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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
110 AMD, CL
Sunday, May 05, 2013 8:30 AM-10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 220-251/D0065-D0096
Organizing Section: Clinical/Epidemiologic Research
Program Number: 220 Poster Board Number: D0065
Presentation Time: 8:30 AM - 10:15 AM
The Number and Distribution of People with Age-Related
Macular Degeneration Worldwide in 2020 and 2040: A
Systematic Review and Hierarchical Bayesian Meta-Analysis
Tien Y. Wong2, 1, Xiang LI2, 1, Xinyi Su2, 1, Gemmy C. Cheung2, 1,
Ching-Yu Cheng1, 2. 1Singapore Eye Research Institute, Singapore,
Singapore; 2Ophthalmology, National University of Singapore,
Singapore, Singapore.
Purpose: To estimate the prevalence, distribution and racial patterns
of age-related macular degeneration (AMD) worldwide and project
the number of people with AMD in 2020 and 2040.
Methods: A systematic literature review was conducted to identify
all population-based studies of AMD worldwide by a literature search
of MEDLINE, EMBASE, and Web of Science databases. Only
studies using standardized diagnosis schemes based on grading of
retinal photos were included in the meta-analysis. Hierarchical
Bayesian (HB) approaches, allowing for differences in study design
effects, were used to determine the pooled prevalence (95% credible
intervals [CrI]) of AMD, and examine the difference in prevalence by
gender and three major ethnic groups (Europeans/Whites, Asians and
Africans/Blacks). The number of people with AMD in 2020 and 2040
was projected based on the database from the United Nations World
Population Prospects. The posterior probability (PP) of difference in
prevalence was calculated, with PP close to 1.00 suggesting moderate
evidence.
Results: We identified a total of 38 studies, comprising of 125,353
individuals between 1989 and 2012. The pooled prevalence for any,
early, and late AMD were 9.84% (95% CrI: 7.06%, 13.51%), 8.61%
(95% CrI: 6.03%, 12.19%), and 0.65% (95% CrI: 0.41%, 1.01%),
respectively. There was no evidence to support a difference in AMD
by gender. Europeans were more likely to have AMD (any: 16.17%;
early: 12.81%; late: 0.96%) than Asians (any: 4.88%, PP = 1.00;
early: 3.70%, PP = 1.00; late: 0.45%, PP = 0.94;) and Africans (any:
5.88%, PP = 0.99; early: 5.68%, PP = 0.97; late: 0.16%, PP = 1.00).
Asians were more likely to have late AMD than Africans (0.45%
versus 0.16%, PP = 0.93). The projected number of people with any
AMD and late AMD in 2020 is 195.49 and 9.33 million worldwide,
respectively, increasing to 287.38 million, and 15.65 million
respectively, in 2040.
Conclusions: There will be nearly 200 million people with AMD
globally in 2020, increasing to nearly 300 million in 2040. There is
evidence for the difference in prevalence and pattern of AMD by
racial/ethnic groups. These data provide for the first global estimates
of one of the major causes of blindness in the world and has
implications on the design and implementation of eye care service in
different countries and regions.
Commercial Relationships: Tien Y. Wong, Allergan (C), Bayer
(C), Novartis (C), Pfizer (C), GSK (F), Roche (F); Xiang LI, None;
Xinyi Su, None; Gemmy C. Cheung, Bayer (C), Bayer (R), Bayer
(F), Novartis (C), Novartis (S), Glaxo Smith Kline (F), Roche (F);
Ching-Yu Cheng, None
Support: NMRC STaR/0003/2008 and Centre Grant
(CG/SERI/2010)
Program Number: 221 Poster Board Number: D0066
Presentation Time: 8:30 AM - 10:15 AM
Prevalence, Pattern and Risk Factors for Asian Age-related
Macular Degeneration in Chinese, Malays and Indians: the
Singapore Epidemiology of Eye Disease Program
Gemmy C. Cheung1, 2, Xiang LI1, 2, Ching-Yu Cheng1, 2, Ying Feng
Zheng1, Paul Mitchell3, Jie Wang3, 4, Tien Y. Wong1, 2. 1Singapore Eye
Research Institute, Singapore, Singapore; 2Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore;
3
University of Sydney, Sydney, NSW, Australia; 4University of
Melbourne, Melbourne, VIC, Australia.
Purpose: To describe the prevalence, pattern and risk factors for agerelated macular degeneration (AMD) in a multiethnic Asian cohort.
Methods: This is a population-based cross-sectional study of 10,033
persons (3,353 Chinese, 3,280 Malay and 3,400 Indian; response rate
75%) aged 40 years and older residing in Singapore. Participants
underwent comprehensive systemic and ocular examination, retinal
photography and laboratory investigations. Early and late AMD signs
were graded from retinal photographs at a central reading centre
using the modified Wisconsin AMD grading scale. Age-standardized
prevalence estimates were calculated using the 2010 Singapore adult
population. Risk factors for AMD were analyzed using logistic
regression models.
Results: Of 10,033 participants, early AMD was present in 588
(5.86%, 95% confidence interval [CI] 5.40%, 6.32% ) and late AMD
in 63 (0.63%, 95% CI 0.47%, 0.78%). Age-standardized prevalence
for early AMD was slightly lower in Malay (4.0%) than in Indian
(5.1%) and Chinese (5.9%) persons aged 40 years and above
(p=0.002), but for late AMD, was similar in Malay (0.4%), Indian
(0.4%) and Chinese (0.6%). Risk factors for early AMD in the overall
population were male gender (odds ratio [OR] = 1.69, 95% CI :1.41,
2.08, p<0.001), hypertension (OR=1.34, CI, 1.09, 1.67, p=0.007) and
shorter axial length (OR = 1.27, 95% CI: 1.16, 1.40, p<0.001), and
myopic refractive error was negatively associated with early AMD
(OR = 0.66, 95% CI: 0.51, 0.86, p=0.002). Risk factors for late AMD
include chronic kidney disease (OR = 2.5, 95% CI: 1.41, 4.42,
p=0.002) and LDL-cholesterol (OR = 1.29, 95% CI: 1.00, 1.66,
p=0.053). Current smoking was associated with late AMD in Malay
and Chinese (OR = 2.25, 95% CI: 1.06, 4.79, p=0.035) but not in
Indian. Diabetes was associated with late AMD in Chinese persons
(OR = 3.93, 95% CI: 1.74, 8.93, p=0.001).
Conclusions: The prevalence and pattern of AMD in this large multiethnic Asian cohort are comparable with previous data from Western
populations. Male gender, hypertension, shorter axial length are
significant risk factors for early AMD, while chronic kidney disease
and LDL-cholesterol are risk factors for late AMD. In addition,
smoking and diabetes were risk factors for late AMD in some ethnic
groups. These data provide further insights into the epidemiology of
AMD in Asians.
Commercial Relationships: Gemmy C. Cheung, Bayer (C), Bayer
(R), Bayer (F), Novartis (C), Novartis (S), Glaxo Smith Kline (F),
Roche (F); Xiang LI, None; Ching-Yu Cheng, None; Ying Feng
Zheng, None; Paul Mitchell, Novartis (R), Bayer (R); Jie Wang,
None; Tien Y. Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer
(C), GSK (F), Roche (F)
Support: Biomedical Research Council (BMRC) Grant
08/1/35/19/550) and National Medical Research Council (NMRC)
Grant STaR/0003/2008, Singapore
Program Number: 222 Poster Board Number: D0067
Presentation Time: 8:30 AM - 10:15 AM
Prevalence and Risk Factors for Age-Related Macular
Degeneration in the Elderly Chinese Population in Taiwan:The
Puzih Eye Study
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Chien-Hsiung Lai1, 3, Evelyn Jou Chen Huang1, 2, Chien Neng Kuo1, 2,
Pei-Lun Wu1, 2, Ching-Lung Chen1, 2, Chau-Yin Chen1, 2, Yin-Chi
King1, Pei-Chen Wu1, 2. 1ophthalmology, Chang Gung Memorial
Hospital, Chiayi, Chiayi County, Taiwan; 2Chang Gung University
College of Medicine, Tao-Yuan, Taiwan; 3Nursing, Chang Gung
University of Science and Technology, Chiayi, Taiwan.
Purpose: To describe the associated risk factors, age-specific
prevalence, and sex-specific prevalence of drusen, early age-related
macular degeneration (AMD), and late AMD in the elderly Chinese
population in southwestern Taiwan
Methods: Grading digital color fundus photographs using the
Wisconsin Age-Related Maculopathy Grading System
Results: A total of 708 participants were enrolled in the study;
gradable fundus photos were acquired from 673 (95%; mean age,
72.47 years). The average age of the late AMD group was
significantly more than that of the early AMD, drusen only, and no
lesion groups, in that order (P = 0.014). The proportion of subjects
with hypertension was significantly higher in the late AMD group
than in the early AMD, drusen only, and no lesion groups, in that
order (P = 0.028). The prevalence of drusen >500μm increased
significantly with age in men (P = 0.019) and in the total cohort (P =
0.008). Early AMD was significantly more common in males than in
females aged 80 years or more (P = 0.047). Soft drusen, early AMD,
and late AMD were found in 40.6%, 13.1%, and 26.7% of the cohort,
respectively.
Hyperlipidemia for more than 10 years was a risk factor associated
with early AMD. Old age, hypertension for more than 10 years, and
exposure to sunlight were associated with late AMD.
Conclusions: The prevalence of early AMD (13.1%) in this elderly
Chinese population in Taiwan was equivalent to that reported in
white people in the European Eye Study (EUREYE) and in the
Japanese in the Hisayama Study. However, the observed prevalence
of late AMD (26.7%) is the highest ever reported anywhere in the
world and conflicts with previous reports that AMD is less prevalent
among Asians than among white people in Western countries.
Commercial Relationships: Chien-Hsiung Lai, None; Evelyn Jou
Chen Huang, None; Chien Neng Kuo, None; Pei-Lun Wu, None;
Ching-Lung Chen, None; Chau-Yin Chen, None; Yin-Chi King,
None; Pei-Chen Wu, None
Support: Chang Gung Medical Research Program (CMRP680341,
CMRP680342)
Program Number: 223 Poster Board Number: D0068
Presentation Time: 8:30 AM - 10:15 AM
Risk Factors of Age-Related Macular Degeneration in Argentina
Van C. Lansingh1, Maria E. Nano2, Marissa J. Carter3, Kristen A.
Eckert3, Luciana Fiocca Vernengo4, Luna D. Jose4, Natalia S.
Zarate2, Hugo Nano2, Clelia Crespo Nano2, Joao M. Furtado5.
1
International Agency for the Prevention of Blindness, Weston, FL;
2
Fundacion Nano, Buenos Aires, Argentina; 3Strategic Solutions,
Cody, WY; 4Centro Privado de Ojos Romagosa, Cordoba, Argentina;
5
Federal University of Sao Paulo, Sao Paulo, Brazil.
Purpose: Age-related macular degeneration (AMD) causes 5% of
global blindness and 1% of visual impairment. In Latin America,
little research has been done on the disease. Argentina has one of the
highest elderly populations in the region with up to 13.1% being 65
years or older. Despite its significantly aging population, there have
been no studies to date on AMD in Argentina, where epidemiological
studies on blindness suggest that AMD may be the cause of 3-4% of
blindness. The purpose of this case-control study is to assess the risk
factors for the development and progression of AMD in Argentina.
Methods: Through email and telephone communications, 28
ophthalmologists from Buenos Aires City and 4 interior provinces
surveyed patients on the possible risk factors of AMD. Surveys were
used for patients’ antioxidant intake, age/gender, race, body mass
index (BMI), hypertension, diabetes (and type of treatment),
smoking, sunlight exposure, red meat consumption, fish
consumption, and the presence of AMD. Ophthalmological
examination composed of indirect ophthalmoscopy and Amsler grid
was performed. Patients were classified according to the severity of
AMD lesions. Patients presenting no signs of AMD were used as
controls. Results were analyzed with main effects models for logistic
regression and ordinal logistic regression.
Results: There were 175 cases and 175 controls with a mean age of
75.4 years and 75.5 years, respectively, of whom 236 (67.4%) were
female. One hundred and fifty-nine (45.4%) had AMD in their left
eyes, 154 (44.0%) in their right eyes, and 138 (39.4%) in both eyes.
Of the cases with AMD in their left eyes, 47.8% had the dry type,
40.3% had the wet type, and the type was unknown for 11.9%. The
comparable figures for right eyes were: 51.9%, 34.4%, and 13.7%,
respectively. The main effects model was dominated by higher
sunlight exposure (OR [odds ratio]: 3.3) and a family history of AMD
(OR: 4.3). Other factors included hypertension (OR: 2.1), smoking
(OR: 2.2), and being of the Mestizo race, which lowered the risk of
AMD (OR: 0.40). Red meat/fish consumption, BMI, and iris color
did not have an effect. Higher age was associated with progression to
more severe AMD.
Conclusions: Sunlight exposure, family history of AMD, and an
older age were the significant risk factors. There may be other
variables, as the risk was not explained very well by the existing
factors. A larger sample may produce different and better results.
Commercial Relationships: Van C. Lansingh, International
Agency for the Prevention of Blindness (E); Maria E. Nano, None;
Marissa J. Carter, IAPB (F); Kristen A. Eckert, Strategic
Solutions (C); Luciana Fiocca Vernengo, None; Luna D. Jose,
None; Natalia S. Zarate, None; Hugo Nano, None; Clelia Crespo
Nano, None; Joao M. Furtado, None
Support: ORBIS financial support
Program Number: 224 Poster Board Number: D0069
Presentation Time: 8:30 AM - 10:15 AM
Increasing the fidelity of AMD prediction models using
population data from three continents
G H. Buitendijk1, 2, Elena Rochtchina3, Chelsea E. Myers4, Sudha K.
Iyengar5, Paul Mitchell3, Johannes R. Vingerling1, 2, Jie Wang3, 6,
Ronald Klein4, Caroline C. Klaver1, 2. 1Ophthalmology, Erasmus
Medical Center, Rotterdam, Netherlands; 2Epidemiology, Erasmus
Medical Center, Rotterdam, Netherlands; 3Centre for Vision
Research, department of Ophthalmology and Westmead Millenium
Institute, University of Sydney, Sydney, ACT, Australia;
4
Ophthalmology and Visual Sciences, University of Wisconsin
School of Medicine and Public Health, Madison, WI; 5Epidemiology
and Biostatistics, Case Western Reserve University, Cleveland, OH;
6
Centre for Eye research Australia, University of Melbourne,
Melbourne, VIC, Australia.
Purpose: Most prediction models for age-related macular
degeneration (AMD) are based on case-control studies. Due to
inclusion of only the extreme ends of the clinical spectrum, these
studies have a tendency to over-estimate risks. The aim of this study
is to develop a prediction model for late AMD based on data from
three population-based studies that included both early and no AMD.
