Ophthalmology RSS : Gourt

U.S. News and World Report-Ranked ‘America’s Top Hospitals’, Major Southwest Metro, #5224 :: Arizona :: Timeline Recruiting

Replete with natural wonders, history & culture, this region has been romancing people with its Old West charm for decades. Residents can also enjoy regional wine & cuisine, and explore a variety of

Detroit Suburb, $200K + potential, Partnership, #3430 :: Michigan :: Timeline Recruiting

Join a dedicated team looking for a partner. The groups founder will be retiring soon and they would like to bring on someone who has aspirations to become a partner after 2 years. The group has a

Ophthalmology Opportunity just East of Champaign, :: Illinois :: Enterprise Medical Service

Well established multi-specialty group in college community in central Illinois in need of Ophthalmologist with Glaucoma fellowship. Financial package to include attractive base guarantee, signing bonus,

Eastern Michigan Seeks another Ophthalmologist :: Michigan :: Enterprise Medical Service

Eastern Michigan community in need of additional general Ophthalmologist to join 2 in private practice. Patient draw area covers 3 counties. Financial package to include attractive income guarantee,

Great Opportunity just outside of St. Louis :: Missouri :: Enterprise Medical Service

Ophthalmologist needed to join VERY successful MSG practice outside St. Louis, MO. Across the board, physicians in top 5% in earnings. 65+ docs in the group. Physician owned and run Multi-Specialty

South Central Michigan - Surg/Ophth Needed :: Michigan :: Enterprise Medical Service

Well established multi-specialty group in south central Michigan in need of 4th Ophththalmologist due to growth. Call 1:4. New Ophthalmologist should be comprehensive and have completed a corneal refractive

Beautiful Emerald Coast Region of Florida :: Florida :: Enterprise Medical Service

Emerald Coast region of Florida's panhandle in need of full time Ophthalmologist due to patient demand. Hospital will assist in establishing of solo practice with income guarantee, signing bonus, marketing

Northwest South Carolina :: South Carolina :: Enterprise Medical Service

NW South Carolina Facility assisting private Ophthalmologist in hiring full time Ophthalmology partner to join him in new state-of-art medical clinic with electronic medical records. Will be busy practice

West Coast Near Tampa :: Florida :: Enterprise Medical Service

Privately owned single specialty Ophthalmology group practice along western coastal Florida in need of hiring additional Ophthalmologist due to growth. Will be joining 5 MDs, 5 Ods, call 1:5, must be

West Central Arkansas :: Arkansas :: Enterprise Medical Service

Wonderful opportunity to establish a solo Ophthalmology practice with 100% hospital support located just over an hour west of Little Rock, AR with excellent payor mix, 170-bed facility, 5 OR Suites.

Northeast Texas :: Texas :: Enterprise Medical Service

Northeast Texas community in need of additional Ophthalmologist due to growth. Financial package to include attractive salary, signing bonus, production bonuses, full benefits package including pension

South Central :: Kansas :: Rural Health Education & Services

KRC.1009.0813.03 BC/BE certified Ophthalmologist needed for a 65 physician multispecialty group. This well-established group is located conveniently near the admitting 200-bed hospital. This is a fee

Not Disclosed :: Texas :: Locum Medical Group

A facility north of Dallas, Texas seeks to hire an Ophthalmologist. Candidates must be either Board Certified or Board Eligible with an active Texas Medical license, DEA and DPS. Work Monday through Friday

Nashville, TN :: Tennessee :: Enterprise Medical Service

Need Ophthalmologist to join 1 other in Single Specialty practice. General or retina Ophthalmologist is acceptable. Must be boarded for consideration. Competitive salary based on academic ranking and

West Coast :: Florida :: Sunbelt Management Associates

This West Coast Florida Healthcare System is looking to employ an ophthalmologist. The ideal physician will be focused on providing unprecedented quality care to the patients they serve and have the

Bristol :: Tennessee :: Wellmont Health System

Ophthalmologist Opportunity In Beautiful Bristol, TN!!!! Adjoining State-of-the-Art cataract and eye center!!! Mountain Empire Eye Physicians of Bristol, TN are seeking an ophthalmologist to fill

