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Focuses on the demand for ophthalmologists based on current market demand and based on public health needs in the United States. Treatment of eye diseases; Work role of ophthalmologists versus optometrists; Efforts to improve the eye care needs in U.S.

This article focuses on Ocular Hypertension Treatment Study (OTHS). The OTHS, a landmark trial in glaucoma therapy, has definitely answered the question "Does lowering intraocular pressure (IOP) in persons with elevated IOP but no glaucoma damage reduce the incidence of glaucoma?", confirming most ophthalmologist knew that treatment works. There is a flip side to the treatment of fewer patients because of ocular hypertension because of the OTHS results and that is the likelihood of treatment of more patients whose glaucoma whose IOP is within the normal range.

Objective: To determine whether racial disparities exist in the use of ancillary testing to evaluate individuals with open-angle glaucoma. Methods: We identified all enrollees aged 40 years and older in a large US managed care network with retinal or optic nerve conditions that could warrant the use of ancillary testing. Among persons with open-angle glaucoma or glaucoma suspects, we performed repeated-measures multivariable logistic regression to determine the odds and probabilities each year of undergoing visual field testing, fundus photography, and other ocular imaging for black, white, Hispanic, and Asian American men and women and compared the groups. Results: Among the 797 879 eligible enrollees, 149 018 individuals had open-angle glaucoma. The odds of undergoing visual field testing decreased for all groups from 2001 through 2009, decreasing most for Hispanic men and women (63% and 57%, respectively) (adjusted odds ratio [AOR], 0.37; 95% CI, 0.31-0.43 and AOR, 0.43; 95% CI, 0.37-0.50, respectively) and least (36%) for Asian American men (AOR, 0.64; 95% CI, 0.51-0.80). By comparison, the odds of undergoing other ocular imaging increased for all groups from 2001 through 2009, increasing most (173%) for black men and women (AOR, 2.73; 95% CI, 2.34-3.18 for men and AOR, 2.73; 95% CI, 2.40- 3.09 for women) and least (77%) for Hispanic women (AOR, 1.77; 95% CI, 1.49-2.09). Conclusion: Hispanic men and women had considerably reduced odds of undergoing visual field testing and other ocular imaging compared with other groups during the decade. Although increases in glaucoma testing have been noted in recent years among Hispanic men and women for some types of ancillary tests, efforts should be made to better understand and overcome some of the persistent barriers to monitoring for glaucoma in this group. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether Fuchs endothelial corneal dystrophy (FECD) severity is associated with glaucoma and/or ocular hypertension (G/OHTN). Methods: A subset of eyes (n=1610) from the FECD Genetics Multi-Center Study were examined to estimate the association between FECD severity (grades 0-6 based on guttae confluence) and G/OHTN. Logistic regression models that accounted for the correlation between eyes and adjusted for age, sex, central corneal thickness, intraocular pressure, presence of diabetes, and time of day of the initial evaluation were fit. Results: A total of 107 eyes (6.6%) had G/OHTN based on the study definition. The prevalence of G/OHTN in the control group was 6.0%. The prevalence was lower in index cases with an FECD grade of 1 through 3 and family members with a grade of 0 or 1 through 3 (0.0% and 2.1%, respectively) but higher in index cases and family members with a grade of 4 through 6 (11.2% and 8.5%, respectively). Adjusting for covariates, eyes with a grade of 4 through 6 were more likely to have concurrent G/OHTN than eyes with no FECD (index cases vs controls: odds ratio [OR]=2.10, P=.04; affected vs unaffected family members: OR=7.06, P=.07). Age (OR=1.06 per 1-year increase, P<.001) and intraocular pressure (OR=1.15 per 1-mm Hg increase, P<.001) were also associated with an increased prevalence of G/OHTN. Sex, diabetes, time of day of evaluation, and central corneal thickness were not associated with the prevalence of G/OHTN (P<.15). Conclusions: Glaucoma and/or ocular hypertension occurs more often in eyes with severe FECD compared with unaffected eyes. Therefore, it may be beneficial to monitor for the development of glaucoma in these patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of cataract surgery on subjective quality of vision. Methods: The Quality of Vision (QoV) questionnaire (Italian translation) was completed before and 3 months after cataract surgery in 4 groups of patients recruited from September through December 2010: first eye with ocular comorbidity, first eye without ocular comorbidity, second eye with ocular comorbidity, and second eye without ocular comorbidity. The questionnaire measures 3 aspects of quality of vision: frequency, severity, and bothersome nature of symptoms. The Lens Opacities Classification System (LOCS) III was used for cataract grading. Friedman and Kruskal-Wallis H tests were performed to compare QoV scores within and between groups. Spearman rank correlations (rs) were calculated to investigate the correlation between LOCS III and QoV symptoms. Results: Two hundred twelve patients (mean [SD] age, 74.2 [8.7] years) were recruited, and 212 eyes were included in the study. Improvements in QoV scores were found in all 4 groups (P<.05). There were no statistically significant (P<.05) differences among the 4 groups in the improvement in QoV scores or in the preoperative or postoperative scores. Blurred vision was correlated with posterior subcapsular cataract (rs=0.420, P=.04). Conclusions: Cataract in one or both eyes causes a similar loss in subjective quality of vision, which is also irrespective of the presence of ocular comorbidity. Posterior subcapsular cataract causes the specific symptom "blurred vision." Cataract surgery resulted in a large and comparable improvement in subjective quality of vision, regardless of ocular comorbidity and first or second eye surgery. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of an automated, interactive, telephone-based health communication intervention for improving glaucoma treatment adherence among patients in 2 hospital-based eye clinics. Method: A total of 312 patients with glaucoma (18-80 years of age) were enrolled in a randomized controlled trial at 2 eye clinics located in hospitals in the southeastern United States. These patients were considered nonadherent because they did not take their medication, refill their medication, and/or keep their appointments. The treatment group received an automated, interactive, tailored, telephone-based health communication intervention and tailored print materials. The control group received usual care. Main Outcome Measures: Adherence with medication taking, prescription refills, and appointment keeping measured by interviews, medical charts, appointment records, and pharmacy data. Results: A statistically significant increase was found for all adherence measures in both the intervention and control groups. Interactive telephone calls and tailored print materials did not significantly improve adherence measures compared with controls. Conclusions: During the study period, patient adherence to glaucoma treatment and appointment keeping improved in both study arms. Participation in the study and interviews may have contributed. Strategies that address individuals' barriers and facilitators may increase the impact of telephone calls, especially for appointment keeping and prescription refills. Application to Clinical Practice: Glaucoma patient care should include reminders about consistent use of medication and the importance of keeping appointments. More frequent, and personalized, telephone contact may be helpful to patients who are known to be nonadherent. [ABSTRACT FROM AUTHOR]

