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Reviewers Who Completed a Review During 2009 [Annual Reviewers List]

About This Journal [About This Journal]

Randomized Trial of Effect of Bifocal and Prismatic Bifocal Spectacles on Myopic Progression: Two-Year Results [Clinical Trial]

Objective To determine whether bifocal and prismatic bifocal spectacles could control myopia in children with high rates of myopic progression. Methods This was a randomized controlled clinical trial. One hundred thirty-five (73 girls and 62 boys) myopic Chinese Canadian children (myopia of ≥1.00 diopters [D]) with myopic progression of at least 0.50 D in the preceding year were randomly assigned to 1 of 3 treatments: (1) single-vision lenses (n = 41), (2) +1.50-D executive bifocals (n = 48), or (3) +1.50-D executive bifocals with a 3–prism diopters base-in prism in the near segment of each lens (n = 46). Main Outcome Measures Myopic progression measured by an automated refractor under cycloplegia and increase in axial length (secondary) measured by ultrasonography at 6-month intervals for 24 months. Only the data of the right eye were used. Results Of the 135 children (mean age, 10.29 years [SE, 0.15 years]; mean visual acuity, –3.08 D [SE, 0.10 D]), 131 (97%) completed the trial after 24 months. Myopic progression averaged –1.55 D (SE, 0.12 D) for those who wore single-vision lenses, –0.96 D (SE, 0.09 D) for those who wore bifocals, and –0.70 D (SE, 0.10 D) for those who wore prismatic bifocals. Axial length increased an average of 0.62 mm (SE, 0.04 mm), 0.41 mm (SE, 0.04 mm), and 0.41 mm (SE, 0.05 mm), respectively. The treatment effect of bifocals (0.59 D) and prismatic bifocals (0.85 D) was significant (P < .001) and both bifocal groups had less axial elongation (0.21 mm) than the single-vision lens group (P < .001). Conclusions Bifocal lenses can moderately slow myopic progression in children with high rates of progression after 24 months. Applications to Clinical Practice Bifocal spectacles may be considered for slowing myopic progression in children with an annual progression rate of at least 0.50 D. Trial Registration clinicaltrials.gov Identifier: NCT00787579

The Infant Aphakia Treatment Study: Design and Clinical Measures at Enrollment [Clinical Trial]

Objective To compare the use of contact lenses and intraocular lenses (IOLs) for the optical correction of unilateral aphakia during infancy. Methods In a randomized, multicenter (12 sites) clinical trial, 114 infants with unilateral congenital cataracts were assigned to undergo cataract surgery with or without IOL implantation. Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL treatment had their aphakia treated with a contact lens. Main Outcome Measures Grating acuity at 12 months of age and HOTV visual acuity at 41/2 years of age. Application to Clinical Practice This study should determine whether either treatment for an infant with a visually significant unilateral congenital cataract results in a better visual outcome. Results Enrollment began December 23, 2004, and was completed January 16, 2009. The median age at the time of cataract surgery was 1.8 months. Fifty patients were 4 to 6 weeks of age at the time of enrollment; 32, 7 weeks to 3 months of age; and the remaining 32, more than 3 to less than 7 months of age. Fifty-seven children were randomized to each treatment group. Eyes with cataracts had shorter axial lengths and steeper corneas on average than the fellow eyes. Conclusions The optimal optical treatment of aphakia in infants is unknown. However, the Infant Aphakia Treatment Study was designed to provide empirical evidence of whether optical treatment with an IOL or a contact lens after unilateral cataract surgery during infancy is associated with a better visual outcome. Trial Registration clinicaltrials.gov Identifier: NCT00212134

Outbreak of Acquired Ocular Toxoplasmosis Involving 248 Patients [Clinical Sciences]

Objective To describe the demographic profile and clinical and laboratory findings of 248 patients with acquired retinitis caused by systemic infection with toxoplasmosis in a presumed outbreak of the disease. Design Retrospective observational case series. Results Most patients (209) were residents of one city in Southern India. A total of 35 patients had a prodrome of fever, and 242 patients had unilateral retinitis without associated old retinochoroidal scars. All had laboratory evidence of acquired systemic infection with Toxoplasma gondii, and all favorably responded to antitoxoplasma therapy. Toxoplasma IgM and IgG antibodies were detected, suggesting recently acquired systemic disease. Complications seen were macular scars in 50 eyes (25.1%); epiretinal membranes, 23 eyes (11.5%); cataract, 5 eyes (2.5%); posterior vitreous detachment, 12 eyes (6%); and retinal detachment, 12 eyes (6%). One recurrence has been seen. The suspected source of infection is municipal drinking water. Conclusion Large numbers of residents of any age in a population are at risk of acquiring ocular disease during an outbreak of toxoplasmosis, which can go unnoticed, and can cause significant ocular morbidity.

