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Neovascular age-related macular degeneration (nAMD) is a leading cause of irreversible vision loss. The present consensus provides suggestions on diagnosis, evaluation, treatment, and follow-up strategies for nAMD from a panel of 11 practicing ophthalmologists. The experts suggest that the baseline visit for nAMD management should include a comprehensive ophthalmologic examination via a multimodal approach consisting of visual and anatomical evaluation. Patients diagnosed with nAMD should be subjected to treatment with the goal of maintaining visual function while diminishing anatomical disease activity and minimizing treatment burden. Currently, anti-VEGF therapy is the main treatment strategy for nAMD, and evaluation involving comprehensive ophthalmologic examination within 1 month of completion of the loading phase comprising three monthly injections is recommended to guide subsequent management. Either a treat-and-extend or pro re nata regimen can be considered for the maintenance phase of anti-VEGF therapy, and the regimen should be chosen and adjusted according to disease activity, reimbursement criteria, financial burden, and patient preferences. In the event of inactive nAMD or poor treatment outcomes, after thorough evaluation and patient education, anti-VEGF therapy may be stopped. The consensus provides practical nAMD management guidelines for ophthalmologists and fellow healthcare professionals.

Objectives: Myopia is the most common refractive vision disorder. In recent years, several studies have suggested that the alteration of the exosomal protein levels in the aqueous humor (AH) is associated with the development of several eye diseases. Therefore, we aimed to explore the exosomal protein profile of the AH from myopia patients. Methods: Exosomes were isolated from the AH. The quality, concentration, and size distribution of exosomes for each patient were measured using nanoparticle tracking analysis system. Then, the exosomal proteins were purified and digested by trypsin for liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Results: There was no significant difference observed between the myopia and control when comparing the concentration and size distribution of exosomes in the AH for each sample. Based on LC-MS/MS analysis, myopia patients had higher and more complex exosomal peptide content. We found two proteins that were common in AH exosomes and eight proteins that were highly expressed in the myopia group. Conclusions: Our results provide pioneering findings for the exploration of the exosomal protein profile in myopia development. Further studies may provide significant information for the diagnosis, clinical treatment, and prognosis of myopia.

Background/Purpose Reactivation of herpes viruses poses threat to corneal graft survival. This study evaluated the presence of herpes simplex virus type 1 (HSV-1), HSV type 2 (HSV-2), and cytomegalovirus (CMV) DNA in recipient corneas and the aqueous humor of patients undergoing penetrating keratoplasty (PKP), and the impact on graft survival. Methods This retrospective study reviewed 90 eyes of 71 patients underwent PKP between 2008 and 2016. Cornea and aqueous humor samples were sent for polymerase chain reaction (PCR) testing for viral DNA. The main outcomes were PCR results and graft survival. Results Recipient corneas tested positive for HSV-1 in 47 eyes (52.2%), for HSV-2 in 24 eyes (26.7%), and for CMV in seven eyes (7.8%). Aqueous humor tested positive for HSV-1 in 44 eyes (48.9%), for HSV-2 in 25 eyes (27.8%), and for CMV in eight eyes (8.9%). The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure (p = 0.005), whereas corneal HSV-1 DNA was not. The presence of HSV-2 DNA had no significant impact on graft survival. Aqueous CMV DNA was associated with higher risk of graft failure in univariate model, but not in multivariate model. Conclusion There were high positive rates of HSV-1, HSV-2, and CMV DNA in recipient corneas and aqueous humor at the time of PKP, even among patients not suspected of latent viral infection. The presence of aqueous HSV-1 DNA was associated with higher risk of graft failure.

The purpose of the study was to explore how fixed and modifiable family, activity, and school factors affect a student’s myopia risk and severity. We used national cross-sectional data from Taiwanese children in Grades 4–6. Bivariate and multivariate analyses, including logistic and ordinary least squares regression, examined factors related to children’s myopia status and severity. Age, parent myopia, and school district were associated with risk of myopia. One hour or more per day of near work ( OR = 1.26) increased the odds of myopia. The same amount of time in outdoor activities ( OR = 0.85) or moderate or vigorous physical activities ( OR = 0.82) was associated with lower risk. Near work (β = 0.06), outdoor activity (β = −0.04), and outdoor recess (β = −0.03) predicted myopia severity. To promote healthy vision, nurses should advocate for and implement interventions that increase school children’s time outdoors and in physical activities and reduce their time on near work.

Artificial intelligence (AI) based on convolutional neural networks (CNNs) has a great potential to enhance medical workflow and improve health care quality. Of particular interest is practical implementation of such AI-based software as a cloud-based tool aimed for telemedicine, the practice of providing medical care from a distance using electronic interfaces. Methods: In this study, we used a dataset of labeled 35,900 optical coherence tomography (OCT) images obtained from age-related macular degeneration (AMD) patients and used them to train three types of CNNs to perform AMD diagnosis. Results: Here, we present an AI- and cloud-based telemedicine interaction tool for diagnosis and proposed treatment of AMD. Through deep learning process based on the analysis of preprocessed optical coherence tomography (OCT) imaging data, our AI-based system achieved the same image discrimination rate as that of retinal specialists in our hospital. The AI platform's detection accuracy was generally higher than 90% and was significantly superior (p < 0.001) to that of medical students (69.4% and 68.9%) and equal (p = 0.99) to that of retinal specialists (92.73% and 91.90%). Furthermore, it provided appropriate treatment recommendations comparable to those of retinal specialists. Conclusions: We therefore developed a website for realistic cloud computing based on this AI platform, available at https://www.ym.edu.tw/~AI-OCT/. Patients can upload their OCT images to the website to verify whether they have AMD and require treatment. Using an AI-based cloud service represents a real solution for medical imaging diagnostics and telemedicine.