Objectives: To estimate the long-term cumulative incidence of and risk factors for retinal detachment (RD) after phacoemulsification using linked administrative medical data. Methods: We used the Western Australian Data Linkage System to identify patients who underwent phacoemulsification in Western Australia between January 1989 and December 2001. Retinal detachment cases were those patients requiring admission for RD surgery after phacoemulsification that were validated by medical record review. Kaplan-Meier analysis was used to calculate a cumulative incidence. Cox proportional hazards regression modeling was used to determine the association between RD and risk factors, including patient demographics and operative and hospital factors. Some important risk factors, including axial length and Nd: YAG laser capsulotomy, were not examined. Objectives: To estimate the long-term cumulative incidence of and risk factors for retinal detachment (RD) after phacoemulsification using linked administrative medical data. Methods: We used the Western Australian Data Linkage System to identify patients who underwent phacoemulsification in Western Australia between January 1989 and December 2001. Retinal detachment cases were those patients requiring admission for RD surgery after phacoemulsification that were validated by medical record review. Kaplan-Meier analysis was used to calculate a cumulative incidence. Cox proportional hazards regression modeling was used to determine the association between RD and risk factors, including patient demographics and operative and hospital factors. Some important risk factors, including axial length and Nd: YAG laser capsulotomy, were not examined. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether Fuchs endothelial corneal dystrophy (FECD) severity is associated with glaucoma and/or ocular hypertension (G/OHTN). Methods: A subset of eyes (n=1610) from the FECD Genetics Multi-Center Study were examined to estimate the association between FECD severity (grades 0-6 based on guttae confluence) and G/OHTN. Logistic regression models that accounted for the correlation between eyes and adjusted for age, sex, central corneal thickness, intraocular pressure, presence of diabetes, and time of day of the initial evaluation were fit. Results: A total of 107 eyes (6.6%) had G/OHTN based on the study definition. The prevalence of G/OHTN in the control group was 6.0%. The prevalence was lower in index cases with an FECD grade of 1 through 3 and family members with a grade of 0 or 1 through 3 (0.0% and 2.1%, respectively) but higher in index cases and family members with a grade of 4 through 6 (11.2% and 8.5%, respectively). Adjusting for covariates, eyes with a grade of 4 through 6 were more likely to have concurrent G/OHTN than eyes with no FECD (index cases vs controls: odds ratio [OR]=2.10, P=.04; affected vs unaffected family members: OR=7.06, P=.07). Age (OR=1.06 per 1-year increase, P<.001) and intraocular pressure (OR=1.15 per 1-mm Hg increase, P<.001) were also associated with an increased prevalence of G/OHTN. Sex, diabetes, time of day of evaluation, and central corneal thickness were not associated with the prevalence of G/OHTN (P<.15). Conclusions: Glaucoma and/or ocular hypertension occurs more often in eyes with severe FECD compared with unaffected eyes. Therefore, it may be beneficial to monitor for the development of glaucoma in these patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of an automated, interactive, telephone-based health communication intervention for improving glaucoma treatment adherence among patients in 2 hospital-based eye clinics. Method: A total of 312 patients with glaucoma (18-80 years of age) were enrolled in a randomized controlled trial at 2 eye clinics located in hospitals in the southeastern United States. These patients were considered nonadherent because they did not take their medication, refill their medication, and/or keep their appointments. The treatment group received an automated, interactive, tailored, telephone-based health communication intervention and tailored print materials. The control group received usual care. Main Outcome Measures: Adherence with medication taking, prescription refills, and appointment keeping measured by interviews, medical charts, appointment records, and pharmacy data. Results: A statistically significant increase was found for all adherence measures in both the intervention and control groups. Interactive telephone calls and tailored print materials did not significantly improve adherence measures compared with controls. Conclusions: During the study period, patient adherence to glaucoma treatment and appointment keeping improved in both study arms. Participation in the study and interviews may have contributed. Strategies that address individuals' barriers and facilitators may increase the impact of telephone calls, especially for appointment keeping and prescription refills. Application to Clinical Practice: Glaucoma patient care should include reminders about consistent use of medication and the importance of keeping appointments. More frequent, and personalized, telephone contact may be helpful to patients who are known to be nonadherent. Trial Registration: clinicaltrials.gov Identifier: NCT00794170 [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between retinal arteriolar and venular diameter and the 6-year incidence of cardiovascular disease and mortality among African Americans with type 1 diabetes mellitus. Methods: Included were 468 African Americans with type 1 diabetes mellitus who participated in the New Jersey 725 and who had undergone a 6-year follow-up examination. At both baseline and 6-year follow-up, hypertension and presence of heart disease, stroke, or lower extremity arterial disease (LEAD) were documented and confirmed by review of hospital admission and medical records. Computer-assisted grading from digitized images of retinal photographs was accomplished to determine the average diameter of retinal arterioles (central retinal arteriolar equivalent) and venules (central retinal venular equivalent). Retinal vessel diameter size was examined in relation to the 6-year incidence of hypertension, any cardiovascular disease (heart disease, stroke, or LEAD), heart disease or stroke, LEAD, and mortality. Results: Narrower central retinal arteriolar equivalent at baseline significantly and independently predicted 6-year incidence of any cardiovascular disease and LEAD, whereas larger retinal venular diameter at baseline significantly and independently predicted 6-year incidence of hypertension. Proteinuria and retinopathy severity at baseline were stronger predictors of mortality than retinal vascular diameter. Conclusion: In African Americans with type 1 diabetes mellitus, baseline retinal vessel caliber is an independent predictor of incident hypertension and LEAD. [ABSTRACT FROM AUTHOR]

Objectives: To project the clinical impact of routine glaucoma screening on visual outcomes in middle-aged African American individuals and help guide glaucoma screening policy. Methods: Using data from the Eye Diseases Prevalence Research Group and Baltimore Eye Study, we developed a microsimulation model to project visual outcomes in African American individuals screened for glaucoma under a national screening policy using frequency-doubling technology.Weprojected the impact of universal screening on glaucoma-related visual impairment (acuity worse than 20/40 but better than 20/200 in the better-seeing eye) and blindness (acuity 20/200 or worse in the betterseeing eye). The diagnostic characteristics of frequencydoubling technology and the hazard ratio for glaucoma progression in treated patients were informed by metaanalyses of randomized controlled trials. Results: Implementation of a national glaucoma screening policy for a cohort of African American individuals between the ages of 50 and 59 years without known glaucoma would reduce the lifetime prevalence of undiagnosed glaucoma from 50% to 27%, the prevalence of glaucoma- related visual impairment from 4.6% to 4.4% (4.1% relative decrease), and the prevalence of glaucomarelated blindness from 6.1% to 5.6% (7.1% relative decrease). We project the cost of the program to be $80 per screened individual, considering only the cost of frequency- doubling technology and confirmatory eye examinations. The number needed to screen to diagnose 1 person with glaucoma is 58. The number needed to screen to prevent 1 person from developing visual impairment is 875. Conclusions: Routine glaucoma screening for middleaged African American individuals is potentially clinically effective but its impact on visual impairment and blindness may be modest. However, we did not assess the impact on visual field loss. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of race, demographic, and ocular variables on optic nerve head and retinal nerve fiber layer (RNFL) thickness measurements using spectral-domain optical coherence tomography. Methods: In a cross-sectional observational study, 284 normal subjects aged 18 to 84 years were evaluated at 7 sites using Cirrus HD-OCT. Disc area, rim area, average cup-disc ratio, vertical cup-disc ratio, cup volume, and average, temporal, superior, nasal, and inferior RNFL thicknesses were calculated. The main outcome measures were associations between Cirrus HD-OC Toptic nerve head and RNFL measurements and age, sex, and race. Results: The 284 subjects self-identified as being of European (122), Chinese (63), African (51), or Hispanic (35) descent. After adjusting for the effect of age, there was a statistically significant difference among racial groups for all optic nerve head and RNFL parameters (all P⩽.005) except rim area (P=.22). Rim area, average cup-disc ratio, vertical cup-disc ratio, and cup volume were moderately associated with disc area (r2=0.15, 0.33, 0.33, and 0.37, respectively). After a linear adjustment for disc area, there was no statistically significant difference among racial groups for any optic nerve head parameter. Individuals of European descent had thinner RNFL measurements except in the temporal quadrant. Conclusions: There are racial differences in optic disc area, average cup-disc ratio, vertical cup-disc ratio, cup volume, and RNFL thickness as measured by Cirrus HDOCT. These differences should be considered when using Cirrus HD-OCT to assess for glaucomatous damage in differing population groups. [ABSTRACT FROM AUTHOR]