McAllen :: Texas :: Eyear Optical

Guaranteed Income, Negotiable Salary Unique opportunity for physician seeking a low stress work environment/lifestyle. OR, if you are considering retirement, are currently semi-retired or fully

McAllen :: Texas :: Eyear Optical

Guaranteed Income, Negotiable Salary Unique opportunity for physician seeking a low stress work environment/lifestyle. OR, if you are considering retirement, are currently semi-retired or fully

Central :: South Carolina :: Medical Search International

OPHTHALMOLOGY - PARTNERSHIP TRACK - PRIVATE GROUP - LAKE FRONT COMMUNITY - GREAT PLACE TO LIVE & PRACTICE - Join 5 Board Certified Ophthalmologists to do General Ophth and possibly have interest or

Central :: Illinois :: Horton Smith Associates

MULTI-SPECIALTY GROUP IN ILLINOIS SEEKS PEDIATRIC OPHTHALMOLOGIST! This highly successful 120-physician multi-specialty group seeks a BE/BC Pediatric Ophthalmologist to join a department that includes

About This Journal [About This Journal]

Prediction of Functional Loss in Glaucoma From Progressive Optic Disc Damage [Clinical Sciences]

Objective To evaluate the ability of progressive optic disc damage detected by assessment of longitudinal stereophotographs to predict future development of functional loss in those with suspected glaucoma. Methods The study included 639 eyes of 407 patients with suspected glaucoma followed up for an average of 8.0 years with annual standard automated perimetry visual field and optic disc stereophotographs. All patients had normal and reliable standard automated perimetry results at baseline. Conversion to glaucoma was defined as development of 3 consecutive abnormal visual fields during follow-up. Presence of progressive optic disc damage was evaluated by grading longitudinally acquired simultaneous stereophotographs. Other predictive factors included age, intraocular pressure, central corneal thickness, pattern standard deviation, and baseline stereophotograph grading. Hazard ratios for predicting visual field loss were obtained by extended Cox models, with optic disc progression as a time-dependent covariate. Predictive accuracy was evaluated using a modified R2 index. Results Progressive optic disc damage had a hazard ratio of 25.8 (95% confidence interval, 16.0-41.7) and was the most important risk factor for development of visual field loss with an R2 of 79%. The R2s for other predictive factors ranged from 6% to 26%. Conclusions Presence of progressive optic disc damage on stereophotographs was a highly predictive factor for future development of functional loss in glaucoma. These findings suggest the importance of careful monitoring of the optic disc appearance and a potential role for longitudinal assessment of the optic disc as an end point in clinical trials and as a reference for evaluation of diagnostic tests in glaucoma.

Intraoperative and Postoperative Effects of Corneal Collagen Cross-linking on Progressive Keratoconus [Clinical Sciences]

Objectives To report intraoperative and 24-month refractive, topographic, tomographic, and aberrometric outcomes after corneal collagen cross-linking in progressive advanced keratoconus. Methods Prospective, nonrandomized single-center clinical study involving 28 eyes. Main outcome measures included uncorrected and best spectacle-corrected visual acuities, sphere and cylinder refraction, topography, tomography, aberrometry, and endothelial cell count evaluated at baseline and follow-up at 1, 3, 6, 12, and 24 months after treatment. Topography was also recorded intraoperatively. Results Two years after treatment, mean baseline uncorrected and best spectacle-corrected visual acuities improved significantly (P = .048 and <.001, respectively) and mean spherical equivalent refraction decreased significantly (P = .03). Mean baseline flattest and steepest meridians on simulated keratometry, simulated keratometry average, mean average pupillary power, and apical keratometry all decreased significantly (P < .03). Deterioration of the Klyce indices was observed in the untreated contralateral eyes but not in treated eyes. Total corneal wavefront aberrations Z0 (piston), Z2 (defocus), and Z7 (III coma) decreased significantly (P ≤ .046). Mean 12-month baseline pupil center pachymetry and total corneal volume decreased significantly (P = .045). Endothelial cell counts did not change significantly (P = .13). Conclusions Two years postoperatively, corneal collagen cross-linking appears to be effective in improving uncorrected and best spectacle-corrected visual acuities in eyes with progressive keratoconus by significantly reducing corneal average pupillary power, apical keratometry, and total corneal wavefront aberrations.