Background The current National Health Insurance scheme in Taiwan reimburses 3 initial plus 4 additional injections of ranibizumab 0.5 mg for eligible patients with neovascular age-related macular degeneration (nAMD). The Ranibizumab AMD Clinical Efficacy in Real-world practice (RACER) study aimed to observe the effectiveness of ranibizumab injections under this reimbursement system. Methods RACER was a 12-month, prospective, observational study conducted in treatment-naïve, adult Taiwanese patients with nAMD. Patients received intravitreal ranibizumab 0.5 mg injections in adherence with local prescribing information. Results Of 161 patients enrolled, 114 (70.8%) completed the 12-month study. Overall, patients received a mean (standard deviation [SD]) of 4.3 (1.7) ranibizumab injections. The mean (SD, [95% confidence interval], P value) gain in best-corrected visual acuity (BCVA) from baseline at Month 3 was 5.2 (12.2, [3.1, 7.3] letters, P P = 0.0352). Mean central retinal thickness also decreased from baseline at Months 3 and 12 (both P Conclusions Treatment with ranibizumab 0.5 mg resulted in significant improvements in visual outcomes among treatment-naïve Taiwanese patients with nAMD. Early treatment and frequent dosing in the real-world setting may be the key to achieving better outcomes.

Objectives: Retinal vein occlusions (RVO) are associated with systemic risk factors. However, the ocular occlusive events might also influence a patient&rsquo, s systemic condition. This study tried to investigate serum biomarkers associated with oxidative stress, before and after intravitreal anti-vascular endothelial growth factor (aVEGF) therapy in patients with RVOs. Methods: Newly-onset RVO patients were categorized into two groups: comorbid with macular edema requiring aVEGF therapy (treatment group) and no edema (observation group). Age and sex-matched patients (who received cataract surgery) were included as the control group. Intravitreal ranibizumab with a pro-re-nata regimen were administered. Serum samples were collected prior to treatment, at 6 and 12 months after therapy/observation and were collected once before controls who received cataract surgery. mRNA expression of sirtuin-1, its downstream genes, anti-oxidative biomarkers, and proinflammatory cytokines were measured. Results: There were 32, 26, and 34 patients enrolled in the treatment, observation, and control groups, respectively. The expressions of sirtuin-1 and its downstream genes were significantly lower in patients with RVO compared with the control group. Sirtuin-1 gene expression increased after 1 year of aVEGF therapy in the treatment group but remained unchanged in the observation group. Biomarkers of oxidative stress and proinflammatory cytokines were reduced after 1 year of aVEGF therapy. These biomarkers remained with no changes in the observation group. Conclusions: Our study showed that the systemic oxidative stress increased in RVO patients. The aVEGF therapy could alter the gene expression of anti-oxidative proteins and reduce systemic oxidative stress in these patients.

Additional file 1: Table S1. Eligibility Criteria for NHI reimbursement [4]. Table S2. Colour fundus photography results compared with baseline (ITT population). Table S3.Baseline demographics, ocular and disease characteristics for patients with nAMD treated with ranibizumab 0.5 mg, by subgroups (ITT population).

Shwu-Jiuan Sheu,1,2 Cheng-Kuo Cheng,3,4 Hsi-Kung Kuo,5 Ching-Yao Tsai,2,6 Tai-Chi Lin,2,7 Jonathan Tan,8 Hitesh Chandwani,8 Michael Adena,9 Shih-Jen Chen2,7 1Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 2Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Ophthalmology, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Department of Medicine, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; 5Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Department of Ophthalmology, Taipei City Hospital Zhongxing Branch, Taipei, Taiwan; 7Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; 8Global Health Economics and Outcomes Research, Allergan Singapore Pte. Ltd., Singapore, Singapore; 9Datalytics Pty Ltd, Kingston, ACT, Australia Objectives: To characterize diabetic macular edema (DME) treatment patterns in Taiwan and examine their impact on health care resource utilization and visual and anatomic outcomes. Methods: Retrospective, observational cohort study of longitudinal data from medical records of five hospital ophthalmology clinics. Patients with type 2 diabetes and DME who received ≥1 laser treatment or pharmacotherapy (intravitreal/subtenon corticosteroids and/or intravitreal anti-vascular endothelial growth factor [VEGF] agents) between January 2012 and December 2013 (index period) and attended ≥1 follow-up visit after the first treatment during that period were identified (prevalent population, N=431). In addition, a subset that received no anti-VEGFs before 2012 (anti-VEGF-naïve population, N=77) was analyzed. Outcome measures were change in DME treatment distribution between January 2009 and December 2014 and health care resource utilization over up to 3 years from the first DME treatment received in the index period (prevalent population), mean number of anti-VEGF injections and change from baseline in visual acuity and central macular thickness over 12 months (anti-VEGF-naïve population).Results: Between 2009 and 2014, laser treatment use declined, overall use of anti-VEGFs increased, and bevacizumab use decreased proportionately as ranibizumab use increased. Patients receiving corticosteroids and anti-VEGFs in the first 6 months post-index had greater health care resource utilization than those treated with laser, corticosteroids, or anti-VEGF alone (P

Compared with conventional penetrating keratoplasty, Descemet's stripping automated endothelial keratoplasty (DSAEK) more effectively maintain global integrity and rapid vision rehabilitation with less ocular surface disorders in patients with endothelial dysfunction. Here, we report a case of a 76-year-old woman who experienced opacification of a hydrophilic intraocular lens (IOL) approximately 10 months after DSAEK. The patient with no history of systemic disease developed pseudophakic bullous keratopathy in the right eye 2 years after undergoing cataract surgery. The best-corrected visual acuity (BCVA) of the right eye was Snellen 0.01 when presented to our hospital. DSAEK was arranged and performed smoothly. However, the graft detached over the upper part of the cornea on postoperative day 1. Thus, rebubbling was performed immediately. After the procedure, the graft was well attached, and the cornea became clear gradually. The BCVA returned to Snellen 0.6. However, progressive opacification over the anterior surface of the IOL was observed 10 months postoperatively. Vision deteriorated to 0.5 with various refractive errors during 2-year follow-up. IOL exchange may be considered if the vision is getting worse. IOL opacification may result from a direct contact between the IOL surface and exogenous air, particularly in a hydrophilic IOL, and can be a rare but significant complication after DSAEK. Clinicians planning to perform DSAEK should consider the composition of the IOL, the amount of intracameral air, duration of air filling, and high intraocular pressure.

