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Background: Patellofemoral instability is associated with chondral injuries to the patella, trochlea, and lateral femoral condyle. Although studies have demonstrated an association between patellar dislocations and chondral injuries, the influence of the number of dislocations on chondrosis is not established. Purpose: To elucidate the precise association between the number of patellar dislocation events and the severity of chondral injuries in a multicenter cohort study at the time of patellar stabilization procedures. Study Design: Cross-sectional study; Level of evidence, 2. Methods: A prospective multicenter cohort study (JUPITER [Justifying Patellar Instability Treatment by Early Results]) database was queried for cases of primary patellofemoral instability procedures from December 2016 to September 2022. Cartilage lesions were classified using the International Cartilage Repair Society (ICRS) classification system during an arthroscopic or open evaluation (direct visualization), with grades 2 to 4 considered abnormal. The number of dislocations was categorized as 1, 2-5, and >5. Categorical variables were compared with the chi-square test, and binary logistic regression was performed to identify predictors of the presence of chondral lesions. Results: A total of 938 knees (mean age, 16.2 ± 3.8 years; 61.4% female) were included, with 580 (61.8%) demonstrating a chondral injury. The most affected region was the patella (n = 498 [53.1%]), followed by the lateral femoral condyle (n = 117 [12.5%]) and trochlea (n = 109 [11.6%]). There were no differences in the presence (P =.17) or grade (P =.63) of patellar lesions by the number of dislocations. Patients with >5 dislocations more frequently had trochlear chondral lesions (19.8%) compared with those with fewer dislocations (1, 7.6%; 2-5, 11.0%; P <.001). More dislocations were also associated with a higher proportion of ICRS grade 2 to 4 trochlear lesions (>5, 15.3%; 2-5, 10.0%; 1, 6.9%; P =.015). Combined patellar and trochlear lesions were also more common in those with >5 dislocations (P =.001). In multivariable regression, >5 dislocations was the only variable predictive of a trochlear lesion (odds ratio, 3.03 [95% CI, 1.65-5.58]; P <.001). Conclusion: This large prospective cohort study demonstrated that recurrent patellar dislocations can lead to more severe chondral damage in specific locations in the knee. More than 5 dislocations was associated with a >3-fold increase in the incidence and severity of trochlear chondral injuries. There were no differences in the presence or grade of patellar lesions by the number of dislocations. These findings should caution surgeons regarding prolonged nonoperative treatment. [ABSTRACT FROM AUTHOR]

This study investigates characteristics and trends of children <18 years old treated in United States emergency departments (EDs) for consumer product-related eye injuries. Data from the National Electronic Injury Surveillance System for January 1, 1997 through December 31, 2019 were analyzed. During the 23-year study period, an estimated 1,453,283 children were treated for consumer product-related eye injuries, averaging 63,186 children annually. Overall, the eye injury rate per 100,000 children <18 years old increased initially from 82.64 in 1997 to 104.53 in 2001 (p =.0492) and then decreased by 32.1% to 70.95 in 2019 (p <.0001). Almost two-thirds (64.5%) were boys and 32.1% were <5 years old. Overall, 2.6% of patients were admitted, but injuries involving non-powder firearms and golf had the highest admission rates (18.8% and 14.7%, respectively). Compared with other product categories, children were more frequently admitted if they had an eye injury associated with non-powder firearms (18.8% admitted; OR: 10.92, 95% CI: 8.67–13.76) or golf (14.7% admitted; OR: 6.59, 95% CI: 3.51–12.34). Contact with a non-chemical product was the leading mechanism of eye injury in all age groups, except children <5 years old, in which the leading mechanism was contact with a chemical product (34.2%). Corneal abrasion (36.5% overall) was the most frequent diagnosis across all age groups. Although the rate of consumer product-related pediatric eye injuries treated in US EDs has decreased since 2001, these injuries remain common among children. Therefore, increased prevention efforts are needed. [ABSTRACT FROM AUTHOR]

Given the expanding elderly population in the United States and the world, it is important to understand the processes underlying both natural and pathological age-related changes in the eye. Both the anterior and posterior segment of the eye undergo changes in biological, chemical, and physical properties driven by oxidative stress. With advancing age, changes in the anterior segment include dermatochalasis, blepharoptosis, thickening of the sclera, loss of corneal endothelial cells, and stiffening of the lens. Changes in the posterior segment include lowered viscoelasticity of the vitreous body, photoreceptor cell loss, and drusen deposition at the macula and fovea. Age-related ocular pathologies including glaucoma, cataracts, and age-related macular degeneration are largely mediated by oxidative stress. The prevalence of these diseases is expected to increase in the coming years, highlighting the need to develop new therapies that address oxidative stress and slow the progression of age-related pathologies. [ABSTRACT FROM AUTHOR]

Purpose: To determine the reported rates of intraocular inflammation (IOI) in patients treated with intravitreal aflibercept (IVT-AFL) 2 mg in routine clinical practice (ie, outside interventional studies), across all indications and within all countries (excluding the United States), with access to either the vial presentation or pre-filled syringe (PFS). Patients and methods: A search was conducted using the Bayer EYLEA® Global Safety Pharmacovigilance Database for reported cases of IOI and IVT-AFL use between October 2012 and March 31, 2022. Results: With more than 10 years of post-marketing experience with the IVT-AFL vial presentation (> 25 million sold units), and over 2 years of experience with the PFS of IVT-AFL (> 6.7 million sold units) the rate of any IOI, including endophthalmitis, outside the United States was 0.3 events per 10,000 units for the PFS and 1.2 events per 10,000 units for the vial presentation. The event rates specifically for endophthalmitis were 0.1 per 10,000 units for the IVT-AFL PFS and 0.6 per  10,000 units for the IVT-AFL vial presentation. Conclusion: In patients with retinal diseases treated in routine clinical practice with IVT-AFL either from a vial or the PFS, medically important adverse events of IOI, and in particular, endophthalmitis, are infrequently reported events. Numerically, reported rates of IOI and endophthalmitis are low for the vial presentation and even lower for the PFS. [ABSTRACT FROM AUTHOR]

With an evolving understanding and new discoveries in extracellular vesicle (EV) biology and their implications in health and disease, the significant diagnostic and therapeutic potential of EVs for vision research has gained recognition. In 2021, the National Eye Institute (NEI) unveiled its Strategic Plan titled 'Vision for the Future (2021-2025),' which listed EV research as a priority within the domain of Regenerative Medicine, a pivotal area outlined in the Plan. In alignment with this prioritization, NEI organized a workshop inviting twenty experts from within and beyond the visual system. The workshop aimed to review current knowledge in EV research and explore gaps, needs and opportunities for EV research in the eye, including EV biology and applications of EVs in diagnosis, therapy and prognosis within the visual system. This perspective encapsulates the workshop's deliberations, highlighting the current landscape and potential implications of EV research in advancing eye health and addressing visual diseases., (© 2024 The Author(s). Journal of Extracellular Vesicles published by Wiley Periodicals LLC on behalf of International Society for Extracellular Vesicles.)

