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Introduction:Dry eye disease (DED) is a common, age-related ocular condition that in its mildest forms causes bothersome symptoms of ocular discomfort, fatigue, and visual disturbance that interfere with quality of life and in its more severe forms causes chronic pain and fluctuating vision. Though it is highly prevalent and costs billions of dollars to manage, current treatments have largely been inadequate, making it a frustrating condition, both for physicians and patients alike.Areas covered:This article will cover the recently discovered pathophysiology of DED that has prompted investigators to explore new molecules that target the core mechanisms that drive DED. These include anti-inflammatory/immune-modulatory drugs, secretagogues, lubricant, hormones, and autologous serum. Their potential mechanism of action and data from recent trials on efficacy/safety will be reviewed.Expert opinion:The emerging drugs have a vast range of putative mechanisms of action that may not only provide symptomatic relief but may potentially break the vicious cycle of DED and provide long-lasting cure. Current and future research may change our perspective on DED and redefine its treatment algorithms.

Essential fatty acids have been of interest in the treatment of systemic and ocular diseases, and is most recently of interest in the area of dry eye disease.

OBJECTIVE To assess the minimal clinically important difference (MCID) for the Ocular Surface Disease Index (OSDI; Allergan Inc, Irvine, California, holds the copyright), a 12-item patient-reported outcome questionnaire designed to quantify ocular disability due to dry eye disease. METHODS Study data were collected within the Restasis Review of Efficacy and Safety vs Tears in the Relief of Dry Eye (RESTORE), an observational registry. A clinician global impression (CGI) and a subject global assessment (SGA) served as anchors to estimate the MCID for the overall OSDI score (range, 0-100). The overall OSDI score defined the ocular surface as normal (0-12 points) or as having mild (13-22 points), moderate (23-32 points), or severe (33-100 points) disease. RESTORE patients were included if they completed the OSDI at the baseline visit and at a follow-up visit and had a global change rating (SGA or CGI). RESULTS Three hundred ten patients were included (82.3% white and 81.6% female [mean age, 57.8 years]). The CGI and SGA correlated with the OSDI score change for all OSDI categories except the normal category. The MCID ranged from 7.0 to 9.9 for all OSDI categories. The MCID ranged from 4.5 to 7.3 for mild or moderate disease and from 7.3 to 13.4 for severe disease. CONCLUSIONS Using observational data, we estimated the MCIDs for different baseline OSDI categories of dry eye disease. These results will assist clinicians and researchers when interpreting OSDI score changes.Arch Ophthalmol. 2010;128(1):94-101--

To understand ophthalmologists' current perceptions and treatment of patients with moderate-to-severe dry eye disease (DED).

Essential fatty acids (EFAs) play many important roles in human biology, affecting organ systems and cellular and intracellular function. Omega-3 and omega-6 EFAs are the precursors of eicosanoids, locally acting hormones involved in mediating inflammatory processes. It is largely via the production of these eicosanoids that the essential fatty acids influence human health and disease. In general, the omega-3 derived eicosanoids are anti-inflammatory while the n-6 pathway eicosanoids promote inflammation. To date, EFAs have been primarily studied with regard to systemic diseases, particularly cardiovascular disease. Currently, no dietary recommendations of EFAs for the prevention or treatment of eye disease exist. The majority of studies concerning EFAs and eye disease have focused on diseases of the retina. This article provides an overview of the current literature regarding EFAs and dry eye disease (DED). Eight studies were identified, including six randomized controlled trials. All the studies preliminarily confirmed that there is a relationship between EFA supplementation and improvement in DED. However, strong conclusions cannot be made yet because of limitations in the research reported. The role of essential fatty acids is an important topic that would benefit from a large, multicenter, randomized clinical trial powered to reach a conclusion regarding the efficacy of essential fatty acids in the treatment of dry eye disease.

Impression cytology (IC) allows cells to be harvested from the ocular surface noninvasively. Superficial layers of the epithelium are removed by application of cellulose acetate filters or Biopore membranes, and the cells can be subsequently analyzed by various methods, depending on the objective of the investigation or pathology involved. IC techniques are easily learned, can be performed in an outpatient setting, and cause virtually no discomfort to the patient. IC facilitates the diagnosis of ocular surface disorders, including, among others, keratoconjunctivitis sicca, ocular surface squamous neoplasia, and ocular surface infections. During the past decade, IC has been used increasingly to assist in diagnosis of ocular surface disease, improve our understanding of the pathophysiology of ocular surface disease, and provide biomarkers to be used as outcome measures in clinical trials. Dry eye disease is one area in which IC has contributed to significant advances.