Objective: To study trends of glaucoma medication expenditure from 2001 to 2006 using a nationally representative sample of US adults. Methods: We analyzed glaucoma medication expenditure trends among participants of the 2001-2006 Medical Expenditure Panel Survey, a sub sample of the National Health Interview Survey, which is a continuous multipurpose, multistage area probability survey of the US civilian non-institutionalized population. After adjusting for survey design and inflation using the 2009 inflation index, data from 1404 participants 18 years and older using glaucoma medication were analyzed. Results: Mean annual glaucoma medication expenditure per subject increased from $445 in 2001 to $557 in 2006 (slope=20.8; P<.001). Subgroup analysis showed expenditure increased significantly in women (P=.02), those with public-only insurance (P<.001), and those with less than a high school education (P<.008). Over the survey period, a significant decrease in expenditures on β-blockers (P=.048) and significant increases in expenditures on prostaglandin analogs (P=.01) and α-agonists (P=.01) were found. Conclusions: Factors associated with increasing glaucoma medication expenditure trends include the increasing use of prostaglandin analogs, changes in insurance coverage, and possibly more aggressive glaucoma treatment. The findings are pertinent to the development of cost-effective strategies that optimize treatment and reduce expenditures. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the neuroprotective effect of short-term hyperglycemia on the retinal ganglion cell body and axon in a rat model of experimental glaucoma. Methods: Using a well-described limbal laser technique, unilateral ocular hypertension was induced in 2 groups (26 per group) of Sprague-Dawley rats. One group remained normoglycemic; the other was rendered hyperglycemic by means of an intraperitoneal injection of streptozocin. After 2 weeks of elevated intraocular pressure, axonal and retinal damage profiles were compared using several histological techniques. Immunohistochemical changes in the retina and optic nerve were also assessed. Results: We found convincing evidence of delayed axonal degeneration and retinal ganglion cell death in hyperglycemic rats. Axon loss was reduced by about 50% 2 weeks after induction of ocular hypertension. Survival of retinal ganglion cell perikarya increased to a similar extent in hyperglycemic rats. Conclusions: The optic nerve and retinal ganglion cells are partially protected by short-term hyperglycemia in this rat model of experimental glaucoma. Energy substrate availability may therefore play a role in glaucomatous optic neuropathy. Clinical Relevance: Our findings, to some extent, support the claims of the Ocular Hypertension Treatment Study, in which diabetes appeared to protect against the conversion to glaucoma. Targeted manipulation of neuronal energy metabolism may delay optic nerve degeneration and may represent a novel neuroprotective strategy for neurodegenerative diseases of the visual system such as glaucoma. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence, characteristics, and risk factors for myopic retinopathy in a rural population in Northern China. Methods: The Handan Eye Study is a population based study of eye disease in rural Chinese individuals 30 years or older. Eligible residents underwent a detailed ophthalmic examination including standardized visual acuity tests and retinal photography after pupil dilation. Myopic retinopathy was defined to include signs of staphyloma, lacquer cracks, Fuchs spot, and myopic chorioretinal atrophy. Results: Of the 6830 participants, 6603 (96.7%) had gradable photographs in at least 1 eye for assessment of myopic retinopathy. The mean (SD) age was 51.9 (11.8) years. Myopic retinopathy was observed in 60 participants (84 eyes), a person-specific prevalence of 0.9% (95% confidence interval, 0.7%-1.1%). Twenty-four (40.0%) had bilateral disease. Higher myopic retinopathy prevalence was associated with older age (P<.001) and increasing myopic spherical equivalent refractive error (P<.001). Mean (SD) spherical equivalent refraction was -12.3 (6.1) diopters for eyes with myopic retinopathy compared with -1.6 (1.6) diopters in myopic eyes without myopic retinopathy (P<.001). Bilateral blindness or low vision as defined by best-corrected visual acuity was present in 14 participants (24.6%) with myopic retinopathy. Staphyloma was the most frequent myopic retinopathy sign (86.9%), followed by chorioretinal atrophy (56.0%), lacquer cracks (36.9%), and Fuchs spot (14.3%). Conclusions: Myopic retinopathy was detected in 0.9% of rural Chinese individuals 30 years or older. The prevalence of myopic retinopathy was lower than that in the Beijing Eye Study but was similar to white individuals of similar age in the Australian Blue Mountains Eye Study. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the incidence of postoperative complications arising in the first year after trabeculectomy and combined phacotrabeculectomy in eyes with primary angle-closure glaucoma (PACG) vs those with primary open-angle glaucoma (POAG). Methods: This was a retrospective study of all glaucoma operations done at a Singapore hospital from January 9, 2001, to December 30, 2004. The types of glaucoma surgery included trabeculectomy and phacotrabeculectomy, all with mitomycin C or fluorouracil. The incidences of postoperative complications and reoperations were analyzed. For those who underwent bilateral or repeated operations, only the first operated eye of each subject was included. Results: A total of 446 subjects with PACG (112 who underwent trabeculectomy and 334 who underwent phacotrabeculectomy) and 816 subjects with POAG (208 who underwent trabeculectomy and 608 who underwent phacotrabeculectomy) were analyzed. Postoperative complications occurred in 65 of 1262 eyes (5.2%) overall, with 27 eyes (8.4%) in the trabeculectomy group (PACG: 8.0%; 95% confidence interval [CI], 4.3%- 14.6%; POAG: 8.7%; 95% CI, 5.5%-13.3%; P>.99) and 38 eyes (4.0%) in the phacotrabeculectomy group (PACG: 5.1%; 95% CI, 3.2%-8.0%; POAG: 3.5%; 95% CI, 2.3%- 5.2%; P=.31). The rate of complications was significantly higher in the trabeculectomy group than the phacotrabeculectomy group overall (P=.003), but there was no significant difference between the POAG and PACG groups overall (POAG: 4.8%; 95% CI, 3.5%- 6.5%; PACG: 5.8%; 95% CI, 4.0%-8.4%; P=.53). The commonest complication found was hypotony with overfiltration (23 cases [1.8%]), followed by bleb leak (11 cases [0.9%]). There was no significant difference in incidence of reoperations between POAG (2.7%; 95% CI, 1.8%-4.1%) and PACG (4.0%; 95% CI, 2.6%-6.3%) (P=.27). Conclusion: The incidences of postoperative complications and reoperations in the first year after glaucoma surgery were similar for PACG and POAG. [ABSTRACT FROM AUTHOR]

