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We report the sensitivity and specificity of van Herick (VH) grading in detecting gonioscopically-defined primary angle closure suspects (PACS) among subjects screened for participation in a population-based trial in southern China. A cut-off of VH≤25% was found to have sensitivity and specificity rates of 98.2% and 25.9%, respectively. Rates were adjusted for missing gonioscopy data, resulting in a sensitivity and specificity of 92.5% and 61.5%, respectively.

Investigate associations of race/ethnicity and preferred language with baseline glaucoma severity, VF test frequency and disease progression.Retrospective cohort study.Patients receiving VF testing at a tertiary eyecare center between 1998 and 2020 with self-identified race, ethnicity and preferred language were included. Outcome measures were VF MD and age at first visit, VF test frequency, VF MD progression.Among 29,891 patients with VF measurements between 1998 and 2020, 55.1% were female, 71.0% self-identified as White/Caucasian, 14.0% as Black/African American, 7.4% as Asian and 6.4% as Hispanic, and 11.2% preferred a language other than English. Mean VF MD at presentation was worse among Black (-9.3±9.7 dB), Asian (-6.2±7.6 dB) and Hispanic (-8.3±9.3 dB) patients (vs. Whites [-5.5±7.3 dB, p0.001] or non-Hispanics [-6.2±7.8 dB, p0.001]). After controlling for age, gender and English proficiency, disparities in glaucoma severity at presentation were reduced, especially among Asian and Hispanic patients. Despite greater severity at presentation, Black patients had lower VF test frequency/person-years (1.07±0.53) compared to Whites (1.12±0.52, p=0.006) and worse VF MD progression (-0.43 dB/year, 95% CI -0.67 to -0.28, p0.001). In contrast, Hispanics had a higher VF frequency vs. non-Hispanics (1.18±0.64 vs. 1.11±0.52, p0.001), and no difference in VF progression (p=0.77).Black, Asian and Hispanic patients had greater baseline severity vs. Whites. Unlike other groups, Black patients had a lower VF frequency vs. Whites and greater VF progression. Disparities in baseline severity were partially explained by English proficiency, especially for Asian and Hispanic patients.

The feasibility of implementing a computerized adaptive test (CAT) system in routine clinical care in ophthalmology has not been assessed. We evaluated the implementation of a glaucoma-specific CAT (GlauCAT) in outpatients at Massachusetts Eye and Ear Institute.In this implementation study (July 2020-April 2021), 216 adults (mean ± SD age 64.8 ± 15.3 years; 56.0% women) completed six adaptive GlauCAT quality of life (QOL) tests on an internet-enabled tablet at the clinic. A real-time printable report summarizing domain scores was shared with physicians prior to consultation. The implementation was evaluated using Proctor's outcomes: acceptability (patient satisfaction); appropriateness (independent complete rate [%]); feasibility (acceptance rate [%]; completion time); and fidelity (percentage of patients discussing GlauCAT results with their physician). Physician barriers/facilitators were explored using open-ended questions.Patients' mean ± SD satisfaction score was 3.5 ± 0.5 of 4, with95% of patients willing to recommend it to others. Of the 216 (89.2%) patients accepting to participate, 173 (80%) completed GlauCAT independently. Patients took 8 minutes and 5 seconds (median) to complete all 6 GlauCAT tests. Almost two-thirds (n = 136/216) of the patients reported discussing their GlauCAT results with their doctor. Physicians described the GlauCAT summary report as helpful and user-friendly, although lack of time and uncertainty about how to action information were reported.Pilot implementation of six GlauCAT QOL tests in glaucoma outpatient clinics was feasible and acceptable. Integration of GlauCAT with electronic medical records (EMRs) and evaluation of long-term implementation outcomes are needed.GlauCAT's multiple outcomes and low test-taking burden makes it attractive for measuring glaucoma-specific QOL in routine clinical care.