Errors in Author Byline in: Further Insight Into West African Crystalline Maculopathy [Correction]

Plateau Iris in Asian Subjects With Primary Angle Closure Glaucoma [Clinical Sciences]

Objective To determine the prevalence of plateau iris in Asian eyes with primary angle closure glaucoma (PACG) using ultrasound biomicroscopy (UBM). Methods In this cross-sectional observational study, subjects older than 40 years with PACG who had a patent laser peripheral iridotomy underwent UBM in 1 eye. Ultrasound biomicroscopy images were qualitatively analyzed using standardized criteria. Plateau iris in a quadrant was defined by anteriorly directed ciliary body, absent ciliary sulcus, steep iris root from its point of insertion followed by a downward angulation, flat iris plane, and irido-angle contact. At least 2 quadrants had to fulfill these UBM criteria for an eye to be classified as having plateau iris. Results One hundred eleven subjects (70 from Singapore, 41 from Thailand) with PACG were recruited. The mean (SD) age was 65.6 (8.1) years, and 63.9% were female. Based on standardized UBM criteria, plateau iris was found in 36 of 111 eyes (32.4%; 95% confidence interval, 24.4%-41.6%). In these 36 eyes, quadrant-wise analysis showed 66.7% had plateau iris in 2 quadrants; 22.2%, in 3 quadrants; and 11.1%, in all quadrants. Conclusions About 30% of PACG eyes with a patent laser peripheral iridotomy were found to have plateau iris on UBM, highlighting the importance of non–pupil block mechanisms in Asian individuals.

Risk Factors for Normal-Tension Glaucoma Among Subgroups of Patients [Clinical Sciences]

Objective To identify risk factors for normal-tension glaucoma among subgroups of patients. Methods In 93 patients with unilateral normal-tension glaucoma, intereye comparison of baseline spherical equivalent, central corneal thickness, untreated intraocular pressure, disc area, and zone β variables was performed among the following 4 subgroups classified according to age and visual field pattern standard deviation of the eye with glaucoma: subgroup 1 (age ≤50 years and visual field pattern standard deviation ≤8 dB), subgroup 2 (≤50 years and >8 dB), subgroup 3 (>50 years and ≤8 dB), and subgroup 4 (>50 years and >8 dB). Results Fourteen, 27, 30, and 22 patients were included in subgroups 1, 2, 3, and 4, respectively. The untreated intraocular pressure in subgroup 1 (P = .005), the zone β variables in subgroup 2 (P < .001), and both the untreated intraocular pressure (P = .010 and P = .034, respectively) and the zone β variables (P ≤ .008 and P ≤ .006, respectively) in subgroups 3 and 4 were significantly greater in the eyes with glaucoma than in the normal contralateral eyes (by paired t test or Wilcoxon signed rank test). The other variables showed no significant difference between the eyes in any subgroup. Conclusion The zone β variables (and not the untreated intraocular pressure) may represent significant risk factors in young patients having normal-tension glaucoma with moderate to severe visual field loss.

Endothelial Cell Loss and Surgically Induced Astigmatism After Sutureless Large-Incision Manual Cataract Extraction (SLIMCE) [Clinical Sciences]

Objectives To describe a modified manual cataract extraction technique, sutureless large-incision manual cataract extraction (SLIMCE), and to report its clinical outcomes. Methods Case notes of 50 consecutive patients with cataract surgery performed using the SLIMCE technique were retrospectively reviewed. Clinical outcomes 3 months after surgery were analyzed, including postoperative uncorrected visual acuity, best-corrected visual acuity, intraoperative and postoperative complications, endothelial cell loss, and surgically induced astigmatism using the vector analysis method. Results At the 3-month follow-up, all 50 patients had postoperative best-corrected visual acuity of at least 20/60, and 37 patients (74%) had visual acuity of at least 20/30. Uncorrected visual acuity was at least 20/68 in 28 patients (56%) and was between 20/80 and 20/200 in 22 patients (44%). No significant intraoperative complications were encountered, and sutureless wounds were achieved in all but 2 patients. At the 3-month follow-up, endothelial cell loss was 3.9%, and the mean surgically induced astigmatism was 0.69 diopter. Conclusions SLIMCE is a safe and effective manual cataract extraction technique with low rates of surgically induced astigmatism and endothelial cell loss. In view of its low cost, SLIMCE may have a potential role in reducing cataract blindness in developing countries.