Myopia is the most common refractive disorder in Eastern Asia. The development of myopia is associated with the cooperation of various ocular tissues. Exosomes in the aqueous humor (AH) have been implicated to modulate intracellular communications by transferring exosomal miRNAs and proteins between cells. These exosomal miRNAs and proteins are likely involved in the pathogenesis of various eye diseases. In this study, we aimed to explore human exosomal miRNA profiles and their roles in myopia development. AH samples were collected from 16 patients (8 myopia and 8 control) undergoing routine cataract surgeries. Exosomes were isolated from AH of each individual using the ExoQuick solution. The numbers and sizes of exosomes were not significantly different between the myopia and control groups. The individual exosomes of the same group were pooled to purify RNA. Unexpectedly, the myopia group contained 2.78-fold total RNA amount than that in the control group. Thereafter, miRNA profiles were analyzed using the OpenArray system. We thus found 15 myopia-specific miRNAs and four myopia-absent miRNAs. By using bioinformatics analysis, we identified six well-known myopia-associated genes that are potential targets of five myopia-specific miRNAs (has-miR-582-3p, has-miR-17-5p, has-miR-885-3p, has-miR-19b-3p, and has-miR-450b-5p). These genes are cholinergic receptor muscarinic 2 (CHRM2), cyclic nucleotide-gated channel beta 3 (CNGB3), vascular endothelial growth factor A (VEGFA), adenosine A2a receptor (ADORA2A), insulin-like growth factor 1 (IGF1), and lumican (LUM). Moreover, CHRM2 may be a target of myopia-absent miRNA (has-miR-378a-5p). In conclusion, we show the expression profiles of AH-derived exosomal miRNAs and their potential roles in myopia development.

The aim of this study was to determine whether students' exposure to digitally projected, multimedia teaching material under naturally varying classroom lighting conditions is associated with myopia risk and severity.A population-based, cross-sectional study in 2012 of children in grades 4-6 across 87 schools in Taiwan.Students (N = 3,686) reported demographic information, outdoor time, physical activity and near work. Parents provided their myopia status. Student-reported multimedia teaching frequency and classroom lighting levels were confirmed with direct observation. School nurses conducted vision screening and ophthalmologist referral. Myopia status and severity were measured by spherical equivalent refraction; SE ≤-0.5 dioptres was coded as myopic. Binary logistic and tobit regression were used to estimate the contributions of classroom multimedia exposure and lighting to myopia risk and severity controlling for risk factors.Age, parental myopia and hours of near work increased the odds of myopia and predicted greater severity. Physical activity and outdoor time predicted lower risk and severity. Multimedia exposure in relatively bright classrooms was associated with greater odds of myopia. Classroom lighting levels during multimedia teaching were inversely related to severity; exposure frequency was unrelated.Multimedia exposure under brighter classroom conditions may contribute to the myopia incidence in schoolchildren.Teaching with digital projection technology is increasingly prevalent. This may increase children's odds of developing myopia, which has far-reaching and lifelong deleterious effects. School nurses should raise awareness of and promote strategies that reduce this risk, including working with children, parents, school personnel and system leaders to adopt eye-healthy behaviours, practices and policies.目的: 本研究旨在确定学生在自然变化的教室照明条件下面对数字投影的多媒体教材是否与近视风险和近视严重程度有关。 设计: 在2012年,对台湾87所学校4-6年级学生进行的一项基于人口的横断面研究。 方法: 学生(N = 3686)报告了人口统计信息、户外时间、体育锻炼和近距离用眼机会。父母提供了他们的近视状况。通过直接观察确认了学生报告的多媒体教学频率和教室照明度。学校护士进行了视力普查以及转诊至眼科医生处。通过等效球镜度数衡量了近视状况和近视严重程度;近视度数大于50屈光度(SE≤-0.5)则被编码为近视。使用二元逻辑和tobit回归估算教室多媒体暴露和照明对近视风险和风险因素导致的严重程度。 结果/发现: 年龄、父母近视和近距离用眼时长增加了患近视的几率,并预示着严重程度更高。进行体育锻炼和户外活动可降低风险和严重程度。在相对明亮的教室里使用多媒体,学生患近视的几率更大。使用多媒体进行教学过程中的教室照明度与近视严重程度呈反比。使用多媒体频率与近视严重程度无关。 结论: 在较明亮的教室环境中,使用多媒体可能导致学生患上近视。 影响: 数字投影教学技术日益普遍。这可能会增加儿童患近视的几率,而近视会会产生深远并且终生有害的影响。驻校护士应提高意识并推广可降低此风险的策略,包括儿童、家长、学校工作人员和教育系统管理者共同努力,采取有益于眼睛的行动、方法和策略。.