Objective: To compare the PO2 distribution in different regions in the eyes of patients undergoing intraocular surgery. Methods: Before initiation of intraocular cataract and/or glaucoma surgery, an optical oxygen sensor was introduced into the anterior chamber via a peripheral corneal paracentesis. The tip of the flexible fiberoptic probe was positioned by the surgeon for 3 measurements in all patients: (1) near the central corneal endothelium, (2) in the mid-anterior chamber, and (3) in the anterior chamber angle. In patients scheduled to undergo cataract extraction, PO2 was also measured (4) at the anterior lens surface and (5) in the posterior chamber just behind the iris. Oxygen measurements at the 5 locations were compared using a 2-tailed unpaired t test and multivariate regression. Results: The PO2 value was significantly higher in African American patients at all 5 locations compared with Caucasian patients. Adjusting for age increased the significance of this association. Adjusting for race revealed that age was associated with increased PO2 beneath the central cornea. Conclusions: Racial differences in oxygen levels in the humaneye reflect an important difference in oxidative metabolism in the cornea and lens and may reflect differences in systemic physiologic function. Increased oxygen or oxygen metabolites may increase oxidative stress, cell damage, intraocular pressure, and the risk of developing glaucoma. Oxygen use by the cornea decreases with age. [ABSTRACT FROM AUTHOR]

Objectives: To identify predictors of inconsistent attendance at glaucoma follow-up visits in a county hospital population. Methods: Prospective recruitment from August 1, 2008, through January 31, 2009, of 152 individuals with glaucoma, with 1-to-1 matching of patients (those with inconsistent follow-up) and controls (those with consistent follow-up). Data were collected via oral questionnaire. Survey results were correlated with attendance at follow- up examinations, using the t test, X2 test, and multivariate stepwise logistic regression analysis to calculate the odds ratios (ORs) and 95% confidence intervals. Results: After adjusting for covariates in the logistic regression analysis, factors independently associated with inconsistent follow-up included black race (adjusted OR, 7.16; 95% confidence interval, 1.64-31.24), Latino ethnicity (adjusted OR, 4.77; 1.12-20.29), unfamiliarity with necessary treatment duration (adjusted OR, 3.54; 1.26- 9.94), lack of knowledge of the permanency of glaucoma-induced vision loss (adjusted OR, 3.09; 1.18-8.04), and perception that it is not important to attend all follow- up visits (adjusted OR, 3.54; 1.26-9.94). Conclusions: Demographic factors, including race and ethnicity, may directly or indirectly affect adherence to recommended glaucoma follow-up visits. Lack of information regarding irreversible vision loss from glaucoma, need for lifelong treatment, and lack of visual symptoms may be significant barriers to follow-up in this population. Targeted glaucoma education by physicians may improve follow-up, thereby decreasing the morbidity associated with glaucomatous disease. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of and risk factors for dry eye disease (DED) in an elderly Korean population. Methods: This population-based study in Yongin, Korea, included 657 individuals 65 years or older randomly selected from an official household registration database. Dry eye symptoms were assessed using a 6-item questionnaire, and DED was defined as having 1 or more dry eye symptoms often or all the time. Dry eye tests, including the Schirmer test, tear film break-up time measured using fluorescein, cornea fluorescein staining, and examination for meibomian gland dysfunction, were performed. Results: The crude prevalence of DED was 30.3%, and the age-, sex-, and region (urban vs rural)-adjusted prevalence was 33.2%. Women (P=.01) and urban dwellers (P=.001) were more likely to have DED. Of those with DED, 85.1% had tear film break-up time of 10 seconds or less, 54.1% had meibomian gland dysfunction, 39.2% had a fluorescein score of 1 or greater, and 32.8% had a Schirmer test score of 5mmor less. A low Schirmer score was correlated with increased prevalence of DED, although sensitivity was low. Conclusions: Dry eye disease is common in elderly Koreans; female sex and living in an urban region were strongly correlated with its frequency. We also noted a positive correlation between low Schirmer test scores and symptom-based DED. [ABSTRACT FROM AUTHOR]

Objectives: To describe the measurement of anterior chamber area and anterior chamber volume by anteriorsegment optical coherence tomography and to investigate the association of these parameters with the presence of narrow angles. Methods: This was a cross-sectional study of subjects aged at least 50 years without ophthalmic symptoms recruited from a community clinic. All participants underwent standardized ocular examination and anterior-segment optical coherence tomography. Customized software was used to measure anterior chamber area (cross-sectional area bounded by the corneal endothelium, anterior surface of iris, and lens within the pupil) and anterior chamber volume (calculated by rotating the anterior chamber area 360° around a vertical axis through the midpoint of the anterior chamber area). An eye was considered to have narrow angles if the posterior pigmented trabecular meshwork was not visible for at least 180° on gonioscopy with the eye in the primary position. Results: A total of 1922 subjects were included in the final analyses, 317 (16.5%) of whom had narrow angles. Mean anterior chamber area (15.6 vs 21.1mm2; P<.001) and anterior chamber volume (97.6 vs 142.1 mm3; P<.001) were smaller in eyes with narrow angles compared with those in eyes without narrow angles. After adjusting for age, sex, anterior chamber depth, axial length, and pupil size, smaller anterior chamber area (odds ratio, 53.2; 95% confidence interval, 27.1-104.5) and anterior chamber volume (odds ratio, 40.2; 95% confidence interval, 21.5-75.2) were significantly associated with the presence of narrow angles. Conclusion: Smaller anterior chamber area and anterior chamber volume were independently associated with narrow angles in Singaporeans, even after controlling for other known ocular risk factors. [ABSTRACT FROM AUTHOR]