Background: Creutzfeldt-Jakob disease (CJD) is a rare, fatal, neurodegenerative prion disease potentially transmissible through corneal transplantation. While statistical analyses performed two decades ago estimated the overall prevalence of CJD in the corneal donor pool to be low, the recent significant increase in corneal transplants performed and deaths due to CJD in the U.S. warrants a contemporary risk analysis. Methods: A literature review was conducted to determine the overall number of globally reported cases of CJD transmission through corneal transplantation. U.S. mortality and cornea donation data were utilized to estimate the age-stratified prevalence of undiagnosed, latent CJD in the cornea donor pool in 2018. A historical statistical analysis was performed to estimate the number of corneas from donors with latent CJD entering the U.S. donor pool for each year between 1979 and 2018. From these statistical analyses, risk factors of iatrogenic transmission were identified and summarized. Results: Ten reported cases of iatrogenic transmission of CJD through corneal transplants were identified globally. In 2018, an estimated 3.8 corneas from donors with undiagnosed latent CJD potentially entered the pool of 111,703 transplant-intended corneas harvested from individuals aged 31–80. Between 1979 and 2018, an estimated 47 corneas may have entered the U.S. transplant-intended pool from donors with latent CJD aged 35 to 84. The advanced age of donors and a history of multiple transplants in recipients were both prominent risk factors for iatrogenic transmission. Conclusions: The 10 reported global cases of iatrogenic transmission likely under-represent the number of individuals with a coinciding history of death by CJD and prior corneal transplantation, as supported by our statistical analysis and lack of geographical diversity of reported cases. As effective screening methods develop and globalization of cornea transplantation broadens, it is of utmost importance that cornea transplantation history among victims of CJD should be investigated and reported. [ABSTRACT FROM AUTHOR]

To describe the epidemiology of Emergency Department (ED) visits related to opioid abuse with primary ophthalmic diagnoses in the United States (US). This retrospective cross-sectional study used National ED Sample (NEDS) (2006–2015), a representative sample of all US EDs, to analyze and compare the epidemiology of primary ophthalmic diagnoses in opioid abusers and a control group of non-opioid users. National incidence and descriptive statistics were calculated for demographics and prevalent diagnoses. Multivariable logistic regression was used to compare outcomes between primary ophthalmic diagnoses in opioid and non-opioid abusers. An estimated 10,617 visits had a primary ophthalmic diagnosis and an accompanying opioid abuse diagnosis, and the incidence increased from 0.2 in 2006 to 0.6 per 100,000 US population in 2015. Opioid abuse group had more adults (6,747:63.5%) and middle-aged (3,361:31.7%) patients, while in controls adults (7,905,003:40.4%) and children (4,068,534:20.8%) were affected more. Leading etiologies were similar: traumatic and infectious etiologies were most common; however, opioid abuse patients had more severe ophthalmic diagnoses such as orbital fractures (8.4%), orbital cellulitis (7.4%), globe injury (3.4%) and endophthalmitis (3.2%) compared to controls. Patients in the opioid abuse group were also more likely to be admitted (adjusted Odds Ratio [aOR], 28.38 [95% CI, 24.50–32.87]). In the era of opioid crisis, an increase in ED visits with ophthalmic complaints is seen, with increasing direct and indirect costs on the healthcare system. More research is needed to establish causality and devise strategies to lower this burden. [ABSTRACT FROM AUTHOR]

Inequitable access to learning opportunities has intersectional consequences for Black students in general and gifted education. Equally important, all students (regardless of race, ethnicity, gender, socioeconomic class, and grade-level), more often than not, lack invaluable opportunities to learn about the innumerable contributions of students and families of color in the United States and worldwide. To address these injustices, Ladson-Billings advocated for a shift from "justice as theory toward justice as praxis." In this article, I unpack the components of justice as praxis work, and I discuss how I engaged in this work in my secondary English Language Arts (ELA) classroom. I address the following questions: What does it mean "to be seen" from the perspective of a Black male academically high-achieving student? What is needed for teachers to adopt a justice as praxis paradigm to improve their teaching and learning with students who have not been well served in public schools? [ABSTRACT FROM AUTHOR]

The products used in nail care services contain toxic chemicals. This study aimed to characterize occupational health risk factors and chemical exposures among Asian nail salon workers on the East Coast of the U.S. for informing the development of more effective, culturally appropriate interventions. We conducted a community-based participatory research (CBPR) study to characterize occupational health risks. A face-to-face, self-reported survey was performed, and personal exposure to volatile organic compounds (VOCs) was evaluated. Three VOCs, acetone, methyl methacrylate (MMA), and toluene, were measured using 3M 3500 organic vapor monitors. We collected data on 112 workers with 100 personal chemical exposure measurements from 25 nail salons. Self-reported health problems that emerged or worsened after participants started working in the nail salon industry included headaches (8%); lightheadedness (9.8%); and irritation to the nose, eyes, throat, and skin (21.2%). Approximately 70% of participants reported that they had been pregnant, 11.7% of whom had at least one miscarriage. The mean concentrations of acetone, MMA, and toluene were 18.51 parts per million (ppm), 39.45 ppm, and 0.09 ppm, respectively. Mean concentrations of acetone and MMA measured from salons in New York City were significantly lower than those measured in Philadelphia and southern New Jersey. CBPR proved to be as an efficient approach for recruiting hard-to-reach Asian immigrant nail salon workers. Adverse health symptoms and problems associated with providing nail salon services were identified in these workers. Further studies are needed to better understand the long-term health effects of chronic chemical exposures in nail salon environments. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the spherical equivalent outcomes of intraoperative aberrometry (IA) power calculations compared with the surgeons' preoperative power calculations in eyes implanted with AcrySof® IQ T3 intraocular lenses (IOLs). Patients and methods: We assessed data collected by an IA system from multiple centers in the United States. Data was from patients who had undergone cataract extraction by phacoemulsification with the use of the Optiwave Refractive Analysis System and whose eyes had been implanted with model SN6AT3 (1.5 diopter [D] at IOL plane) aspheric lenses. The analysis was performed in 2 stages: hypothesis generation and confirmatory testing. Confirmatory endpoints were a comparison of absolute prediction errors for IA for the implanted IOL versus preoperative formula power calculations. Design: Retrospective analysis of preoperative, intraoperative, and postoperative data concerning eyes implanted with model SN6AT3 (1.5 D) aspheric lenses from the AnalyzOR™ database. Results: Mean absolute IA prediction error was significantly lower than preoperative prediction error (paired difference: −0.06 D; p<0.0001); this was mirrored by the median paired difference of −0.04 D (p<0.0001). For eyes where the power of the implanted IOL differed from the power of the preoperatively planned lens, mean and median paired differences in prediction errors were greater: −0.13 D (p<0.0001) and −0.15 D (p<0.0001), respectively. The percentage of eyes with prediction error ≤0.50 D was significantly higher with IA (83.4%, n=5388/6460) than with the preoperative formula (76.5%, n=4942/6460, p<0.0001). When the powers of the implanted IOL and the preoperatively planned lens were different, the percentage of eyes with prediction error ≤0.50 D was 83.3% (2155/2587) for IA and 68.8% (1781/2587, p<0.0001) for the preoperative formula. Conclusion: IA produces more accurate spherical equivalent outcomes for eyes implanted with a low toric IOL than the preoperative formulas. [ABSTRACT FROM AUTHOR]

Introduction. There are few studies that describe the prevalence of ocular morbidity among people who are homeless in the United States. The goal of this study was to describe rates of visual impairment and ocular pathology of men at a homeless shelter in a major United States city. Methods. An ophthalmologist lead eye-screening clinic was established at a homeless shelter in Philadelphia, Pennsylvania. Results were obtained prospectively from 2015 to 2017. Results. During the study period, 91 patients were enrolled. Visual impairment, defined as vision worse than 20/40, was identified in 42% and ocular pathology in 57% of those studied. This was higher than the national average and higher than or similar to international studies conducted in homeless shelters. Common findings included cataracts, glaucoma, and past eye trauma. Conclusion. This study describes a high rate of eye disease and refractive error in an urban homeless sample in the United States. [ABSTRACT FROM AUTHOR]

Objective: (a) To evaluate the epidemiology of equine eosinophilic keratoconjunctivitis (EK) in the western United States, (b) to ascertain the efficacy of keratectomy and diamond burr debridement vs medical management alone, (c) to determine the efficacy of various medical therapies, and (d) to further characterize the histopathologic findings of the disease in horses. Animals studied: Twenty‐nine horses (47 eyes) diagnosed with EK from 1993 to 2017. Procedure: Retrospective medical record review; owner questionnaire. Results: Average age of presentation was 11 ± 4 years. Warmbloods were significantly overrepresented (P = 0.024). Twenty horses were treated with medical therapy alone, five were treated with superficial lamellar keratectomy, and four were treated with diamond burr debridement. Follow‐up data were available for 38 eyes of 23 horses. Median time to resolution for horses treated with either superficial keratectomy or diamond burr debridement (62 days) was not statistically significantly different from those that underwent medical therapy alone (46 days; P = 0.33). Eyes treated with topical steroids had a statistically significant longer median time to resolution (61 days) compared to those that did not receive topical steroid (44 days; P = 0.023). Common histopathologic findings in keratectomy samples included the presence of eosinophils, vascularization, and an eosinophilic membrane spanning areas of ulceration. Conclusion: In this population, time to EK resolution was similar for horses treated with medical and surgical management. The use of topical steroids was associated with a prolonged time to resolution. Keratectomy samples from horses with EK had similar findings to those reported in other species. [ABSTRACT FROM AUTHOR]