Methods: Participants included those with gradable fundus
photographs, follow-up, and genotype data (n=8094) from the
population-based Rotterdam Study (RS), the Beaver Dam Eye Study
(BDES) and the Blue Mountain Eye Study (BMES) in the 3Continent AMD Consortium. Incident late AMD (total 4-5 visits;
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
median follow-up 11.1 years) was determined on fundus photographs
at each visit using the AMD Consortium Harmonized 5-Level AMD
Scale. An initial prediction model developed on the RS population
included all available risk factors. This model was validated in BDES
and BMES. A risk score was constructed using regression
coefficients from Cox proportional hazards analysis; predictive
values (AUC) were estimated by receiver operating characteristic
(ROC) curves; and absolute risks were estimated using Kaplan-Meier
product-limit analysis.
Results: In all, 278 participants developed incident late AMD, 2720
early AMD, and 5096 remained free of any AMD. The predictive
value was 0.88 in the initial model, and 0.85 in the validation (Z-test
P>0.05). The best prediction was achieved with age, sex, 25 SNPs in
AMD risk genes, smoking, BMI, and baseline AMD phenotype in the
model. The risk score varied from -3 to 8 with the hazard of 22.0
(95%CI 15.2-31.8) for the highest risk scores (5-8). Life time risks up
to age 90 were 60% for the highest risk scores and virtually nought
for the lowest risk scores.
Conclusions: Our study distinguishes well between the risk of those
with a low number of risk factors and those with many risk factors .
The population-based setting may provide a more generalizable risk
assessment measure than a case-control setting.
Commercial Relationships: G H. Buitendijk, None; Elena
Rochtchina, None; Chelsea E. Myers, None; Sudha K. Iyengar,
None; Paul Mitchell, Novartis (R), Bayer (R); Johannes R.
Vingerling, None; Jie Wang, None; Ronald Klein, None; Caroline
C. Klaver, Bayer (F), Novartis (F), Topcon (F)
Program Number: 225 Poster Board Number: D0070
Presentation Time: 8:30 AM - 10:15 AM
Dietary Fat and Age-related Macular Degeneration in a
Multiethnic Asian population: The Singapore Prospective Study
Program
Kumari Neelam1, 2, Huang Huiqi2, Salome Rebello3, E Shyong Tai3,
Jeannette Lee3, Rob M. vanDam3, Gemmy C. Cheung4, 2, Ching-Yu
Cheng3, 2, Tien Yin Wong2, 3. 1Ophthalmology and Visual Sciences,
Khoo Teck Puat Hospital, Singapore, Singapore; 2Singapore Eye
Research Institute, Singapore, Singapore; 3National University of
Singapore, Singapore, Singapore; 4Singapore National Eye Center,
Singapore, Singapore.
Purpose: To examine the association between dietary fat intake and
age-related macular degeneration (AMD) in multiethnic Asian
population of Singapore.
Methods: Baseline data from 4121 study participants in the
Singapore Prospective Study Program, a multiethnic (Chinese,
Malays and Indians) cohort study, were analyzed. Information
relating to dietary fat was gathered using a validated semiquantitative food-frequency questionnaire as part of the dietary
history. Presence and severity of AMD was assessed on digital colour
fundus photographs using the Multiethnic Study of Atherosclerosis
Grading Protocol. Odds ratios (ORs) and 95% confidence intervals
(CI) were estimated using multivariable regression model to examine
the relationship between dietary fat intake and risk of AMD.
Results: The mean age of the study population was 49.44 (± 10.72)
years, with a range of 24.62 to 94.87 years. There was slight
preponderance of female participants (females = 54.70%; males =
45.30%). Any AMD (early and late AMD) was seen in 108 study
participants (5.5%) and was associated with older age (p < 0.001),
male gender (p < 0.001) and smoking (p = 0.043). No significant
association was observed between dietary fat and any AMD in
multivariable regression model after adjusting for age, gender,
smoking, body mass index, and ethnicity [total fat: OR = 0.86, CI =
0.48-1.53, p = 0.604; saturated fat: OR = 1.09, CI = 0.62-1.92, p =
0.771; monounsaturated fat: OR = 1.22, CI = 0.69-2.18, p = 0.494;
polyunsaturated fat: OR = 0.94, CI = 0.54-1.65, p = 0.833].
Conclusions: Dietary fat was not associated with AMD in this
epidemiological study of a large multiethnic Asian population.
Differences in AMD risk factors and characteristics between Asians
and Caucasians may explain the lack of association.
Commercial Relationships: Kumari Neelam, None; Huang Huiqi,
None; Salome Rebello, None; E Shyong Tai, None; Jeannette Lee,
None; Rob M. vanDam, None; Gemmy C. Cheung, Bayer (C),
Bayer (R), Bayer (F), Novartis (C), Novartis (S), Glaxo Smith Kline
(F), Roche (F); Ching-Yu Cheng, None; Tien Yin Wong, Allergan
(C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche (F)
Program Number: 226 Poster Board Number: D0071
Presentation Time: 8:30 AM - 10:15 AM
Data-Driven Pattern Analysis of Dietary Items in Relation to
Age-Related Macular Degeneration
Amirul Islam1, Elaine W. Chong1, Allison M. Hodge2, Robyn H.
Guymer1, Khin Zaw Aung1, Galina A. Makeyeva1, Dallas R. English2,
3
, Graham G. Giles2, 3, Paul N. Baird1, Liubov D. Robman1. 1Centre
for Eye Research Australia, University of Melbourne, Royal
Victorian Eye and Ear Hospital, The University of Melbourne,
Melbourne, VIC, Australia; 2Cancer Epidemiology, Centre, The
Cancer Council Victoria, Melbourne, VIC, Australia; 3Centre for
Molecular, Environmental, Genetic and Analytic Epidemiology,
School of Public Health,, University of Melbourne, Melbourne, VIC,
Australia.
Purpose: To identify dietary patterns by use of data-driven principal
component analysis and to evaluate their associations with agerelated macular degeneration (AMD) in the Melbourne Collaborative
Cohort Study (MCCS).
Methods: Food frequency data were collected from the ethnically
diverse cohort of 41514 older Australians in 1990-1994, and 21,132
of them were assessed in 2003-2007 for early or late AMD
prevalence. Principal component analysis (PCA) was used to identify
eating patterns from the measured food and beverage items. PCA is a
data driven statistical method to reduce a large number of intercorrelated variables (e.g., dietary items) into a few distinct factors of
inter-correlated variables which are similar within the factor and
dissimilar between the factors. Logistic regression adjusting for age,
sex, country of birth, smoking, educational level and total energy
intake was used to assess associations with early and late AMD.
Results: Of total, 2508 (12.8%) participants had early AMD and 108
(0.6%) had late AMD. Six factors characterised by predominant
intakes of fruits (F1), vegetables (F2), grains, fish, steamed or boiled
chicken, vegetables and nuts (F3), red meat products (F4), processed
foods comprising of cakes, sweet biscuits and desserts (F5) and salad
(F6) explained 33% of the total variation. F3 above median level was
strongly associated with lower prevalence of late AMD, odds ratio
(OR) (95% confidence interval) 0.59, (0.39-0.89), whereas F4 above
median level was associated with higher prevalence of late AMD
(OR 1.47, 95% CI 1.0-2.18).
Conclusions: Dietary factor characterised by grains, steamed, grilled
and canned fish, steamed or boiled chicken, vegetables and nuts was
associated with lower prevalence of late AMD whereas a factor
characterised predominantly by red meat intake was associated with
higher late AMD prevalence. These results amplify the arguments
that the patterns and combinations of dietary intakes could be more
informative than individual dietary component.
Commercial Relationships: Amirul Islam, None; Elaine W.
Chong, None; Allison M. Hodge, None; Robyn H. Guymer, Ellex
Pty Ltd (F), Novartis (C), Bayer (C), Novartis (R); Khin Zaw Aung,
None; Galina A. Makeyeva, None; Dallas R. English, None;
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Graham G. Giles, None; Paul N. Baird, None; Liubov D.
Robman, None
Program Number: 227 Poster Board Number: D0072
Presentation Time: 8:30 AM - 10:15 AM
Dietary Omega-3 Fatty Acids, Other Fat Intake, Genetic
Susceptibility and Progression to Incident Geographic Atrophy
Robyn Reynolds1, Bernard Rosner2, Johanna M. Seddon1, 3.
1
Ophthalmic Epidemiology and Genetics Service, New England Eye
Center, Tufts Medical Center, Boston, MA; 2Channing Laboratory,
Boston, MA; 3Ophthalmology, Tufts University School of Medicine,
Boston, MA.
Purpose: To investigate associations between dietary omega-3 fatty
acids and other fat intake, genes related to age-related macular
degeneration (AMD) and progression to geographic atrophy (GA).
Methods: Participants included 2531 individuals from the AgeRelated Eye Disease Study, among whom 525 eyes progressed to GA
and 4165 eyes did not. Eyes without advanced AMD (GA or
neovascular disease) at baseline were evaluated for progression to
GA. Behavioral data, including smoking and body mass index
measurements were collected at baseline. Dietary data was collected
from food frequency questionnaires (FFQ) at baseline. Omega-3 fatty
acids (docosahexaenoic acid or DHA and eicosapentaenoic acid or
EPA), omega-6 fatty acids, monounsaturated, saturated,
polyunsaturated and total fat were adjusted for sex and caloric intake
and divided into quintiles. Eight SNPs in 7 genes: CFH,
ARMS2/HTRA1, CFB, C2, C3, CFI, and LIPC were genotyped. Cox
proportional hazards models were used to test for associations
between incident GA and intake of dietary lipids, as well as
interaction effects between dietary fat intake and genetic variation on
risk of GA.
Results: Increased intake of DHA was significantly associated with
reduced risk of progression to GA in multivariate models with
behavioral factors (Model A) plus genetic variants (Model B) (P
trend=0.008 and 0.03, respectively). Omega-3 long chain
polyunsaturated (DHA + EPA) fatty acid intake was significantly
associated with reduced risk of progression in Model B (P trend
=0.02). Monounsaturated fat was associated with increased risk in
Model A (P trend=0.05). DHA intake was significantly associated
with reduced risk of incident GA among those with the
ARMS2/HTRA1 homozygous risk genotype (HR Q5 vs Q1 = 0.4, P =
0.002); DHA was not associated with reduced risk of GA among
those with the homozygous non-risk genotype (HR = 1.0, P= 0.90, P
interaction between ARMS2 and fat intake = 0.05).
Conclusions: Increased self- reported dietary intake of omega-3 fatty
acids is associated with reduced risk of GA and may modify genetic
susceptibility for progression to GA.
Commercial Relationships: Robyn Reynolds, None; Bernard
Rosner, None; Johanna M. Seddon, Genentech (F), Tufts Medical
Center (P)
Support: NEI R01 EY011309; FFB, RPB, Lion's, MVRF, AMDF,
Macular Degeneration Research Fund, Tufts Medical Center, Boston,
MA
Program Number: 228 Poster Board Number: D0073
Presentation Time: 8:30 AM - 10:15 AM
Attenuation of Genetic Risk for Age-Related Macular
Degeneration by Healthy Diets and Lifestyles
Kristin J. Meyers1, Zhe Liu1, Barbara A. Blodi1, Elizabeth J.
Johnson4, Rob Igo3, Gloria E. Sarto6, Lesley Tinker5, Sudha K.
Iyengar3, Julie A. Mares1, 2. 1Ophthalmology and Visual Sciences,
University of Wisconsin, Madison, WI; 2McPherson Eye Research
Institute, University of Wisconsin, Madison, WI; 3Epidemiology and
Biostatistics, Case Western Reserve University, Cleveland, OH; 4Jean
Mayer USDA Human Nutrition Research Center on Aging, Tufts
University, Boston, MA; 5Cancer Prevention Research Program, Fred
Hutchinson Cancer Research Center, Seattle, WA; 6Obstetrics and
Gynecology, University of Wisconsin, Madison, WI.
Purpose: To investigate whether the risk of age-related macular
degeneration (AMD) associated with Y402H in the complement
factor H (CFH) gene is modified by dietary lutein and zeaxanthin
(dietary LZ) or Healthy Lifestyle Score in the Carotenoids in AgeRelated Eye Disease Study (CAREDS), an ancillary study to the
Women’s Health Initiative (WHI) Observational Study.
Methods: Dietary LZ for CAREDS participants was estimated using
food frequency questionnaires at WHI baseline (1994-1998). Healthy
Lifestyle Scores (0-6 points) were assigned based on levels of three
lifestyle variables: Healthy Eating Index score, physical activity
(MetHrs/week), and pack years of smoking at WHI baseline. Six
years later, stereoscopic fundus photographs were taken and graded
for AMD. The current analysis was restricted to 728 women, 120
with early or late AMD, for whom there was no evidence of recent
diet change, history of cardiovascular disease, hypertension, diabetes,
or AMD prior to assessment of diet and physical activity. Interactions
between Y402H genotypes and dietary LZ or Healthy Lifestyle Score
were assessed separately using a multiplicative interaction term in
logistic regression models adjusted for age. The referent group was
low genetic risk (TT) and low diet scores (first quintile of dietary LZ
or Healthy Lifestyle Scores 0-2).
Results: Overall, the largest reduction in odds for AMD from healthy
diets and lifestyles was among women homozygous for the risk allele
of CFH Y402H, CC (Pinteraction=0.15). Homozygotes for the risk
allele had over 2-fold lower odds of AMD when in the highest
quintile of dietary LZ (OR=0.93, 95% CI: 0.21-4.17) versus the
lowest quintile (OR=2.23, 95% CI: 0.56-8.91); Ptrend=0.06. The
same patterns were observed for Healthy Lifestyle Score:
homozygotes having a combination of unhealthy behaviors (0-2
points) vs. healthy behaviors (4-6 points) including healthy diets,
physical activity and <7 packyears of smoking reduced odds for
AMD from 3.21 (95% CI: 1.14-8.98) to 0.98 (95% CI: 0.37-2.60);
Ptrend=0.03. Synergy between genotype and healthy lifestyle score
was observed (synergy index=1.29, 95% CI: 1.12-1.49). Adjustment
for hormone therapy, sunlight exposure, and iris color did not alter
the conclusion.
Conclusions: These results suggest the greatest benefit of healthy
diets and lifestyle in reducing odds of AMD is in women with high
risk genotypes, characterized by Y402H.
Commercial Relationships: Kristin J. Meyers, None; Zhe Liu,
None; Barbara A. Blodi, None; Elizabeth J. Johnson, None; Rob
Igo, None; Gloria E. Sarto, None; Lesley Tinker, None; Sudha K.
Iyengar, None; Julie A. Mares, None
Support: NIH Grant EY13018, EY16886, Retina Research
Foundation, and Research to Prevent Blindness
Program Number: 229 Poster Board Number: D0074
Presentation Time: 8:30 AM - 10:15 AM
Complement factor B (CFB) polymorphisms and early and late
age-related macular degeneration in the EUREYE Study
Astrid E. Fletcher1, Reecha Sofat2, Usha Chakravarthy3, Paulus T. de
Jong4, Mati Rahu5, Jesus Vioque6, Johan H. Seland7, Fotis Topouzis8,
Gisele Soubrane9. 1Epidemiology & Population Health, London
School of Hygiene & Tropical Med, London, United Kingdom;
2
Centre for Clinical Pharmacology, University College, London,
United Kingdom; 3Vision Sciences, Queens University, Belfast,
United Kingdom; 4Ophthalmogenetics, Netherlands Institute of
Neuroscience, Amsterdam, Netherlands; 5Epidemiology and
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Biostatistics, National Institute for Health Development, Tallinn,
Estonia; 6Dpto. Salud Publica, Universidad Miguel Hernandez,
Alicante, Spain; 7Stavanger University Hospital, University of
Bergen, Bergen, Norway; 8Ophthalmology, Aristotle Univ of
Thessaloniki, Thessaloniki, Greece; 9Ophthalmology, Univ Paris
Descartes, Paris, France.