Background: High myopia is associated with multiple ocular morbidities that may lead to irreversible blindness. Because high myopia in an adult is thought to be related to onset of myopia in very early childhood, detecting myopia early and working to improve modifiable risk factors may help reduce the development of high myopia. In this study, we tried to evaluate the prevalence of myopia and associated risk factors in second-grade primary school children in Taipei, Taiwan. Methods: A questionnaire was distributed to the participants’ parents, and their written informed consent was obtained before performing eye examinations that included visual acuity testing and cycloplegic autorefraction. Multiple logistic regression models were applied to assess possible risk factors associated with myopia. Myopia was defined as spherical equivalent of −0.50 D or less in either eye. Results: The prevalence of myopia in the second graders was 36.4%. After adjustment for other characteristics, the following variables were significantly associated with a higher risk of myopia: male sex [odds ratio (OR)=1.24, p

The mitochondrial genetic disorder, Leber&rsquo, s hereditary optic neuropathy (LHON), is caused by a mutation in MT-ND4 gene, encoding NADH dehydrogenase subunit 4. It leads to the progressive death of retinal ganglion cells (RGCs) and causes visual impairment or even blindness. However, the precise mechanisms of LHON disease penetrance and progression are not completely elucidated. Human-induced pluripotent stem cells (hiPSCs) offer unique opportunities to investigate disease-relevant phenotypes and regulatory mechanisms underlying LHON pathogenesis at the cellular level. In this study, we successfully generated RGCs by differentiation of LHON patient-specific hiPSCs. We modified the protocol of differentiation to obtain a more enriched population of single-cell RGCs for LHON study. Based on assessing morphology, expression of specific markers and electrophysiological activity, we found that LHON-specific hiPSC-derived were more defective in comparison with normal wild-type RGCs. Based on our previous study, whereby by using microarray analysis we identified that the components of glutamatergic synapse signaling pathway were significantly downregulated in LHON-specific RGCs, we focused our study on glutamate-associated &alpha, amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptors. We found that the protein expression levels of the subunits of the AMPA receptor, GluR1 and GluR2, and their associated scaffold proteins were decreased in LHON-RGCs. By performing the co-immunoprecipitation assay, we found several differences in the efficiencies of interaction between AMPA subunits and scaffold proteins between normal and LHON-specific RGCs.

To evaluate the 1-year progression of myopia and associated risk factors in second-grade primary school children.The myopia investigation study in Taipei provided semiannual visual acuity testing and cycloplegic refraction for all second-grade primary school children (mean age: 7.49 years) in Taipei who provided parental consent. A questionnaire was distributed to the participants' parents before the first and third examinations. We evaluated 1-year follow-up data for children noted to have myopia on the first examination. Multinomial logistic regression models were applied to assess risk factors associated with myopia progression. Myopia progression was categorised, based on the change in spherical equivalent (ΔSE) over 1 year, as slow (ΔSE-0.5 dioptres (D)), moderate (-1.0 DΔSE≤-0.5 D) or fast (ΔSE≤-1.0 D). Of the 4214 myopic children, data were analysed for 3256 (77.3%) who completed the 1-year follow-up evaluation.The baseline SE was -1.43±1.1 D. The average ΔSE was -0.42±0.85 D, with 46.96%, 28.50% and 24.54% of the study subjects showing slow, moderate and fast myopia progression, respectively. When compared with slow myopia progression, fast myopia progression was associated with a greater myopic SE at baseline (OR: 0.67, 95% CI: 0.61 to 0.72) and a shorter eye-object distance when doing near work (OR: 1.45, 95% CI: 1.18 to 1.78). More outdoor activity time and self-reported cycloplegic treatment were not associated with slow myopia progression.Children with fast annual myopia progression were more myopic at baseline and had a shorter reading distance. Our study results highlight the importance of having children keep a proper reading distance.

PurposeThis study investigated the changes of refractive status in both phakic and pseudophakic eyes after pars plana vitrectomy (PPV) surgery without scleral buckling or silicone oil tamponade, and examines the possible factors that may affect the refractive changes.MethodsA retrospective case note review of 172 eyes (172 patients) undergoing PPV surgery for a variety of vitreoretinal conditions. Refractive status was measured before and after vitrectomy surgery in 60 eyes after the application of inclusion and exclusion criteria. Refractive status before and after PPV was analyzed using paired t-tests. An independent t-test and analysis of variance were subsequently conducted to analyze any significant differences in refractive change under a variety of etiological factors. Changes in refraction were also analyzed using a linear regression model.ResultsA total of 60 eyes from 60 consecutive patients were included in this study. The mean spherical equivalence (SE) before PPV was 0 diopters (D), and −1.21 D after PPV. The mean change of SE was −1.21 D (95% confidence interval −1.70 to −0.71 D, p

Rationale, aims and objectives To develop a short screening test for the detection of preclinical glaucoma. Method This case–control study involved 690 participants aged 40 years or older: 338 patients with glaucoma or suspected glaucoma and 352 patients without glaucoma, who served as a control group. All participants were interviewed by a single trained research assistant. Patients' basic demographic and clinical information, past ophthalmic history and responses on the National Eye Institute 25-item Visual Function Questionnaire were collected. Two glaucoma-trained ophthalmologists examined all the participants using standard procedures to make a diagnosis. The biostatistical differences between the two groups were determined. Results Five items were selected for glaucoma screening: ‘Sense of worse vision compared with those of the same age’, ‘Ocular pain or discomfort during the past 6 months’, ‘History of cataract’, ‘Family history of glaucoma’ and ‘Hyperopia’. A score of 2 or more was used to define a group of positive cases with the most appropriate values for sensitivity (79.0%), specificity (76.7%) and predictive power (a positive predictive value of 76.5% and a negative predictive value of 79.2%). Conclusion A five-item instrument was developed to detect preclinical glaucoma. Anyone with a score of 2 or more may need further ophthalmic examination and treatment.