Dr Thompson's Eye Water [Ophthalmological Ephemera]

Contributions of the Capsulorrhexis to Straylight [Clinical Sciences]

Objectives To quantify the effect of the capsulorrhexis on straylight and to determine optimal capsulorrhexis size. Methods Fifty-six pseudophakic eyes with intact capsulorrhexis were included in the study. Straylight was measured with a straylight meter before and after pupil dilation. Capsulorrhexis and pupil diameter were measured and opacity of the anterior capsule was graded (on a scale of 0-5) with the slitlamp. Capsulorrhexis size and opacity were compared with the difference in straylight values between natural and dilated pupils. Results The mean capsulorrhexis diameter was 4.5 mm (range, 2.9-6.2 mm). Most anterior capsular rims were opaque in the area of contact with the intraocular lens (62.5% higher than grade 1). Mean straylight before pupil dilation was logs=1.25 (range, 0.68-2.13), which increased to 1.46 (range, 0.88-2.22) after pupil dilation, which corresponds to a 62% increase (P <.001). The effect of capsulorrhexis size and opacity on the increase in straylight in scotopic conditions can be quantified by the following formula: s = 19 x (grading of anterior capsular rim) x (fraction of pupil area covered by rhexis). Conclusions The influence of size and opacity of the capsulorrhexis via straylight is described in a quantitative model. Capsulorrhexis size must be greater than 4 mm to prevent functional problems at night.

Pars Plana Vitrectomy Alone With Diffuse Illumination and Vitreous Dissection to Manage Primary Retinal Detachment With Unseen Breaks [Clinical Sciences]

Objective To report on pars plana vitrectomy with diffuse illumination, wide-angle viewing, and meticulous vitreous dissection for identifying and managing retinal breaks when no breaks were detected before surgery for primary rhegmatogenous retinal detachment. Methods Prospective clinical study of 61 of 800 consecutive eyes (7.6%) (61 of 782 patients) seen at a university hospital during the 48-month study for primary rhegmatogenous retinal detachment in whom no break could be identified preoperatively despite thorough examinations. All of the patients underwent pars plana vitrectomy alone with meticulous peripheral vitreous dissection assisted by diffuse illumination, a wide-angle viewing system, perfluorocarbon liquid, triamcinolone acetonide suspension, and balanced salt solution to identify and manage primary retinal breaks. Results Retinal breaks were found intraoperatively in 60 eyes (98%). In 51 of 61 eyes (84%), balanced salt solution was left in the vitreous cavity. Best-corrected visual acuity was 20/40 or better in 25 of 61 study eyes (41%). Primary retinal reattachment was attained in 60 study eyes (98%). Final reattachment was achieved in all 61 eyes (100%). Conclusions Pars plana vitrectomy alone with diffuse illumination and extensive vitreous dissection led to identification and management of retinal breaks undetectable before surgery, achieving a high primary reattachment rate.

Features and Function of Multiple Evanescent White Dot Syndrome [Clinical Sciences]