To compare the difference and agreement of corneal higher-order aberrations (HOAs) in keratoconic eyes using Scheimpflug and dual Scheimpflug–Placido imaging systems. Emory University, Atlanta, Georgia, and the University of Southern California, Los Angeles, California, USA. Retrospective between-devices reliability and agreement study. Patients diagnosed with keratoconus were evaluated sequentially by Scheimpflug and dual Scheimpflug–Placido devices. Differences, correlations, and agreement between values for total root mean square (RMS), trefoil, coma, and spherical aberration were analyzed, and Bland-Altman plots were generated. Fifty eyes from 50 patients (31 men, 19 women) were evaluated. Trefoil at 30 degrees, spherical aberration, and total RMS were significantly different between groups (P <.05), whereas trefoil at 0 degrees and total coma values were not statistically different. There was a weak positive correlation between devices for trefoil at 0 degrees (r = 0.228), and a moderate positive correlation for trefoil at 30 degrees (r = 0.473), horizontal coma (r = 0.430), and for total corneal RMS (r = 0.637). Vertical coma (r = 0.816) and spherical aberration (r = 0.874) showed a strong positive correlation. The 95% limits of agreement (LoA) for absolute values were 1.963 μm for trefoil at 30 degrees, 2.449 μm for trefoil at 0 degrees, 3.530 μm for horizontal coma, 2.145 μm for vertical coma, 1.242 μm for spherical aberration, and 10.527 μm for RMS. Significant differences were found between measurements of corneal HOAs generated by Scheimpflug and dual Scheimpflug–Placido devices in patients with keratoconus, with generally limited correlations and wide LoA. HOAs measurements from these devices should not be considered equivalent. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the age-related course of best-corrected visual acuity in healthy eyes. Methods: Two hundred participants (400 eyes) 25 to 74 years of age (114 females, 86 males) were investigated, 20 per 5-year age group. Best-corrected visual acuity was measured monocularly with the ETDRS 2000 charts at a distance of 4 m (Precision Vision, Woodstock, IL, USA). Strict exclusion and termination criteria were used. Results: Visual acuity did not change between ages 25 and 54 years (mean of the better eyes, − 0.18 ± 0.05 logMAR). A significant age-related break-point in visual acuity was found at the ages of 55–59 years. For all age groups, the overall mean visual acuity was − 0.15 ± 0.06 logMAR for the better eyes and − 0.13 ± 0.06 logMAR for the worse eyes. There was no difference between the right and left eyes (− 0.14 ± 0.06 logMAR). The visual acuity was better in the right eye in 29% (n = 58) of the participants, better in the left eye in 32% (n = 64), and the same in both eyes in 39% (n = 78). From ages 25 to 64 years, neither the better nor the worse eye had a visual acuity worse than 0.0 logMAR. Conclusion: Best-corrected visual acuity was constantly high until the age of 54 years. An age-related break-point appeared at 55 to 59 years of age. Until age 64, a minimal angle of resolution smaller than 1 min of arc (visual acuity better 0.0 logMAR) can be expected in healthy eyes. [ABSTRACT FROM AUTHOR]

Purpose: Eye and skin irritation test data are required or considered by chemical regulation authorities in the United States to develop product hazard labelling and/or to assess risks for exposure to skin- and eye-irritating chemicals. The combination of animal welfare concerns and interest in implementing methods with greater human relevance has led to the development of non-animal skin- and eye-irritation test methods. To identify opportunities for regulatory uses of non-animal replacements for skin and eye irritation tests, the needs and uses for these types of test data at U.S. regulatory and research agencies must first be clarified. Methods: We surveyed regulatory and non-regulatory testing needs of U.S. Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM) agencies for skin and eye irritation testing data. Information reviewed includes the type of skin and eye irritation data required by each agency and the associated decision context: hazard classification, potency classification, or risk assessment; the preferred tests; and whether alternative or non-animal tests are acceptable. Information on the specific information needed from non-animal test methods also was collected. Results: A common theme across U.S. agencies is the willingness to consider non-animal or alternative test methods. Sponsors are encouraged to consult with the relevant agency in designing their testing program to discuss the use and acceptance of alternative methods for local skin and eye irritation testing. Conclusions: To advance the implementation of alternative testing methods, a dialog on the confidence of these methods to protect public health and the environment must be undertaken at all levels. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of induced astigmatic defocus on visual performance in pseudophakic eyes implanted with a small aperture, trifocal, or monofocal intraocular lens (IOL). Patients and methods: The study included 44 eyes with one of four types of IOL (IC-8 IOL (AcuFocus Inc., USA); FineVision (PhysIOL SA, Belgium); AT Lisa (Carl Zeiss AG, Germany); and enVista monofocal (Bausch & Lomb, USA). For astigmatic tolerance assessment, monocular distance visual acuity was measured with cylindrical lenses (power range=0.00–2.50 diopters (D) in 0.50 D increments) added to the subjects best-corrected distance manifest refraction. The assessment was repeated on three pre-determined axes (90°, 180°, and either 45° or 135°). The magnitude of astigmatic tolerance at each defocus step was assessed by taking the difference between logMAR visual acuity at the defocus step relative to that at 0.0 D (ie, no defocus condition). Results: Across all three axes, the reduction of mean monocular visual acuity at all defocus levels relative to no defocus was significantly smaller in IC-8 group compared to the other IOL groups. When the data was combined across all axes, the astigmatic tolerance of the IC-8 group was better than AT Lisa group from 0.50 D to 2.50 D and FineVision group from 0.50 D to 1.50 D (all P<0.05, ANOVA). The IC-8 group was better than the enVista group, but not significantly (P>0.05, ANOVA). Among individual orientations, statistically significant differences were seen between IC-8 IOLs and the other IOLs, with the largest difference being in the oblique axis. Astigmatic tolerance at all axes combined was 1.40 D for IC-8 IOL, 0.70 D for AT Lisa and FineVision, and 1.00 D for enVista IOLs. Conclusion: The small aperture IC-8 IOL showed greater tolerance to induced astigmatic defocus compared to trifocal and monofocal IOLs. [ABSTRACT FROM AUTHOR]

Radiation maculopathy, a subset of significant radiation retinopathy, is one of the most common causes of visual loss following localized, regional, or whole-brain radiotherapy. Ozurdex (Allergan Inc., Irvine, CA, USA), a sustained-release intravitreal implant of 0.7 mg dexamethasone, has been used as an off-label treatment for treating recalcitrant radiation maculopathy. However, to the best of our knowledge, the beneficial effect of intravitreal dexamethasone in the contralateral eye in a patient with radiation maculopathy has not been described in the literature so far. In this case report, we report the efficacy of dexamethasone 0.7 mg intravitreal implant in recalcitrant radiation maculopathy which was refractory to intravitreal bevacizumab therapy. The patient showed good anatomical and functional outcomes in both the eyes after unilateral injection of intravitreal dexamethasone as evident by optical coherence tomography scans and fundus fluorescein angiography. It is noteworthy that the contralateral was not treated for 4 years. The case reveals systemic exposure of dexamethasone after intravitreal injection by demonstrating the bilateral effect after unilateral injection of intravitreal dexamethasone [ABSTRACT FROM AUTHOR]