Purpose: A recent meta-analysis (Thakkinstian Am J Epid 2012;
176:361-372) showed a protective effect of variants in CFB/
Complement component 2 on age-related macular degeneration
(AMD). Most studies were of late AMD in clinic patients. Little is
known on whether these findings apply to early AMD or whether
environmental factors modify the association. We investigated the
associations of a variant in CFB (rs4151667) with both early and late
AMD in the population based EUREYE study.
Methods: EUREYE was conducted in seven European countries with
ethics approval obtained at each centre. Participants gave written
informed consent, were interviewed for risk factors and underwent
fundus photography and blood collection. Fundus images were
graded by an independent reading centre according to the modified
International Classification and Grading System for AMD based on
staging morphological signs of increasing severity into early AMD
(stages 1-3) and late AMD (stage 4). Individuals were genotyped for
rs4151667 using KASPar technology. We assessed the effect of
genotype (homozygote or heterozygote vs. non risk homozygote) on
risk of early and late AMD using multiple logistic regression. Crude
and adjusted (age, sex, country) Odds Ratios (ORs) with 95% CI’s
were generated. We explored interactions with smoking, obesity,
diabetes and cardiovascular disease.
Results: Genotype data were available on 92% of participants (2073
with no AMD (control), 2158 early AMD and 144 late AMD). The
rs4151667 control MAF was 0.05 and in Hardy Weinberg
equilibrium (p=0.8). Analysis was restricted to the AT vs. TT
comparison, as there were only 5 individuals with an AA genotype.
The OR and 95% CI were 0.74 (0.58, 0.95) for early AMD and 0.34
(0.14, 0.81) for late AMD. There were significant interactions
between smoking and early (p <0.0001) and late (p<0.0001) AMD. In
early AMD the OR of AT in never smokers was 0.51 (0.38, 0.68) and
in ever smokers, 1.14 (0.81, 1.58). For late AMD the OR was 0.19
(0.05, 0.74) in never smokers and 0.54 (0.26, 1.14) in ever smokers.
There were no interactions with the other environmental variables.
Conclusions: We found that rs4151667 was associated with a
protective association of early AMD although the effect was smaller
compared to late AMD. We report novel results for effect
modification by smoking with the lowest ORs reported for non
smokers carrying the A allele.
Commercial Relationships: Astrid E. Fletcher, None; Reecha
Sofat, None; Usha Chakravarthy, Bayer (C), Novartis (F), Neovista
(C), Oraya (F); Paulus T. de Jong, None; Mati Rahu, None; Jesus
Vioque, None; Johan H. Seland, None; Fotis Topouzis, None;
Gisele Soubrane, Allergan (C), Novartis (C)
Support: European Commission QLK-6-CT-1999-02094, Macular
Disease Society UK, UK Medical Research Council
Program Number: 230 Poster Board Number: D0075
Presentation Time: 8:30 AM - 10:15 AM
Effects of Cataract Surgery and Polymorphisms in CFH and
ARMS2 on the risk of Age-related Macular Degeneration
Chee Wai Wong1, 2, Tien Y. Wong4, 2, Jiemin Liao4, 2, Gemmy C.
Cheung1, Chiea Chuen Khor4, 5, Eranga N. Vithana2, Paul Mitchell3,
Jie Wang3, Tin Aung2, 1, Ching-Yu Cheng4, 2. 1Singapore National Eye
Centre, Singapore, Singapore; 2Singapore Eye Research Institute,
Singapore, Singapore; 3Centre for Vision Research, University of
Sydney, Sydney, NSW, Australia; 4Department of Ophthalmology,
National University Hospital, National University Health System,
Singapore, Singapore; 5Saw Swee Hock School of Public Health,
National University of Singapore, Singapore, Singapore.
Purpose: To determine the independent and joint effects of cataract
surgery and genetic polymorphism in the CFH and ARMS2 genes on
the risk of early age-related macular degeneration (AMD)
Methods: A total of 9,529 eyes of 4,918 participants from the
Singapore Malay Eye Study and the Singapore Indian Eye Study
were analyzed. Participants underwent a structured questionnaire and
a detailed ocular examination, including slit lamp examinations for
lens status and dilated fundus photography. AMD grading was done
based on the retinal photos according to the Wisconsin age-related
maculopathy grading system. Previous cataract surgery was defined
as pseudophakia or aphakia. Genotyping was performed using
Illumina Human 610 BeadChip platform. SNP rs10801555 (Y402H)
in the CFH gene and rs3750847 in ARMS2 were included for
analysis.
Results: We found a weak association between previous cataract
surgery and early AMD (odds ratio [OR]=1.36; 95% confidence
interval [CI]: 0.99-1.87). In individuals without previous cataract
surgery, the risk of early AMD was similar between those with the
CFH Y402H wild-type genotype (GG) and the Y402H risk genotypes
(genotype GA: OR = 0.95 [95% CI: 0.72-1.24]; AA: OR = 0.90 [95%
CI 0.52-1.55]). In contrast, individuals with both previous cataract
surgery and the Y402H risk genotype were more likely to have early
AMD, with an OR of 1.63 [95% CI: 1.11-2.41] for the GA genotype
and an OR of 2.46 (95% CI: 1.26-4.80) for the AA genotype,
compared to those with the GG genotype and without cataract
surgery. The interaction between previous cataract surgery and CFH
Y402H on the risk of early AMD remained significant (P = 0.045)
after adjusting for age, gender, genetic ancestry, smoking status,
diabetes mellitus, hypertension, hyperlipidemia and chronic kidney
disease. There was no significant interaction between cataract surgery
and the ARMS2 rs3750847.
Conclusions: A trend towards an association between cataract
surgery and early AMD was found. There is significant geneenvironment interaction between CFH genetic polymorphism and
cataract surgery on the risk of early AMD, suggesting a role of the
complement system in the pathogenesis of AMD following cataract
surgery.
Commercial Relationships: Chee Wai Wong, None; Tien Y.
Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F),
Roche (F); Jiemin Liao, None; Gemmy C. Cheung, Bayer (C),
Bayer (R), Bayer (F), Novartis (C), Novartis (S), Glaxo Smith Kline
(F), Roche (F); Chiea Chuen Khor, None; Eranga N. Vithana,
None; Paul Mitchell, Novartis (R), Bayer (R); Jie Wang, None; Tin
Aung, Alcon (R), Alcon (C), Alcon (F), Allergan (R), Allergan (C),
Carl Zeiss Meditec (F), Carl Zeiss Meditec (R), Ellex (F), Ellex (R),
Santen (R); Ching-Yu Cheng, None
Program Number: 231 Poster Board Number: D0076
Presentation Time: 8:30 AM - 10:15 AM
The Genetics of Age-Related Maculopathy II (GARM II) study:
an interim analysis
Van Lam1, Maria Carolina Ortube1, Yvette Conley2, Daniel E.
Weeks3, Ariadna Martinez1, Nelson J. Aguilar1, Victor Andon1,
Orlando Machuca1, Angela Su1, Michael B. Gorin1. 1Ophthalmology,
Jules Stein Eye Institute at UCLA, Los Angeles, CA; 2Health
Promotion & Development, University of Pittsburgh School of
Nursing, Pittsburgh, PA; 3Human Genetics & Biostatistics,
University of Pittsburgh Graduate School of Public Health,
Pittsburgh, PA.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Purpose: The goal of the Genetics of Age-Related Maculopathy II
(GARM II) study is to determine how a combination of genetic,
dietary, health and exposure factors contributes to an individual’s risk
of developing age related macular degeneration (AMD) through the
use of an innovative web-based interface.
Methods: GARM II (NCT01115387) is a nationwide observational,
prospective, 5-year study, comprised of AMD affected individuals
(Group 1), individuals (ages 49-65 years old) with at least one parent
with AMD (Group 2A), and unaffected partners of Group 2A (Group
2B). Participants use a HIPAA-compliant, confidential website
(www.jsei.org/garm) to complete multiple questionnaires. Fundus
images and clinical records are sent by the eye care providers’ offices
through a HIPAA-compliant FTP transfer portal (Yousendit) or by
mail. Saliva samples are submitted for DNA analysis.
Results: A total of 541 subjects (58-Group 1, 464-Group 2A, 19Group 2B) were enrolled into the study. Within Group 2, the current
mean age is 59; there were 28 withdrawals. Primary data is currently
available for 383 Group 2 subjects (67% female, 99% Caucasian).
88% of this group had one parent with AMD, 8% had two parents
with AMD and 4% report no AMD for either parent. 36% have
smoking exposure and 56% are overweight. 48% reported at least 1
visual symptom, and 8% reported 3 or more visual symptoms. 314
Group 2 subjects have had fundus imaging with macular drusen
observed in 78 subjects (25%) and 8 cases of AMD.
Conclusions: Despite the convenience of a web-based protocol, this
age group is challenged by family/work demands and limited
computer literacy that has adversely affected recruitment,
questionnaire completion, and fundus imaging. Individuals with a
positive AMD family history are more likely to enroll than their
partners or spouses. This cohort of middle-aged individuals is
predicted to have a 6-12 times higher risk of developing AMD than
the general population. Molecular genetic testing is planned to
determine the extent to which current risk models may predict the
development of AMD. Dietary, comorbidities, and environmental
exposures will be a consideration with respect to future risks; we
hope to establish if early visual symptoms may be a useful predictor.
This group, which is being prospectively followed, provides an
invaluable opportunity to test new diagnostic imaging tools for the
early detection and monitoring of AMD.
Commercial Relationships: Van Lam, None; Maria Carolina
Ortube, None; Yvette Conley, University of Pittsburgh (P); Daniel
E. Weeks, US Patent 7,695,909 B2 (P), US Patent 8,053,190 (P);
Ariadna Martinez, None; Nelson J. Aguilar, None; Victor Andon,
None; Orlando Machuca, None; Angela Su, None; Michael B.
Gorin, University of Pittsburgh (P)
Support: NIH Grant 5R01EY-09859-17, Research to Prevent
Blindness, Harold & Pauline Price Foundation
Clinical Trial: NCT01115387
dataset, a longitudinal randomized clinical trial of high-dose
antioxidants for prevention of age-related macular degeneration
(AMD) in predominantly whites, was analyzed. AREDS (Category 1,
2, 3 and 4) was used to assess the hazard of baseline AMD status on
self- reported, newly diagnosed stroke since the last study visit. The
proportional hazard assumption among AMD categories was tested
with Kaplan-Meier Survival Curves and the Log-Rank and Wilcoxon
tests. The hazard ratio and 95% confidence interval (95% CI) for the
effect of AMD on the hazard of incident stroke was estimated using
multivariable Cox Proportional Hazard regression models, treating
AMD as a categorical regression variable. Testing of null hypotheses
and model building was conducted (SAS v9.3, Cary, NC) by
comparing -2LogLikelihood (-2LL) model values among nested
models (using a Chi-Square test with appropriate degrees of
freedom).
Results: Subject demographics are presented in Table 1. A total of 77
analyzed incident stroke events occurred, 42 (2.0%) in women and 35
(2.2%) in men during 12.5 years of follow-up. Proportional hazard
ratio testing among AMD categories indicated a constant hazard ratio
with time (Log-Rank, p = 0.23; and Wilcoxon p = 0.22 tests).
Multivariable Cox regression analysis results and sex-stratified
results are presented in Table 2. There is noted to be a significant
dose-response increase in stroke risk in men based upon AMD
category. Specifically, Categories 3 & 4 were associated with
increased risk of stroke. (p<0.05) This was not seen in female
subjects. Women demonstrate increased risk (p<0.001) for stroke
associated with hypertension and diabetes. Significantly, stroke risk
was not associated with BMI/obese, antioxidant treatment category,
angina, or systolic/diastolic blood pressure.
Conclusions: While the incident of stroke was low, amongst this
cohort advance AMD may serve as a risk marker for stroke in men.
The difference in results between men and women may be related to
differences in systemic disease pathogenesis between the sexes. Sexstratified analyses with additional datasets are necessary to confirm
these results.
Program Number: 232 Poster Board Number: D0077
Presentation Time: 8:30 AM - 10:15 AM
Stroke Risk in Advance Macular Degeneration from AREDS
Data Set
Lawrence J. Ulanski1, Thasarat S. Vajaranant1, Charlotte E. Joslin1,
2 1
. Illinois Eye and Ear Infirmary, UIC Department of
Ophthalmology and Visual Sciences, University of Illinois at
Chicago, Chicago, IL; 2Epidemiology and Biostatistic, University of
Illinois at Chicago, Chicago, IL.
Purpose: The AREDS dataset was analyzed to determine the
relationship between AREDS category of disease and the risk of
stoke to determine if there maybe a relationship between AMD
category and risk for stroke.
Methods: The dbGaP Age-Related Eye Disease Study (AREDS)
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Lawrence J. Ulanski, Allergan (C);
Thasarat S. Vajaranant, None; Charlotte E. Joslin, None
Support: The dataset used for the analyses described in this
manuscript was obtained from the Age-Related Eye Disease Study
(AREDS) Database through dbGaP accession number [#14756-1].
Funding support for AREDS was provided by the National Eye
Institute (N01-EY-0-2127) and Research to Prevent Blindness, Inc.
Program Number: 233 Poster Board Number: D0078
Presentation Time: 8:30 AM - 10:15 AM
Prevalence and Risk Factors of Age-related Macular
Degeneration in Korean Population
Sang Jun Park1, 2, Se Joon Woo1, 2, Kyu Hyung Park1, 2.
1
Ophthalmology, Seoul National University Bundang Hospital,
Seongnam, Republic of Korea; 2Ophthalmology, Seoul National
University College of Medicine, Seoul, Republic of Korea.
Purpose: To determine the prevalence of age-related macular
degeneration(AMD) in Korean aged over 50 years living in Ansung
which is a representative rural farming community and to identify the
influence of obesity on AMD.
Methods: A total of 5018 individuals recruited to Ansung cohort in
2000 were followed up at year 8 follow-up examination in 20092010. The retinal photographs were included at year 8 follow-up
examination and were assessed using the grading protocol of the
International Age-related Maculopathy Epidemiological Study
Group.
Results: Of 3253 participants over 50 years of age, 74(2.3%) were
diagnosed as AMD. The prevalence of early AMD and late AMD
was 1.8% and 0.5% respectively. In men, the high waist/hip ratio was
strongly associated with lower prevalence of AMD and early AMD
and the high waist circumference was significantly associated with
lower prevalence of AMD. In women, the high waist/hip ratio was
strongly associated with higher prevalence of AMD and early AMD
and the waist circumference was significantly associated with higher
prevalence of early AMD. No other adiposity measure was associated
prevalence of AMD.
Conclusions: The prevalence of AMD in Korean population was
2.3% and the influence of obesity on AMD might be inconsistent.