Objective To describe and compare the tomographic features and macular abnormalities of multiple evanescent white dot syndrome (MEWDS) during the disease course. Methods In 5 patients (5 eyes) with characteristic MEWDS lesions (hypofluorescent in the late phase of indocyanine green angiography [IA]), results of microperimetric retinal sensitivity examination and IA were compared with findings from enhanced spectral-domain optical coherence tomography (SD-OCT) at diagnosis and until clinical resolution. Results Enhanced SD-OCT revealed moderately reflective focal lesions within the outer photoreceptor layer, where the inner and outer segment junction was disrupted, that corresponded with hypofluorescent areas in the late phase of IA. Areas of decreased retinal sensitivity on microperimetric examination matched areas of disruption in the inner/outer segment junction on SD-OCT images. In the first month after diagnosis, microperimetric examination and enhanced SD-OCT showed a shift in areas of decreased retinal sensitivity and disruption in the inner/outer segment junction from around the optic disc to the temporal macula. Retinal sensitivity and the inner/outer segment junction returned to almost normal in all eyes about a month after diagnosis of MEWDS. Conclusion Enhanced SD-OCT revealed abnormalities in the photoreceptor layer that were specific to MEWDS and that, with retinal shape and function, seemed to change location during clinical recovery from MEWDS.

Error in Text in: Atypical Infectious Nodular Scleritis [Correction]

Incidence of Retinopathy of Prematurity in Infants Born Before 27 Weeks' Gestation in Sweden [Clinical Sciences]

Objective To determine the incidence of retinopathy of prematurity (ROP) in extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period. Methods A national, prospective, population-based study was performed in Sweden from April 1, 2004, to March 31, 2007. The ophthalmologic part of the study was separately organized, and screening for ROP was performed beginning postnatal week 5. The criteria for the treatment of ROP agreed with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. Results During the study, 506 of 707 live-born infants survived until the first eye examination. Of these, 368 (72.7%) had ROP: 37.9% had mild ROP and 34.8% had severe ROP. Ninety-nine infants (19.6%) were treated. Gestational age at birth was a stronger predictor of ROP than was birth weight. A log-linear relationship between severe ROP and gestational age at birth was found in the present cohort, and the risk of ROP was reduced by 50% for each week of increase in gestational age at birth. Conclusions Today, extremely preterm infants are surviving, and this population-based study with ROP as a primary outcome shows a higher incidence of this condition than in previously reported national cohorts.

Descemet Stripping Automated Endothelial Keratoplasty Using Cultured Corneal Endothelial Cells in a Rabbit Model [Laboratory Sciences]

Objective To investigate the feasibility of Descemet stripping automated endothelial keratoplasty (DSAEK) using cultured human corneal endothelial cells (HCECs) in an animal model. Methods Descemet stripping automated endothelial keratoplasty grafts were produced by seeding cultured HCEC suspensions onto human corneal stromal discs. Three insertion techniques were assessed in an ex vivo model. The feasibility of DSAEK grafts with cultured HCECs was examined in a rabbit model. Rabbits received stromal disc transplants with cultured HCECs (c-DSAEK) or without HCECs (controls). Results The HCECs on the DSAEK grafts had a consistent size and polygonal shape. Mean (SD) percentage of cell loss in the taco-folding group (38.7% [5.2%]) was significantly greater than that in the Busin glide (11.6% [1.5%]; P = .001) and lens glide (18.0% [5.4%]; P = .007) groups. Corneal transparency gradually recovered in the c-DSAEK group, whereas edema persisted for up to 28 days in controls. Histologic examination after surgery revealed donor HCECs covering the posterior surface of the graft in the c-DSAEK group. Conclusions Further enhancements of the efficacy and safety of DSAEK using cultured HCECs will make this a clinically feasible alternative therapy for corneal endothelial dysfunction. Clinical Relevance Descemet stripping automated endothelial keratoplasty using cultured HCECs may be a novel therapeutic approach to treat corneal endothelial dysfunction.

Preclinical Evaluation of the Novel Small-Molecule Integrin {alpha}5{beta}1 Inhibitor JSM6427 in Monkey and Rabbit Models of Choroidal Neovascularization [Laboratory Sciences]