To study eyes with 20/10 uncorrected distance visual acuity (UDVA) 3 months and 12 months after topography-guided LASIK for myopia and myopic astigmatism, and to identify factors predictive of this excellent level of visual acuity. Nine practices in the USA. Prospective unmasked study of safety and effectiveness. The percentage of eyes with UDVA of 20/10 or better at 3 months and 12 months after topography-guided laser in situ keratomileusis (LASIK) with the Contoura Vision excimer laser in a U.S. Food and Drug Administration clinical trial was compared, and possible contributing factors were investigated. Preoperatively, only 1% of eyes had 20/10 corrected distance visual acuity (CDVA). Postoperatively, 7.0% of eyes had 20/10 or better UDVA at 3 months, and this number increased to 16% at 12 months (odds ratio, 2.48; 95% confidence interval, 1.33-4.61). The lower preoperative corneal astigmatism and postoperative refractive cylinder correlated with better postoperative UDVA and CDVA, respectively (P <.01 in all cases). The postoperative UDVA correlated with the postoperative CDVA (P <.01). The number of eyes with UDVA of 20/10 increases significantly between 3 months and 12 months after topography-guided LASIK and correlates with better postoperative CDVA. Eyes with lower preoperative corneal astigmatism are more likely to achieve 20/10 or better UDVA postoperatively. A significant improvement in the number of eyes with 20/10 or better from 3 months to 12 months after LASIK might be unique to topography-guided treatment. [ABSTRACT FROM AUTHOR]

Purpose To compare higher order aberrations (HOAs) in normal eyes between a Scheimpflug imaging system (Pentacam HR) and dual Scheimpflug–Placido imaging system (Galilei G4). Setting Emory University, Atlanta, Georgia, and the University of Southern California, Los Angeles, USA. Design Retrospective case series. Methods Eyes screened for refractive surgery were evaluated sequentially using a Scheimpflug device and a dual Scheimpflug–Placido device. Differences, correlations, and agreement between values for total root mean square (RMS), trefoil, coma, and spherical aberration were analyzed, and Bland-Altman plots were generated. Results One hundred five eyes of 105 patients (44 men, 61 women) were evaluated. Total RMS, coma, and trefoil were significantly different between groups (all P <.001), while spherical aberration values were not. There was moderate correlation between devices for trefoil (r = 0.475 to 0.652), coma (r = 0.574 to 0.651), and spherical aberration (r = 0.483) and a strong correlation for total cornea RMS (r = 0.817). There was no directional bias between groups. The 95% limits of agreement for absolute values was 0.039 μm for trefoil at 30 degrees, 0.405 μm for trefoil at 0 degree, 0.553 μm for horizontal coma, 0.545 μm for vertical coma, 0.318 μm for spherical aberration, and 0.617 μm for RMS. Conclusions A Scheimpflug imaging device and dual Scheimpflug–Placido imaging device generated statistically different values for total cornea HOAs; however, the correlation between devices was moderate to strong and there was reasonable agreement in all measures for normal eyes. Based on these findings, the devices appear functionally equivalent for clinical use, although caution is warranted for outcomes-based research protocols that report HOAs. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the long-term safety and efficacy of a trabecular microbypass stent as a sole procedure in pseudophakic eyes with open-angle glaucoma. Setting Private practice; Sioux Falls, South Dakota, USA. Design Retrospective, consecutive case series. Methods The series included pseudophakic eyes of patients with mild to severe open-angle glaucoma (OAG) implanted with 1 trabecular microbypass stent. Data was collected at baseline before the surgery and at 1 day, 1 week, 1 month, and up to 48 months postoperatively. The data included intraocular pressure (IOP), number of glaucoma medications, and whether there was a requirement for secondary surgery. Results The study comprised 40 patients (51 eyes). The mean IOP was reduced from 20.33 mm Hg ± 4.83 (SD) at baseline to 15.65 ± 3.45 mm Hg at 48 months postoperatively, indicating a 23% reduction (P <.01). The mean number of glaucoma medications was 2.08 ± 1.06 preoperatively and 1.46 ± 1.07 at 48 months postoperatively (P >.05). Postoperatively, 3 eyes (6%) had IOP spikes of 15 mm Hg or higher than the preoperative value, which responded to topical therapy. Ten eyes (20%) required secondary glaucoma surgery. There were no postoperative or intraoperative complications. Patients who had previous ocular hypotensive medication use and an IOP of 18 mm Hg or higher achieved a statistically significant reduction in both IOP and medication use. Conclusions The insertion of a single trabecular microbypass stent effectively provided a sustained reduction in IOP in pseudophakic patients with mild to severe OAG. The IOP reduction was more robust in eyes that had a higher baseline IOP. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI) is a major cause of mortality and morbidity in the USA as well as in the world. As a result of TBI, the visual system is also affected often causing complete or partial visual loss, which in turn affects the quality of life. It may also lead to ocular motor dysfunction, defective accommodation, and impaired visual perception. As a part of the therapeutic strategy, early rehabilitative optometric intervention is important. Orthoptic therapy, medication, stem cell therapy, motor and attention trainings are the available treatment options. Gene therapy is one of the most promising emerging strategies. Use of state-of-the-art nanomedicine approaches to deliver drug(s) and/or gene(s) might enhance the therapeutic efficacy of the present and future modalities. More research is needed in these fields to improve the outcome of this debilitating condition. This review focuses on different visual pathologies caused by TBI, advances in pre-clinical and clinical research, and available treatment options. [ABSTRACT FROM AUTHOR]

Purpose To analyze planning strategies for eyes that gained 1 or more lines of corrected distance visual acuity (CDVA) after topography-guided custom treatment (TCAT). Setting Refractive Surgery Clinic, Cleveland Clinic, Ohio, USA. Design Retrospective case series. Methods Eyes having TCAT by the same surgeon between February 2016 and June 2017 were enrolled. The corneal shape was captured with the Wavelight Allegretto Topolyzer diagnostic device coupled with refraction, generating an ablation profile. The cylinder magnitude and axis of laser entry were decided by the surgeon based on the manifest and measured values, assisted by additional data from the Pentacam Scheimpflug tomographer and Ladarwave ocular wavefront aberrometer. Results The study comprised 256 eyes. At 3 months, uncorrected distance visual acuity was 20/20 or better in 95.7% and 20/15 or better in 81.4%; 25.6% gained 1 or more lines of CDVA. The measured and manifest axes differed by less than 15 degrees in 59%, between 15 degrees and 30 degrees in 18%, and by more than 30 degrees in 23%. When it differed by at least 5 degrees, the measured axis was treated in 79%, 75%, and 73% of eyes, respectively. In eyes with higher measured cylinder, 75% were treated between the manifest and measured values, with 7% at full measured value. When the manifest value was greater, 60% were treated at the total measured value and 40% in between. Whole-eye aberrometry showed a small increase in coma, spherical aberration and the total root mean square (all P <.001). Conclusions The TCAT procedure achieved visual acuity better than the preoperative CDVA in more than 25.0% of eyes. Tomography and wavefront aberrometry assisted in the selection process to achieve optimum visual outcomes. [ABSTRACT FROM AUTHOR]