High Caloric and Sodium Intakes as Risk Factors for Progression of Retinopathy in Type 1 Diabetes Mellitus [Clinical Sciences]

Objective To report the association of dietary nutrient intakes in relation to the 6-year progression of diabetic retinopathy (DR) in African American patients with type 1 diabetes mellitus. Methods African American patients with type 1 diabetes who participated in the baseline and 6-year follow-up examinations as part of the New Jersey 725 study were included. At the baseline examination, a food frequency questionnaire was used to document average daily dietary nutrient intakes. Clinical evaluations at baseline and at the 6-year follow-up also included a structured clinical interview, ocular examination, grading of 7 standard field stereoscopic fundus photographs, and blood pressure measurements. Biological evaluations included blood and urine assays. Nutrient intake data were analyzed using DietSys software and nutrient databases developed by the National Cancer Institute. Results Among the 469 participants at risk for progression of DR, baseline total caloric intake was significantly associated with 6-year incidence of vision-threatening DR (either proliferative DR or macular edema) and of severe hard exudates—after adjusting for clinical risk factors for DR progression. Baseline high sodium intake was a significant and independent risk factor for 6-year incidence of macular edema. Conclusions In African American patients with type 1 diabetes, high caloric and sodium intakes are significant and independent risk factors for progression to severe forms of DR. Dietary recommendations of low caloric and sodium intakes may be beneficial in relation to the development of DR.

Prevalence and Risk Factors of Retinopathy in an Asian Population Without Diabetes: The Singapore Malay Eye Study [Clinical Sciences]

Objective To describe the prevalence and risk factors of retinopathy in an Asian population without diabetes. Methods We conducted a population-based, cross-sectional study of 3280 Malays aged 40 to 80 years residing in Singapore. Participants had retinal photographs taken, which were graded for retinopathy signs using the modified Airlie House Classification System. Risk factors were assessed from standardized interviews, clinical examinations, and laboratory investigations. Results Of participants without diabetes (n = 2500), 149 (6.0%; 95% confidence interval [CI], 5.0-6.9) had signs of retinopathy that represented minimal (5.8%) or mild (0.2%) retinopathy. After adjusting for multiple covariables, higher serum glucose levels (odds ratio [OR], 1.13; 95% CI, 1.00-1.28; per millimole per liter increase), higher systolic blood pressure (OR, 1.15; 95% CI, 1.06-1.25; per 10–mm Hg increase), higher body mass index (OR, 1.04; 95% CI, 1.00-1.07 per point increase), and a history of heart attack (OR, 2.68; 95% CI, 1.48-4.83) were significantly associated with the presence of retinopathy lesions in persons without diabetes. Conclusions Similar to studies in white individuals, signs of retinopathy are common in Asian persons without diabetes. Early signs of retinopathy in persons without diabetes are related to metabolic and vascular risk factors and may indicate intermediate pathologic changes along the pathway to cardiovascular disease.

Fundus Autofluorescence Imaging of the White Dot Syndromes [Clinical Sciences]