Objective To evaluate the pharmacologic activity and tolerability of JSM6427, a potent and first selective small-molecule inhibitor of integrin 5β1, in monkey and rabbit models of choroidal neovascularization (CNV). Methods JSM6427 selectivity for 5β1 was evaluated by in vitro binding assays while the ability of JSM6427 to inhibit CNV was investigated in a laser-induced monkey model and a growth factor–induced rabbit model. Intravitreal injections of JSM6427 (100, 300, or 1000 µg) or vehicle were administered immediately after the CNV induction procedure and at weekly intervals for 4 weeks. Fluorescein angiography was performed weekly. Ocular tolerability was evaluated ophthalmoscopically and histologically in both models; additional assessments in monkeys included electroretinography, biomicroscopy, pathological examination, and analysis of JSM6427 pharmacokinetics. Results JSM6427 was highly selective for the 5β1-fibronectin interaction. Weekly intravitreal injections of JSM6427 resulted in a statistically significant dose-dependent inhibition of CNV in laser-induced and growth factor–induced models without any ocular JSM6427-related adverse effects. JSM6427 was cleared through the systemic circulation with no evidence of systemic accumulation. Conclusions Intravitreal JSM6427 provided dose-dependent inhibition of CNV in monkey and rabbit experimental models. Clinical Relevance JSM6427 may provide a new approach for the treatment of ocular neovascular diseases such as age-related macular degeneration in humans.

Complement Factor H and the Bilaterality of Age-Related Macular Degeneration: The Blue Mountains Eye Study [Epidemiology]

Objective To determine whether complement factor H (CFH Y402H) genotype influences bilateral involvement of age-related macular degeneration (AMD) lesions. Methods The Blue Mountains Eye Study (BMES) followed up 3654 participants 49 years and older (BMES 1, 1992-1994), including 2335 (75.3% of survivors) at the 5-year (BMES 2, 1997-1999) and 1952 (76.5%) at the 10-year (BMES 3, 2002-2004) examinations. Age-related macular degeneration retinal photographic grading used the Wisconsin system. Early and late AMD included prevalent and incident cases from all visits. CFH genotyping used TaqMan assays. Results Of 767 AMD cases, 53.3% of early and 53.1% of late AMD cases were bilateral. After adjusting for age and other covariants, the CFH CC (Y402H polymorphism) genotype was associated with an increased likelihood of bilateral compared with unilateral involvement by any soft drusen (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.4-4.5), distinct soft drusen (OR, 2.8; 95% CI, 1.0-8.1), and pigmentary abnormalities (OR, 1.7; 95% CI, 1.0-2.8). We could not establish significant associations between this genotype and the bilaterality of late AMD (OR, 1.8; 95% CI, 0.4-7.7), either geographic atrophy (OR, 0.6; 95% CI, 0.07-4.6) or neovascular AMD (OR, 3.4; 95% CI, 0.3-41.4). Conclusions Persons with the CFH CC genotype at any given age have an increased likelihood of bilateral compared with unilateral involvement of some early AMD lesions.

Direct and Indirect Effects of Visual Impairment on Mortality Risk in Older Persons: The Blue Mountains Eye Study [Epidemiology]

Objective To investigate pathways from visual impairment to increased all-cause mortality in older persons. Methods The Blue Mountains Eye Study examined 3654 persons 49 years and older (82.4% response) during 1992-1994 and after 5 and 10 years. Australian National Death Index data confirmed deaths until 2005. Visual impairment was defined as presenting, correctable, and noncorrectable, using better-eye visual acuity. Associations between visual impairment and mortality risk were estimated using Cox regression and structural equation modeling. Results After 13 years, 1273 participants had died. Adjusting for mortality risk markers, higher mortality was associated with noncorrectable visual impairment (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.04-1.75). This association was stronger for ages younger than 75 years (HR, 2.58; 95% CI, 1.42-4.69). Structural equation modeling revealed greater effects of noncorrectable visual impairment on mortality risk (HR, 5.25; 95% CI, 1.97-14.01 for baseline ages <75 years), with both direct (HR, 2.16; 95% CI, 1.11-4.23) and indirect (HR, 2.43; 95% CI, 1.17-5.03) effects. Of mortality risk markers examined, only disability in walking demonstrated a significant indirect pathway for the link between visual impairment and mortality. Conclusions Visual impairment predicted mortality by both direct and indirect pathways, particularly for persons younger than 75 years with noncorrectable visual impairment. Disability in walking, which can substantially influence general health, represented a major indirect pathway.