ObjectivesMeasure quality of life (QoL) outcomes using a novel computerised adaptive test in a clinical setting, and determine the social and demographic factors associated with specific QoL domains in patients with glaucoma.DesignCross-sectional study between July 2020 and April 2021.ParticipantsEnglish-speaking adults presenting to glaucoma clinic. Patients with cognitive impairment on a six-item cognitive impairment screen or with intraocular surgery within 90 days prior to presentation were excluded.ResultsOf 206 patients surveyed, mean age was 64.8 years (SD 15.2), 122 (56.7%) were female and 159 (74.7%) were white. On multivariable regression, visual acuity was associated with greater activity limitation (β=−2.8 points, 95% CI −3.8 to –1.8, pConclusionsIn a busy glaucoma clinic where QoL was measured with online adaptive tests for glaucoma, we found that several demographic and clinical variables are associated with lower domain scores, suggesting that patients with predisposing demographic and clinical factors are at a higher risk of worse QoL.

Purpose Evaluate differences in eye care utilization among patients with glaucoma by race and socioeconomic status (SES). Design Retrospective cohort study. Participants Representative 5% sample of Medicare beneficiaries aged > 65 years with continuous part A/B enrollment between January 1, 2014, and July 1, 2014, at least 1 diagnosis code for glaucoma within that period, and a glaucoma diagnosis in the Chronic Conditions Warehouse before January 1, 2014. Methods The following race/ethnicity categories were defined in our cohort: non-Hispanic White, Black/African American, Hispanic, and Asian/Pacific Islander. Low SES was defined as having 2 or more enrollment-based low-income indicators (dual eligibility for Medicare/Medicaid, Part D limited income subsidies, and eligibility for Part A and B State buy-in). Negative binomial regression analyses were carried out to compare relative rate ratios (RRs) of eye care utilization among racial groups stratified by low and non-low SES. Main Outcome Measures Measured from July 1, 2014, to December 31, 2016: eye examinations and eye care–related office visits; eye care–related inpatient and emergency department (ED) encounters; eye care–related nursing home and home-visit encounters; visual field and retinal nerve fiber OCT tests; glaucoma lasers and surgeries. Results Among 78 526 participants with glaucoma, mean age was 79.1 years (standard deviation, 7.9 years), 60.9% were female, 78.4% were non-Hispanic White, and 13.8% met enrollment-based criteria for low-SES. Compared with White beneficiaries, Blacks had lower counts of outpatient visits (RR, 0.92; 95% confidence interval [CI], 0.90–0.93), visual field (VF) tests (RR, 0.92; 95% CI, 0.90–0.94), but more inpatient/ED encounters (RR, 2.42; 95% CI, 1.55–3.78) and surgeries (RR, 1.14; 95% CI, 1.03–1.27). Hispanics had fewer outpatient visits (RR, 0.97; 95% CI, 0.95–0.98) and retinal nerve fiber layer (RNFL) OCT tests (RR, 0.89; 95% CI, 0.86–0.93), but more inpatient/ED encounters (RR, 2.32; 95% CI, 1.18–4.57) and selective laser trabeculoplasty (SLT) (RR, 1.25; 95% CI, 1.11–1.42) versus non-Hispanic Whites. In the non-low SES group, Black versus White disparities persisted in outpatient visits (RR, 0.93; 95% CI, 0.92–0.95), VF (RR, 0.96; 95% CI, 0.94–0.98), RNFL OCT (RR, 0.81; 95% CI, 0.78–0.83), and inpatient/ED encounters (RR, 2.57; 95% CI, 1.55–4.26). Conclusions Disparities were found in eye care utilization among Black and Hispanic patients with glaucoma. These differences persisted among Blacks after stratification by SES, suggesting that systemic racism may be an independent driver in this population.