OBJECTIVE To validate photographic bioimaging for evaluating the severity of herpes simplex virus keratitis. METHODS Stromal keratitis of patients in the Herpetic Eye Disease Study was clinically measured with a slitbeam micrometer and then photographed at trial entry. Calibrated images of 169 eyes were analyzed for the size, location, and density of stromal keratitis and endotheliitis, with shape factor as a function of area and perimeter. Validity was assessed by comparing clinical and computerized measurements and by correlating the keratitis area with visual acuity. Logistic regression explored characteristics associated with larger or denser corneal inflammation. RESULTS Stromal keratitis had a median area of 22.4 mm2 (interquartile range, 12.8-31.6 mm2) with a median shape factor of 0.69 (interquartile range, 0.56-0.79); 126 eyes (75%) had their midpoint within 2 mm of the cornea's geometric center. Photoanalytical area estimates of herpetic stromal keratitis correlated closely with clinical measurements (correlation coefficient, 0.83). Eyes with larger stromal keratitis had worse vision (correlation coefficient, 0.32) and were more likely to have iritis (P = .01). Necrotizing stromal keratitis was significantly whiter (P = .02). CONCLUSIONS Image analysis validly assesses the disciform geometry of herpetic stromal keratitis and confirms that increased severity is associated with uveitis and reduced vision.Arch Ophthalmol. 2009;127(2):161-166--

To report and define the clinical presentation, hygienic practices, treatment regimens, and visual sequelae of contact lens wearers infected with Fusariumkeratitis in the New York City metropolitan area and to review the literature on Fusariumkeratitis.

Conductive keratoplasty is a noninvasive, in-office procedure for the correction of hyperopia, hyperopic astigmatism, and management of presbyopia. It serves as an alternative to laser-based refractive surgery with essentially no intraoperative or postoperative complications.

ABSTRACTBackground:Dry eye syndrome is a highly prevalent, yet largely under diagnosed, condition that can substantially affect quality of life. Left untreated, dry eye is associated with chronic eye pain and increased risk of ocular surface disease. Current demographic changes and lifestyle factors indicate that the dry eye syndrome patient population will increase significantly, ensuring that general practitioners and ophthalmic clinicians alike will experience more patients presenting with dry eye symptoms. Greater public and practitioner awareness of emerging research, technologies, and therapies is crucial to ensuring appropriate interventions to meet specific patient needs and result in clinically favorable outcomes.Roundtable assembly:In August 2005, a team of ocular surface experts convened for a 1‐day roundtable session to discuss the latest information on diagnosing and treating dry eye syndrome and real-world issues in artificial tear therapy, including preservative use.Roundtable discussion:The discussion centered on the mild to moderate dry eye patient and critical features of the ideal artificial tear, which are preservative-free formulation, protection from microbial contamination, cost-effective, non-blurring, and easy to use. Products that match this profile have the advantage of being able to benefit the myriad of patients who comprise the dry eye syndrome population. Ocular surface health should always remain a top priority. Preferred Practice Pattern Dry Eye Syndrome Medical Treatment guidelines should be modified to recommend the use of preservative-free formula artificial tear products for all levels of dry eye conditions in consideration of the medical benefit they offer to dry eye syndrome sufferers.Conclusion:The growing prevalence of dry eye syndrome demands increased attention. Further research, enhanced diagnostic tests, increased use of preservative-free artificial tear formulations as first-line therapy, greater patient–practitioner interaction, and patient education are warranted.

Pseudomonas aeruginosaocular infections most frequently originate from an environmental source; successful treatment with various ocular antibiotics is well established. However, emergence of resistant clones to available antibiotics poses a real threat to successful treatment. The purpose of this study was to evaluate the antibiotic susceptibilities of 100 random clinical isolates of P. aeruginosato levofloxacin, moxifloxacin, and gatifloxacin, potential agents for the treatment of ocular infections caused by this microorganism.

To evaluate and compare the wavefront characteristics of normal eyes with and without hydrogel soft contact lenses for correction of myopia.

The side effects of topical antiglaucoma medications and their preservatives range from ocular discomfort to sight-threatening alterations of the ocular surface. Conjunctival hyperemia, decreased tear production and function, and superficial punctate keratitis are among the most common signs seen on routine clinical examination. Squamous cell metaplasia and changes in cell morphology have been demonstrated by impression cytology studies and evaluation of biopsy specimens, and inflammatory effects are documented by the presence of inflammatory markers. The adverse effects of topical antiglaucoma eyedrops interfere with the treatment of glaucoma on two levels: first, the discomfort produced by the eye drops discourages patient compliance; and, second, long-term treatment with eyedrops is associated with a higher failure of filtration surgery. The detailed mechanism of inflammatory response and/or direct toxicity of eye drops has yet to be determined, but it may vary with the different classes of eye drops, different preservatives, and durations of treatments. Upcoming multicenter trials for new antiglaucoma eye drops should specifically evaluate ocular surface effects.