Diabetes, Metabolic Abnormalities, and Glaucoma: The Singapore Malay Eye Study [Epidemiology]

Objective To examine the relationship of diabetes mellitus and metabolic abnormalities with intraocular pressure and glaucoma. Methods A population-based study was conducted in 3280 (78.7% response) Malay adults aged 40 to 80 years. Diabetes was defined as a random serum glucose level of 200 mg/dL or greater or physician diagnosis of diabetes mellitus. Metabolic abnormalities including body mass index, lipid levels, and blood pressure were measured. Glaucoma was defined from a standardized examination by means of the International Society for Geographical and Epidemiological Ophthalmology criteria. Results There were 764 persons (23.3%) who had diabetes. After controlling for age, sex, education, smoking, central corneal thickness, and diabetes treatment, intraocular pressure was higher in persons with than without diabetes (16.7 vs 15.0 mm Hg, P < .001) and in those with higher serum glucose levels (P < .001), glycosylated hemoglobin concentrations (P < .001), total cholesterol levels (P = .001), triglyceride levels (P = .002), and body mass index (P = .001). However, the prevalence of glaucoma was similar between persons with and without diabetes (4.7% vs 4.5%). In multivariate logistic regression models adjusting for age, sex, education, smoking, central corneal thickness, and diabetes treatment, diabetes was not associated with glaucoma (odds ratio, 1.00; 95% confidence interval, 0.63-1.61). Conclusion These data suggest that, although diabetes and metabolic abnormalities may be associated with a small increase in intraocular pressure, they are not significant risk factors for glaucomatous optic neuropathy.

Prevalence and Causes of Visual Impairment in Chinese Adults in Urban Southern China: The Liwan Eye Study [Epidemiology]

Objective To assess the prevalence and causes of visual impairment and blindness in adults living in an urban area of southern China. Methods Random cluster sampling was used to identify the adults 50 years and older living in the Liwan district of Guangzhou, China. Presenting visual acuity (PVA) with habitual correction and best-corrected visual acuity (BCVA) based on autorefraction and subjective refraction were measured using the Early Treatment Diabetic Retinopathy Study visual chart. Blindness and low vision were defined according to World Health Organization criteria. Eyes with visual impairment were assigned 1 principal cause for the impairment. Results Visual acuity measurements were available for 1399 adults 50 years and older (75.3% participation rate). The prevalence of blindness and low vision based on the PVA was 0.6% (95% confidence interval, 0.2%-1.0%) and 10.1% (95% confidence interval, 8.5%-11.7%), respectively. These rates were reduced to 0.5% and 3.1% when the BCVA was considered. Based on the PVA, the principal causes for blindness were cataract (39.6%), glaucoma (11.0%), and myopic maculopathy (6.6%). The majority of low vision cases were attributable to cataract (45.3%) and uncorrected refractive error (43.9%). Conclusion The majority of eye diseases leading to visual impairment are potentially treatable in this population.

Typing of ARMS2 and CFH in Age-Related Macular Degeneration: Case-Control Study and Assessment of Frequency in the Italian Population [Ophthalmic Molecular Genetics]

Objectives To determine the effects of the polymorphisms CFH Tyr402His and ARMS2 del443ins54 on susceptibility to age-related macular degeneration (AMD) and to find the frequencies of these single-nucleotide polymorphisms in an Italian population that was not examined clinically. Methods A total of 286 control subjects (126 men and 160 women) and 159 white patients (73 men and 86 women) harboring exudative AMD in 1 eye were recruited. A third group of 182 DNA samples from blood donors of the same geographical areas were also typed to assess the frequency of CFH Tyr402His and ARMS2 del443ins54 polymorphisms in the general population. The data were analyzed statistically by a standard 2 x 2 table, Fisher exact tests, and odds ratios. Results The deletion-insertion at chromosome 10q26 (del443ins54) showed the strongest association with AMD in terms of both P value and odds ratio (P = 2.7 x 10–15; odds ratio = 3.25), and a highly significant association was also confirmed for Tyr402His at the CFH locus (P = 9.9 x 10–13; odds ratio = 2.86). We found no differences in allele and genotype association between classic and occult choroidal neovascularization. We also observed that 39% of the samples in the general Italian population were at least 5.4 times more likely than control subjects to develop AMD. Conclusions To our knowledge, this is the first confirmation of the association of del443ins54 in Italian patients with AMD, and we also confirmed the association of Tyr402His with CFH. Genetic analysis of the general population suggested that analysis of the ARMS2 and CFH risk alleles alone may be helpful in differentiating high-risk individuals (odds ratio > 5.00) from low-risk individuals (odds ratio < 0.45). Clinical Relevance Individuals at high risk for developing AMD could be identified and selected for specific prevention programs. In this context, the development of prevention programs based on dietary antioxidants or on close monitoring of at-risk individuals should be considered or suggested.