Background: Millions of interventional pain procedures are performed each year to address chronic pain. The increase in these procedures also raises the concern of health risks associated with ionizing radiation for interventional pain management physicians who perform fluoroscopy-guided operations. Some health concerns include cancers, cataracts, and even pregnancy abnormalities. Little is known regarding the long-term and cumulative effects of small radiation doses., Objectives: The objective of this systematic review was to identify common body parts that are exposed to ionizing radiation during interventional pain procedures and examine methods to help physicians reduce their radiation exposure., Study Design: The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist was used to comprehensively identify articles from 2 medical databases. The radiation dose to interventional pain management physicians obtained from relevant peer-reviewed articles were aggregated and used for analysis., Methods: PubMed was first used to collect the articles for two broad keyword searches of "radiation exposure pain management" and "radiation exposure interventionalist" with years ranging from 1956 - February 2023. EMBASE was also used to collect the articles for the two keyword searches of "radiation exposure pain management" and "radiation exposure interventionalist" with years ranging from 1969 - February 2023. This systematic approach yielded a total of 2,736 articles; 24 were included in our paper. The risk of bias for these articles was performed using the Cochrane Risk of Bias tool and the National Institutes of Health tool., Results: Through our systematic literature search, more than 3,577 patients were treated by 30 interventional pain management physicians. Some areas of exposure to radiation include the physician's neck, chest, groin, hands, and eyes. One common body region that is exposed to radiation is the chest; our review found that wearing lead aprons can lower the radiation dose by more than 95%. Wearing protective equipment and managing the distance between the operator and fluoroscope can both independently lower the radiation dose by more than 90% as well. Our literature review also found that other body parts that are often overlooked in regard to radiation exposure are the eyes and hands. In our study, the radiation dose to the outside (unprotected) chest ranged from 0.008 ± 27 mrem to 1,345 mrem, the outside neck ranged from 572 mrem to 2,032 mrem, the outside groin ranged from 176 mrem to 1,292 mrem, the hands ranged from 0.006 ± 27.4 mrem to 0.114 ± 269 mrem, and the eyes ranged from 40 mrem to 369 mrem. When protective equipment was worn, the radiation exposure to the inside chest ranged from 0 mrem to 108 mrem, the inside neck ranged from 0 mrem to 68 mrem, and the inside groin ranged from 0 mrem to 15 mrem., Limitations: Limitations of this study include its small sample size; only the radiation exposure of 30 interventional pain management physicians were examined. Furthermore, this review mainly consisted of observational studies rather than randomized clinical trials., Conclusion:   Implementing safety precautions, such as wearing protective gear, providing educational programs, and keeping a safe distance, demonstrated a significant decrease in radiation exposure. The experience of interventional pain management physicians also factored into their radiation exposure during procedures. Radiation is a known carcinogen, and more research is needed to better understand its risk to interventional pain management physicians.

Purpose: To study the practical use of the Rubric for Assessment of Eye Bank Professionals for Eye Retrieval (RAEPER) as a competency assessment tool by organizing a workshop in two eye banks - one in India and other in America.Methods: Two-day workshop was conducted in two eye banks - named Shroff's Charity Eye Hospital (SCEH) in India and Miracles in Sight (MIS) in America. Day 1 of workshop comprised of didactic lectures and discussions and day 2 was eye retrieval assessment done on human eyes in a wet lab setting. Assessment was done using RAEPER by two independent senior eye bank managers.Results: MIS had 27 participants, 15 males and 12 females (mean age: 38.8 years, range: 28-55) and SCEH had 11 participants, 10 males and 1 female (mean age: 48 years, range: 22-68). All participants were in house technicians, who had a minimal experience of at least 150 eye retrievals. At MIS, step 19 (crystalline lens check) got a score of 3 (Competent) 93.5% of the time. At SCEH, step 6 (conjunctival removal) and step 4 (Irrigation of cornea with sterile saline) were high scoring with 90.11% and 72.7% scoring 3, respectively.Conclusion: India's cornea blind population is expected to reach 10 million by 2020. Steps need to be taken to improve cornea retrieval rates in the country and make various eye banks self-sufficient. Incorporating such training modules not only improves the cornea utilization rates, but also helps standardize the entire eye banking process. [ABSTRACT FROM AUTHOR]

Purpose To compare the glare-type photic phenomena for a new intraocular lens (IOL) to other monofocal IOLs, and to investigate how IOL design features might affect these phenomena. Setting Alcon Laboratories, Inc., Fort Worth, Texas; John A Moran Eye Center, University of Utah, Salt Lake City, USA. Design Schematic model eye evaluation and in vitro study. Methods Five monofocal IOL models (Clareon CNA0T0, Tecnis ZCB00, enVista MX60, Eternity W-60, and Vivinex XY1) were used to evaluate glare or positive dysphotopsia-type phenomena. Optical simulations of incoming light were generated using nonsequential ray-tracing software based on a collimated light source for various off-axis angles of illumination. The simulation analyses were verified using a laboratory in vitro bench-top glare measurement system. Results The Clareon and Vivinex IOLs produced focused off-axis images with negligible peripheral glare characteristics. The Tecnis and enVista IOLs produced dispersed images with additional glare characteristics at 45 degrees of off-axis illumination and higher. The Eternity IOL showed the highest edge-reflected glare characteristic, likely because of its straight optic edge geometry. The laboratory bench images and glare intensity profiles were consistent with the simulation data. Conclusions In vitro and nonsequential ray-tracing evaluations showed that straight optic edges and peripheral nonimaging optic geometry might contribute to positive dysphotopsia. The IOL designs with optic edge curvature and full functional optics demonstrated the lowest level of glare-type photic phenomena. Only clinical studies can confirm whether the differences observed between the IOLs in vitro are clinically significant. [ABSTRACT FROM AUTHOR]

BACKGROUND: Allheimer's is a syndrome mostly affecting geriatric causing medial temporal lobe atrophy and memory impairment. It is untreatable in geriatrics patients, but lack of using simpl and reliabl measurements to determine the severity of Allheimer's disease. This paper collects the severity of Allheimer's geriatric patients based on the popular visual grading system MTA, linear measurements applied on MRI scan to determine the severity of Allheimer's disease, and the reliability and repeatability of these measurements. OBJECTIVES: The aims of this study are to find the common grade of Allheimer's disease by using a simpl and reliabl measurement, find the reliability and repeatability of hippocampal linear measurements. Find the relation of the grade of atrophy with gender, and age. Measure hippocampal height and width to give a reference value of Allheimer's patient and measure radial temporal horn width and compare between right and left side. Compare between the United States and international Allheimer's patients. METHODOLOGY: A cross-sectional study was conducted on 60 geriatric Allheimer's subjects from ADNI database which represent 5% of all Allheimer's population in the United States. By using a visual grading system which is applied on MRI scan and compare them to each other. Statistical analysis was done by SPSS (V-21) software. The aim of this paper is to find the most common grade and the relation between the grade of Allheimer's with gender and age. Give reference value of mean volume for both right and left hippocampus. Compare between right and left temporal horn width. RESULT: The aim of this paper was to find the most common grade of Allheimer's disease among ADNI database which was done on 60 patients from ADNI. The most common grade is grade one and Allheimer is more common in males, but it is more severe in femals. MTA grading system must change from visual grading system to a system that depends on measurabl values. The new MTA system must include hippocampal width since hippocampal width has a higher association with MTA more than the hippocampal height. RR can be used as criteria to verify the grade of the new MTA. CONCLUSION: The suggestions and recommendations for future studies are to focus on transforming the MTA grading system to a system that depends on measurable values. Add the width of the hippocampus to the MTA grading system criteria. Provide simple software's that can measure the hippocampal volume in a simple clinical sitting. [ABSTRACT FROM AUTHOR]

Purpose: To compare dry eye (DE) diagnosis patterns by season in Miami vis-a-vis the US and examine differences in DE symptoms and signs by season in Miami.Patients and methods: US veteran affairs (VA) patient visits with ICD-9 codes for DE (375.15) and routine medical examination (V70.0) from 2010 to 2013 were retrospectively analyzed to evaluate the seasonal pattern of DE diagnosis. A total of 365 patients with normal ocular anatomy were prospectively recruited from the Miami VA eye clinic from 2014 to 2016 for the assessment of symptoms and signs.Results: While DE visit prevalence in Miami was about 10% lower than that of the rest of the country (22.5% vs 33.7%), Miami had roughly four times higher variability in DE visit prevalence throughout the year than the US. Peak values for DE symptoms in the Miami cohort aligned with peak DE prevalence seen in the retrospective sample, occurring in spring and fall. A similar, but less dramatic, pattern was noted with DE signs. The seasonal pattern in DE symptoms remained even after controlling for confounders including demographics and medication use.Conclusion: DE symptoms, and to a lesser degree signs, varied by month, with the highest severity of symptoms occurring in spring and fall, which corresponded with peak allergy season and weather fluctuations, respectively. These findings have important implications for season-specific diagnosis, treatment, and management of DE. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the power of trend-based visual field (VF) progression end points against long-term development of event-based end points accepted by the US Food and Drug Administration (FDA)., Methods: One eye from 3352 patients with ≥10 24-2 VFs (median = 11 years) follow-up were analyzed. Two FDA-compatible criteria were applied to these series to label "true-progressed" eyes: ≥5 locations changing from baseline by more than 7 dB (FDA-7) or by more than the expected test-retest variability (GPA-like) in 2 consecutive tests. Observed rates of progression (RoP) were used to simulate trial-like series (2 years) randomly assigned (1000 times) to a "placebo" or a "treatment" arm. We simulated neuroprotective "treatment" effects by changing the proportion of "true progressed" eyes in the two arms. Two trend-based methods for mean deviation (MD) were assessed: (1) linear mixed model (LMM), testing average difference in RoP between the two arms, and (2) time-to-progression (TTP), calculated by linear regression as time needed for MD to decline by predefined cutoffs from baseline. Power curves with 95% confidence intervals were calculated for trend and event-based methods on the simulated series., Results: The FDA-7 and GPA-like progression was achieved by 45% and 55% of the eyes in the clinical database. LMM and TTP had similar power, significantly superior to the event-based methods, none of which reached 80% power. All methods had a 5% false-positive rate., Conclusions: The trend-based methods can efficiently detect treatment effects defined by long-term FDA-compatible progression., Translational Relevance: The assessment of the power of trend-based methods to detect clinically relevant progression end points.