We assessed the impact of race on survival in men treated with external beam radiotherapy with or without hormonal therapy for localized prostate cancer in Radiation Therapy Oncology Group randomized trials.

The purpose of this investigation was to examine changes in pretreatment prostate-specific antigen (PSA), stage, and grade over the past decade as a function of race and geographic region. A multiinstitutional database representing 6,790 patients (1,417 African-American, 5,373 white) diagnosed with nonmetastatic prostate cancer between 1988 and 1997 was constructed. PSA, stage, and grade data were tabulated by calendar year and region, and time trend analyses based on race and region were performed. There was an overall decline of PSA of 0.8%/year, which was significant (P = 0.0001), with a faster rate of decline in African-Americans (1.9%/year) than for whites (0.6%/year). The odds ratio (OR) for a stage shift was 1.09, which was significant (P < 0.0001), and this shift was greater in whites. The OR for an overall grade shift was 1.15, which was significant (P < 0.0001). Although grade and PSA trends were similar for the different regions, there were significant regional differences in stage trends. The implications are that the face of prostate cancer has changed over the past decade; i.e., the distributions of stage, grade, and PSA (the most important prognosticators) have changed. In addition, the countenances of that face are different for whites and African-Americans. For African-Americans, this is good news: the stage, grade, and PSA distributions are more favorable now than before. For whites, the trends are more complex and more dependent on region. These findings should be used for future clinical and health-policy decisions in the screening and treatment of prostate cancer. © 2001 Wiley-Liss, Inc.

Offers bowhunters advice on how to determine what bow length they should use.

Describes how a bowhunter killed an eight-point elk in Colorado.

Explains how bowhunters should practice shooting traditional bows.

•ARMOR surveillance data updated (2009–2020) for presumed endophthalmitis isolates•In vitro antibiotic resistance was common in all presumed endophthalmitis isolates•Almost half of all staphylococci isolates were methicillin-resistant•Methicillin-resistant strains had high resistance to azithromycin and fluoroquinolones•Multidrug resistance was prevalent among staphylococcal isolates

PurposeWe assess the relative importance of the several pretreatment characteristics in predicting death from prostate cancer in patients treated with curative intent with external beam radiotherapy alone.Materials and MethodsPatients entered on 4 prospective phase III randomized trials conducted by the Radiation Therapy Oncology Group between 1975 and 1992 were selected for this analysis if they were deemed evaluable and eligible for the trial, they had received no hormonal therapy with initial treatment and followup information was available. A disease specific survival event was declared if death was certified as due to prostate cancer, complications of treatment or unknown causes with clinically active malignancy. Median followup for patients treated on early and late studies exceeded 11 and 6 years, respectively.ResultsMost of the patients (1,557) had tumors clinically staged at T3 (59%), and 87 (36%) with clinically staged T1-2 tumors had pathologically positive lymph nodes. On multivariate analysis Gleason score, clinical stage and nodal status were associated with a less favorable overall and disease specific survival, whereas others factors, such as age and race, were not. A Gleason score of 8 to 10 was associated with a high risk of dying of prostate cancer in the first 5 years (risk ratio 20.0, p = 0.0001). The 10-year disease specific survival for patients with a Gleason score of 2 to 5, 6 to 7 and 8 to 10 was 87, 75 and 44%, respectively, following radiotherapy. Based on published reports these rates were higher than expected with observation alone.ConclusionsIn the first 10 years Gleason score was the single most important predictor of death. Gleason score should be incorporated into the current clinical staging system.

Comments on strategies for developing natural skills for traditional bowhunting. Use of instincts before shooting to achieve the best results; Concentration on the eye's field of vision to hone natural shooting ability; Position of the hand when using a bow and arrow.

Field studies were conducted to determine cowpea [Vigna unguiculata(L.) Walp.] response to different intensities of drought at different stages of growth to guide programs for the development of improved cultivars and improved management practices for semi‐arid zones. Two cowpea cultivars were subjected to different levels of irrigation using a line‐source sprinkler system in the field on a coarse‐loamy, mixed, thermic Haplic Durixeralf soil during 2 years with contrasting weather patterns. Well‐watered plants were irrigated weekly. In other treatments, water was not supplied during either the vegetative, flowering, or pod filling stages. Dry seed yields of well‐watered treatments were negatively correlated with degree days above 35 C during flowering. Yields of both cultivars were not reduced by drought during the vegetative stage, compared with the weekly irrigated treatment, providing subsequent environmental conditions were conducive to rapid recovery of growth and efficient pod set. Drought during the flowering stage substantially reduced yields, but partial yield recovery was observed where drought caused all flowers to abscise and the subsequent environment, after irrigation was resumed, permitted a new flush of flowers to produce pods. Drought during pod filling substantially reduced yields of both cultivars in both years. Variations in yield due to environmental stresses were mainly due to variations in number of pods/m2except for drought during pod filling which resulted in both low pod density and small seed. Yield with abundant water or drought during pod filling appeared to be partially source limited, whereas intermediate levels of drought at other stages may have resulted in sink limitations on yield because these treatments produced the heaviest seed.