Clinical and Genetic Profile of Avellino Corneal Dystrophy in 2 Families From North India [Ophthalmic Molecular Genetics]

Objective To report Avellino corneal dystrophy and underlying R124H mutation in 2 families of Indian origin. Methods Peripheral blood was collected in EDTA for genomic DNA isolation from leukocytes of all affected and unaffected individuals. Amplification of transforming growth factor β-induced gene (TGFBI) using polymerase chain reaction followed by direct sequencing was carried out to determine the mutations underlying the disorder. A detailed clinical evaluation was undertaken to establish a genotype-phenotype correlation. Results R124H mutation resulting from a missense heterozygous substitution of G to A at nucleotide 418 of TGFBI was detected in all affected members of the 2 families. The affected individuals were clinically diagnosed as having granular corneal dystrophy. Histopathological examination was not done because no surgical intervention was undertaken. Conclusions To our knowledge, this is the first report of Avellino corneal dystrophy from India clinically diagnosed as granular corneal dystrophy, emphasizing that TGFBI screening is essential for the accurate diagnosis and classification of corneal dystrophies. Clinical Relevance Molecular genetics is a useful tool for accurate diagnosis and classification of corneal dystrophies. All autosomal dominant stromal dystrophies should be screened for underlying mutations in TGFBI because the clinical and phenotypic appearance is variable.

The Cost of Care for People With Impaired Vision in Australia [Socioeconomics and Health Services]

Objective To prospectively collect data on the providers, types, and costs of care for people with impaired vision in Australia. Methods Adults with impaired vision, visual acuity worse than 20/40, were recruited from clinics, vision rehabilitation agencies, and support groups. Participants completed daily diaries for 12 months, entering information on the amount of time they used caregivers and providers and types of care. Demographic information was obtained from questionnaires. The cost of care was calculated using mean hourly wage rates. Results The mean age of the 114 participants was 66.5 years (standard deviation [SD], 19.7) with 64% of participants female; 105 of 114 participants relied on a caregiver at least once during the 12 months. The mean amount of yearly caregiver time used was 152.2 hours (SD, 193; median, 81.3; range, 1-851 hours). The median time represents 4.6% of a working week. There were no significant associations of age, sex, type, or place of residence with the amount of care received (P ≥ .1). As most of the caregivers were family members who assisted with transport, written communications, and personal affairs, the "opportunity costs" were calculated. The median annual opportunity cost was A$915 (US $710) (range, $A0-$9653 [US $0-$7491]). Conclusions This study prospectively obtained data for the cost of caregivers for people with impaired vision. The degree of vision impairment was not associated with the amount of care used but showed a threshold effect: when vision is impaired to the extent that people cannot legally hold a driver's license, reliance on caregivers appears to be independent of the severity of loss of vision.

Progressive Optic Disc Change: Implications for Clinical Practice and Trial Design [Editorial]

Canadian Health Care: A Question of Access [Editorial]

Archives Web Quiz Winner [Archives Web Quiz Winner]

The Need for Diversity in Medical Education: Barriers to Be Broken [Editorial]

Interface Wavelike Deposits After Descemet Stripping Automated Endothelial Keratoplasty [Small Case Series]

Clinical and Tomographic Features of Macular Punctate Outer Retinal Toxoplasmosis [Small Case Series]

Central Corneal Thickness and Thickness of the Lamina Cribrosa and Peripapillary Sclera in Monkeys [Research Letters]

Chronic Localized Fibrosing Vasculitis of the Eyelid [Research Letters]