Commercial Relationships: Sang Jun Park, None; Se Joon Woo,
None; Kyu Hyung Park, None
Support: None in the Support
Program Number: 234 Poster Board Number: D0079
Presentation Time: 8:30 AM - 10:15 AM
C-reactive protein levels and the risk for developing age related
macular degeneration in the National Health and Nutrition
Examination Survey 2005-2008
Diego T. Barbosa, Sophia Wang, Shan C. Lin. Ophthalmology,
UCSF, San Francisco, CA.
Purpose: To determine the association between age-related macular
degeneration and plasma levels of C-reactive protein.
Methods: This cross-sectional study included 5418 participants in
the National Health and Nutrition Examination Survey (NHANES)
from 2005 to 2008, ≥ 40 years of age, who were diagnosed with or
without age-macular degeneration (AMD) and had laboratory
determination of C-reactive protein level (CRP). Information
regarding demographics, co-morbidities, and health-related behavior
such as smoking were obtained.
Results: CRP levels were divided into four categories based on the
risk for cardiovascular diseases. Those with less than 0.05 mg/dL
were considered normal, low risk was considered for levels between
0.05 and 1 mg/dL, moderate risk from 1 to 2 mg/dL and high risk was
grater than 3 mg/dL. Participants diagnosed with AMD had higher
levels of CRP 0.583 mg/dL (SEM 0.74%) than those without 0.435
mg/dL (SEM 0.15%). A multivariate regression model shows that
individuals with higher values for CRP have a greater risk for having
AMD (odds ratio [OR] 3.11, 95% confidence interval [CI] 1.10-8.75;
P=0.032). We also observed a trend showing that increasing levels of
CRP are significantly related with AMD.
Conclusions: Our results demonstrate that higher levels of CRP were
significantly associated with high odds for having AMD. This could
indicate that individuals with high risk for cardiovascular disease also
have a higher risk for developing AMD.
Commercial Relationships: Diego T. Barbosa, None; Sophia
Wang, None; Shan C. Lin, None
Program Number: 235 Poster Board Number: D0080
Presentation Time: 8:30 AM - 10:15 AM
Modeling the Risks of Age-related Macular Degeneration and its
Predictive Comparisons in a Population in South India
Krishnaiah Sannapaneni1, Bapi Rajiu Surampudi2, Jill E. Keeffe3.
1
Center for Clinical Epidemiology and Biostatistics, L V Prasad Eye
Institute, Hyderabad, India; 2Department of Computer and
Information Sciences, University of Hyderabad, Hyderabad, India;
3
Center for Eye Research Australia, University of Melbourne,
Melbourne, VIC, Australia.
Purpose: To model the modifiable risk factors by using the logistic
regression (LR) and artificial neural network (ANN) models for
prediction of progression of Age-related Macular Degeneration
(AMD) and cross-validate these models for their predictive
accuracies in a population in South India.
Methods: The data (N = 3,723) were analyzed from Andhra Pradesh
Eye Disease Study (APEDS) on participants aged ≥40 years. Subpopulation data from this sample were drawn by using Random under
Sampling (RUS) (n = 213) and combination of RUS and Random
over Sampling (ROS) (n = 1420) techniques. The modifiable and
non-modifiable risk factors which were elicited as part of the study
were used to derive the LR based risk score models and the model fit
was assessed using bootstrap method for internal validity. The ANN
model was built for three sets of data using the multi-layer feedforward back propagation network method. The ANN model's
predictive ability was compared with that of traditional LR model
using the Area under the Receiver Operating Characteristic Curve
(AUROC).
Results: The ANN and LR models revealed the modifiable risk
factors of heavy smoking (risk score from 10 to 18), lower intake of
antioxidants (risk scores from 5 to 10), hypertension (risk scores from
2 to 10) were in order of priority predictors for AMD. The ANN
model showed significantly less predictive ability in a total sample
analysis, AUROC curve (0.66 vs 0.76; p<0.0001). The LR risk score
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
was built with a score ranging from 0 to 60 for a sub-population
dataset (n = 213). A cut-off score of ≥30 had a sensitivity of 79% and
a specificity of 69%. The predictive accuracies of ANN and LR
models in predicting AMD were statistically equivalent (AUROC =
0.76 vs 0.78; p=0.624) in a sub-population (n = 213) analysis,
however, the ANN model outperformed with a good predictive
ability (AUROC = 0.89 vs 0.79; p<0.0001) in a sub-population (n =
1420) analysis. Both the models were stable and consistently
obtained the same predictive accuracies in a 30-fold split-sample
cross validation including bootstrap method.
Conclusions: The sub-population analysis yielded the better
predictive ability of ANN model. The LR model and sensitivity
analysis of the ANN model both indicated the relative importance of
prioritizing modifiable risk factors for AMD for preventive
interventions to reduce the impact of the modifiable factors on onset
of AMD.
Commercial Relationships: Krishnaiah Sannapaneni, None; Bapi
Rajiu Surampudi, None; Jill E. Keeffe, Novartis (F)
Program Number: 236 Poster Board Number: D0081
Presentation Time: 8:30 AM - 10:15 AM
Factors associated with early age-related macular degeneration:
The Korea National Health and Nutrition Examination Survey
2008-2010
Kyungsik Lee, Tyler Hyung Taek Rim, Christopher S. Lee, SungChul
lee. Ophthalmology, Yonsei University College of Medicine, Seoul,
Republic of Korea.
Purpose: To assess the association between early age-related
macular degeneration (AMD) and ocular/general parameters.
Methods: In 2008-2010 a total of 12,902 randomly selected national
representative participants of the Korea National Health and Nutrition
Examination Survey underwent additional ophthalmologic
examinations by the Korean Ophthalmologic Society. The digital
fundus images obtained by a digital fundus camera were graded twice
using the grading protocol of the International Age-related
Maculopathy Epidemiological Study Group. The independent
variables were divided into five categories: 1) socio-demographic
factors, 2) health examination variables, 3) Cormobidities, 4) health
behavioral risk factors, and 5) variables of eyes. The risk factors for
early AMD were identified using multivariate logistic regression
analysis.
Results: Subjects with 5.2-12.6 g/dL of Hb(1st quintile) were more
likely to have an early AMD compared to the subjects with 13.5-14.2
g/dL of Hb (3rd quintile) as a reference group (aOR=1.5, 95% CI,
1.1-2.1). In terms of spherical equivalent (SE), subjects with 22.75<SE≤-1.5 D (first quintile) were less likely to have an early
AMD compared to the subjects with -0.5<SE≤0.0 D (3rd quintile) as
a reference group (aOR=0.5, 95% CI, 0.3-0.8). In order to further
support the result, patients with anisometric refractive error were
examined. The adjusted proportion of early AMD in the right eye was
lower in subjects with SE ≤-1.5D of the right eye and >-1.5D of the
left eye, compared to subjects with SE >-1.5D of the right eye and ≤1.5D of the left eye (1.6% vs 2.3%). The result was the same for
subjects who develop early AMD in the left eye.
Conclusions: Age is the most important risk factor in developing an
early AMD. Interestingly, positive association was found between an
early AMD and anemia. Also, myopic eye is less likely to develop an
early AMD.
Figure 1. Framework of the study.
Figure 2. As for the unadjusted and adjusted* proportion of early
AMD in participants with different SE in both eyes, the results show
that if participants have anisometric refractive error, the proportion of
early ARD is lower in the more myopic eye (black arrow). This
means that higher myopic refractive error could prevent the incidence
of early AMD.
Commercial Relationships: Kyungsik Lee, None; Tyler Hyung
Taek Rim, None; Christopher S. Lee, None; SungChul lee, None
Program Number: 237 Poster Board Number: D0082
Presentation Time: 8:30 AM - 10:15 AM
Assocation of Cotinine Level to Self Reported Nicotine Use and
ARMD
Mark W. Swanson. Optometry, Univ of Alabama at Birmingham,
Birmingham, AL.
Purpose: Studies of the relationship of smoking and macular
degeneration(ARMD) have relied on self-reported smoking status.
Cotinine, a nicotine metabolite, has been used to identify smoking
deception and is considered to better represent exposure to nicotine
from all sources including smokeless and environmental tobacco.
This study looks at the association of serum cotinine(SC) to selfreported smoking status and ARMD in data from the National Health
and Nutrition Examination Survey (NHANES).
Methods: Data from the 2005-2006 and 2007-2008 NHANES were
used. Subjects over the age of 20 were asked if they currently smoked
cigarettes every day, some days or never. During clinical assessment
participants over the age of 12 were asked if they had used any
products containing nicotine in the last five days. Ophthalmic
photography (n=5575) was done for a subset of participants over the
age of 40. ARMD was graded as absent, as mild (drusen >125 or
pigment abnormalities) or severe (wet or geographic atrophy). SC
level(n=6416) was sorted into a three level categorical variable of no
measurable serum cotinine <0.5ng/ml, environmental exposure level
≥ .05ng/ml- <10ng/ml, and ≥ .10ng/ml active smoking. Associations
between SC, self-reported nicotine use, and ARMD were evaluated
using SAS Survey 9.3 accounting for the complex study design.
Results: Self-reported active cigarette smokers did not show
increased odds of any level ARMD (OR 1.2 95% CI 0.8, 1.7). All
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
source nicotine use in the last five days (OR 1.4 95%CI 1.04, 1.8)
and SC at the active use level (OR 1.4 1.03, 1.9) were associated with
ARMD in analyses controlling for age and ethnicity. SC at the
environmental exposure level was not associated with ARMD (OR
0.9 95% CI 0.6, 1.8) Among those with any level of ARMD 8.5%
(95% CI 3.1%, 13.5%) of persons who denied cigarette smoking had
SC levels consistent with active nicotine use. Among those with
ARMD who denied any nicotine use, 2.0%(95% CI 2.0 0.1 4.0) SC
levels consistent with active nicotine use and 27.2%(95% CI 20.6,
33.8) had environmental level exposure.
Conclusions: Between 2-9% of persons with ARMD who deny
nicotine use have SC levels consistent with active exposure. Current
all form nicotine use and serum cotinine levels better reflected the
increased odds of ARMD than did current cigarette smoking alone.
This suggests nicotine exposure rather combustion products may be
the source of increased ARMD risk.
Commercial Relationships: Mark W. Swanson, None
Program Number: 238 Poster Board Number: D0083
Presentation Time: 8:30 AM - 10:15 AM
Qualitative Visual Symptoms in Age-Related Macular
Degeneration
Ray Gariano1, 2, Anne M. Hanneken2. 1Ophthalmology, Scripps
Clinic, La Jolla, CA; 2Molecular & Experimental Medicine, The
Scripps Research Institute, La Jolla, CA.
Purpose: Various qualitative visual disturbances are reported by
patients with age-related macular degeneration (AMD). Here we
characterize such visual phenomena, and estimate their prevalence
and associations with clinical aspects of AMD.
Methods: Consecutive patients (n=100) with AMD in an out-patient
clinic were presented a questionnaire to investigate aspects of
transient visual phenomena (TVP), subjective day-to-day and
intradiurnal variation in visual functioning, and formed visual
hallucinations.
Results: TVP typically consisted of large central dark scotomas that
resolve within several seconds to minutes after onset. TVP were
reported by 35/100 of patients; these were bilateral in 25/30 (83%,
“uncertain” in 5) and most often occurred with eye opening at night
or upon awakening. Most patients had not previously discussed such
symptoms with their physician, even though they were "emotionally
concerning" in 28%, and disrupted daily activities in 6%, of subjects.
TVP was reported by patients with mild to severe levels of visual
impairment, and in patients with either atrophic or with exudative
AMD.
Day-to-day variation in vision (sufficient to preclude or enable visual
activities) was present in 38% of patients, and visual variation across
the day in 27% (most were either “worst in the morning” or “best in
the morning”). Nearly all patients reported improved reading with
brighter lighting. Formed visual hallucinations were noted in 3/100
patients.
Assessment of associations of TVPs with medications or with
physical findings such as visual acuity, choroidal neovascularization,
drusen type and number, and geographic atrophy, requires further
analysis.
Conclusions: Qualitative visual symptoms, in particular TVPs, are
common among patients with AMD. These symptoms may be
disturbing to patients, yet are often overlooked by their physicians.
These symptoms likely relate to defective outer retinal visual
processing and may provide insight into the pathophysiology of
macular disease.
Commercial Relationships: Ray Gariano, None; Anne M.
Hanneken, None
Program Number: 239 Poster Board Number: D0084
Presentation Time: 8:30 AM - 10:15 AM
Periodontal Disease and Age-related Macular Degeneration
Sushant Wagley1, 2, Rama A. Salhi1, Kyle Marra2, Jorge G. Arroyo2.
1
College of Human Medicine - Michigan State University, East
Lansing, MI; 2Ophthalmology, Beth Israel Deaconess Medical
Center, Boston, MA.
Purpose: To examine the association between periodontal disease
and age-related macular degeneration (AMD).
Methods: Data from The National Health and Nutrition Examination
Survey III (NHANES III) was utilized to conduct secondary analysis.
Survey participants provided blood samples, were interviewed for
demographic, behavioral, and medical information, and also
underwent a physical and oral examination. Retinal images obtained
during the study were graded using standardized protocols to measure
AMD. Early and late AMD diagnoses were combined to create a
global variable of "any AMD". Periodontal disease was modeled
using pocket depth measurements obtained during the oral
examination portion of the NHANES III survey. Serum CRP levels,
alongside other clinical measure were also analyzed. Univariate and
multivariate analysis were performed to test association between oral
health and AMD.
Results: Out of 9737 fundus photographs obtained during the survey,
940 (9.65%) had AMD with 885 (9.09%) early AMD and 55 (0.56%)
late AMD. Stratifying for age (people <60 years of age vs. ≥ 60 years
of age) and adjusting for confounding variables, poor periodontal
status was significantly associated with high risk for AMD (odds
ratio=1.937; 95% confidence interval: 1.192-3.149; p=0.009) in the
population under the age of 60. There was no significant association
between periodontal status and AMD in people ≥60 years of age. In
persons aged <60 years, there was also a statistically significant
difference in mean CRP levels between those with poor periodontal
status vs. those without. No such significant difference in CRP levels
was found in those ≥60 years of age.
Conclusions: Poor periodontal health, as measured by pocket depth,
increases the risk of developing AMD in persons under the age of 60.
Such association is not seen in those above the age of 60, which
suggests that proper oral care at a younger age may play a role in
reducing the risk of developing AMD.
Commercial Relationships: Sushant Wagley, None; Rama A.
Salhi, None; Kyle Marra, None; Jorge G. Arroyo, None
Program Number: 240 Poster Board Number: D0085
Presentation Time: 8:30 AM - 10:15 AM
Determinants of macular pigment optical density in subjects at
high risk for age-related macular degeneration: the LIMPIA
Study
Marie-Noelle Delyfer1, 2, Marie B. Rougier1, Catherine CreuzotGarcher4, Hélène Savel5, Geneviève Chêne5, Cecile Delcourt2, 3,
Jean-Francois Korobelnik1, 2. 1Ophthalmology, Hopital Pellegrin,
Bordeaux, France; 2Univ. Bordeaux, ISPED, Centre INSERM U897Epidemiologie-Biostatistique, Bordeaux, France; 3: INSERM,
ISPED, Centre INSERM U897-Epidemiologie-Biostatistique,
Bordeaux, France; 4CHU de DIjon, Dijon, France; 5CHU de
Bordeaux, Pôle de Santé Publique, Unité de soutien méthodologique
à la recherche clinique et épidémiologie (USMR), Bordeaux, France.