Objective: To determine intraocular pressure (IOP)- dependent and IOP-independent variables associated with visual field (VF) progression in treated glaucoma. Design: Retrospective cohort of the Glaucoma Progression Study. Methods: Consecutive, treated glaucoma patients with repeatable VF loss who had 8 or more VF examinations of either eye, using the Swedish Interactive Threshold Algorithm (24-2 SITA-Standard, Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc, Dublin, California), during the period between January 1999 and September 2009 were included. Visual field progression was evaluated using automated pointwise linear regression. Evaluated data included age, sex, race, central corneal thickness, baseline VF mean deviation, mean follow-up IOP, peak IOP, IOP fluctuation, a detected disc hemorrhage, and presence of beta-zone parapapillary atrophy. Results: We selected 587 eyes of 587 patients (mean [SD] age, 64.9 [13.0] years). The mean (SD) number of VFs was 11.1 (3.0), spanning a mean (SD) of 6.4 (1.7) years. In the univariable model, older age (odds ratio [OR], 1.19 per decade; P=.01), baseline diagnosis of exfoliation syndrome (OR, 1.79; P=.01), decreased central corneal thickness (OR, 1.38 per 40 μm thinner; P<.01), a detected disc hemorrhage (OR, 2.31; P<.01), presence of betazone parapapillary atrophy (OR, 2.17; P<.01), and all IOP parameters (mean follow-up, peak, and fluctuation; P<.01) were associated with increased risk of VF progression. In the multivariable model, peak IOP (OR, 1.13; P<.01), thinner central corneal thickness (OR, 1.45 per 40 μm thinner; P<.01), a detected disc hemorrhage (OR, 2.59; P<.01), and presence of beta-zone parapapillary atrophy (OR, 2.38; P<.01) were associated with VF progression. Conclusions: IOP-dependent and IOP-independent risk factors affect disease progression in treated glaucoma. Peak IOP is a better predictor of progression than is IOP mean or fluctuation. [ABSTRACT FROM AUTHOR]

Objective: To compare the reattachment rate and visual acuity results among patients with rhegmatogenous retinal detachment who underwent scleral buckle surgery with retinopexy by intraoperative cryotherapy (cryopexy) vs postoperative (1 month later) laser photocoagulation (laserpexy). Methods: Eighty-six patients with rhegmatogenous retinal detachment scheduled for scleral buckle surgery were randomly assigned to the cryopexy or laserpexy group. Main Outcome Measures: The primary outcome was the 1-week reattachment rate. Other outcome measures included later reattachment rate (1 month and 6 months), best-corrected visual acuity, rate of subsequent operations, and postoperative complications. Results: The 1-week, 1-month, and 6-month anatomical success rates were similar in the 2 groups: 93% (40 patients), 100%, and 100% in the cryopexy group and 95% (41 patients), 100%, and 100% in the laserpexy group, respectively. Three patients in the cryopexy group and 2 in the laserpexy group underwent 1 additional rhegmatogenous retinal detachment surgery (pars plan vitrectomy) after primary failure at 1-week follow-up. The types of postoperative complications were similar in both groups, except for eyelid edema. Visual recovery was slower in the cryotherapy group, but the difference in visual acuity after 6 months was not significant. Conclusions: In patients with uncomplicated retinal detachment, both techniques of retinopexy have shown satisfactory anatomical and functional success. Laserpexy offers faster visual acuity recuperation with fewer postoperative complications but requires a second intervention and costs more than cryotherapy. Application to Clinical Practice: Laserpexy is a successful alternative to cryopexy in creating chorioretinal adhesion for scleral buckle surgery. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the peri-papillary distribution of retinal nerve fiber layer thickness (RNFLT) in normal eyes using spectral-domain optical coherence tomography and to study potentially related factors. Methods: In 7 institutes in Japan, RNFLT in 7 concentric Peri-papillary circles with diameters ranging from 2.2 to 4.0 mm were measured using spectral-domain optical coherence tomography in 251 ophthalmologically normal subjects. Multiple regression analysis for the association of RNFLT with sex, age, axial length, and disc area was performed. Results: Retinal nerve fiber layer thickness decreased linearly from 125 to 89 μm as the measurement diameter increased (P<.001, mixed linear model). Retinal nerve fiber layer thickness correlated with age in all diameters (partial correlation coefficient [PCC]=-0.40 to -0.32; P<.001) and negatively correlated with disc area in the 2 innermost circles but positively correlated in the 3 outermost circles (PCC=-0.30 to -0.22 and 0.17 to 0.20; P≤.005). Sex and axial length did not correlate with RNFLT (P<.08). The decay slope was smallest in the temporal and largest in the nasal and inferior quadrants (P<.001); positively correlated with disc area (PCC=0.13 to 0.51; P≤.04); and negatively correlated with RNFLT (PCC=-0.51 to -0.15; P≤.01). Conclusions: In normal Japanese eyes, RNFLT significantly correlated with age and disc area, but not with sex or axial length. Retinal nerve fiber layer thickness decreased linearly as the measurement diameter increased. The decay slope of RNFLT was steepest in the nasal and inferior quadrants and steeper in eyes with increased RNFLT or smaller optic discs. [ABSTRACT FROM AUTHOR]

Objective: To observe how the treatment of retinal conditions changed over the preceding decade. Methods: Medicare fee-for-service data claims filed between 1997 and 2007 were analyzed. Results: Fewer than 5000 intravitreal injections of a pharmacological agent were performed annually between 1997 and 2001. Thereafter, the annual number of intravitreal injections more than doubled every year through 2006, reaching a high of 812 413 in 2007. Photodynamic therapy procedures decreased 83% from a peak of 133 565 procedures in 2004 to 22 675 procedures in 2007, while laser treatment of choroidal lesions or neovascularization decreased 83% from a peak of 82 089 in 1999 to a minimum of 13 821 in 2007. Vitrectomies for primary retinal detachment (with or without scleral buckling) increased 72% over the study period from 11 212 in 1997 to 19 923 in 2007, while scleral buckles performed without vitrectomy decreased 69% from 8691 to 2660. Substantial volume increases were also observed for vitrectomy with retinal membrane stripping (90% increase from 29 426 in 1997 to 56 051 in 2007) or endolaser panretinal photocoagulation (86% increase from 10 319 in 1997 to 19 154 in 2007). Volumes of pneumatic retinopexy, laser prophylaxis for retinal detachment, laser treatment for retinal edema, and laser treatment for retinopathy all changed less than 25% from 1997 and 2007. Conclusions: Marked changes in the use of several retinal procedures occurred between 1997 and 2007, particularly in the treatment of macular degeneration and retinal detachment. These changes point to greater acceptance and incorporation of vitrectomy and intravitreal injection as treatment modalities. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between anterior chamber (AC) sterilization and vitreous positivity rate in cases of endophthalmitis. Design: Retrospective case-control study. A review of all consecutive cases of endophthalmitis (N=758) between January 1, 1999, and December 31, 2008, identified 229 matched AC and vitreous samples. Matched samples were evaluated for sensitivity and specificity, positive and negative predictive values, and positive and negative likelihood ratios. The main outcome measures were sensitivity and specificity of AC and vitreous samples in cases of endophthalmitis. Antibiotic resistance profiles from culture-positive endophthalmitis cases are given. Results: Gram-positive organisms accounted for 124 of 154 (80.5%) culture-positive endophthalmitis isolates (146 of 229 [63.8%]). The sensitivity (0.36%) and specificity (0.71%) of AC culture results were poor predictors of positive vitreous culture. Positive and negative predictive values were less than 60%. Positive likelihood ratio (1.24) and negative likelihood (0.91) of AC culture results did not aid in predicting vitreous findings. Grampositive isolates demonstrated in vitro resistance to moxifloxacin (47.1%), ciprofloxacin (43.4%), gatifloxacin (36.8%), levofloxacin (29.0%), gentamicin (19.2%), and ceftazidime (16.7%). Conclusions: The AC lacks concordance with vitreous findings in cases of endophthalmitis. Use of broadspectrum antibiotics to sterilize the ocular surface and provide therapeutic levels in the AC may not prevent endophthalmitis. In this study, the finding of a sterile AC did not rule out vitreous infection. These results may have implications for the routine use of broad-spectrum antibiotics as a means of vitreous protection and endophthalmitis prophylaxis. [ABSTRACT FROM AUTHOR]