Objective To characterize the fundus autofluorescence (FAF) findings in patients with white dot syndromes (WDSs). Methods Patients with WDSs underwent ophthalmic examination, fundus photography, fluorescein angiography, and FAF imaging. Patients were categorized as having no, minimal, or predominant foveal hypoautofluorescence. The severity of visual impairment was then correlated with the degree of foveal hypoautofluorescence. Results Fifty-five eyes of 28 patients with WDSs were evaluated. Visual acuities ranged from 20/12.5 to hand motions. Diagnoses included serpiginous choroidopathy (5 patients), birdshot retinochoroidopathy (10), multifocal choroiditis (8), relentless placoid chorioretinitis (1), presumed tuberculosis-associated serpiginouslike choroidopathy (1), acute posterior multifocal placoid pigment epitheliopathy (1), and acute zonal occult outer retinopathy (2). In active serpiginous choroidopathy, notable hyperautofluorescence in active disease distinguished it from the variegated FAF features of tuberculosis-associated serpiginouslike choroidopathy. The percentage of patients with visual acuity impairment of less than 20/40 differed among eyes with no, minimal, and predominant foveal hypoautofluorescence (P < .001). Patients with predominant foveal hypoautofluorescence demonstrated worse visual acuity than those with minimal or no foveal hypoautofluorescence (both P < .001). Conclusions Fundus autofluorescence imaging is useful in the evaluation of the WDS. Visual acuity impairment is correlated with foveal hypoautofluorescence. Further studies are needed to evaluate the precise role of FAF imaging in the WDSs.

Retinoschisis Detected With Handheld Spectral-Domain Optical Coherence Tomography in Neonates With Advanced Retinopathy of Prematurity [Clinical Sciences]

Objectives The recent development of handheld spectral-domain optical coherence tomography (HHSD-OCT) has enabled us to obtain high-resolution retinal scans of premature infants with retinopathy of prematurity (ROP). The purpose of this study is to document HHSD-OCT findings in laser-treated neonates with progressive ROP. Methods This is a retrospective consecutive case series of 3 patients with progressive ROP despite laser photocoagulation. All patients were transferred from peripheral neonatal intensive care units (NICUs) to the Children's Hospital Los Angeles. All patients had a complete ocular examination, fundus photography, fluorescein angiography, and HHSD-OCT. Results All 3 patients had active progressive ROP despite prior laser photocoagulation. Of the 6 eyes, 1 was excluded from the study because it had an exudative retinal detachment following laser photocoagulation. Retinal detachment was not detected on clinical examination in the 5 remaining eyes, although there was vitreoretinal traction at the ridges of 3 of the 5 eyes. The HHSD-OCT identified presumed retinoschisis in all 5 study eyes. Conclusions Tractional retinoschisis may be an important finding in progressive laser-treated ROP, made possible by use of the HHSD-OCT. This finding may have significant implications for how we classify and treat patients whose ROP is progressing despite laser treatment. Furthermore, the use of the HHSD-OCT can provide valuable insight into the interaction of the retina, vitreous, and ridge in patients with progressive ROP, and it allows shallow detachments and retinoschisis to be diagnosed earlier and more accurately than would otherwise be possible.

Dr Thompson's Eye Water [Ophthalmological Ephemera]

Endothelial Cell Density to Predict Endothelial Graft Failure After Penetrating Keratoplasty [Clinical Sciences]

Objective To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema. Methods In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail. Results Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (±95% confidence interval) of failure was 13% (±12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm2 vs 2% (±3%) for the 137 participants with a 6-month ECD of 2500 cells/mm2 or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm2. Conclusions Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm2. Clinical Trial Registry clinicaltrials.gov Identifier: NCT00006411

Recognition Acuity, Grating Acuity, Contrast Sensitivity, and Visual Fields in 6-Year-Old Children [Clinical Sciences]

Objective To measure monocular distance visual acuity (VA), grating VA, contrast sensitivity, and visual field extent in full-term, 6-year-old children. Methods Subjects were 59 healthy full-term children aged 5.8 to 6.3 years who had no ocular abnormalities and no myopia of 1.00 diopter (D) or greater, hyperopia of 4.00 D or greater, astigmatism of 1.50 D or greater, or anisometropia of 1.50 D or greater spherical equivalent or cylinder, as evaluated by a standard eye examination with cycloplegic refraction. All were tested monocularly for recognition acuity (Early Treatment Diabetic Retinopathy Study VA charts), grating acuity (Teller acuity cards), contrast sensitivity (Pelli-Robson contrast sensitivity charts), and visual field extent (white-sphere kinetic perimetry). Results Right and left eye values did not differ significantly. Mean values for the right eye were 0.040 logMAR (SD, 0.075 log units) for Early Treatment Diabetic Retinopathy Study VA, 24.5 cycles per degree (SD, 0.3 octaves) for grating acuity, and 1.63 (SD, 0.12 log units) for contrast sensitivity. Mean visual field extent for the inferonasal, superonasal, superotemporal, and inferotemporal meridians was 59.1° (SD, 9.7°), 57.8° (SD, 9.6°), 71.2° (SD, 12.3°), and 100.4° (SD, 6.6°), respectively. Conclusions The results provide additional normative monocular data on visual function in 6-year-old children and indicate that their thresholds are less than those of adults for distance recognition VA, grating VA, and contrast sensitivity, but similar to those of adults for white-sphere kinetic perimetry.