Lipid-rich drusen are the sine qua non of age-related macular degeneration (AMD), the leading cause of blindness in older adults in the developed world. Efforts directed at uncovering effective therapeutic strategies have led to the hypothesis that altered lipid metabolism may play a pathogenic role in AMD. This hypothesis is supported by the fact that: (1) drusen, the hallmark histopathologic feature of AMD, are composed of lipids, (2) polymorphisms of genes involved in lipid homeostasis are associated with increased odds of AMD, (3) metabolomics studies show that patients with AMD have alterations in metabolites from lipid pathways, and (4) alterations in serum lipid profiles as a reflection of systemic dyslipidemia are associated with AMD. There is strong evidence that statins, which are well described for treating dyslipidemia and reducing risk associated with cardiovascular disease, may have a role for treating certain cohorts of AMD patients, but this has yet to be conclusively proven. Of interest, the specific changes in serum lipoprotein profiles associated with decreased cardiovascular risk (i.e., high HDL levels) have been shown in some studies to be associated with increased risk of AMD. In this review, we highlight the evidence that supports a role for altered lipid metabolism in AMD and provide our perspective regarding the remaining questions that need to be addressed before lipid-based therapies can emerge for specific cohorts of AMD patients.摘要: 富含脂质的玻璃疣是年龄相关性黄斑变性 (AMD) 的重要特征, AMD是发达国家老年人失明的主要原因。为发现有效的治疗策略提出了一个假说, 即脂质代谢的改变可能在AMD中起致病作用。这一假说目前有以下事实支持: (1) 作为AMD标志性组织病理学特征的玻璃疣是由脂质组成, (2) 参与脂质稳态的基因多态性与AMD的患病几率增加有关, (3) 代谢组学研究表明AMD患者的脂质代谢产物发生了改变, 以及4) 反映全身性血脂异常的血脂谱变化与AMD有关。有强有力的证据表明, 他汀类药物可能在治疗某些AMD患者的队列中发挥作用, 但这一观点尚未得到确凿的证明, 且他汀类药物在治疗血脂异常和降低与心血管疾病相关的风险方面得到了证实。有趣的是, 一些研究表明, 血清脂蛋白谱中与心血管风险降低 (即高密度脂蛋白水平) 相关的特定变化与AMD风险增加有关。在这篇综述中, 我们强调了支持脂质代谢改变在AMD中作用的证据, 并就AMD患者特定队列中在脂质治疗前需要解决的问题提出了我们的观点。.

Background A decline in instrumental activities of daily living (IADL) correlates with the progression from mild cognitive impairment (MCI) to Alzheimer’s disease (AD) dementia and has been associated with frontal and parietal hypometabolism, lower cerebrospinal fluid amyloid β 1–42, and inferior temporal cortical thinning. Identifying the underlying biomarkers of functional decline will allow for the early identification of individuals at risk of disease progression. Objective To investigate the association between IADL impairment and in vivo regional cerebral tau and cortical amyloid deposition across clinically normal (CN) elderly, MCI, and AD dementia. Methods Fifty-one CN elderly, 30 MCI, and 9 AD dementia participants of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) underwent assessment of regional tau deposition with flortaucipir (FTP) positron emission tomography (PET). An aggregate of cortical amyloid burden was assessed by florbetapir PET. IADL were assessed using the Functional Activities Questionnaire (FAQ). Tau regions with unadjusted correlations of p ≤ 0.006 (Bonferroni correction) with FAQ were used to evaluate the cross-sectional association between FAQ (dependent variable) and regional cerebral tau deposition, amyloid burden, and tau-amyloid interaction in separate general linear regression models with backward elimination. Covariates included age, American National Adult Reading Test (AMNART) intelligence quotient (IQ), and Rey Auditory Verbal Learning Test (RAVLT) total learning. Results Unadjusted correlations between FAQ and tau in the entorhinal cortex (EC) and inferior temporal cortex (IT) survived Bonferroni correction. FAQ was associated with the tau-amyloid interaction, such that in participants with greater amyloid burden, greater IADL impairment was associated with greater regional tau (EC tau × amyloid: partial r (pr) = 0.47, p

Age-related macular degeneration (AMD) is a leading cause of blindness in older adults. One of the strongest genetic risk factors for AMD is a complement factor H (CFH) gene polymorphism characterized by a tyrosine-histidine change at amino acid position 402 (Y402H). The magnitude of this association between the Y402H variant and AMD is among the strongest that has been identified for any complex, multifactorial human disease. This strong association has motivated researchers to investigate a potential link between various elements of the complement pathway and AMD pathogenesis. Given the possible contribution of complement dysregulation to AMD, complement inhibition has emerged as a therapeutic strategy for slowing geographic atrophy (GA). Randomized clinical trials thus far have yielded mixed results. In this article, we provide the historical context for complement inhibition as a strategy for treating GA, discuss potential advantages and disadvantages of complement inhibition, and highlight the questions that must be addressed before complement inhibition can take center stage as a therapy for AMD.