Purpose To evaluate age-related changes in astigmatism of both corneal surfaces and the whole cornea. Methods The right eyes of 370 subjects were measured with a rotating Scheimpflug camera (Pentacam). Astigmatisms of the anterior and posterior corneal surfaces were determined. The total corneal astigmatism was derived using power vector summation and vergence tracing. Age-related changes to corneal astigmatism were evaluated using polar value analysis (both in diopter and millimeter). Results For the anterior and total cornea, the proportion of with-the-rule astigmatisms decreased and those of oblique and against-the-rule astigmatisms increased with age. For the posterior cornea, most eyes displayed against-the-rule astigmatisms in all age groups. There was a significant trend toward against-the-rule astigmatism associated with increasing age for both anterior and total corneal astigmatisms (mean changes of -0.18 and -0.16 diopters/5 years, respectively), and toward with the rule in posterior corneal astigmatism (a mean change of 0.022 diopters/5 years). Regarding shape changes, a "flat meridian toward a more vertical orientation" trend with increasing age for both the anterior and posterior corneal surfaces was observed (mean changes of 0.0295 and 0.0224 mm/5 years, respectively). The posterior corneal surface compensated for the astigmatism arising from the anterior corneal surface in 91.4% and 47.7% of eyes in the 21-30 and > or =71 years groups, respectively. Conclusions There were age-related shifts toward against-the-rule and with-the-rule astigmatisms for the anterior and posterior corneal surfaces, respectively. The compensating effects of the posterior corneal surface on anterior corneal astigmatism decreased with advancing age.

To report intraocular lens (IOL) power calculation in 2 eyes that were highly undercorrected by previous myopic automated lamellar keratoplasty (ALK).A 35-year-old man underwent bilateral myopic ALK, which caused high residual myopia (-9.0 -4.0 x 171 and -9.5 -4.5 x 74). The patient then underwent cataract surgery with IOL implantation for cataract development. The double-K clinical history method was utilized, and satisfactory IOL power prediction results were obtained. Two no-history IOL power calculation methods (Rosa correcting factor method and Ferrara theoretical variable refractive index method), which involved axial length-dependent modification of the keratometer-measured corneal radius, and 1 no-history IOL power calculation method (Shammas' method), which involved axial length-independent modification of the keratometer-measured corneal power, were tested on these 2 eyes.In both eyes, the double-K SRK-T clinical history method gave small IOL prediction errors (-0.66 and -0.81 D). The Shammas' no-history method gave a slightly higher IOL prediction error in the right eye (-1.67 D) and a small IOL prediction error in the left eye (-0.74 D). Unacceptable IOL power prediction errors would have resulted if Rosa's correcting factor method (-8.07 and -8.35 D) or Ferrara's theoretical variable refractive index method (-17.56 and -18.51 D) had been applied. When we utilized Rosa's method for the IOL power calculation by assuming that the previous ALK had fully corrected the refractive error, the predicted IOL powers were very close to the benchmark IOL powers (IOL power prediction errors: 1.16 and 0.37 D). When we utilized Ferrara's method with the same assumption, the IOL power prediction errors remained high (-6.32 and -7.16 D).For patients who have had previous myopic ALK (and whose eyes are highly undercorrected) and who require cataract surgery and for whom the pre-ALK history is available, the double-K method appears to yield excellent predictive results. However, if the pre-ALK history is not available, the Shammas' no-history method appears to yield better results than the Rosa's or the Ferrara's method. High undercorrection by the previous ALK might have been one of the major reasons why Rosa's method resulted in a high IOL prediction error in these 2 eyes. The cause for the marked IOL prediction error by Ferrara's method in this case, however, remains to be determined.

Purpose To determine the keratometric index based on actual measurements of the anterior and posterior corneal surfaces using a rotating Scheimpflug camera (Pentacam, Oculus) and evaluate the accuracy of this keratometric index in estimating total and posterior corneal powers. Setting Departments of Ophthalmology, Taipei Medical University Hospital and Taipei City Hospital, Taipei, Taiwan. Methods The right eye of 221 subjects was measured with the Pentacam system. The radius of the best-fit sphere for the anterior corneal surface (r ant ) and posterior corneal surface (r post ), mean radius of simulated keratometry (r simK ), and central corneal thickness were obtained. The ratio of r ant to r post (AP ratio) and keratometric index were calculated in each eye. Results The means for r ant , r post , r simK , and AP ratio were 7.75 mm ± 0.28 (SD), 6.34 ± 0.28 mm, 7.75 ± 0.27 mm, and 1.223 ± 0.034 mm, respectively. These parameters were normally distributed. The mean calculated keratometric index (N cal ) was 1.3281 ± 0.0018. Using the keratometric indices of 1.3281 (N cal ), 1.3315 (Gullstrand schematic eye), and 1.3375 (conventional), the mean arithmetic and absolute estimation errors for the total corneal power were, 0.00 ± 0.24 diopter (D) and 0.17 ± 0.17 D, 0.43 ± 0.23 D and 0.45 ± 0.21 D, and 1.21 ± 0.24 D and 1.21 ± 0.24 D, respectively. The total corneal power was predicted to within ±0.50 D of the actual value in 95.0%, 60.2%, and 0.9% of eyes, respectively. The mean arithmetic and absolute estimation errors for the posterior corneal power using an AP ratio of 1.223 (this study) or 1.132 (Gullstrand schematic eye) were 0.00 ± 0.17 D and 0.13 ± 0.12 D and 0.47 ± 0.18 D and 0.47 ± 0.17 D, respectively. The posterior corneal power was estimated to within ±0.50 D of the actual value in 97.7% and 60.2% of eyes, respectively. Conclusion Using the Pentacam-derived keratometric index improved the prediction accuracies of total and posterior corneal powers.

Background: The purpose of this study was to assess the prevalence and associated factors of cataract surgery among patients with type 2 diabetes in Kinmen, Taiwan. Methods: A community-based population survey between 1991 and 1993 identified 971 patients over the age of 30 years with type 2 diabetes. In 1999, a total of 578 patients (59.5%) with type 2 diabetes from the population were examined in an ophthalmic screening study. Two senior ophthalmologists employed slit-lamp biomicroscopy, indirect ophthalmoscopy, and retinal photographs with pupil dilatation to examine the patients' lenticular and retinal status. Results: The prevalence of cataract surgery in one eye, both eyes, and any cataract surgery among patients with type 2 diabetes was 4.5%, 5.4%, and 9.9%, respectively. The prevalence of cataract surgery in women (11.3%) was not significantly higher than in men (7.7%), but there was a statistical increase with age ( p = 0.001, χ 2 trend test). Multiple logistic regression showed that age (OR 1.13,95% CI 1.07–1.19) and diabetic retinopathy (OR 4.68,95% CI 1.94–11.33) were independent factors associated with cataract surgery. Interpretation: Age and diabetic retinopathy were associated with prevalence of cataract surgery among persons with type 2 diabetes.

