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Archives of Ophthalmology current issue

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Prediction of Functional Loss in Glaucoma From Progressive Optic Disc Damage [Clinical Sciences]
Medeiros, F. A., Alencar, L. M., Zangwill, L. M., Bowd, C., Sample, P. A., Weinreb, R. N. 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]
Vinciguerra, P., Albe, E., Trazza, S., Seiler, T., Epstein, D. 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]
Kumar, R. S., Tantisevi, V., Wong, M. H., Laohapojanart, K., Chansanti, O., Quek, D. T., Koh, V. T., MohanRam, L. S., Lee, K. Y., Rojanapongpun, P., Aung, T. 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]
Park, S. C., Lee, D. H., Lee, H. J., Kee, C. 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.

 

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