Purpose: We studied the associations of macular pigment optical
density (MPOD) with potential determinants (including smoking,
body mass index and other cardiovascular risk factors) in subjects
with at least one parent affected by neovascular age-related macular
degeneration (AMD).
Methods: The Limpia Study is a double-blind, placebo controlled,
prospective randomized clinical trial performed in 120 subjects with
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
at least one parent affected by neovascular AMD. To be included,
subjects had to be aged 40-70 years, have best-corrected visual acuity
(BCVA) greater than 20/25, be free of late AMD and other major eye
conditions (severe glaucoma, high myopia, severe retinal disease,
cataract surgery…). Subjects having used supplements containing
lutein and/or zeaxanthin in the preceding year were not included.
Macular pigment optical density (MPOD) was measured by two
methods (modified Heidelberg Retinal Analyzer (HRA), Heidelberg,
Germany and Visucam 200 MPD, Carl Zeiss Meditec, Germany).
Body mass index (BMI, in kg/m2) was calculated from measured
weight and height: weight/(height)2. Plasma lipids (total and HDLcholesterol, triglycerides) were measured from fasting blood samples.
Associations of MPOD with potential determinants were assessed by
mixed linear models, taking into account the data from both eyes and
their correlation.
Results: After adjustment for age and gender, MPOD measured with
modified HRA strongly decreased with increasing BMI (p=0.009,
p=0.002 and p=0.0004, for MPOD within 0.5°, 1° and 2°
respectively). Area of MPOD measured with Visucam MP also
decreased with increasing BMI (p=0.002), while other parameters
(volume, mean, maximum) showed no significant associations with
BMI. Current smokers also tended to have lower MPOD measured
with modified HRA, mainly for higher eccentricities (p=0.13,
p=0.046, p=0.03 at 0.5°, 1° and 2°, respectively), but not for any
MPOD parameters measured with Visucam MP. We observed no
significant associations of MPOD with total or HDL-cholesterol.
Conclusions: This study confirms a decrease of macular pigment
density in subjects with high BMI and in current smokers, in a
population of middle-aged subjects at high risk for AMD.
Commercial Relationships: Marie-Noelle Delyfer, Thea
Laboratories (F); Marie B. Rougier, THEA (C), Bausch&Lomb (C),
Allergan (C), Kemin (C); Catherine Creuzot-Garcher, None;
Hélène Savel, None; Geneviève Chêne, None; Cecile Delcourt,
Laboratoires Théa (F), Novartis (C), Bausch+Lomb (C); JeanFrancois Korobelnik, Alcon (C), Allergan (C), Bayer (C), Carl
Zeiss Meditec (C), Novartis (C), Thea (F)
Support: Laboratoires Théa, Carl Zeiss Meditec
Clinical Trial: NCT01269697
Program Number: 241 Poster Board Number: D0086
Presentation Time: 8:30 AM - 10:15 AM
Drusen Characteristics, Retinal Pigmentary, and Visual Acuity
Changes associated with 10 year Progression Rates to
Intermediate and Advanced Age-Related Macular Degeneration
in the Age-Related Eye Disease Study (AREDS)
Emily Y. Chew1, Traci E. Clemons2, Elvira Agrón1, Frederick L.
Ferris1. 1Epidemiology & Clinical Applications, National Eye
Inst/NIH, Bethesda, MD; 2EMMES Corporation, Rockville, MD.
Purpose: To describe the associations of drusen characteristics and
retinal pigmentary abnormalities with the 10-year incidence of agerelated macular degeneration (AMD) and visual acuity outcomes in
the Age-Related Eye Disease Study (AREDS).
Methods: Participants with varying AMD severity (n=4757) enrolled
in a multi-centered randomized controlled clinical trial of antioxidant
vitamins and minerals, median duration of 6.5 years. When the trial
ended, 3549 of 4203 surviving participants were followed for 5 more
years. The rates of progression to intermediate and advanced AMD
were evaluated using annual color fundus photographs assessed
centrally. Best-corrected visual acuity was measured at annual study
visits..
Results: The risk of progression to advanced AMD increased with
age, female gender, smoking and increasing severity of drusen and
pigmentary abnormalities. In the oldest participants with the most
severe AMD/drusen status, 75% developed advanced AMD by 10
years. Similarly, the risk of progression from no AMD or early AMD
to intermediate AMD was associated with severity of drusen at
baseline. 71% of participants with bilateral medium sized drusen
progressed to large drusen and 13% to advanced AMD in 10 years.
Large drusen and pigmentary abnormalities remained important risk
factors for progression, as demonstrated by the AREDS Simple Scale
using presence or absence of drusen and pigmentary abnormalities to
determine severity. Interestingly, the presence of large drusen within
1500 µm of the fovea also was an important predictor for
development of advanced AMD.
Median visual acuity at 10 years in eyes that had large drusen at
baseline but never developed advanced AMD was 20/25; eyes that
developed advanced AMD during follow-up had a median visual
acuity of 20/200 at the 10-year visit, and also had a mean of 5 letter
decrease from baseline at the annual visit prior to advanced AMD
detection.
Conclusions: Data collected in AREDS, prior to anti-VEGF inhibitor
treatment, demonstrate the high risk of vision loss in persons who
developed advanced AMD and are untreated. The natural history data
and risk factors identified for progression to advanced AMD from
long-term follow-up of AREDS participants may be helpful to
investigators conducting research in clinic populations.
Commercial Relationships: Emily Y. Chew, None; Traci E.
Clemons, None; Elvira Agrón, None; Frederick L. Ferris, Bausch
and Lomb (P)
Support: Contract NOI-EY-0-2127
Program Number: 242 Poster Board Number: D0087
Presentation Time: 8:30 AM - 10:15 AM
Risk Factors Associated with Earlier Age of Onset of Wet Agerelated Macular Degeneration
Yara T. Lechanteur1, Patrick L. van de Camp1, Joannes M.
Groenewoud2, Anneke I. Den Hollander1, 3, B. Jeroen Klevering1,
Carel B. Hoyng1. 1Ophthalmology, Radboud University Nijmegen
Medical Centre, Nijmegen, Netherlands; 2Epidemiology, Biostatistics
and Health Technology Assessment, Radboud University Nijmegen
Medical Centre, Nijmegen, Netherlands; 3Human Genetics, Radboud
University Nijmegen Medical Centre, Nijmegen, Netherlands.
Purpose: To determine the association between the age of onset of
neovascular age-related macular degeneration (AMD) and genetic,
socio-demographic, behavioral and ocular risk factors.
Methods: We conducted a retrospective cohort study with 286
patients from the European Genetic Database (EUGENDA).
Univariate analysis of covariance (ANCOVA) was performed for
gender, body mass index (BMI), smoking, education, diabetes,
hypertension, alcohol consumption, refractive error, pseudophakia,
subtype of wet AMD, and 20 single nucleotide polymorphisms
(SNPs) associated with AMD. Significant risk factors were then
included in a multivariate model.
Results: A significant association was observed for smoking, with
each pack year contributing to an earlier age of onset of 0.88 months
(P=0.015). Higher educated patients (above high school level) had an
average age of onset that was 44.78 months later than patients with
the lowest education levels (P=0.002).
Carriers of risk alleles in the Age-Related Maculopathy Susceptibility
2 (ARMS2) (rs10490924) and the Complement Factor H (CFH)
(rs1410996) genes developed neovascular AMD at an earlier age
compared to carriers of the wild-type genotypes. The mean age of
onset was 57.74 (P=0.001) and 60.85 (P=0.041) months earlier for
homozygous carriers of the ARMS2 and CFH risk alleles,
respectively.
For the Cholesteryl Ester Transfer Protein (CETP) (rs3764261) and
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
the Serpin peptidase inhibitor clade G type 1 (SERPING1)
(rs2511989) genes a significant association was found only for
heterozygous risk allele carriers compared to the wild-type carriers
(mean age of onset 30.03 (P=0.029) and 27.70 (P=0.044) months
earlier, respectively).
Conclusions: Both environmental and genetic risk factors are
associated with an earlier age of onset of wet AMD. The results of
this study demonstrate that risk factors previously described to be
associated with the development of AMD also influence the age of
onset of AMD. This could provide patients with more accurate
information about their prognosis, could give them more insight in
their individual risk profile, and could provide them with an incentive
to change their lifestyle, in order to preserve vision as long as
possible.
Commercial Relationships: Yara T. Lechanteur, None; Patrick L.
van de Camp, None; Joannes M. Groenewoud, None; Anneke I.
Den Hollander, None; B. Jeroen Klevering, None; Carel B.
Hoyng, None
Support: MD Fonds
Program Number: 243 Poster Board Number: D0088
Presentation Time: 8:30 AM - 10:15 AM
Visual acuity outcomes after cataract surgery in patients with
age-related macular degeneration in the Age-Related Eye Disease
Study 2 (AREDS2)
Benjamin P. Nicholson1, Nancy Huynh2, Elvira Agrón1, Traci E.
Clemons3, Emily Y. Chew1. 1Epidemol & Clin Applications, NEI,
Bethesda, MD; 2Ophthalmic Clinical Genetics, NEI, Bethesda, MD;
3
The EMMES Corporation, Rockville, MD.
Purpose: To evaluate visual acuity outcomes after cataract surgery in
patients with varying degrees of age-related macular degeneration
(AMD).
Methods: A total of 4203 participants with varying degrees of AMD
were enrolled in the Age-Related Eye Disease Study 2 (AREDS2), a
multicenter, randomized, controlled trial of nutritional supplements
for AMD. In assessing secondary outcomes, pre- and post-operative
characteristics of participants who underwent cataract extraction
during the 5 year trial were analyzed. This analysis was accomplished
using both clinical data and standardized lens and fundus
photographs obtained at baseline and yearly thereafter. Photographs
were graded by a centralized reading center for lens opacities and
severity of AMD. Analyses were conducted using multivariate
logistic regression.
Results: Visual acuity results were analyzed for 1232 eyes (793
patients) that had cataract surgery during AREDS2. After adjustment
for age at cataract surgery, gender, and type and severity of cataract,
the mean changes in visual acuity were as follows: eyes with mild
AMD (AREDS AMD Scale (AAS) 1-3, n=31) gained 10.7 letters
(P<0.0001 when compared to pre-operative acuity), eyes with
moderate AMD ((AAS 4-6, n=346) gained 11.2 letters (P<0.0001),
eyes with moderate AMD (AAS 7-8, n=464) gained 8.8 letters
(P<0.0001), eyes with non-central geographic atrophy (AAS 9, n=70)
gained 9.0 letters (P<0.0001), and eyes with advanced AMD (AAS
10-11, n=321) gained 7.0 letters (P<0.0001). The mean time from
measurement of pre-operative acuity to cataract surgery was 5.9±3.6
months, and the mean time from surgery to measurement of postoperative acuity was 7.0±3.6 months.
Conclusions: In AREDS2, mean visual acuities improved
significantly after cataract surgery across varying severities of AMD.
Commercial Relationships: Benjamin P. Nicholson, None; Nancy
Huynh, None; Elvira Agrón, None; Traci E. Clemons, None;
Emily Y. Chew, None
Support: NIH Intramural Research Program and National Eye
Institute/National Institutes of Health (NEI/NIH), Department of
Health and Human Services, Contract No. HHS-N-260-2005-00007C and ADB Contract No. N01-EY-5-0007
Clinical Trial: NCT00345176
Program Number: 244 Poster Board Number: D0089
Presentation Time: 8:30 AM - 10:15 AM
Pulmonary Function, Respiratory Disease and the Incidence of
Early and Late Age-Related Macular Degeneration: the Beaver
Dam Eye Study
Chelsea E. Myers1, Barbara E. Klein1, Sudha K. Iyengar2, Theru A.
Sivakumaran3, Kristine E. Lee1, Ronald E. Gangnon4, 5, Ronald
Klein1. 1Ophthalmology and Visual Sciences, University of
Wisconsin School of Medicine and Public Health, Madison, WI;
2
Epidemiology and Biostatistics, Case Western Reserve University,
Cleveland, OH; 3Division of Human Genetics, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH; 4Population Health
Sciences, University of Wisconsin School of Medicine and Public
Health, Madison, WI; 5Biostatistics and Medical Informatics,
University of Wisconsin School of Medicine and Public Health,
Madison, WI.
Purpose: To determine whether pulmonary function and respiratory
disease are associated with the incidence of early and late age-related
macular degeneration (AMD).
Methods: Participants were aged 43-86 years at the Beaver Dam Eye
Study (BDES) baseline examination in 1988-1990 and participated in
follow-up examinations spaced 5 years apart. Current history of
emphysema, asthma and respiratory symptoms was determined from
self-report. Respiratory symptoms were defined by winter cough,
wheezing, and coughing up phlegm. Peak expiratory flow rate
(PEFR) was measured. Current history of emphysema was first
measured at the baseline examination (N=2773 and N=3461 at risk
for early and late AMD, respectively), current history of asthma was
first measured at BDES examination phase 2 (N=2014 and N=2603
at risk for early and late AMD, respectively), and PEFR and history
of respiratory symptoms were first measured at BDES examination
phase 3 (N=1596 and N=2051 at risk for early and late AMD,
respectively). Incidence was defined over each interval conditional
upon being free of disease at all previous examinations. Relationships
were analyzed using discrete-time hazard models using the
complementary log-log link function, and risk factors were updated at
each examination phase. AMD severity was assessed by grading of
fundus photographs.
Results: A history of respiratory symptoms was present in 42.9%,
emphysema in 3.2% and asthma in 6.6% of the population. The 5year incidence of early AMD was 8.5% and late AMD was 1.5%.
While adjusting for age, sex, smoking status and other factors, a
current history of respiratory symptoms was associated with the
incidence of late AMD (reported as hazard ratio, 95% confidence
interval, P value; mild vs. no symptoms 1.86, 1.07-3.24, P=0.02).
Individuals with PEFR in the highest sex-specific quartile had a
borderline decreased risk of early AMD (0.69, 0.46-1.04, P=0.07)
and late AMD (0.35, 0.11-1.15, P=0.08) compared to those in the
lower 3 quartiles. There was a trend of an association between a
current history of emphysema and incidence of early AMD (1.30,
0.81-2.10, P=0.28). A current history of asthma was not associated
with early or late AMD.
Conclusions: Our findings suggest that respiratory symptoms and
dysfunction that possibly result from smoking remain associated with
the incidence of early and late AMD independent of smoking.
Commercial Relationships: Chelsea E. Myers, None; Barbara E.
Klein, None; Sudha K. Iyengar, None; Theru A. Sivakumaran,
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
None; Kristine E. Lee, None; Ronald E. Gangnon, None; Ronald
Klein, None
Support: Supported by NIH-NEI grant EY06594 and Research to
Prevent Blindness (R Klein, BEK Klein, Senior Scientific
Investigator Awards)
Program Number: 245 Poster Board Number: D0090
Presentation Time: 8:30 AM - 10:15 AM
Age-related macular degeneration and mortality in AREDS: the
effect of sex and time
Charlotte E. Joslin1, 2, Thasarat S. Vajaranant1, Lawrence J.