Purpose: Pseudoexfoliation syndrome (PXS) is an age related microfibrillopathy characterized by deposition of whitish flaky material over various ocular tissues. PXS eyes are known to have thinner corneas and thus can lead to an underestimation in intraocular pressure measurement. The purpose of this study was to find if there is any variation in central corneal thickness and intraocular pressure in PXS eyes and if there was any relationship between them.Methods: A prospective observational study was done on 141 eyes of 85 patients with PXS without glaucoma between November 2015 to April 2017 in the department of Ophthalmology in a tertiary hospital. CCT and IOP were measured by a handheld ultrasonic pachymeter (DGH Technology INC. Pachette 2, USA) and Goldmann applanation tonometer respectively at 4 different times during office hours.Results: A significant reduction of about 10 μm in mean CCT and 1.4 mmHg in mean IOP was noted over the 4 sessions which was statistically significant (P < 0.001). A significant correlation exists between IOP and CCT in PXS eyes at all times during the day (P < 0.001).Conclusion: The CCT measurements show significant thinning throughout the day, similar drop in IOP was also noted. Our study shows that there is a significant correlation between diurnal variation of CCT and IOP. Hence, it is prudent to measure CCT along with IOP at all times. [ABSTRACT FROM AUTHOR]

Gordonia bronchialis is an aerobic actinomycetes that rarely causes infections in humans. Few reports describe Gordonia spp. causing eye-related infections. We report a case of chronic infectious endophthalmitis in Oregon, USA, associated with infection by G. bronchialis. [ABSTRACT FROM AUTHOR]

Prcis: The cost of cyclophotocoagulation is less than the cost of a second glaucoma drainage device., Purpose: To compare the total direct costs of implantation of a second glaucoma drainage device (SGDD) with transscleral cyclophotocoagulation (CPC) for patients with inadequately controlled intraocular pressure (IOP) reduction, despite the presence of a preexisting glaucoma drainage device in the ASSISTS clinical trial., Methods: We compared the total direct cost per patient, including the initial study procedure, medications, additional procedures, and clinic visits during the study period. The relative costs for each procedure during the 90-day global period and the entire study period were compared. The cost of the procedure, including facility fees and anesthesia costs, were determined using the 2021 Medicare fee schedule. Average wholesale prices for self-administered medications were obtained from AmerisourceBergen.com. The Wilcoxon rank sum test was used to compare costs between procedures., Results: Forty-two eyes of 42 participants were randomized to SGDD (n=22) or CPC (n=20). One CPC eye was lost to follow-up after initial treatment and was excluded. The mean (±SD, median) duration of follow-up was 17.1 (±12.8, 11.7) months and 20.3 (±11.4, 15.1) months for SGDD and CPC, respectively ( P =0.42, 2 sample t test). The mean total direct costs (±SD, median) per patient during the study period were $8790 (±$3421, $6805 for the SGDD group) and $4090 (±$1424, $3566) for the CPC group ( P <0.001). Similarly, the global period cost was higher in the SGDD group than in the CPC group [$6173 (±$830, $5861) vs. $2569 (±$652, $2628); P <0.001]. The monthly cost after the 90-day global period was $215 (±$314, $100) for SGDD and $103 (±$74, $86) for CPC ( P =0.31). The cost of IOP-lowering medications was not significantly different between groups during the global period ( P =0.19) or after the global period ( P =0.23)., Conclusion: The total direct cost in the SGDD group was more than double that in the CPC group, driven largely by the cost of the study procedure. The costs of IOP-lowering medications were not significantly different between groups. When considering treatment options for patients with a failed primary GDD, clinicians should be aware of differences in costs between these treatment strategies., Competing Interests: Disclosure: Dr R.L.G. reports personal fees from Aerie during the conduct of the study; membership of Data and Safety Monitoring Board for Glauckos and consultant and stockholder for Intelligent Retinal Imaging Systems, outside the submitted work. Dr D.S.G. reports personal fees (consultant) from Allergan, Alcon, Aerie, and Eyenovia outside the submitted work. Dr L.R.P. reports grants from NIH, The Glaucoma Foundation, and Research to Prevent Blindness, as well as personal fees from Eyenovia, Twenty-Twenty, and Skye Biosciences outside the submitted work. Dr S.L.M. reports a research grant from AbbVie and the National Eye Institute (outside the submitted work); and consulting fees from Nicox and Thea. Dr A.P.T. reports grants or contracts from Google and Research to Prevent Blindness (to Northwestern University); consulting fees from Ivantis, Sandoz, and Zeiss; and payment for expert testimony from Ivantis. Dr R.N.W. reports personal fees (consultant) from Abbvie, Allergan, Amydis, Aerie, Equinox, Eyenovia, Iantrek, Implandata, IOPtic, Nicox, Perivision, Topcon Medical. He reports research support from the National Eye Institute, National Institute of Minority Health and Health Disparities, Bausch + Lomb, Heidelberg Engineering, Zeiss-Meditec, Optovue, Centervue, and Topcon. Dr R.M.F. reports personal fees from Bausch and Lomb and Catawba; stock in 4DMD; and grants from Santen and Ivantis outside the submitted work. Dr L.S.B. reports personal fees (consultant) from Allergan, Abbive and Aerie outside the submitted work. The remaining authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Ocular complaints represent a sizeable burden to emergency departments, accounting for an estimated 2.4 million ED visits annually. We sought to characterise visits associated with ocular injury and examine factors contributing to inpatient admission.Methods: We searched the Nationwide Emergency Department Sample between 2006 and 2011 and identified cases in which patients presented with a primary or secondary diagnosis of ocular trauma. We described these cases according to age, sex, external mechanism of injury, payer status, and identified relationships between these variables. Logistic regression models were employed to identify crude and adjusted relative odds of admission to inpatient status based on patient demographics, mechanism of injury, payer status, and the existence of multiple injuries.Results: Between 2006 and 2011, a total of 5541,434 visits were made to EDs in the United States with a primary or other diagnosis of ocular trauma; ocular trauma was the primary diagnosis in 77.9% of these cases. Overall, mean age at presentation was 33.8 years and the majority of patients were male (64.8%). Male sex, older age, being struck by or against an object, the existence of multiple injuries, and Medicaid as a primary payer were all associated with significantly higher odds of hospital admission.Discussion: The distribution of primary external mechanism of injury suggested that individuals are at higher risks for different injury types at each successive stage of life. Age and injury mechanism were correlated with odds of admission to inpatient status, with the highest odds among older adults who had been injured by being struck by or against an object.Conclusions: Ocular injury plays a substantial role in the ED. Further work is necessary to determine whether developing and implementing age- and sex-appropriate prevention strategies could reduce the incidence of ocular injury and reduce morbidity related to these types of injuries. [ABSTRACT FROM AUTHOR]