Age-related macular degeneration (AMD) is a leading cause of irreversible blindness among older adults in the Western world. While therapies exist for patients with exudative AMD, there are currently no approved therapies for non-exudative AMD and its advanced form of geographic atrophy (GA). The discovery of genetic variants in complement protein loci with increased susceptibility to AMD has led to the investigation of the role of complement inhibition in AMD with a focus on GA. Here, we review completed and ongoing clinical trials evaluating the safety and efficacy of these studies. Overall, complement inhibition in GA has yielded mixed results. The inhibition of complement factor D has failed pivotal phase 3 trials. Studies of C3 and C5 inhibition meeting their primary endpoint are limited by high rates of discontinuation and withdrawal in the treatment arm and higher risks of conversion to exudative AMD. Studies evaluating other complement members (CFB, CFH, CFI and inhibitors of membrane attack complex—CD59) are ongoing and could offer other viable strategies.

To identify common causes of emergency department-treated eye injury among older adults in the United States and to characterize fall-related ocular trauma in this population.Retrospective cohort study.Data from the National Electronic Injury Surveillance System, a nationally representative database of US emergency department-treated injuries, was used to assemble a cohort of adults ≥65 years of age with eye injuries between January 1, 2000 and December 31, 2019. Demographic information, diagnosis, disposition, injury location, and the consumer product associated with injury were collected. Narrative descriptions of all injuries were reviewed to identify eye injuries caused by falls.Four thousand nine hundred fifty-three eye injuries among older adults were reported from 2000-2019, a stratified probability sample representing approximately 238,162 injuries, with an average annual frequency of 12,000 injuries. Falls accounted for 11.5% of these injuries. Fall-related eye injuries commonly presented from home (66.5%) and were more likely to occur in the winter than eye injuries from other causes (28.1% vs 18.4%, P.01). Risk factors for fall-related eye injury included older age (odds ratio [OR] 1.11 [95% confidence interval {CI} 1.10-1.13 per year), female sex (OR 2.3 [95% CI 1.6-3.1] vs male), black race (OR 2.4 [95% CI 1.3-4.5] vs white), and presentation from a nursing home (OR 12.7 [95% CI 4.9-32.8] vs other locations). Older adults with fall-related injuries were more likely to be hospitalized (OR 22.8 [95% CI 15.3-33.9]) and to have a ruptured globe (OR 14.1 [95% CI 6.5-30.6]) than those with fall-unrelated injury.Falls are an important mechanism of ocular trauma in older adults and are associated with worse outcomes compared with eye injuries from other causes.

Patients with functional pain disorders often complain of generalized sensory hypersensitivity, finding sounds, smells, or even everyday light aversive. The neural basis for this aversion is unknown, but it cannot be attributed to a general increase in cortical sensory processing. Here, we quantified the threshold for aversion to light in patients with fibromyalgia, a pain disorder thought to reflect dysregulation of pain-modulating systems in the brain. These individuals expressed discomfort at light levels substantially lower than that of healthy control subjects. Complementary studies in lightly anesthetized rat demonstrated that a subset of identified pain-modulating neurons in the rostral ventromedial medulla unexpectedly responds to light. Approximately half of the pain-facilitating "ON-cells" and pain-inhibiting "OFF-cells" sampled exhibited a change in firing with light exposure, shifting the system to a pronociceptive state with the activation of ON-cells and suppression of OFF-cell firing. The change in neuronal firing did not require a trigeminal or posterior thalamic relay, but it was blocked by the inactivation of the olivary pretectal nucleus. Light exposure also resulted in a measurable but modest decrease in the threshold for heat-evoked paw withdrawal, as would be expected with engagement of this pain-modulating circuitry. These data demonstrate integration of information about light intensity with somatic input at the level of single pain-modulating neurons in the brain stem of the rat under basal conditions. Taken together, our findings in rodents and humans provide a novel mechanism for abnormal photosensitivity and suggest that light has the potential to engage pain-modulating systems such that normally innocuous inputs are perceived as aversive or even painful.

Cannabis has been used in medicine for centuries. Modern understanding of the clinical effects of cannabis and cannabinoids in the treatment of pain is evolving. Cannabinoid compounds include phytocannabinoids, endocannabinoids, and synthetics. The two main phytocannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The endocannabinoid system is comprised of endogenous cannabinoids and cannabinoid receptors including CB1 receptors located primarily in the brain and peripheral tissue and CB2 receptors in the immune and hematopoetic systems. Cannabis bioavailability and metabolism varies significantly for inhaled versus oral/sublingual routes of delivery. Large, well-designed clinical trials are limited; however the studies available provide evidence to support the use of cannabinoids for some cancer, neuropathic, and chronic pain conditions.