Ulanski1. 1Illinois Eye and Ear Infirmary, UIC Department of
Ophthalmology and Visual Sciences, University of Illinois at
Chicago, Chicago, IL; 2Epidemiology and Biostatistics, University of
Illinois at Chicago, Chicago, IL.
Purpose: Age-related macular degeneration (AMD), stroke and
cardiovascular disease (inclusive of all circulatory disease) share risk
factors and a similar pathogenesis. Previous studies yield mixed
associations, potentially due to differences in follow-up time that
minimize sample size and study power or alter competing risks, as
well as an absence of sex-stratified results masking sex/gender
differences.
Methods: The Age-Related Eye Disease Study (AREDS) dataset was
used for secondary data analysis. Standard AREDS categories (1, 2, 3
and 4) were used to assess the hazard of baseline AMD status on allcause and circulatory disease mortality. Cause of death was based on
hospital records and death certificates collected during AREDS
(11/92 - 12/05), and a search of the National Death Index (NDI) after
the study conclusion. The proportionality hazard assumption was
tested by including time-dependent covariates in the model using
PROC PHREG to assess the hazard ratio (HR) and 95% confidence
interval (95% CI) for the effect of AMD on mortality in whites (SAS
v9.3, Cary, NC). Multivariable Cox Proportional Hazard regression
models were fit adjusting for covariates and stratifying on nonproportional predictors to estimate the HR overall at multiple time
points, including survival at 5-, 7-, and 10-years for 1) any death;
and, 2) death due to circulatory disease.
Results: The mean follow-up among 4116 subjects was 9.6 years,
with 967 of 1096 deaths identified during AREDS (Table 1).
Regression models (Table 2) generally show a significant HR
between AMD and circulatory system death, in which the magnitude
of association is stronger 1) in men than women; 2) with increasing
AMD severity; and, 3) with shorter vs. longer survival analysis.
Among all-cause mortality, a similarly increased HR, dampened vs.
circulatory deaths, exists that is stronger in men and increases with
increasing AMD severity; HR differences by survival duration are
less apparent.
Conclusions: Results suggest a significant association between
increasing AMD severity and mortality. Variation in the strength of
association exists by sex for both all-cause and circulatory disease
mortality. Convergence in the HR between AMD and mortality by
length of survival analysis comparing circulatory disease vs. all-cause
mortality suggests the importance of competing risks in longer
survival analyses.
Commercial Relationships: Charlotte E. Joslin, None; Thasarat
S. Vajaranant, None; Lawrence J. Ulanski, Allergan (C)
Support: The dataset used for the analyses described was obtained
from the Age-Related Eye Disease Study (AREDS) Database through
dbGaP accession number [#14756-1]. Funding support for AREDS
was provided by the National Eye Institute (N01-EY-0-2127).
Research to Prevent Blindness, Inc.
Program Number: 246 Poster Board Number: D0091
Presentation Time: 8:30 AM - 10:15 AM
Predicting Non-response to Ranibizumab in Patients with
Neovascular Age-related Macular Degeneration
Freekje van Asten1, Maroeska M. Rovers2, Yara T. Lechanteur1,
Dzenita Smailhodzic1, Philipp S. Muether3, Anneke I. Den
Hollander1, 4, Sascha Fauser3, Carel B. Hoyng1, Gert Jan van der
Wilt2, B. Jeroen Klevering1. 1Ophthalmology, UMC St Radboud,
Nijmegen, Netherlands; 2Epidemiology, Biostatistics and HTA, UMC
St Radboud, Nijmegen, Netherlands; 3Ophthalmology, University of
Cologne, Cologne, Germany; 4Human Genetics, UMC St Radboud,
Nijmegen, Netherlands.
Purpose: To validate known and to determine new predictors of nonresponse to ranibizumab in patients with neovascular age-related
macular degeneration (AMD) and to incorporate these factors into a
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
prediction rule.
Methods: This multicenter, observational case series study included
394 patients treated with ranibizumab for neovascular AMD. We
performed genetic analysis for single nucleotide polymorphisms in
AMD-associated genes and collected questionnaires regarding
environmental factors and disease history. The primary outcome was
non-response to treatment, which we defined as a loss of visual acuity
of 30% of letters or more on EDTRS chart.
Results: Of the 394 patients, 47 were classified as non-responder.
Independent predictors for non-response were: age, baseline visual
acuity, diabetes mellitus and accumulation of risk alleles in the CFH,
ARMS2 and VEGF-A genes. The area under the receiver operating
characteristic curve was 0.77 (95% confidence interval: 0.70 - 0.84).
We derived a clinical prediction rule, with possible total risk scores
ranging from 0 to 21 points. The absolute risk of non-response varied
from 2% to 53% between risk score groups.
Conclusions: A straightforward clinical prediction rule can aid
clinicians identifying AMD patients with an increased or decreased
likelihood of non-response to treatment with ranibizumab.
Commercial Relationships: Freekje van Asten, None; Maroeska
M. Rovers, None; Yara T. Lechanteur, None; Dzenita
Smailhodzic, None; Philipp S. Muether, Heidelberg Engineering
(C); Anneke I. Den Hollander, None; Sascha Fauser, None; Carel
B. Hoyng, None; Gert Jan van der Wilt, None; B. Jeroen
Klevering, None
Program Number: 247 Poster Board Number: D0092
Presentation Time: 8:30 AM - 10:15 AM
MULTICENTER RETROSPECTIVE STUDY OF AMD IN
SPAIN
Ricardo P. Casaroli-Marano1, Roberto Gallego-Pinazo2, Clemencia
Torrón Fernández-Blanco3, Marta S. Figueroa4, Begoña Pina
Marín5, Gustavo Fernández-Baca Vaca6, Antonio PiñeroBustamante7, Juan Donate López8, Jose Garcia-Arumi9, Jordi Farres
Martí10. 1Instituto Clinic de Oftalmologia, Hospital Clínic de
Barcelona, Barcelona, Spain; 2Hospital Universitario y Politécnico La
Fe, Valencia, Spain; 3Hospital Universitario Miguel Servet,
Zaragoza, Spain; 4Hospital Universitario Ramón y Cajal, Madrid,
Spain; 5Hospital Dos de Maig de Barcelona, Barcelona, Spain;
6
Hospital Regional Universitario Carlos Haya, Málaga, Spain;
7
Hospital Universitario de Valme, Sevilla, Spain; 8Hospital Clínico
Universitario de San Carlos, Madrid, Spain; 9Hospital Universitario
Vall d'Hebrón, Barcelona, Spain; 10Bayer Healthcare, Barcelona,
Spain.
Purpose: The aim of the present study was to assess the diagnosis
and management patterns of patients with neovascular AMD in
Spain, as well as their visual outcomes.
Methods: A retrospective observational study was conducted in a
multicenter national setting. The variables analyzed were: sociodemographic characteristics, visual acuity (VA), OCT, type of
treatment, number of follow-up visits and injections, and the
adherence or not to the initial loading dose. These variables were
analyzed at 3, 6, 12 and 24 months after diagnosis.
Results: A total of 208 patients were analyzed within a mean period
of 23.3 months. Baseline VA was 48±18.6 letters. Mean time
between appearance of symptoms and diagnosis was 1.9±2.3 months.
Treatment was administered 15 days after diagnosis in average. The
average number of follow up visits was 9.0 (5.4 and 3.6 during the
first and second year, respectively). Patients received a mean number
of 6.1 injections of antiangiogenic drugs: 4.5 and 1.6 during the first
and second year respectively. The mean VA gain was 2.4±16.6
ETDRS letters at 12 months and 3.1±16.6 at 24 months of follow-up,
presenting the most improvement at 3 months, followed by declining
VA. These results became more evident among patients who received
3 monthly loading doses (50% of them) who gained 9.1±13 versus
4.58±13 letters at 3 months. A subgroup analysis of the 33 patients of
a study center who had the higher median of injections (10.8 vs 5.2)
showed better VA with 22.59±10.14 vs -1.65 ± -18.43 letters gained,
with less number of follow up visits at the end of the study period
(9.7 vs 5.1) compared with the rest of the study population.
Conclusions: Our results regarding VA are in accordance with other
studies published in a real-life clinical setting, where a peak of VA
gain occurred after 3 months of treatment and followed by a decrease
during the follow up period. Variability related to the management of
neovascular AMD was found with a wide interval between follow up
visits, which could be the cause of the low number of injections
administered, thus the very limited VA outcomes achieved in this
population. More aggressive approach in treating seems related to get
better VA. Therefore, it is evident the need for a standardized
approach in the management and treatment of neovascular AMD, a
disease which is increasing the clinical burden in ophthalmology
departments of the health public system in Spain.
Commercial Relationships: Ricardo P. Casaroli-Marano, None;
Roberto Gallego-Pinazo, Bayer (R), Novartis (R), Novartis (C), Carl
Zeiss Meditec (R); Clemencia Torrón Fernández-Blanco, None;
Marta S. Figueroa, Bayer (C), Novartis (C), Allergan (C), Alcon
(C), Allimera (C); Begoña Pina Marín, None; Gustavo FernándezBaca Vaca, None; Antonio Piñero-Bustamante, Bayer (F), Novartis
(F); Juan Donate López, None; Jose Garcia-Arumi, None; Jordi
Farres Martí, Bayer HealthCare (E)
Support: Sponsored by Bayer HealthCare (EPI-DMAE Study)
Program Number: 248 Poster Board Number: D0093
Presentation Time: 8:30 AM - 10:15 AM
Does Treatment of Hypertension Affect the Risk of Developing
Macular Degeneration or Disease Progression?
Partho S. Kalyani, Taylor S. Blachley, David N. Zacks, Joshua D.
Stein. Department of Ophthalmology and Visual Sciences, University
of Michigan, Ann Arbor, MI.
Purpose: Age-related macular degeneration (AMD) is the most
common cause of visual loss in the developed world. While, the
pathogenesis of AMD remains unclear, hypertension is generally
regarded as a risk factor for AMD development. Yet, little is known
on the impact of treating hypertension on AMD risk. We studied the
effect of treating hypertension on the incidence of non-exudative
(NE) and exudative (E) AMD in a large population of patients with
systemic arterial hypertension.
Methods: Claims data from a United States managed care network
were reviewed to identify all persons with hypertension, ≥ 55 years
old, who had ≥ 1 visits to an eye provider between 2001 and 2011.
International Classification of Disease (ICD-9CM) billing codes were
used to identify incident cases of any form of AMD, non-exudative
macular degeneration (NE-AMD), exudative macular degeneration
(E-AMD), and conversion from NE to E-AMD. Multivariable Cox
regression modeling was performed to determine the impact of
antihypertensive medication use on hazard of developing different
forms of AMD, with adjustment for socio-demographic factors,
ocular and medical comorbidities.
Results: Of 416,897 enrollees who met inclusion criteria, there were
28,589 incident cases of NE-AMD (6.8%) and 3,503 cases (0.8%) of
E-AMD during the follow-up period. Use of any antihypertensive
agent ≥ 20% of time significantly reduced the hazard of developing
any form of AMD by 17.7% (adjusted hazard ratio [HR], 0.833; 95%
confidence interval [CI], 0.811-0.855), NE-AMD by 18.1% (HR,
0.829; CI, 0.807-0.851), and E-AMD by 16.0% (HR, 0.840; CI,
0.778-0.906) relative to persons with untreated hypertension
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
(p<0.0001 for all comparisons).
Conclusions: In this large cohort of persons with hypertension, use
of antihypertensive medications appears to reduce the risk of
development of all forms of AMD. Additional analyses are needed to
assess the impact of different classes of antihypertensive medications
and duration of medication use on AMD risk and how severity of
hypertension affects the risk of AMD. Should these findings be
confirmed in a prospective trial, they may lead to novel options for
the prevention or treatment of AMD.
Commercial Relationships: Partho S. Kalyani, None; Taylor S.
Blachley, None; David N. Zacks, ONL Therapeutics, LLC (I),
University of Michgian (P); Joshua D. Stein, University of Michigan
- time to next glaucoma test algorithm patent (P)
Support: Beckman Institute for Macular Research, National Eye
Institute K23 Mentored Clinician Scientist Award (1K23EY01951101), Research to Prevent Blindness Physician Scientist Award,
Research to Prevent Blindness unrestricted grant
Program Number: 249 Poster Board Number: D0094
Presentation Time: 8:30 AM - 10:15 AM
Systemic adverse events after antiangiogenic therapy in clinical
trials comparing Bevacizumab and Ranibizumab
Jose Lorenzo Carrero, Alexandros Deligiannidis. Ophthalmology,
Povisa Hospital, Vigo, Spain.
Purpose: To examine and compare the evidence of incidental severe
systemic adverse events one year after antiangiogenic therapy with
Ranibizumab and Bevacizumab.
Methods: We searched CENTRAL, MEDLINE, EMBASE. There
were no date or language restrictions in the electronic searches for
trials. We included all randomised controlled trials (RCTs)
comparing bevacizumab and ranibizumab. we examine the ocurrence
of systemic serious adverse events. We pooled data using a fixedeffect model.
Results: We included three RCTs in this review. Overall the quality
of the evidence was high. There were 1795 treated patients; 882 with
bevacizumab, and 913 with ranibicizumab. The pooled risk
difference for systemic adverse events was 0.001 (p=0.265). An
analysis by specific event showed that the risk difference for
gastrointestinal disorders was 0.017 more frequent in patients
undergoing bevacizumab treatment (p=0.003).
Conclusions: Though reviewed RCTs were not specifically designed
to detect any difference in adverse outcomes, pooled data show that
both treatments are comparably safe, except for differences found in
the ocurrence of Gastrointestinal disorders which could be related to
the baseline differences in medical conditions of participants.
Commercial Relationships: Jose Lorenzo Carrero, None;
Alexandros Deligiannidis, None
Program Number: 250 Poster Board Number: D0095
Presentation Time: 8:30 AM - 10:15 AM
Outcomes of Second eye Versus First eye in Patients Treated with
Ranibizumab for Bilateral Neovascular Age Related Macular
Degeneration
Ramu Muniraju, Jayashree Ramu, Sobha Sivaprasad. Laser and
Retinal Research Unit, Department of Ophthalmology, King's
College Hospital, London, United Kingdom.
Purpose: To assess the time to conversion of wet AMD in the fellow
eye and compare the visual outcomes between first and second eyes
in patients with bilateral neovascular AMD (nAMD).
Methods: Retrospective analysis of case notes of patients with
bilateral neovascular AMD treated with ranibizumab monotherapy
with at least 12 months follow up was done. Visual Acuity (VA) at
baseline and at 12 months, number of injections for both first and the
second eyes and the time interval of conversion to nAMD of second
eye were recorded. SPSS software version 18 was used to perform
regression analysis where change in VA of second eye was a
dependent variable and the predictors were the age, injection
frequency, time interval between first and second eye and the VA at
baseline.
