymethylcellulose/glycerine eye-drop (O/CMC) for ocular surface staining.

Methods

This was a multicentre, randomised, observer-masked, parallel-group study. Adults with dry eye instilled HPG/PEG/PG/ or O/CMC 4 times daily for 35 days and then as needed through day 90. Total ocular surface staining (TOSS) score changes from baseline and Impact of Dry Eye on Everyday Life (IDEEL) treatment satisfaction module scores were assessed. Non-inferiority, based on TOSS score change from baseline, was concluded if the upper limit of the 2-sided CI was <2 units.

Results

Mean±SD patient age was 64.4±13.7 years; 94 patients were randomised to treatment (HPG/PEG/PG, n=46; O/CMC, n=48). Mean±SE TOSS score change from baseline to day 35 was –2.2±0.33 with HPG/PEG/PG and –1.7±0.47 with O/CMC (treatment difference, –0.47±0.47; p=0.38), and the non-inferiority criterion was met. IDEEL treatment satisfaction scores were similar between groups at day 35 and day 90. The most frequently reported adverse event was eye irritation (HPG/PEG/PG, n=2; O/CMC, n=3).

Conclusions

HPG/PEG/PG and O/CMC reduced ocular surface damage, and HPG/PEG/PG was non-inferior to O/CMC. Both treatments were effective, convenient and well tolerated.

Trial registration number

NCT01863368, Results.

Author: Labetoulle, M., Messmer, E. M., Pisella, P.-J., Ogundele, A., Baudouin, C., Baillif-Gostoli, Bohringer, Chiambaretta, Cochener, Gabison, Gabisson, Girard, Gohier, Moremousque, Mouriaux, Touboul, Ziemssen
Posted: March 22, 2017, 12:00 am

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