Resumen Introduccion Los leiomiomas son neoplasias benignas de musculo liso. En la piel existe este tipo de tejido en los musculos pieloerectores, paredes de los vasos y como musculo especializado de la region genital, que incluye vulva, escroto y musculo liso del pezon. De estos tejidos se derivan leiomiomas pilares, vasculares y leiomiomas de la piel genital, respectivamente. El leiomioma de piel genital es frecuentemente una lesion solitaria, bien circunscrita, situada profundamente, ocasionalmente pediculada y raramente dolorosa, microscopicamente formada por fasciculos entrecruzados de musculo liso, sin componente vascular prominente. Solamente se han descrito ocho casos de leiomioma de pene en la bibliografia revisada. Caso clinico Presentamos el caso de un varon de 38 anos, con lesion indolora de 4 cm de diametro a nivel del surco balano-prepucial, de un ano de evolucion y asociada a incurvacion del glande. Se realizo exeresis de la lesion subcutanea, situada adyacente al cuerpo cavernoso derecho, con buenos planos de separacion. El estudio histopatologico fue informado como leiomioma de pene, presentando alta celularidad, bajo indice mitotico y calcificaciones frecuentes. La inmunohistoquimica expresa positividad para actina y desmina, y un indice proliferativo de un 5–10% con Ki-67. Discusion Se han descrito ocho casos de leiomioma de pene en la bibliografia, los cuales presentan diferentes localizaciones, con un tamano que oscila entre 0,8 y 4 cm. El glande es la localizacion mas frecuente y aparece tanto en pacientes pediatricos como en adultos y ancianos. En ningun caso se presento recurrencia. Conclusiones Dado el crecimiento progresivo de los leiomiomas, esta indicada su exeresis para establecer su diagnostico diferencial con otro tipo de neoplasias y para evitar las deformaciones esteticas y funcionales que conlleva, especialmente en el area genital.

Results of previous studies suggest that β-adrenoreceptor activation may augment pain, and that β-adrenoreceptor antagonists may be effective in reducing pain, particularly in individuals not homozygous for the catechol-O-methyltransferase (COMT) high-activity haplotype.Consenting patients admitted for thermal burn injury at participating burn centers were genotyped; those who were not high-activity COMT homozygotes were randomized to propranolol 240 mg/d or placebo. Primary outcomes were study feasibility (consent rate, protocol completion rate) and pain scores on study days 5 to 19. Secondary outcomes assessed pain and posttraumatic stress disorder symptoms 6 weeks postinjury.Seventy-seven percent (61/79) of eligible patients were consented and genotyped, and 77% (47/61) were genotype eligible and randomized. Ninety-one percent (43/47) tolerated study drug and completed primary outcome assessments. In intention-to-treat and per-protocol analyses, patients randomized to propranolol had worse pain scores on study days 5 to 19.Genotype-specific pain medication interventions are feasible in hospitalized burn patients. Propranolol is unlikely to be a useful analgesic during the first few weeks after burn injury.

The later stages of Parkinson's disease (PD) are characterized by altered gait patterns. Although decreased arm swing during gait is the most frequently reported motor dysfunction in individuals with PD, quantitative descriptions of gait in early PD have largely ignored upper extremity movements. This study was designed to perform a quantitative analysis of arm swing magnitude and asymmetry that might be useful in the assessment of early PD. Twelve individuals with early PD (in "off" state) and eight controls underwent gait analysis using an optically-based motion capture system. Participants were instructed to walk at normal and fast velocities, and then on heels (to minimize push-off). Arm swing was measured as the excursion of the wrist with respect to the pelvis. Arm swing magnitude for each arm, and inter-arm asymmetry, were compared between groups. Both groups had comparable gait velocities (p = 0.61), and there was no significant difference between the groups in the magnitude of arm swing in all walking conditions for the arm that swung more (p = 0.907) or less (p = 0.080). Strikingly, the PD group showed significantly greater arm swing asymmetry (asymmetry angle: 13.9 + or - 7.9%) compared to the control group (asymmetry angle: 5.1 + or - 4.0%; p = 0.003). Unlike arm swing magnitude, arm swing asymmetry unequivocally differs between people with early PD and controls. Such quantitative evaluation of arm swing, especially its asymmetry, may have utility for early and differential diagnosis, and for tracking disease progression in patients with later PD.