Results: A total of 49 patients with bilateral sequential nAMD
treated with ranibizumab monotherapy had completed 12 months
follow up. Mean age at presentation of the first eye was 83.3 years ±
7.4, majority were females (60%). The mean time interval of
conversion to nAMD in the second eye was 11.2 ± 8.1 months and
the median time interval was 10 months (range 1-30 months). The
mean baseline VA of first eye was 46.8 ± 14.5 letters while that of
second eye was 58.8 ± 14.6 letters. The mean change of VA in first
eye was +1.7 ± 16.7 (p<0.01) letters while that of second eye was 2.3 ± 14.7 letters (p<0.03). The mean final VA at 12 months of first
and second eyes was 48.8 ± 20.1 letters and 56.5 ± 19.1 letters
respectively. The mean number of injections in the first eye was 5 ± 2
and the second eye was 4.9 ± 1.9. Regression analysis showed that
the time interval between first and the second eye significantly
(p<0.001) influenced the change in VA of the second eyes, where
longer intervals was associated with better VA. Baseline VA
(P<0.001) and the number of injections (p<0.05) were the other
significant predictors of change in VA of second eyes.
Conclusions: Second eyes have better baseline VA, but there were
no significant difference in mean change in VA in first and second
eye at 12 months. Longer the time interval of conversion to nAMD
between first and second eyes, the better was the final visual acuity of
the second eyes.
Commercial Relationships: Ramu Muniraju, None; Jayashree
Ramu, None; Sobha Sivaprasad, Allergan (F), Bayer (F), Novartis
(F)
Program Number: 251 Poster Board Number: D0096
Presentation Time: 8:30 AM - 10:15 AM
« DODMLA » : Organized screening of age-related macular
degeneration by delayed reading of retinophotography
Flore De Bats1, Christiane Vannier Nitenberg2, Bruno Fantino2,
Laurent Kodjikian1. 1Croix Rousse Hospital, Lyon, Lyon, France;
2
CPAM, Lyon, France.
Purpose: Age-related macular degeneration (AMD) is the first cause
of severe visual impairment in elderly in industrialized countries. The
early stages of AMD can be diagnosed by retinophotography and thus
receive efficient prevention. The aim of our study was to assess the
interest and the feasibility of AMD ’s screening in over 65 years old
patients using telemedicine transmitted and interpreted
retinophotography .
Methods: Non mydriatic retinography was proposed to all the 65
years old and over participants completing a periodic health check up
in a Regional Insurance Center between 02/01/2012 and 11/13/2012.
Participant with a known AMD were excluded from the study. After
obtaining their informed consent, a retinophotography on both eyes
was made by a trained nurse. A risk factors questionnaire of this
disease (sex, age, family history of AMD, iris color, smoking,
cataract surgery) was administered by the nurse. The images were
electronically transmitted and interpreted by an ophthalmologist of
Croix-Rousse hospital University in Lyon.
Results: A retinophotography was proposed to 866 consultants. 584
participants (67,4 %) were included with a majority of men (52,1 %).
The mean age was of 72 years [± 5,72]. The causes of not inclusions
were : refusal to participate (15,1 %), impossibility to perform the
exam (7 %), no obtention of the consent (9,2 %), presence of a
known AMD (1,2 %). Photos were no interpretable in 21,4 % of
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
cases. So 458 photos were treated and 22,27 % were abnormal.
Concerning the right eye, 38 (8 %) presented a stage 1, 26 (5,47 %) a
stage2, 8 (1,68 %) a stage 3 and 2 (0,42 %) an atrophic stage 4.
Concerning the left eye 36 (7,87 %) presented a stage 1, 22 (4,81 %)
a stage 2, 9 (1,96 %) a stage 3 and 2 (0,43 %) an atrophic stage 4. No
exsudative AMD was found. The presence of abnormalities was
correlated to familial history of AMD (OR=2,94 [1,2-7,22]) or to
cataract surgery past history (OR= 1,96 [ 1,04-3,71 ]). The mean age
increased with the stage of the AMD.
Conclusions: Our results confirm the interest and feasibility of
retinophotography in AMD screening for over 65 years old
participants. Age, familial history of AMD or familial history of
cataract surgery were identified as risk factors.
Commercial Relationships: Flore De Bats, None; Christiane
Vannier Nitenberg, None; Bruno Fantino, None; Laurent
Kodjikian, None
118 Age-Related Macular Degeneration: Novel Markers and Risk
Factors
Sunday, May 05, 2013 10:30 AM-12:15 PM
615-617 Paper Session
Program #/Board # Range: 367-373
Organizing Section: Clinical/Epidemiologic Research
Program Number: 367
Presentation Time: 10:30 AM - 10:45 AM
The Incidence and Progression of Reticular Drusen: Findings
from an Older Australian Cohort
Nichole D. Joachim1, Paul Mitchell1, Elena Rochtchina1, Ava G.
Tan1, Jie Jin Wang1, 2. 1Centre for Vision Research, Department of
Ophthalmology and Westmead Millennium Institute, University of
Sydney, Sydney, NSW, Australia; 2Centre for Eye Research
Australia, University of Melbourne, Melbourne, VIC, Australia.
Purpose: To assess 15-year incidence of reticular drusen (RDR) and
their associations with known age-related macular degeneration
(AMD) risk factors in an older Australian cohort.
Methods: The Blue Mountains Eye Study examined 3654
participants aged 49+ years at baseline (1992-94), and re-examined
75.8, 76.5 and 56.1% of survivors 5, 10 and 15 years later,
respectively. Retinal photographs were taken at each visit and DNA
samples genotyped. Incidence and progression of RDR were
confirmed using side-by-side grading from colour photographs.
Incidence was estimated using the Kaplan-Meier product-limit
survival method, controlling for competing risk of death.
Associations between incidence of RDR and smoking, fish
consumption, serum lipids, white cell count, and CFH-rs1061170 and
ARMS2-rs10490924 single nucleotide polymorphisms were analyzed
using discrete logistic regression models adjusting for age and sex.
Results: The 15-year cumulative incidence of RDR was 4.0%
(n=95); increasing from 0.4% in the age group 49-54 years to 7.0% in
those aged 65-74 years, and then decreasing to 4.9% in those aged
75+ years (P for trend <.0001). Women had a higher incidence of
RDR compared to men (5.6% versus 2.2%, P=0.003). Increasing age
(per decade; odds ratio, OR, 3.4; 95% confidence interval, CI, 2.64.4), female sex (OR 2.0, 95% CI 1.3-3.2) and presence of each risk
allele of CFH (OR 1.8, 95% CI 1.3-2.4) or ARMS2 (OR 3.0, 95% CI
2.1-4.4) were associated with increased risk of developing RDR.
Baseline current smokers had a significantly higher risk of RDR (OR
2.1, 95% CI 1.0-4.5) after adjusting for age, sex, and CFH and
ARMS2 polymorphisms. Of 218 eyes with RDR (prevalent and
incident cases), 40 eyes (18.4%) developed late AMD in 5 years
(neovascular AMD 42.5%; geographic atrophy 57.5%). Total area of
RDR or RDR extending to a near central location was found not to be
associated with progression to late AMD in 5 years. A higher
proportion of eyes with RDR located outside the macular area
progressed to late AMD (36.4%), compared to those with RDR
involving the macula area (10.1 and 22.2% for RDR within inner and
outer subfields of the Wisconsin Grading grid, respectively).
Conclusions: Known AMD risk factors were associated with
increased long-term risk of developing RDR. RDR area and location
were not associated with progression to late AMD over 5 years.
Commercial Relationships: Nichole D. Joachim, None; Paul
Mitchell, Novartis (R), Bayer (R); Elena Rochtchina, None; Ava G.
Tan, None; Jie Jin Wang, None
Support: NHMRC (Australia), grants 974159, 211069, 457349
Program Number: 368
Presentation Time: 10:45 AM - 11:00 AM
Inflammatory Markers and Age-related Macular Degeneration:
Findings from an Older Cataract Surgical Cohort
Jie Jin Wang1, 2, Calvin S. Fong1, Elena Rochtchina1, Ava G. Tan1,
Paul Mitchell1. 1Ctr for Vision Research/Ophthalmol, University of
Sydney, Westmead, NSW, Australia; 2Centre for Eye Research
Australia, Department of Ophthalmology, University of Melbourne,
Melbourne, VIC, Australia.
Purpose: To investigate the associations between inflammatory
markers and incidence of early and late age-related macular
degeneration (AMD) in a cataract surgical cohort.
Methods: We followed cataract surgical patients from Westmead
Hospital, Sydney, aged 64+ years for 5 post-operative years in the
Australian Cataract Surgery and Age Related Macular Degeneration
(CSAMD) Study. We performed annual examinations with retinal
photography to assess incident AMD using a side-by-side grading
method. Preoperative and one-month postoperative images provided
baseline information. Incident early AMD was defined as the new
appearance of either indistinct soft/reticular drusen or co-existing
retinal pigmentary abnormality and distinct soft drusen, in persons
without early AMD in either eye at baseline. Incident late AMD was
defined as the new appearance of neovascular AMD or geographic
atrophy in persons without previous late AMD in either eye. White
cell count (WCC), high sensitive C-reactive protein (hs-CRP) and
fibrinogen were assessed from blood taken 3-5 years after surgery.
Results: Of 1930 patients recruited, 1597 (82.7%) were followed up
for 1 to 5 years postoperatively; 1277 (80.0% of 1579) had gradable
retinal images at baseline and follow-up visits and were at risk of late
AMD. Of the 1277, 791 (61.9%) had blood samples taken. Median
(interquartile range) values were: WCC, 6.90 (5.80-8.20) x10-9/L; hsCRP, 2.31 (1.08-4.65) mg/L; fibrinogen, 3.60 (3.10-4.10) g/L. Of
1277 at risk, 45 developed late AMD. Of 921 at risk, 143 developed
early AMD. After adjusting for age, sex and current smoking, WCC
above the median was associated with increased risk of late AMD
(odds ratio, OR, 2.21, 95% confidence interval, CI, 1.04-4.73); hsCRP above the median was associated with increased risk of early
AMD (OR 1.64, 95% CI 1.08-2.48); additional adjustment for hsCRP in the model for late AMD, or WCC in the model for early
AMD, did not alter these associations. Further adjustment for
baseline large drusen and retinal pigment abnormalities weakened the
association of WCC with late AMD (OR 1.84, 95% CI 0.84-1.05).
Fibrinogen was not associated with early or late AMD incidence.
Conclusions: The specific associations of WCC with late AMD and
hs-CRP with early AMD suggest different inflammatory processes
leading to late and early AMD in patients after cataract surgery.
Commercial Relationships: Jie Jin Wang, None; Calvin S. Fong,
None; Elena Rochtchina, None; Ava G. Tan, None; Paul Mitchell,
Novartis (R), Bayer (R)
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Support: Australian NHMRC project grant ID 302010 (2004-06),
Retina Australia research grant (2005), and Australian NHMRC
Centre for Clinical Research Excellence (CCRE) grant ID 529923
(2009-2013)
Program Number: 369
Presentation Time: 11:00 AM - 11:15 AM
Inflammatory and Oxidative Stress Markers and the 20-Year
Cumulative Incidence of Age-related Macular Degeneration: the
Beaver Dam Eye Study
Ronald Klein1, Chelsea E. Myers1, Sudha K. Iyengar2, Theru A.
Sivakumaran3, Karen J. Cruickshanks1, 4, Kristine E. Lee1, Ronald E.
Gangnon5, 4, Barbara E. Klein1. 1Ophthalmology and Visual
Sciences, University of Wisconsin School of Medicine and Public
Health, Madison, WI; 2Epidemiology and Biostatistics, Case Western
Reserve University, Cleveland, OH; 3Division of Human Genetics,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;
4
Population Health Sciences, University of Wisconsin School of
Medicine and Public Health, Madison, WI; 5Biostatistics and Medical
Informatics, University of Wisconsin School of Medicine and Public
Health, Madison, WI.
Purpose: To determine whether inflammatory and oxidative stress
markers are associated with the 20-year cumulative incidence of early
and late age-related macular degeneration (AMD).
Methods: A randomized sample of the Beaver Dam Eye Study
cohort of 1597 persons was identified for assessment of 4
inflammatory markers (serum high sensitivity C-reactive protein
[CRP], tumor necrosis factor-α [TNF-α], interleukin-6 [IL-6], and
white blood cell [WBC] count) and 2 oxidative stress markers (serum
isoprostane and total carbonyl content [TCC]) at baseline and were
examined at 4 follow-up exams spaced 5 years apart. AMD was
assessed from fundus photographs using the modified Wisconsin
Age-Related Maculopathy Grading System. Genetic risk was defined
by the number of risk alleles for variants of Complement Factor H
(1061170) and Age-Related Maculopathy Susceptibility 2
(rs10490924) as low (0-1, n=1063), intermediate (2, n=416) and high
(3-4, n=118).
Results: The 20-year cumulative incidence of early AMD was 20.4%
and for late AMD it was 3.8%. While adjusting for age, sex, smoking
status, genetic risk status and other risk factors, only CRP (reported
as odds ratio trend per quartile, P value for test of trend; 1.23,
p=0.008) and IL-6 (1.18, p=0.04) were statistically significantly
associated with the 20-year incidence of early AMD, and only CRP
(1.44, P=0.04) was associated with the 20-year cumulative incidence
of late AMD. Similar models were run stratifying by genetic risk. In
the intermediate risk group, CRP (1.77, P=0.0001), TNF-α (1.54,
P=0.006) and IL-6 (1.41, P=0.02) were associated with the risk of
early AMD. CRP (2.13, p=0.01) and TNF-α (2.62, p=0.04) were also
were associated with the 20-year cumulative incidence of late AMD.
Among those in the high genetic risk group, isoprostane (2.13,
P=0.04), TCC (2.03, P=0.04) and WBC count (2.07, P=0.03) were
associated with the cumulative incidence of early AMD.
Conclusions: Our findings suggest a relation of inflammatory and
oxidative stress markers to the 20-year cumulative incidence of early
and late AMD in those with intermediate and high genetic risk.
Commercial Relationships: Ronald Klein, None; Chelsea E.
Myers, None; Sudha K. Iyengar, None; Theru A. Sivakumaran,
None; Karen J. Cruickshanks, None; Kristine E. Lee, None;
Ronald E. Gangnon, None; Barbara E. Klein, None
Support: NIH-NEI grant EY06594 and Research to Prevent
Blindness (R Klein, BEK Klein, Senior Scientific Investigator
Awards)
Program Number: 370
Presentation Time: 11:15 AM - 11:30 AM
Association between vitamin D status and age-related macular
degeneration (AMD) by complement factor H (CFH) Y402H
genotype
Amy E. Millen1, Kristin J. Meyers2, Zhe Liu2, Corinne D. Engelman2,
Erin S. LeBlanc3, Robert B. Wallace4, Lesley Tinker5, Sudha K.
Iyengar6, Julie A. Mares2. 1Social and Preventive Medicine,
University at Buffalo, The State University of New York, Buffalo,
NY; 2Department of Ophthalmology and Visual Sciences, University
of Wisconsin, Madison, WI; 3Center for Health Research, Kaiser
Permanente NW, Portland, OR; 4Department of Epidemiology,
University of Iowa, Iowa City, IA; 5Fred Hutchinson Cancer
Research Center, Seattle, WA; 6Department of Epidemiology &
Biostatistics, Case Western Reserve University, Cleveland, OH.