Confocal Microscopy of Corneal Wound Healing After Deep Lamellar Keratoplasty in Rabbits [Laboratory Sciences]

Objective To compare wound healing and morphologic characteristics of the host-donor interface in rabbit corneas after maximum-depth and near–Descemet membrane anterior lamellar keratoplasty. Design Descriptive analysis of confocal microscopy images after 2 types of deep lamellar keratoplasty (deep stromal dissection vs total stromal resection). Methods Deep anterior lamellar keratoplasty (DALK) was performed in 16 rabbit eyes, with exposure of the Descemet membrane in 8 eyes (deep group) and deep stromal dissection to near the Descemet membrane in 8 eyes (near group). A full-thickness graft devoid of endothelium and Descemet membrane was sutured in place. Confocal examination of lamellar interface and wound edge was performed throughout 6 months. Results Four days postoperatively, confocal microscopy revealed numerous highly reflective keratocytes at and adjacent to the interface in all eyes, fewer in the deep than the near group. Keratocyte density and reflectivity returned to normal at 4 to 6 weeks (deep) and 8 to 10 weeks (near) postoperatively. Conclusions In the deep group, the smooth interface showed less scarring. In the near group, stroma-to-stroma healing stimulated more activated keratocytes and hence more haze. Successful DALK requires minimal central healing for clarity but significant suture-stimulated healing at the edge to prevent corneal bulge. Clinical Relevance Deep anterior lamellar keratoplasty is rarely accompanied by rejection, avoids entrance into the anterior chamber, and can be performed with tissue that does not have living keratocytes. Interface healing is a determinant of the final visual acuity; depth of the lamellar bed is a major determinant of the healing response. Although dissection to bare the Descemet membrane is more difficult, there is less keratocyte activation and scarring.

Subconjunctival Delivery of Antibiotics in a Controlled-Release System: A Novel Anti-infective Prophylaxis Approach for Cataract Surgery [Laboratory Sciences]

Objective To compare the efficacy of subconjunctival injection of a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL, in a controlled-release system (DuoCat) with that of ciprofloxacin hydrochloride, 0.3%, eyedrops for infection prophylaxis. Methods Rabbit eyes were injected subconjunctivally with a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL, or ciprofloxacin hydrochloride, 2 mg/0.1 mL, alone. The aqueous and vitreous humor pharmacokinetic profiles were compared with those of a single drop of ciprofloxacin hydrochloride, 0.3%, 6 times daily. In 45 rabbits, Staphylococcus aureus was injected into the anterior chamber: 15 randomly received 1 drop of ciprofloxacin hydrochloride, 0.3%, every 4 hours during 24 hours; 15 received drops of balanced salt solution; and 15 received a combination of triamcinolone and ciprofloxacin hydrochloride, 2 mg/0.1 mL. After 24 hours, endophthalmitis scores were recorded, aqueous and vitreous humors underwent culture, and histologic analysis was performed. Results The combined triamcinolone and ciprofloxacin treatment allowed higher intraocular levels of ciprofloxacin. The median endophthalmitis clinical scores for the combination of triamcinolone and ciprofloxacin and ciprofloxacin-only eyedrop groups were equivalent (P = .42) and were significantly lower than those of the balanced salt solution group (P < .001). The culture was negative for S aureus in the combined triamcinolone and ciprofloxacin and ciprofloxacin eyedrop regimens. No adverse effects were observed with either route. Conclusions Ciprofloxacin eyedrops and combined triamcinolone and ciprofloxacin were equally tolerated and efficacious. The combined triamcinolone and ciprofloxacin treatment may eliminate noncompliance issues and may prove to be a valuable clinical tool for surgical prophylaxis. Clinical Relevance The combined triamcinolone and ciprofloxacin treatment may be a new useful strategy for surgical prophylaxis.