Objectives: Investigate current treatment and prescription practices of topical ophthalmic anesthetic agents (TOAAs) in emergency departments (EDs) across the United States to understand how these encounters may affect ocular health., Methods: A six question survey regarding the use of topical ophthalmic anesthetics was completed by 73 emergency medicine (EM) physicians across 34 states through the American College of Emergency Physicians (ACEP) Emergency Medicine Practices Research Network (EMPRN)., Results: The survey was completed by 73 EM physicians. The majority indicated treating eye-related complaints frequently and comfort using (TOAAs) for pain control in sterile corneal abrasion. Over half of respondents indicated never discharging a patient from the ED with a prescription for TOAAs. The consensus for patient instructions included offering a short course (<48 hr) of treatment. Furthermore, 96% of respondents indicated that they would not prescribe refills for TOAAs, mostly due to concern regarding corneal damage., Conclusions: Despite demonstrable concern regarding the use of TOAAs and risk of corneal damage, a minority of EM physicians continue to prescribe these agents in the treatment of sterile corneal abrasion, which poses risks to visual health. Ophthalmologists have begun to advocate for decreased availability of TOAAs in settings such as the ED., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2022 Contact Lens Association of Ophthalmologists.)

The outbreak of monkeypox in May and June 2022 is the largest outside of central and western Africa since the 2003 outbreak in the United States. Monkeypox, like smallpox, is caused by an orthopoxvirus, though its clinical manifestations tend to be less severe. It is characterized by a prodromal flu-like illness with lymphadenopathy followed by a centrifugally spreading rash, sometimes involving the face, palms, soles, and oral mucosa. Although the vast majority of cases resolve with symptomatic management, a small number of patients can suffer severe outcomes including, but not limited to, secondary bacterial skin infections, pneumonitis, ocular sequelae, encephalitis, hypovolemia, and death. Local, state, and federal health authorities should be involved in the care of people under investigation for this illness. With confirmed cases worldwide and the possibility of community spread, emergency clinicians need to be aware of the manifestations and management of this disease, both to treat those with the disease as well as to provide education to those exposed and at risk of infection., (Copyright © 2022 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)

Highlights: [•] Sulfur mustard is a potent vesicating chemical warfare agent. [•] We summarize acute and chronic effects on skin, eyes, and lungs. [•] Casualties from the Iran–Iraq War and recent accidents in the US are discussed. [ABSTRACT FROM AUTHOR]

Objective: Thyroid eye disease (TED) is an autoimmune, inflammatory disease resulting in retro-orbital fat and extraocular muscle expansion. TED quiets ("inactivates") as inflammation wanes; however, signs/symptoms often persist. Signs/symptoms of the disease and the impact on quality of life (QoL) were examined in noninflammatory and inflammatory TED., Methods: Data of patients with moderate-to-severe TED were collected from treating physicians. Clinical activity score (CAS, 6/7 measures available) was used to classify TED as inflammatory (CAS ≥ 3) or noninflammatory (CAS = 0 or 1). QoL impact was scored as 1 = "not at all impaired" to 7 = "extremely impaired." Patients with noninflammatory TED were further grouped into longer (>3 years) and shorter (≤3 years) disease courses., Results: Patients with inflammatory (N = 307) and noninflammatory (N = 281) TED had comparable age (50.0 ± 13.3 years vs 48.3 ± 13.8 years), gender (66% men vs 64% women), TED duration (4.0 ± 4.9 years vs 4.6 ± 5.5 years), and proportion of smokers (15% vs 11%). The most common signs/symptoms of noninflammatory TED included ocular dryness/grittiness (77%), proptosis (56%), excessive tearing (43%), soft tissue edema (42%), conjunctival redness (24%) decreased vision (24%), and eye muscle involvement (22%; 14% had diplopia). All signs/symptoms were less frequently reported in these patients than in those with inflammatory TED. QoL was impacted by noninflammatory TED, although to a lesser degree than the inflammatory disease (3.6 ± 1.5 vs 4.7 ± 1.4). However, mental health issues were similarly reported. Patients with noninflammatory TED with a longer disease course (9.0 ± 6.0 years) had similar QoL impact, mental health diagnoses, and TED signs/symptoms as those with a shorter disease course (1.4 ± 1.0 years)., Conclusion: The signs/symptoms of TED often chronically persist long after TED has "quieted," continuing to impact a patient's QoL and mental health. These data suggest that moderate-to-severe TED should be thought of as a robust symptomatic chronic disease, regardless of its inflammatory status., (Copyright © 2022 AACE. Published by Elsevier Inc. All rights reserved.)

The article offers information on the diagnosis, causes and treatments related to Sjogren's disease, an autoimmune condition that usually causes chronic inflammation with salivary and lacrimal gland dysfunction. Sjogren's is shown to usually lead to arthralgia, myalgias and fever and can be diagnosed by different qualitative and quantitative tests. The condition thus requires multidisciplinary treatment with physicians, ophthamologists and dentists.

Swine are a frequent species of choice for testing new surgical procedures and for transplantation studies. However, information concerning best practice to prepare pigs for surgery and postoperative treatment and monitoring is limited, despite a perception that preoperative socialization is beneficial. Therefore we examined the effect of preoperative visits by project personnel on compliance of 26 National Institutes of Health (NIH) minipigs subject to corneal transplantation. We briefly describe sedation and anaesthesia protocols developed for surgery and multiple postoperative interventions in order to facilitate interpretation of data relating to pig compliance. Preoperative visit variables and measures of preoperative socialization were correlated with postoperative outcome. Principal component analysis (PCA) of postoperative outcome variables identified a factor accounting for 53.5% of the variance that was significantly associated with two factors derived from PCA of preoperative factors (accounting, respectively, for 54.7% and 26.0% of the variance; P = 0.019 for the overall model, P = 0.041 and 0.040 for factors 1 and 2, respectively), such that more time spent with pigs before surgery and higher socialization scores were associated with less postoperative stress and difficulty of eye medication. Moreover, two of the preoperative visit variables, time spent with only one person in the pen and time spent with two or more people in the pen, contributed predominantly to PCA factors 1 and 2, respectively, indicating that they were fulfilling two qualitatively different requirements for socialization. We conclude that NIH minipigs are fully compliant with anaesthetic and postoperative experimental procedures provided they are well-socialized to project personnel before surgery. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual outcome of Soflens Daily Disposables and Soflens Daily Disposable for Astigmatism (Bausch & Lomb, Rochester, NY, USA) when worn by subjects with low astigmatism. Methods: Forty-one subjects (aged 19 to 40 years) with myopia between 0.50 D to 6.00 D and astigmatism not more than -1.25 D in at least one eye were recruited and fitted with spherical and toric soft contact lenses in this double-masked, non-dispensing cross-over study. High and low contrast logMAR visual acuities were measured over the lenses. At the end of the study, each subject was asked to complete a questionnaire on vision, initial comfort and ease of handling of the two lens types. Results: Monocular and binocular high and low contrast logMAR visual acuities were significantly better with the toric lenses compared with the spherical lenses (p < 0.01). Results from the questionnaire showed a significantly higher grade for vision with the toric lenses than with the spherical lenses (p = 0.003) but no significant differences in initial comfort and ease of handling between spherical and toric lenses (p > 0.21). Conclusions: The results of the present study show that both subjective and objective vision in myopic subjects with low astigmatism improves significantly when corrected with toric lenses compared with spherical lenses. [ABSTRACT FROM AUTHOR]

We describe the neuropathologic procedure utilized in the Stillbirth Collaborative Research Network (SCRN), focusing on the examination of central nervous system (CNS) in stillbirth (SB). The SCRN was organized to perform a case-control study to determine the scope and causes of SB. Pathologists at all the participating centers agreed on and used the same standardized neuropathologic techniques. Standardized sections were taken and detailed data were collected. Fresh brain tissue was saved for investigative purposes. A total of 663 women with SB were enrolled into the case-control study: 620 delivered a single stillborn, 42 delivered twins, and 1 delivered triplets. Of the 560 (84.5%) who consented to postmortem examination, 465 (70.1%) also gave consent to the examination of the CNS. In the 440 stillborn infants in whom CNS examination was possible, 248 (56.4%) of the brains were intact, 72 were fragmented (16.4%), and 120 (27.3%) were liquefied. In summary, this is the largest prospective study dedicated to investigate the causes of SB and collect essential information and biological samples in the United States. A protocol for neuropathologic examination was instituted, and a brain tissue repository was created to provide samples and related data for future investigations. [ABSTRACT FROM AUTHOR]