Objective: To explore the relationship of refractive error and ocular biometry with primary open-angle glaucoma (POAG) in the Malay population. Methods: The Singapore Malay Eye Study is a population- based cross-sectional survey that examined 3280 persons (78.7% response) aged 40 to 80 years. Participants underwent a standardized clinical examination including slitlamp biomicroscopy, Goldmann applanation tonometry, refraction, dilated optic disc assessment, and measurement of axial length (AL) and central corneal thickness (CCT). Glaucoma was defined according to International Society for Geographical and Epidemiological Ophthalmology criteria. Results: After adjusting for possible confounders, persons with moderate or high myopia (less than -4.0 diopters, right eyes) were more likely to have POAG (odds ratio [OR], 2.87; 95% confidence interval, 1.09-7.53); this association remained significant after controlling for CCT (2.80; 1.07-7.37). Longer AL was associated with POAG (ORs, 2.49, 3.61, and 2.88, comparing quartiles 2, 3, and 4, respectively, with quartile 1 of AL; P=.03 for trend). If CCTwas controlled for, persons with AL in quartile 4were 3 times more likely to have POAG (OR, 3.00; 95% confidence interval, 1.09-8.24) than those in quartile 1. Conclusion: This population-based study in Singapore shows an association of moderate myopia and increasing AL with POAG independent of other factors, including CCT. [ABSTRACT FROM AUTHOR]

Objectives: To compare and contrast 2 methods of quantitating papilledema, namely, optical coherence tomography (OCT) and Modified Frisén Scale (MFS). Methods: Digital optic disc photographs and OCT fast retinal nerve fiber layer (RNFL) thickness, fast RNFL map, total retinal thickness, and fast disc images were obtained in 36 patients with papilledema. Digital optic disc photographs were randomized and graded by 4 masked expert reviewers using the MFS. We performed Spearman rank correlations of OCT RNFL thickness, OCT total retinal thickness, and MFS grade from photographs. Results: OCT RNFL thickness and MFS grade from photographs correlated well (R=0.85).OCT total retinal thickness and MFS grade from photographs had a similar correlation of 0.87. Comparing OCT RNFL thickness with OCT total retinal thickness, a slope of 1.64 suggests a greater degree of papilledema thickness change when using the latter. Conclusions: For lower-grade abnormalities, OCT compares favorably with clinical staging of optic nerve photographs. With higher grades, OCT RNFL thickness processing algorithms often fail, with OCT total retinal thickness performing more favorably. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of partially attached posterior vitreous detachments (pPVDs) at the optic disc on retinal nerve fiber layer (RNFL) thickness as measured by optical coherence tomography. Methods: A retrospective study was conducted using stored Stratus optical coherence tomography III scans of patients with suspected glaucoma from January 2003 to September 2006 at the Monte-fiore Medical Center, Bronx, New York. All scans were evaluated for vitreous attachments at the disc and were divided into control (without pPVD) and pPVD groups. The RNFL thickness was compared using the fast RNFL protocol. Patients were defined as glaucoma suspects based on clinical findings of either glaucomatous- appearing optic discs or elevated intraocular pressure. All study patients had normal Humphrey visual fields. Results: A total of 110 eyes from 110 patients were included; 59 were in the pPVD group and 51 were controls. Partial PVD was found in 40% of the glaucoma suspects. The mean RNFL thickness of eyes with pPVD was significantly broader than that of controls (101.6 μm vs 95.6 μm, respectively; P<.001). The average RNFL thickness of each quadrant was greater in the pPVD group than in the control group, with statistically significant differences in superior and inferior quadrants (P<.001 and P=.001, respectively). Conclusions: More than one-third of this population of glaucoma suspects had a pPVD, indicating that this is a common phenomenon. The results suggest that RNFL thicknesses are greater in patients with pPVD than in controls. This may indicate a limitation of using RNFL thickness as a criterion for evaluating glaucomatous damage in patients with pPVD. [ABSTRACT FROM AUTHOR]

Objective: To evaluate documentation of physician evaluations of patients with dry eye for the presence of key elements as defined in the American Academy ofOphthalmology Summary Benchmarks for Preferred Practice Patterns. Methods: One hundred thirty-one medical records of patients seen at the Duke Eye Center from January 1998 to July 2008 were reviewed relative to both the dry eye preferred practice patterns benchmarks for 1998 (all patients) and 2003 (for those seen between 2004 and 2008). Overall total score and subsection scores were calculated for all patients, as well as by specialty provider types and by type of medical record (electronic vs paper). Results: Of all records reviewed, 84.8% were for women and the mean (SD) age of all patients was 60.3 (20.8) years. On average, 66.4% of the initial history key elements, 77.3% of the initial physical examination key elements, 40.0% of care management key elements, and 67.9% of patient education key elements were documented. The physical examination scores were highest in the "other" subspecialty ophthalmologist group compared with the comprehensive ophthalmologist group (P=.03) and cornea specialists (P=.02). The physical examination scores were 87% in the electronic medical record and 75% in the standard paper medical record (P<.001) groups. Conclusions: In an academic practice, the process of care delivery for dry eye does conform to the American Academy of Ophthalmology Preferred Practice Patterns in some areas; however, there is room for improvement especially in the areas of patient education and care management. Additional data are needed from other practice settings to further evaluate the quality of dry eye care. [ABSTRACT FROM AUTHOR]

Objective: To investigate differences in visual function between the healthy eyes of people of African (AD) and European descent (ED). Methods: Visual function was assessed in 393 AD and 367 ED participants selected from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study. Participants had normal appearance of the optic disc and intraocular pressure of less than 22 mmHg. Each participant had 2 reliable 24-2 standard automated perimetry tests, and most had short-wavelength automated perimetry and frequency-doubling technology tests. The generalized estimating equation was used to adjust for intereye correlations. Results were adjusted for age, vertical cup-disc ratio, disc size, central corneal thickness, and presence of high blood pressure. Results: The AD participants were younger (mean [SD] age, 46.2 [13.2] years) than the ED participants (age, 49.5 [16.6] years) (P=.003). The AD participants had worse mean deviation and pattern standard deviation and more points triggered as abnormal on the total and pattern deviation plots compared with ED participants on all tests (P<.05). A larger percentage of AD participants had confirmed abnormal glaucoma hemifield test results on standard automated perimetry only. Conclusions: People of AD have significantly worse performance than people of ED on all tests of visual function. Additional research using longitudinal data is needed to determine the cause of these small but significant ancestry differences in visual function. [ABSTRACT FROM AUTHOR]