Background: The objective was to examine the incidence of optic neuritis in Taiwan. A 5-year longitudinal, nationwide, population-based study was conducted. The participants were a random sample of 191,761 subjects, or about 1% of the enrollees in the National Health Insurance program of Taiwan. Methods: We identified subjects who had at least 1 service claim for ambulatory or inpatient care with a principal diagnosis of optic neuritis between 2000 and 2004. We calculated and statistically analyzed the rates of optic neuritis. The main outcome measures were the incidence rates of optic neuritis. Results: From 2000 to 2004, the total cumulative incidence was 1.33 per 1,000 (1.00 vs. 1.67 for male vs. female subjects; p < 0.001, χ2 test). The cumulative incidence rates for the age groups of 0–19, 20–39, 40–59 and ≧60 years were 0.33, 1.05, 2.16 and 2.81 cases per 1,000, respectively. Among the subjects aged 40–59 years, the cumulative incidence was higher in women than in men (p < 0.001, χ2 test). The incidence density of developing multiple sclerosis after optic neuritis was 0.41% per person-year, and the cumulative incidence of multiple sclerosis after a new diagnosis of optic neuritis was 0.78%. Conclusions: We believe our study is the first nationwide investigation of the incidence rates of optic neuritis in Taiwan. In our investigation, the cumulative incidence peaked among the subjects aged 40–59 years, especially in women. In Taiwan, patients with optic neuritis have a notably low rate of conversion to multiple sclerosis.

Oxidative damage to cornea can be induced by alkaline chemical burn which may cause vision loss or blindness. Recent studies showed that exogenous application of natural antioxidants may be a potential treatment for corneal wound healing. However, low ocular bioavailability and short residence time are the limiting factors of topically administered antioxidants. Ferulic acid (FA) is a natural phenolic compound and an excellent antioxidant. The study was aimed to investigate the effects of FA in corneal epithelial cells (CECs) under oxidative stress and evaluate the feasibility of use the thermosensitive chitosan-based hydrogel containing FA for corneal wound healing. The results demonstrated that post-treatment of FA on CECs could decrease the inflammation-level and apoptosis. In the rabbit corneal alkali burn model, post-treatment FA-loaded hydrogel may promote the corneal wound healing. The results of study suggest that FA-loaded hydrogel may have the potential applications in treating corneal alkali burn.

This study was conducted to explore the prevalence and the associated factors of visual impairment and blindness among the elderly Taiwanese population. A nationwide population-based visual health care screening program of elderly people aged 65 years or older was conducted between 1 July 2002 and 31 December 2002 in Taiwan. Based on the same standardized protocol used by the Bureau of Health Promotion, Department of Health, and a stratified random sampling design, 3160 out of 5000 elderly subjects were selected by a two-stage visual care screening method. The overall response rate was 63.2%. The mean age of the elderly participants was 72.4 ± 5.1 years. The overall prevalence of glaucoma, corneal diseases, trauma, cataracts, myopic or diabetic retinopathy, and age-related macular degeneration among the elderly population was 2.1%, 6.3%, 0.9%, 60.2%, 7.5%, and 2.9%, respectively. The overall prevalence of visual disability (visual acuity of the better eye

Background/Purpose: Topical atropine treatment is generally accepted to retard the progression of myopia, but it is associated with side effects such as photophobia and elevation of intraocular pressure (IOP). IOP measurements in children are challenging. The traditional applanation tonometry by direct contact with the cornea will require patient's cooperation. The rebound tonometer, using a dynamic electromechanical method for measuring IOP, shows good correlation with traditional tonometry. The purpose of this study is to evaluate the IOP of myopic children under atropine treatment using rebound tonometer and to compare the characteristics between rebound tonometry and applanation tonometry. Methods: This study is a prospective study measuring IOP by rebound tonometer in myopic children under regular low-dose atropine treatment. We recruited children with refraction error showing myopia over −0.5 D with 0.15%, 0.3%, or 0.5% atropine eye drops use every night or every other night for myopia control. Children with treatment duration of atropine

The prevalence of hepatitis B virus (HBV) is particularly high in Asian countries, including Taiwan. Previous studies have reported detection of HBV surface antigens in tears and aqueous humor of HBV-seropositive individuals, suggesting that ophthalmologists may be at risk of contracting HBV infection by treatment of such patients. Herein we report the case of an asymptomatic Taiwanese HBV patient in whom HBV was detected in aqueous humor using PCR. To our knowledge this is the first report of HBV detection in aqueous humor by PCR. Eye care providers should take all necessary precautions when treating individuals who have or are at high risk of being infected with HBV.

A 56-year-old woman complained of blurred vision and pain in her right eye for several days. Slit lamp examination revealed a large epithelial defect and disciform stromal edema with ring infiltration in her right cornea. Unfortunately, hypopyon and purulent discharge subsequently developed in both eyes. Herpetic keratouveitis and a superimposed pseudomonas infection were diagnosed. A systemic review on the patient showed malnutrition due to her dietary preference and vegetarianism. After the infection was controlled, bilateral epithelial defects persisted for a long time. We performed amniotic membrane transplantation on both eyes and the clinical status improved with administration of vitamin and protein supplements. Although rare in Taiwan, vitamin A deficiency should be kept in mind when conjunctival and corneal xerosis occurred. Vitamin A supplements are suggested because of the increased susceptibility to infection in patients with this clinical status.