The prevalence of Age-related macular degeneration (AMD) is increasing as the population of elderly in the United States grows. Currently the pathogenesis is not fully understood, however oxidative injury is felt to play a significant role. The Age-Related Eye Disease Study (AREDS) established that a supplemental combination of dietary antioxidants of zinc, ββ-carotene, vitamin C and vitamin E slowed progression of AMD. Recently lutein, zeaxanthin, B vitamins, and omega-3 fatty acids have also been reported to decrease AMD progression, while vitamin E and ββ-carotene where found to increase the risk of late AMD. AREDS2 is currently underway, further examining the effects of omega-3 fatty acids, carotenoids, and the original AREDS formulation. While awaiting the results of AREDS2, it is important to understand the evidence currently available, so that physicians can safely advise patients today. This review examines the most current literature available exploring nutritional supplementation in age-related macular degeneration. [ABSTRACT FROM AUTHOR]

The article discusses the risk factors and prevention of postoperative endophthalmitis. Endophthalmitis is an inflammation of the internal coats of the eye that can lead to complete loss of vision. It states that critical care must be taken to address all risk factors for endophthalmitis in the operative stages of treatment.

Eye trauma results in 30,000 cases of blindness each year in the United States and is the second leading cause of monocular visual impairment. Eye injury is caused by a wide variety of projectile impacts and loading scenarios with common sources of trauma being motor vehicle crashes, military operations, and sporting impacts. For the current study, 79 experimental eye impact tests in literature were computationally modeled to analyze global and localized responses of the eye to a variety of blunt projectile impacts. Simulations were run with eight different projectiles (airsoft pellets, baseball, air gun pellets commonly known as BBs, blunt impactor, paintball, aluminum, foam, and plastic rods) to characterize effects of the projectile size, mass, geometry, material properties, and velocity on eye response. This study presents a matched comparison of experimental test results and computational model outputs including stress, energy, and pressure used to evaluate risk of eye injury. In general, the computational results agreed with the experimental results. A receiver operating characteristic curve analysis was used to establish the stress and pressure thresholds that best discriminated for globe rupture in the matched experimental tests. Globe rupture is predicted by the computational simulations when the corneoscleral stress exceeds 17.21 MPa or the vitreous pressure exceeds 1.01 MPa. Peak stresses were located at the apex of the cornea, the limbus, or the equator depending on the type of projectile impacting the eye. A multivariate correlation analysis revealed that area-normalized kinetic energy was the best single predictor of peak stress and pressure. Additional incorporation of a relative size parameter that relates the projectile area to the area of the eye reduced stress response variability and may be of importance in eye injury prediction. The modeling efforts shed light on the injury response of the eye when subjected to a variety of blunt projectile impacts and further validate the eye model's ability to predict globe rupture. Results of this study are relevant to the design and regulation of safety systems and equipment to protect against eye injury. [ABSTRACT FROM AUTHOR]

Abstract: As a result of trauma, approximately 30,000 people become blind in one eye every year in the United States. A common injury prediction tool is computational modeling, which requires accurate material properties to produce reliable results. Therefore, the purpose of this study was to determine the dynamic material properties of the human sclera. A high-rate pressurization system was used to create dynamic pressure to the point of rupture in 12 human eyes. Measurements were obtained for the internal pressure, the diameter of the globe, the thickness of the sclera, and the changing coordinates of the optical markers using high-rate video. A relationship between true stress and true strain was determined for the sclera tissue in two directions. It was found that the average maximum true stress was 13.89±4.81MPa for both the equatorial and meridional directions, the average maximum true strain along the equator was 0.041±0.014, and the average maximum true strain along the meridian was 0.058±0.018. Results show a significant difference in the maximum strain in the equatorial and meridional directions (p=0.02). In comparing these data with previous studies, it is concluded that the human sclera is both anisotropic and viscoelastic. The dynamic material properties presented in this study can be used for advanced models of the human eye to help prevent eye injuries in the future. [Copyright &y& Elsevier]

Purpose: To study use of protective eyewear in children who participated in activities that can cause eye injury. Methods: National Health Interview Survey (NHIS) data from 2002 were used to analyze protective eyewear use by children who participated in activities that can cause eye injury. Weighted percentages and 95% confidence intervals (CI) of the sociodemographic characteristics of children who wore protective eyewear were analyzed. Odds ratios (OR) were estimated in logistic regression models. Results: In the 2002 NHIS, 3,901 children aged 6–17 years (51% of interviewed children) participated in activities that can cause eye injury, but while doing so, only 14.5% of children wore protective eyewear. After controlling for potentially confounding effects of study variables, females were less likely to wear protective eyewear than males (OR = 0.61; 95% CI: 0.48–0.76) and children aged 12–17 years were more likely to wear protective eyewear than children aged 6–8 years (12–14 year olds: OR = 1.72, 95% CI: 1.20–2.46; 15–17 year olds: OR = 1.60; 95% CI: 1.11–2.31). Race/ethnicity, parent's education, family structure, poverty status, and region of United States residence did not have significant influence on protective eyewear use. Conclusions: To achieve the Healthy People 2010 objective of 20% of children using protective eyewear in recreational activities and hazardous situations around the home, intervention/education programs must continue to be improved and implemented. [ABSTRACT FROM AUTHOR]

The article presents several classroom activities in the United States that explore how the eyes and the brain receive and process visual information. Each activity, which take about five minutes, will enable students in science classes to gain a better understanding of the visual and thought processes that go hand-in-hand when they see things. It includes background information for each activity, as well as the materials and procedures used to achieve the end goals of each educational activity.

PurposeTo determine the molecular pathology and clinical severity of two pedigrees with a history of early retinal detachment and peripheral retinal vascular abnormalities.DesignLongitudinal cohort study.MethodsA longitudinal clinical study and DNA analysis was performed on 49 family members of two pedigrees.ResultsNine individuals were found to be hemizygous for a mutation at codon 112 (Gly112Glu) of the Norrie disease protein (NDP) in one pedigree. Significant phenotypic heterogeneity was found. The proband presented with a unilateral subtotal retinal detachment at the age of 3 years, and subsequently developed a slowly progressive tractional retinal detachment involving the macula in the contralateral eye at the age of 4 years. One individual had only mild peripheral retinal pigmentary changes with normal vision at the age of 79 years. The remaining seven individuals had varying degrees of peripheral retinal vascular abnormalities and anterior segment findings. Seven affected members of a second pedigree affected by a previously reported mutation, Arg74Cys, also demonstrated wide ocular phenotypic variation.ConclusionA novel mutation (Gly112Glu), which represents the most carboxy located, NDP mutation reported, results in significant phenotypic heterogeneity. These data support the contention that the spectrum of ocular disease severity associated with these NDP mutations is broad. Use of terms that characterize this entity by phenotypic appearance, such as familial exudative vitreoretinopathy, do not adequately communicate the potential spectrum of severity of this disorder to affected or carrier family members.Eye (2006) 20, 234–241. doi:10.1038/sj.eye.6701840; published online 18 March 2005 [ABSTRACT FROM AUTHOR]

Botulinum toxin type A (BOTOX®, Dysport™) has revolutionized treatment of wrinkles around the eyes. Since the first publications of its cosmetic benefit by Drs. Jean and Alastair Carruthers, hundreds of articles have been published about its cosmetic use. BOTOX® holds U.S. Food and Drug Administration approval in the United States for treatment of glabellar lines. BOTOX® is in widespread use worldwide and is currently the most popular cosmetic treatment in the United States. [Copyright &y& Elsevier]