Objective: To define differences in optic disc, retinal nerve fiber layer, and macular structure between healthy participants of African (AD) and European descent (ED) using quantitative imaging techniques in the African Descent and Glaucoma Evaluation Study (ADAGES). Methods: Reliable images were obtained using stereoscopic photography, confocal scanning laser ophthalmoscopy (Heidelberg retina tomography [HRT]), and optical coherence tomography (OCT) for 648 healthy subjects in ADAGES. Findings were compared and adjusted for age, optic disc area, and reference plane height where appropriate. Results: The AD participants had significantly greater optic disc area on HRT (2.06 mm2; P<.001) and OCT (2.47 mm2; P<.001) and a deeper HRT cup depth than the ED group (P<.001). Retinal nerve fiber layer thickness was greater in the AD group except within the temporal region, where it was significantly thinner. Central macular thickness and volume were less in the AD group. Conclusions: Most of the variations in optic nerve morphologic characteristics between the AD and ED groups are due to differences in disc area. However, differences remain in HRT cup depth, OCT macular thickness and volume, and OCT retinal nerve fiber layer thickness independent of these variables. These differences should be considered in the determination of disease status. [ABSTRACT FROM AUTHOR]

Objective: To compare the safety and efficacy of earlier vs later treatment in preventing primary open angle glaucoma (POAG) in individuals with ocular hypertension. Methods: One thousand six hundred thirty-six individuals with intraocular pressure (IOP) from 24 to 32 mm Hg in 1 eye and 21 to 32 mm Hg in the fellow eye were randomized to observation or to topical ocular hypotensive medication. Median time of treatment in the medication group was 13.0 years. After a median of 7.5 years without treatment, the observation group received medication for a median of 5.5 years. To determine if there is a penalty for delaying treatment, we compared the cumulative proportions of participants who developed POAG at a median follow-up of 13 years in the original observation group and in the original medication group. Main Outcome Measures: Cumulative proportion of participants who developed POAG. Results: The cumulative proportion of participants in the original observation group who developed POAG at 13 years was 0.22 (95% confidence interval [CI], 0.19- 0.25), vs 0.16 (95% CI, 0.13-0.19) in the original medication group (P=.009). Among participants at the highest third of baseline risk of developing POAG, the cumulative proportion who developed POAG was 0.40 (95% CI, 0.33-0.46) in the original observation group and 0.28 (95% CI, 0.22-0.34) in the original medication group. There was little evidence of increased adverse events associated with medication. Application to Clinical Practice: Absolute reduction was greatest among participants at the highest baseline risk of developing POAG. Individuals at high risk of developing POAG may benefit from more frequent examinations and early preventive treatment. [ABSTRACT FROM AUTHOR]

Objective: To estimate the annual incidence of endophthalmitis after cataract surgery from January 1, 1996, through December 31, 2005, in Quebec, Canada. Methods: Deidentified data were obtained from an outpatient physician billing database (Quebec State Control for Health Insurance [RAMQ]) with regard to all cataract surgical procedures performed from January 1, 1996, through December 31, 2005, in Quebec. For this cohort, records of an International Classification of Diseases, Ninth Revision (ICD-9) code for endophthalmitis during the same years were requested from 2 sources: the RAMQ outpatient database and an inpatient hospital discharge database (Maintenance and Exploitation of Data for the Study of Hospitalized Patients [MED-ECHO]). Endophthalmitis after cataract surgery was assumed if it occurred within 90 days of the surgery. Risk factors were examined using X2 tests and logistic regression. Results: After exclusions, 490 690 cataract surgical procedures were performed from January 1, 1996, through December 31, 2005. A total of 754 cases of endophthalmitis occurred within 90 days after surgery for an overall incidence rate of 1.5 per 1000 surgical procedures (95% confidence interval [CI], 1.4-1.7). Factors associated with endophthalmitis included age of 85 years or older (odds ratio [OR],1.34; 95% CI, 1.06-1.70), male sex (1.44; 1.24- 1.66), later year of surgery (0.94; 0.92-0.97), and region of cataract surgery, because regions 6 (2.21; 1.91-2.55) and 9 (4.00; 2.48-6.43) had higher rates compared with all other regions. Conclusion: Reasons that explain the apparent decrease in endophthalmitis, especially in 2005, should be explored and further research performed to understand why certain patients and regions have higher risks of endophthalmitis after cataract surgery. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: To assess the complication rates of pars plana vitrectomy (PPV) among older Americans and to determine whether rates of adverse events and additional operations have changed during the past decade. Methods: Claims data were reviewed to identify all adults aged 68 years or older in the 5% Medicare sample who underwent their first PPV during 1994- 1995, 1999-2000, and 2004-2005. One-year rates of severe complications (endophthalmitis, suprachoroidal hemorrhage, or retinal detachment), less severe complications, receipt of an additional operation, and blindness were calculated and compared among the 3 groups using Cox regression. Analyses were adjusted for prior adverse events (during the previous 3 years), demographic characteristics, and comorbid conditions. Results: The 1994-1995, 1999-2000, and 2004-2005 cohorts had 3263, 5064, and 5263 patients, respectively. The 1-year severe complication rates did not differ among the 3 groups (range, 4.8%-5.5%). The hazard of a less severe complication or an additional operation was higher in the 2004-2005 cohort than in the earlier cohorts (P<.05 for all comparisons). The hazard of endophthalmitis was higher in black individuals (P=.07) and those of other races (P=.02) than in white patients. Conclusions: During the past decade, rates of severe complications after PPV remained stable, but rates of less severe complications and subsequent operations increased. Future studies should explore the potential factors that explain these changes and the alarming elevated incidence of post-PPV endophthalmitis among nonwhite individuals. [ABSTRACT FROM AUTHOR]

Objective: To investigate the protective effects of c-Jun N-terminal kinase (JNK)-1 and -2 gene knockout (KO) on the corneal epithelial response to desiccating stress. Methods: The C57BL/6, JNK1KO, and JNK2KO mice were subjected to desiccating stress (DS) for 5 days. The effects of DS on the corneal epithelium were evaluated by measuring corneal smoothness and permeability. Expression of matrix metalloproteinases (MMP)-1, MMP-9, and cornified envelope protein precursors (small prolinerich protein [SPRR]-1a, SPRR-2a, and involucrin) in the corneal epithelia was evaluated by immunostaining and real-time polymerase chain reaction. Collagenase and gelatinase activity in corneal sections as measured with in situ fluorescent assays. Results: The JNK2KO mice had smoother corneal surfaces and less corneal barrier disruption in response to DS than JNK1KO mice and C57BL/6 wild-type control mice. The DS increased levels of MMP-1, MMP-9, SPRR- 1a, SPRR-2a, involucrin immunoreactivity, and mRNA transcripts in the corneal epithelium of JNK1KO and C57BL/6 mice, but not in JNK2KO mice. Knockout of JNK2 prevented DS-induced increase in gelatinase and collagenase activity in the cornea. Conclusion: The JNK2 protein appears to have an essential role in desiccation-induced corneal epithelial disease by stimulating production of MMP-1, MMP-9, and cornified envelope precursors. Clinical Relevance: The JNK2 protein could be a novel therapeutic target in dry eye disease. [ABSTRACT FROM AUTHOR]