Purpose To evaluate the correlation between the severity of lens opacity, patient age, and the level of silent information regulator T1 (SirT1) expression in the lens epithelium of age-related cataracts. Setting Department of Ophthalmology, Zuoying Armed Forces General Hospital, Kaohsiung, Taiwan. Design Case control study. Methods Patient age at the time of cataract surgery and lens opacity severity, classified using the modified version of the Lens Opacities Classification System III (LOCS III), were recorded. Lens epithelium samples were obtained, and the expression level of SirT1 mRNA was evaluated. Results The study evaluated 233 eyes with cataract. Older patients had higher nuclear (N), cortical (C), and posterior subcapsular (P) cataract LOCS III scores. The expression of SirT1 in lens opacity was significantly less in patients 51 years and older than in those younger than 51 years. The level of SirT1 expression was significantly negatively associated with patient age ( r = −0. 746, P P Conclusions The decreased expression of SirT1 in the lens epithelium was associated with higher cataract scores and patient age. The results suggest that a local SirT1 decrease in cataractous lens could be a risk factor for the initiation of age-related cataract formation. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

PURPOSE To report a case of recurrent cytomegalovirus (CMV) corneal endotheliitis after penetrating keratoplasty. METHODS Penetrating keratoplasty (PK) was performed in a 49-year-old man with bullous keratopathy. Pigmented keratic precipitates (KPs) were found in the corneal endothelium of the graft 13 days after surgery, with the subsequent appearance of coin-shaped lesions. Confocal microscopy was performed on the corneal endothelium. Aqueous humor was analyzed for viral DNA by polymerase chain reaction (PCR). RESULTS CMV DNA was detected from the excised corneal button, and aqueous humor revealed positive results for CMV and HSV1 by PCR. Confocal microscopy showed large corneal endothelial cells, consistent with the typical owl's eye morphology of CMV endotheliitis. After systemic ganciclovir was administered, the pigmented KPs and coin-shaped lesions gradually decreased. CONCLUSIONS Stress from surgery and corticosteroid usage can revitalize CMV activity. PCR and confocal microscopy are valuable for the diagnosis of CMV corneal endotheliitis.

Purpose: To evaluate the accuracy of corneal surgically induced astigmatism (SIA) estimation when neglecting the posterior corneal surface measurement. Methods: Fifty right eyes undergoing phacoemulsification were measured with a rotating Scheimpflug camera (Pentacam; Oculus Inc., Wetzlar, Germany) both before and after surgery. Clear corneal incisions with one suture were used in the phacoemulsification surgery. The keratometric corneal SIA (KSIA) was derived using the anterior corneal surface measurement and the keratometric index (1.3375) while neglecting the posterior corneal surface measurement. The Pentacam-derived total corneal SIA (PSIA) was derived by vergence tracing and polar value analysis [KP(135) and KP(180)] of the measurements on both corneal surfaces. Results: The mean arithmetic estimation errors of the KSIA for the PSIA were 0.16 ± 0.32 (−0.52 to 1.14) D for the KP(135), and −0.02 ± 0.30 (−0.75 to 1.29) D for the KP(180). There was a significant difference between the KP(135) components of the KSIA and PSIA. Bivariate analysis revealed a statistically significant difference between the combined means of the KSIA and PSIA. Overall, 24% had either a KP(135) component of the KSIA that differed by > 0.50 D from that of the PSIA or a KP(180) component of the KSIA that differed by > 0.50 D from that of the PSIA. The blurring strength caused by neglecting the posterior corneal measurement was > 0.50 D in 24% of eyes. Conclusion: Neglecting the posterior corneal surface measurement may lead to significant deviation in the corneal SIA estimation after phacoemulsification in a proportion of eyes.

The aim was to study the association of surgeon age with operative outcomes for primary rhegmatogenous retinal detachment (RRD) in Taiwan. A total of 7427 adult patients of primary RRD who were treated by 284 ophthalmologists with scleral buckling (SB), pars plana vitrectomy (PPV), or their combination from 2002 to 2004 were identified in the Taiwan National Health Insurance Research Database. The adjusted odds ratios (OR) of 180-day readmission between ophthalmologist age groups were calculated. For SB, patients treated by ophthalmologists aged ⩾51 years had a greater 180-day readmission rate (OR=1.44, 95% confidence interval (CI)=1.01–2.07, P

Purpose To evaluate the accuracy of corneal astigmatism estimation by neglecting the posterior corneal surface measurement. Design Prospective, observational study. Methods The right eyes of 493 subjects were measured with a rotating Scheimpflug camera (Pentacam; Oculus, Wetzlar, Germany). The keratometric corneal astigmatism (KA) was obtained by using the anterior corneal surface measurement and the keratometric index (1.3375) while neglecting the posterior corneal surface measurement. The Pentacam-derived total corneal astigmatism (PA) was derived by doubled-angle vector analysis of the astigmatisms on both corneal surfaces. Results The mean arithmetic and absolute estimation errors of the KA magnitude for the PA magnitude were −0.06 ± 0.28 diopters (D) (range, −0.59 to 0.91 D) and 0.24 ± 0.16 D (range, 0 to 0.91 D), respectively. The mean arithmetic and absolute estimation errors of the KA angle for the PA angle were −0.6 degrees ± 12.7 degrees (range, −69.9 degrees to 83.4 degrees) and 7.4 degrees ± 10.3 degrees (range, 0 degrees to 83.4 degrees), respectively. Among all eyes, 142 eyes (28.8%) had either a KA magnitude that differed by > 0.50 D from the PA magnitude or a KA angle that differed by > 10 degrees from the PA angle. For the 282 eyes with a KA magnitude exceeding 1.0 D (that are candidates for intraoperative correction of a preexisting astigmatism during cataract surgery), 29 eyes (10.3%) had either a KA magnitude that differed by > 0.50 D from the PA magnitude or a KA angle that differed by > 10 degrees from the PA angle. Conclusions Neglecting the posterior corneal surface measurement may lead to significant deviation in the corneal astigmatism estimation in a proportion of eyes.