Measuring Refraction in Adults in Epidemiological Studies [Epidemiology]

Objective To compare refraction measured before and after pharmacologic cycloplegia. Methods This study used preliminary data from the Beaver Dam Offspring Study, which includes adult children of participants in the population-based Epidemiology of Hearing Loss Study of older adults living in Beaver Dam, Wisconsin. Data were available for 5018 eyes of 2529 participants. Refraction was defined by the spherical equivalent (SE), using autorefractor readings. Differences were calculated as the SE after drops were administered minus the SE before drops were administered. Myopia was defined as SE of –1 diopter (D) or less; emmetropia, as SE more than –1 D and less than 1 D; and hyperopia, as SE of 1 D or more. Results The mean age was 48 years (range, 22-84 years). The mean difference in SE between measurements before and after cycloplegia was 0.29 D (95% confidence interval, 0.28-0.31). The difference decreased with age and varied by refractive status for participants younger than 50 years, with the largest differences observed among young persons with hyperopic refractive errors. Across all age groups, agreement on classifications of refraction was high (84%-92%). Conclusions Overall, clinically inconsequential differences were observed between SEs before and after pharmacologic cycloplegia, suggesting that cycloplegia may not be necessary in epidemiological studies of refraction in adults.

Minimal Clinically Important Difference for the Ocular Surface Disease Index [Socioeconomics and Health Services]

Objective To assess the minimal clinically important difference (MCID) for the Ocular Surface Disease Index (OSDI; Allergan Inc, Irvine, California, holds the copyright), a 12-item patient-reported outcome questionnaire designed to quantify ocular disability due to dry eye disease. Methods Study data were collected within the Restasis Review of Efficacy and Safety vs Tears in the Relief of Dry Eye (RESTORE), an observational registry. A clinician global impression (CGI) and a subject global assessment (SGA) served as anchors to estimate the MCID for the overall OSDI score (range, 0-100). The overall OSDI score defined the ocular surface as normal (0-12 points) or as having mild (13-22 points), moderate (23-32 points), or severe (33-100 points) disease. RESTORE patients were included if they completed the OSDI at the baseline visit and at a follow-up visit and had a global change rating (SGA or CGI). Results Three hundred ten patients were included (82.3% white and 81.6% female [mean age, 57.8 years]). The CGI and SGA correlated with the OSDI score change for all OSDI categories except the normal category. The MCID ranged from 7.0 to 9.9 for all OSDI categories. The MCID ranged from 4.5 to 7.3 for mild or moderate disease and from 7.3 to 13.4 for severe disease. Conclusions Using observational data, we estimated the MCIDs for different baseline OSDI categories of dry eye disease. These results will assist clinicians and researchers when interpreting OSDI score changes.

Association Between Erythropoietin Gene Polymorphisms and Diabetic Retinopathy [Ophthalmic Molecular Genetics]

Objective To determine whether sequence variation in the erythropoietin gene (EPO) is associated with the development of diabetic retinopathy (DR). Methods This was a multicenter study based on 518 subjects with long-standing diabetes mellitus (DM), 173 with type 1 DM (T1DM) and 345 with type 2 DM (T2DM). Study groups consisted of 233 control subjects with no DR, 155 subjects with nonproliferative DR, 126 with proliferative DR, and 90 with clinically significant macular edema. Subjects with end-stage renal disease were excluded. DNA extracted from blood of each subject was genotyped for 3 EPO single-nucleotide polymorphisms (SNPs). Results All 3 SNPs in EPO were associated with overall DR status in the combined T1DM and T2DM and T2DM alone groups (CC genotype of rs507392, P < .008; GG genotype of rs1617640, P < .008; and CC genotype of rs551238, P < .008) in the multivariate analysis. The GCC haplotype was also associated with overall DR status in the combined DM and T2DM alone groups (P = .008) by multivariate analysis. All SNPs and the GCC haplotype were also associated with proliferative DR and clinically significant macular edema in the combined DM and T2DM alone groups. No associations were found with T1DM alone. Conclusion Sequence variation in EPO is associated with the risk of DR independent of duration of DM, degree of glycemic control, and nephropathy. Clinical Relevance Identifying EPO genetic markers for high risk of developing DR could lead to the possibility of developing novel treatments or preventive therapies.