Objective: To describe the associations between sociodemographic, lifestyle, and medical risk factors and visual impairment in a Southeast Asian population. Methods: Population-based cross-sectional study of 3280 (78.7% response rate) Malay Singaporeans aged 40 to 80 years. Participants underwent a standardized interview, in which detailed sociodemographic histories were obtained, and clinical assessments for presenting and best corrected visual acuity. Visual impairment (log- MAR>0.30) was classified as unilateral (1 eye impaired) or bilateral (both eyes impaired). Analyses used multivariate- adjusted multinomial logistic regression. Results: Older age and lack of formal education was associated with increased odds of both unilateral and bilateral visual impairment based on presenting and best corrected visual acuity. The odds doubled for each decade older, and lower education increased the odds 1.59- to 2.83-fold. Bilateral visual impairment was associated with being unemployed (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.30-2.60), widowed status (OR, 1.51; 95% CI, 1.13-2.01), and higher systolic blood pressure (OR, 1.96; 95% CI, 1.44-2.66). Diabetes was associated with unilateral (OR, 1.47; 95% CI, 1.10-1.95) and bilateral (OR, 1.69; 95% CI, 1.23-2.32) visual impairment using best-corrected visual acuity. Conclusions: Older age, lower education, unemployment, being widowed, diabetes, and hypertension were independently associated with bilateral visual impairment. Public health interventions should be targeted to these at-risk populations. [ABSTRACT FROM AUTHOR]

Objective: To measure annual population-based volume of emergency department (ED) eye care and concurrent ophthalmology on-call coverage. Methods: Analysis and correlation of the 2006 Florida Agency of Health Care Administration ED and inpatient data sets with the 2007 Florida Physician Workforce Survey. Results: The Florida Physician Workforce Survey showed 46.3% of ophthalmologists surveyed took ED call in Florida in 2006. Based on estimates derived from the survey, 462 to 532 ophthalmologists participated in ED coverage that year. The level of workload varied considerably depending on International Classification of Diseases code diagnosis. Annual workload for open wounds to the eye, on average, ranged from 2.7 to 3.1 per ophthalmologist taking ED call. Conclusions: Strategic planning for the delivery of ED eye care needs to consider both the number and types of cases presenting to the ED and the availability of ophthalmologists to provide care that other specialists cannot. This preliminary study explores the use of a workload statistic that may help to gauge manpower needs in the future. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationships between the amount and type of dietary fat and intermediate agerelated macular degeneration (AMD). Design: Women aged 50 to 79 years with high and low lutein intake from 3 sites of the Women's Health Initiative Observational Study were recruited into the Carotenoids in Age-Related Eye Disease Study. Fat intake from 1994 through 1998 was estimated using food frequency questionnaires, and AMD was assessed photographically from 2001 through 2004. Results: Intakes of ω-6 and ω-3 polyunsaturated fatty acids, which were highly correlated (r=0.8), were associated with approximately 2-fold higher prevalence of intermediate AMD in high vs low quintiles. However, monounsaturated fatty acid intake was associated with lower prevalence. Age interactions were often observed. In women younger than 75 years (n=1325), total fat and saturated fatty acid intakes were associated with increased prevalence of AMD (multivariate adjusted odds ratios [95% confidence interval] for intermediate AMD, 1.7 [1.0-2.7] for quintile 5 vs quintile 1 for total fat [P=.10 for trend] and 1.6 [0.7-3.6] for saturated fatty acids [P=.23 for trend]). The associations were reversed in older women. Conclusions: These results support a growing body of evidence suggesting that diets high in several types of fat may contribute to the risk of intermediate AMD and that diets high in monounsaturated fatty acids may be protective. [ABSTRACT FROM AUTHOR]

Objective: To document age-related macular degeneration (AMD) progression after cataract surgery. Methods: Surgeons prospectively enrolled patients with nonneovascular AMD who were awaiting cataract surgery. Fluorescein angiography was performed preoperatively and at the postoperative week 1, month 3, and month 12 visits. Incidence of neovascular AMD development within 12 months after operation was the primary outcome measure. Results: A total of 108 subjects were enrolled. Of 86 eyes with preoperatively photographically confirmed nonneovascular AMD, 71 had gradable images by month 12. Neovascular AMD was observed in 9 of 71 eyes (12.7%; 95% confidence interval, 6.0%-22.7%). The progression rate between week 1 and month 12 decreased to 3 of 65 eyes (4.6%; 95%confidence interval, 1.0%-12.9%) after excluding 5 neovascular events identified on the postoperative week 1 visit and 1 case with missing photographs at this visit. Conclusion: The low incidence rate of neovascular AMD development between 1 week and 1 year after cataract surgery did not support the hypothesis that cataract surgery increases the risk of AMD progression. Several eyes appeared to have disease progression on postsurgery week 1 fluorescein angiograms, suggesting that many cases of presumed progression to neovascular AMD following cataract surgery may have been present prior to cataract surgery, but not recognized owing to lens opacity. [ABSTRACT FROM AUTHOR]

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 15.0mmHg, 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. [ABSTRACT FROM AUTHOR]

Objective: To identify risk factors for normal-tension glaucoma among subgroups of patients. Methods: In 93 patients with unilateral normaltension 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. [ABSTRACT FROM AUTHOR]

Objective: To identify factors accounting for differences in glaucoma onset and rate of progression between individuals of African descent and European descent. Design: A prospective, multi center observational cohort study of 1221 participants of African descent and European descent with no glaucoma (normal), suspected glaucoma, and glaucoma. Six hundred eightysix patient participants in the African Descent and Glaucoma Evaluation Study will be followed up longitudinally. Four hundred thirty-six participants of European descent from the Diagnostic Innovations in Glaucoma Study (DIGS) were also included. Baseline demographics, visual function (standard automated perimetry, shortwavelength automated perimetry, frequency doubling technology perimetry), optic nerve structure (retina tomography, optical coherence tomography), clinical status, and risk factors were measured. Results: Individuals of African descent had (1) thinner corneas (P<.001) across all diagnostic groups, (2) a higher percentage of reported diabetes mellitus (P<.001) and high blood pressure (P<.001) and a lower percentage of reported heart disease (P=.001), and (3) worse pattern standard deviation for standard automated perimetry fields overall (P=.001) and within normal limits (P=.01) than individuals of European descent. No differences were present for mean intraocular pressure (P=.79). Conclusions: Significant baseline differences were found in a number of clinical findings between persons of African descent compared with European descent. Longitudinal data from the African Descent and Glaucoma Evaluation Study will be important for determining which baseline features are important and predictive for accurate diagnosis and follow-up in this high-risk group. [ABSTRACT FROM AUTHOR]