Purpose To describe a no-history method of estimating the effective lens position (ELP) for double-K intraocular lens (IOL) power calculation in eyes that had previous refractive surgery. Setting Departments of Ophthalmology, Taipei Medical University Hospital and Taipei City Hospital, Taipei, Taiwan. Methods The corneal height (H m ) and anterior chamber diameter (AG m ) in 106 unoperated eyes were measured using a rotating Scheimpflug camera. The theoretical anterior corneal radius (R rt ) was then derived from H m and AG m by regression and rearrangement of the Fyodorov equation. The ELP estimate was then calculated from R rt . The performance of this ELP estimation method in double-K IOL power calculation and the performance of other methods were compared retrospectively in 11 eyes having cataract surgery that had previous refractive surgery. The refractive results 9 to 12 weeks after cataract surgery were selected for data analysis. Results The new ELP estimation method, combined with the BESSt formula or the Savini et al. method for estimating post refractive–surgery corneal power (K post ) in the double-K SRK/T formula, provided the best IOL power prediction results. The mean arithmetic and absolute IOL prediction errors were −0.05 ± 0.62 diopters (D) and 0.49 ± 0.34 D, respectively, when combined with the BESSt formula and 0.03 ± 0.73 D and 0.60 ± 0.36 D, respectively, when combined with the Savini et al. method. With either combination, all 11 eyes were within ±1.00 D of the refractive prediction error. Conclusion This ELP estimation method may be helpful for IOL power calculation in post refractive–surgery eyes when historical data are unavailable.

Aims: The purposes of this study were to describe the visual outcome of highly myopic eyes undergoing cataract surgery, to investigate associated risk factors for poor postoperative vision, and to assess postoperative complication frequency among the prevalent myopic Taiwanese population. Methods: We conducted a retrospective, noncomparative case series study at the Department of Ophthalmology, Zhongxing Branch, Taipei City Hospital, Taiwan. High myopia was defined as axial length of 26.0 mm. Main study outcomes were visual acuity for the initial 6-month postoperative period (including visual acuities and improvement of postoperative vision), and postoperative complications (including subsequent cataract formation and postoperative retinal detachment). Results: Fifty-two highly myopic eyes were registered between January 2002 and December 2004. Mean follow-up interval was 43.3 ± 20.2 weeks (range 25–103). Thirty-two eyes (61.5%) had good postoperative visual improvement (≧4 line Snellen chart). Thirty-seven eyes (71.2%) achieved good postoperative vision (20/40 or better). Fifteen eyes (28.8%) demonstrated poor postoperative vision. Pre-existing maculopathy was an independent risk factor for failure to achieve good postoperative vision (odds ratio, OR, 6.84, 95% confidence interval, CI: 1.12–41.8) and improvement (OR 16.1, 95% CI: 2.2–119.9). Diabetic history was considered another independent risk factor for poor postoperative vision (OR 15.6, 95% CI: 0.97–267.6). Six eyes (11.5%) developed subsequent posterior capsular opacification requiring Nd:YAG laser capsulotomy. Two eyes (3.8%) developed retinal detachment during follow-up. Conclusions: Most of highly myopic eyes achieved good visual improvement and good postoperative visual acuity after cataract surgery. Pre-existing maculopathy was an independent risk factor of postoperative visual improvement and status. It is crucial to examine retinal status prior to cataract surgery to prevent poor vision improvement, poor postoperative vision, or retinal complications.

The purpose of this study was to assess the prevalence and risk factors of each type of cataract among type 2 diabetics in Kinmen, Taiwan. There were 971 type 2 diabetics ascertained from a community-based mass screening between 1991 and 1993. In 1999, a total of 578 (59.5%) patients with type 2 diabetes were examined with an eye screening performed by two senior ophthalmologists using a 45-degree thin slit-lamp biomicroscopy and ophthalmoscopy to examine the lens after dilating the pupils. The overall prevalence, including subjects with or without surgery, was 31.0% (179/578, 95% CI: 27.3-34.7%), and had a statistically significant difference for gender (chi2 = 8.78, p = 0.003) and age (chi2-trend = 11.89, p0.0001). Based on multiple logistic regression, the significant risk factors of all types of cataracts were age (OR = 1.16, 95% CI: 1.12-1.20), lower diastolic blood pressure (DBP) at baseline (OR = 0.47, 95% CI: 0.25-0.88), and higher triglyceride at baseline (OR = 2.19, 95% CI: 1.07-4.45). In conclusion, our results found that in addition to age, lower DBP and higher triglyceride at baseline may increase the risk of prevalent cataracts in type 2 diabetics.

A 22-year-old female patient received penetrating keratoplasty (PK) of her right eye for ocular rosacea complicated with corneal perforation. Intraocular pressure (IOP) fluctuated and could not be well controlled by full antiglaucomatous agents after surgery. Therefore transscleral diode laser cyclophotocoagulation (TSCPC) was performed for the intractable glaucoma one year after PK. Unfortunately, acute cataract formation was noted 50 days after the laser treatment. Pigmented keratic precipitates (KPs) developed and IOP rose subsequently. Cataract extraction with intraocular lens implantation combined with trabeculectomy was performed 3 months later. Polymerase chain reaction (PCR) tests of the aqueous humor to detect cytomegalovirus (CMV) and herpes simplex virus (HSV) were negative. However, HSV type I DNA was detected in the lenticular material and excised trabecular tissue. Trabeculitis caused by herpetic infection could be the reason of fluctuated and intractable IOP elevation. The virus hidden in the intraocular tissue could be reactivated by TSCPC and result in cataract formation. Therefore, performing TSCPC in a phakic eye with atypical IOP presentation should be undertaken with caution.