Previous studies in vitro have shown that it is possible to achieve comparable temperature distribution in bone and the adjacent soft tissues, under appropriate experimental conditions. The objective of the present work was to determine the effects of hyperthermia on bone in vivo. In order to obtain direct temperature measurements in bone, catheters were surgically installed on top of and inside the medullary cavity of the femur of normal rabbits. The thighs were irradiated with 915 MHz microwaves for 45 min, once or twice a week. The temperatures on and inside the bone were maintained between 42.5 and 44.0° the resulting temperatures in the muscle were within 1.0°C at depths equidistant from the applicator. After four to six treatments the femora were excised for histopathological examination. New trabecular bone was deposited around the catheters; most bone components including periosteum, osteoid, and fully calcified matrix could be seen. Large numbers of osteoblasts and osteoclasts lined the trabecular surfaces, and numerous cement lines were visible, running in all directions, indicating extensive bone deposition and remodelling. In contrast, control bones (catheters installed - no hyperthermia) showed much less ossification, with many areas of thin incomplete osteoid. Further, bones treated with hyperthermia only (no surgical trauma) showed no such changes. Thus, it appears that following an initial insult, hyperthermia promotes bone deposition.

We describe the initial heating rate patterns generated by microwave irradiation of 915 MHz, with constant power output, in muscle-equivalent phantoms containing a freshly excised bone, and compared with those in phantoms consisting of muscle-equivalent gel only. At 1 cm depth the muscle was cooler in the centre of the field when bone was present underneath. Also, the orientation of the bone in the field had a pronounced effect on the heating rate profiles in the overlying muscle: when the long axis of the bone was parallel to E field, a hot area in the centre of the field was observed; after rotation of the applicator by 90° so that the long axis of the bone was perpendicular to the E field, more homogeneous heating was obtained along most of the field. In contrast, the heating patterns obtained in the cortex of the bone at similar depth (1.3 cm) were not substantially influenced by its orientation in the field. Depending on field location, the heating rate of the cortical bone closest to the applicator was within 50-75% of the SAR in muscle at the same depth. We believe that these data may be useful for the extension of such measurements in vivo, to permit the effective application of hyperthermia, with or without radiation, in the treatment of bone lesions.

The correction factors to allow for the excess transmission through the lung were worked out for 25 patients who underwent radiation treatment of lesions in thorax. The geometrical arrangements of the beams used for the treatments were reconstructed on the CT scans to identify the amount of lung that intervened. The lung transmission correction factors were worked out for four possible photon energies covering Cobalt-60, 6 MV, 10 MV, and 20 MV. Isocentric treatment was considered throughout and the isocenter was regarded as the point of dose prescription as is done in normal practice. Correction factors were based on published experimental data for situations that had the isocenter inside the lung. Ratio of TAR (or TMR) method and Batho’s power law of TAR (or TMR) method were used if the isocenter was behind the lung. It was observed that the average increase in the total dose after lung corrections were 11.5 ± 6%, 8.5 ± 5%, 5.5 ± 3%, and 4.0 ± 2% at the energies of Cobalt-60, 6 MV, 10 MV, and 20 MV, respectively. This proves the importance of carrying out the lung transmission corrections to achieve a greater consistency in the doses delivered between groups of patients treated with different photon energies.

Four siblings in an East Indian family showed typical ophthalmoscopic findings of toxoplasmic retinochoroiditis. Serologic data confirmed exposure to Toxoplasma gondiiand the results of other tests excluded other etiologic agents. Three siblings had documented episodes of ocular inflammation consistent with recurrent toxoplasmic retinochoroiditis. The fourth sibling developed a de novo lesion following an illness consistent with systemic toxoplasmosis.

Objective:The purpose of the study was to evaluate the safety and efficacy of the intrastromal corneal ring segments (ICRS) for the correction of myopia.

• Although cataract surgery is feasible in children with unilateral cataracts, visual rehabilitation depends on optical correction and conscientiously maintained amblyopia therapy. Epikeratophakia for the correction of aphakia was performed in 47 children (50 grafts). Postoperative keratometry readings showed an average increase of 12.68 diopters in early patients. With new tissue-handling techniques, the last eight patients showed an average increase of +16.80 D, with −0.64-D overrefraction for emmetropia. Visual results indicate that epikeratophakia is an effective primary procedure for patients with unilateral traumatic cataracts and that it is superior to leaving vision uncorrected in children who have had unilateral congenital cataracts removed and are contact-lens intolerant. Further studies with younger patients will be necessary to define its role in neonates; however, individual results demonstrate that good vision is obtainable with epikeratophakia.