Genotype-Phenotype Correlation for Leber Congenital Amaurosis in Northern Pakistan [Ophthalmic Molecular Genetics]

Objectives To report the genetic basis of Leber congenital amaurosis (LCA) in northern Pakistan and to describe the phenotype. Methods DNA from 14 families was analyzed using single-nucleotide polymorphism and microsatellite genotyping and direct sequencing to determine the genes and mutations involved. The history and examination findings from 64 affected individuals were analyzed to show genotype-phenotype correlation and phenotypic progression. Results Homozygous mutations were found in RPGRIP1 (4 families), AIPL1 and LCA5 (3 families each), and RPE65, CRB1, and TULP1 (1 family each). Six of the mutations are novel. An additional family demonstrated linkage to the LCA9 locus. Visual acuity, severe keratoconus, cataract, and macular atrophy were the most helpful features in predicting the genotype. Many of the phenotypic variables became more prevalent with increasing age. Conclusions Leber congenital amaurosis in northern Pakistan is genetically heterogeneous. Mutations in RPGRIP1, AIPL1, and LCA5 accounted for disease in 10 of the 14 families. This study illustrates the differences in phenotype, for both the anterior and posterior segments, seen between patients with identical or different mutations in the LCA genes and also suggests that at least some of the phenotypic variation is age dependent. Clinical Relevance The LCA phenotype, especially one including different generations in the same family, may be used to refine a molecular diagnostic strategy.

August 2009 Archives Web Quiz Winner [Archives Web Quiz Winner]

Use of a Microvascular Clip for Iris Fixation of an Intraocular Lens: A Laboratory Model [Surgical Technique]

Here we present a potential novel surgical technique consisting of fixation of a posterior-chamber intraocular lens to the iris that may be used in the treatment of aphakia or the management of intraocular lens complications when capsular support has been compromised. The technique was performed in a laboratory model using cadaveric human eyes. A commercially available neurovascular clip was used to securely fasten the intraocular lens to the iris with minimal trauma. The use of a metal clip has the advantage of avoiding potential risks of suture fixation such as suture breakage. Also, this technique is easier than suturing and may potentially serve as another tool in a cornea surgeon's armamentarium.

Simulating Vision With and Without Macular Disease [Special Article]

Conventional photographs do not show how, at any moment of visual fixation, neural vision is clear only in the foveal center. We have developed new computer simulations to show both normal vision and vision with macular disease. These simulations show the nature of momentary vision for life tasks such as reading, facial recognition, and walking in the street. They also dramatically show the impact of macular disease (with scotomas and visual distortion), as there is no surrounding region of clarity. We hope these images will be instructive to both physicians and patients.

Colorful Visual Experiences During Cataract Surgery [Ophthalmic Images]

An Epidemic of Toxoplasmosis: Lessons From Coimbatore, India [Editorial]

Informing Patient Choice and Consent: What Patients Really Want and Need to Know [Editorial]

Idiopathic Orbital Inflammation and Graves Ophthalmopathy [Small Case Series]

Delayed Diagnosis of Microcystic Adnexal Carcinoma in Progressive Eyelid Distortion [Small Case Series]

Cost Analysis of Povidone-Iodine for Ophthalmia Neonatorum Prophylaxis [Research Letters]

Shifting Distribution of Chicago-Area Acanthamoeba Keratitis Cases [Research Letters]

Marked Cup Reversal Presumably Associated With Scleral Biomechanics in a Case of Adult Glaucoma [Research Letters]

Characterization of Retinal Nerve Fiber Layer in Nonglaucomatous Eyes With Tilted Discs [Research Letters]

Intraretinal Neovascularization in Diabetic Retinopathy [Research Letters]

Glomus Cell Tumor of the Orbit [Research Letters]

Association of Proliferative Diabetic Retinopathy With Insulin Use and Microalbuminuria [Letters]

Association of Proliferative Diabetic Retinopathy With Insulin Use and Microalbuminuria--Reply [Letters]

Controversies of Diagnosing Autoimmune Retinopathy [Letters]

Controversies of Diagnosing Autoimmune Retinopathy--Reply [Letters]