Purpose: It is well established that the Y402H CFH polymorphism
increases risk for AMD. Previous research shows that high versus
low vitamin D status, assessed with serum concentrations of 25hydroxyvitamin D [25(OH)D], is associated with decreased odds of
AMD. Whether the vitamin D association is modified by genetic risk
for AMD remains to be examined.
Methods: Using data from the Carotenoids in Age-Related Eye
Disease Study, an ancillary study of the Women’s Health Initiative,
we examined whether the association between serum [25(OH)D] and
AMD was modified by presence of the CFH Y402H polymorphism.
There were 1,230 postmenopausal women aged 50-79 at study
baseline (1994-98) with complete genotype data and available serum
samples. [25(OH)D] were assessed at baseline by competitive
chemiluminescence immunoassay. Prevalent AMD (n=249) was
assessed six years later by stereoscopic fundus photographs. Logistic
regression was used to estimated odds ratios (ORs) and 95%
confidence intervals (CIs) for early or late AMD by [25(OH)D] (<30,
30 to <50, ≥50 to <75, and ≥75 nmol/L) and CFH Y402H genotype
(noncarrier, one risk allele, two risk alleles). The referent group was
Y402H noncarriers with inadequate vitamin D status (<30 nmol/L).
Results: Among women with inadequate ([25(OH)D]<30 nmol/L) or
adequate ([25(OH)D]>75 nmol/L) vitamin D status, having two risk
alleles was associated with an increased odds of AMD but the odds
was attenuated in those adequate vitamin D status (OR=4.30, 95%
CI=1.21-15.20 and OR=1.56, 95% CI=0.54, 4.52, respectively).
Among noncarriers and women with one risk allele, the odds of
AMD was decreased in women with [25(OH)D]>75 (OR=0.82, 95%
CI=0.29-2.33 and OR=0.89, 95% CI=0.34-2.35, respectively). In
women with 2 risk alleles, having [25(OH)D]>75 lowered the odds
for AMD 64% (OR=1.56, 95% CI=0.54, 4.52) relative to those with
[25(OH)D]<30 (OR=4.30, 95% CI=1.21-15.20). The P for interaction
between vitamin D status and genotype was 0.35. Further adjustment
for use of hormone therapy, sunlight exposure and eye color did not
alter the associations.
Conclusions: In this sample of postmenopausal women, the odds of
AMD decreased with increasing [25(OH)D] across all genotypes, but
most markedly among those with two risk alleles for the CFH Y402H
genotype.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Amy E. Millen, Mushroom Council
(F); Kristin J. Meyers, None; Zhe Liu, None; Corinne D.
Engelman, None; Erin S. LeBlanc, None; Robert B. Wallace,
None; Lesley Tinker, None; Sudha K. Iyengar, None; Julie A.
Mares, None
Support: NIH Grant EY13018, EY16886, Retina Research
Foundation, and Research to Prevent Blindness
Program Number: 371
Presentation Time: 11:30 AM - 11:45 AM
LIPC and LPL polymorphisms, age-related macular
degeneration and plasma lutein and zeaxanthin: the Alienor
Study
Benedicte Merle1, 2, Cécilia Maubaret1, 2, Jean-Francois Korobelnik1,
2
, Marie-Noelle Delyfer1, 2, Marie B. Rougier3, jean-Charles
Lambert4, 5, Philippe Amouyel5, 6, Joseph Colin2, 3, Pascale
Barberger-gateau1, 2, Cecile Delcourt1, 2. 1Bordeaux, INSERM U897,
Bordeaux, France; 2Univ. Bordeaux, Bordeaux, France; 3Service
d’Ophtalmologie, CHU de Bordeaux, Bordeaux, France; 4Inserm,
U744, Lille, France; 5Institut Pasteur de Lille, Lille, France;
6
Université Lille Nord de France, Lille, France.
Purpose: Genes implicated in high density lipoprotein (HDL)
metabolism have been reported to be associated with age-related
macular degeneration (AMD). HDL, transport the two carotenoids,
lutein (L) and zeaxanthin (Z), which are highly suspected to play a
key-role in the protection against AMD. We aimed at assessing
associations of some genes implicated in HDL metabolism with
AMD and plasma L and Z
Methods: The Alienor study is a prospective population-based study
on nutrition and age-related eye diseases, performed in 963 residents
of Bordeaux, aged 73 years or more (2006-08). Early and late AMD
were graded according to the international classification, from non
mydriatic colour retinal photographs. Plasma L and Z were
determined by normal-phase high-performance liquid
chromatography. A genome-wide scan was performed. Genotypes
data for rs10468017 (LIPC), rs3764261 (CETP) and rs12678919
(LPL) were available. Genotypes for rs10490924 (ARMS2/HTRA1),
rs493258 (LIPC), rs9621532 and rs1883025 (ABCA1) SNPs were
imputed using Markov Chain-based haplotyper (MACH v1.0.16a)
software and the 1000 Genomes Project data. Persons implicated in
AMD classification had no access to either plasma or genetic data.
Associations of late AMD with genetic polymorphisms were
estimated using Generalized Estimating Equation logistic regressions.
Associations of L and Z with genetic polymorphisms were estimated
using linear regression
Results: After multivariate adjustment, the TT genotype of the LIPC
rs493258 variant was significantly associated with a reduced risk of
early and late AMD (OR=0.64, 95%CI: 0.41-0.99; p=0.049 and
OR=0.26, 95%CI: 0.08-0.85; p=0.03, respectively), and with higher
plasma Z concentrations (p=0.03), while plasma lipids were not
significantly different according to this SNP. Associations of AMD
with LIPC rs10468017 were weaker, and did not reach statistical
significance after full multivariate adjustment (early AMD, OR=0.73,
95%CI: 0.41-1.29; p=0.20 and late AMD, OR=0.21, 95%CI: 0.031.61; p=0.13). Besides, the LPL variant was associated with early
AMD (OR=0.67, 95%CI: 0.45-1.00; p=0.05) and both with plasma
lipids and plasma L (p=0.047). Associations between CETP and
ABCA1 polymorphisms and AMD did not reach statistical
significance
Conclusions: These findings suggest that LIPC and LPL genes,
implicated in HDL metabolism, could both modify the risk for AMD
and the metabolism of L and Z
Commercial Relationships: Benedicte Merle, Laboratoires Théa
(F); Cécilia Maubaret, None; Jean-Francois Korobelnik, Alcon
(C), Allergan (C), Bayer (C), Carl Zeiss Meditec (C), Novartis (C),
Thea (F); Marie-Noelle Delyfer, Thea Laboratories (F); Marie B.
Rougier, THEA (C), Bausch&Lomb (C), Allergan (C), Kemin (C);
jean-Charles Lambert, None; Philippe Amouyel, None; Joseph
Colin, Alcon (C), Abbott (C), AdditionTechnology (C); Pascale
Barberger-gateau, Danone (F), Vifor Pharma (C); Cecile Delcourt,
Laboratoires Théa (F), Novartis (C), Bausch+Lomb (C)
Support: Laboratoires Théa (Clermont-Ferrand, France), Fondation
Voir et Entendre (Paris, France), Conseil Régional d’Aquitaine
(Convention n° 20091301029, Bordeaux, France), Fondation pour la
recherche médicale, France (FRM)
Program Number: 372
Presentation Time: 11:45 AM - 12:00 PM
Intravitreal ranibizumab treatment of wet macular degeneration
in SE Scotland - effect on blindness rates and 5 year follow up
data
Peter Cackett1, Shyamanga Borooah1, Mike Gavin2, Dilys
Oladiwura2, V.Swetha E. Jeganathan1. 1Princess Alexandra Eye
Pavilion, Edinburgh, United Kingdom; 2Tennent Institute of
Ophthalmology, Glasgow, United Kingdom.
Purpose: Intravitreal ranibizumab (IVTR) has been routinely used
for the treatment of wet age-related macular degeneration (AMD) in
the United Kingdom since 2007. There is little reported in the
literature on the effect on blindness rates in the population or long
term follow up data. We predicted that the new intervention of IVTR
would reduce blind registration rates secondary to wet AMD in our
population.
Methods: We obtained blind registration data for the population of
SE Scotland which is recorded by the Royal National Institute for the
Blind. Legal blindness is defined as a visual acuity of 0.05 (20/400)
or lower in a person’s better-seeing eye. We also retrospectively
analysed the case-notes of our first cohort of 100 patients who
entered the service in 2007 to determine our long term follow up data
to 2012. We obtained visual acuity outcome data, number of clinic
visits per year, total number of injection treatments and attrition rates.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Results: The incidence rate of legal blindness attributable to wet
AMD in the population of SE Scotland decreased from 10.6 cases per
100 000 in 2004 to 4.3 cases per 100 000 in 2012, corresponding to a
reduction of 59%. The incidence of legal blindness from all causes
decreased from 27.8 per 100,000 in 2004 to 20.4 per 100,000 in
2011, corresponding to a reduction of 27%. For our first cohort of
100 patients mean visual acuity at the start of treatment was logmar
0.60 and after five years follow up was logmar 0.68 corresponding to
a mean loss of 4 ETDRS chart letters. Average number of injections
was 9.7 and mean number of clinic visits by year were 9.0 in year 1,
5.8 in year 2, 4.8 in year 3, 2.3 in year 4 and 0.5 in year 5.
Conclusions: Ranibizumab has been shown to be efficacious in the
treatment of wet AMD through the ANCHOR and MARINA trial
data. Our data showing significant reduction in blindness rates
secondary to wet AMD since the commencement of treatment with
IVTR demonstrates that the efficacy translates into clinical real-world
practice and results in reduction in morbidity secondary to this
potentially blinding condition.
Commercial Relationships: Peter Cackett, Novartis (R), Allergan
(R); Shyamanga Borooah, None; Mike Gavin, Novartis (R); Dilys
Oladiwura, None; V.Swetha E. Jeganathan, None
Program Number: 373
Presentation Time: 12:00 PM - 12:15 PM
Cost-effectiveness of ranibizumab and bevacizumab for
neovascular age-related macular degeneration: 1 year IVAN
results
Chris Rogers1, Helen A. Dakin2, Sarah Wordsworth2, Giselle
Abangma2, James Raftery3, Simon P. Harding5, Usha Chakravarthy7,
Andrew J. Lotery4, Susan Downes6, Barnaby C. Reeves1. 1Clinical
Trials & Evaluation Unit, University of Bristol, Bristol, United
Kingdom; 2Health Economics Research Centre, Department of Public
Health, University of Oxford, Oxford, United Kingdom; 3Wessex
Institute for Health Research and Development, University of
Southampton, Southampton, United Kingdom; 4Clinical and
Experimental Sciences, Faculty of Medicine, University of
Southampton, Southampton, United Kingdom; 5Department of Eye
and Vision Science, Institute of Ageing and Chronic Disease,
University of Liverpool, Liverpool, United Kingdom; 6Oxford
University Hospitals NHS Trust, Oxford, United Kingdom; 7Institute
of Clinical Science, The Queen’s University of Belfast, Belfast,
United Kingdom.
Purpose: To assess the incremental cost and cost-effectiveness of
monthly and as-needed treatment regimens of bevacizumab (Avastin)
and ranibizumab (Lucentis) for neovascular age-related macular
degeneration (nAMD) from the perspective of the UK National
Health Service.
Methods: In IVAN, a double-masked, factorial randomized
controlled trial
(ISRCTN92166560), 610 patients aged ≥50 years with untreated
nAMD were randomized to ranibizumab or bevacizumab and to
monthly or as-needed treatment. Quality of life (EQ-5D) and
healthcare resource use (including: study medication; drug
administration/monitoring consultations; and any concomitant
medication, ambulatory consultations and hospitalizations linked to
expected adverse events) were collected prospectively for all patients.
We conducted a within-trial cost-utility analysis with a 1-year time
horizon to assess the relative costs and cost-effectiveness of
bevacizumab vs. ranibizumab and of as-needed vs. monthly
treatment.
Results: Total annual costs ranged from £9670 (95% CI: £9541,
£9,799) per patient for monthly ranibizumab to £1504 (95% CI:
£1433, £1575) for as-needed bevacizumab. Ranibizumab was
significantly more costly than bevacizumab, costing an additional
£7875 (95% CI: £7659, £8091; p<0.001) per patient for monthly
treatment and £4993 (95% CI: £4556, £5430; p<0.001) for as-needed
treatment. Preliminary results suggested that quality-adjusted life
years (QALYs) varied between 0.817 (95% CI: 0.793, 0.840) for asneeded bevacizumab to 0.829 (95% CI: 0.805, 0.852) for as-needed
ranibizumab, with no significant differences between drugs or dosing
regimens (p>0.4). Bootstrapping analyses showed that if society is
willing to pay £20,000 to gain a QALY, there is a 66% chance that
as-needed bevacizumab is the most cost-effective treatment evaluated
in IVAN and a 34% chance that monthly bevacizumab is best. The
probability of either ranibizumab regimen being cost-effective was
<0.01% at £20,000 and £30,000 (~$50,000) per QALY. Costs and
QALYs allowing for expected and unexpected serious adverse events
will also be presented.
Conclusions: The analysis, which included all treatment-related
healthcare costs, demonstrates that we can be confident that
ranibizumab is not cost-effective compared with bevacizumab, being
substantially more costly and producing little or no additional health
improvement.
Commercial Relationships: Chris Rogers, Novartis (R); Helen A.
Dakin, Pfizer (in different diseases - not AMD) (C), Pfizer (in
different diseases - not AMD) (F); Sarah Wordsworth, None;
Giselle Abangma, None; James Raftery, None; Simon P. Harding,
Novartis (F), Novartis (R); Usha Chakravarthy, Bayer (C), Novartis
(F), Neovista (C), Oraya (F); Andrew J. Lotery, Novartis (F), Bayer
(R); Susan Downes, Novartis (F), Novartis (R); Barnaby C. Reeves,
None
Support: The IVAN trial is funded by the National Institute for
Health Research (NIHR) Health Technology Assessment (HTA)
programme (project number 07/36/01) and will be published in full in
Health Technology Assessment. Visit the HTA programme website
(www.hta.ac.uk) for further project information. The views and
opinions expressed are those of the authors and do not necessarily
reflect those of the HTA programme, NIHR, the UK National Health
Service or the Department of Health
Clinical Trial: ISRCTN92166560
137 Cornea and Cataract
Sunday, May 05, 2013 1:00 PM-2:45 PM
Exhibit Hall Poster Session
Program #/Board # Range: 857-899/B0081-B0123
Organizing Section: Clinical/Epidemiologic Research
Program Number: 857 Poster Board Number: B0081
Presentation Time: 1:00 PM - 2:45 PM
Insurance, race, gender and how they relate to visual acuity at
the time of cataract surgery
Michelle Oboite1, Sandra Stinnett1, Alan N. Carlson1, Natalie A.
Afshari2. 1Duke Eye Center, Duke University School of Medicine,
Duke University Medical Center, Durham, NC; 2Shiley Eye Center,
University of California, San Diego, San Diego, CA.
Purpose: To determine if there is any relationship between
preoperative visual acuity and sociodemographic variables at the time
of cataract surgery
Methods: Four hundred thirty candidates for cataract surgery
between January 1, 2007 and December 31, 2011 were included in
this study. Patient care records were used to collect visual acuity,
race, gender, health insurance plans, systemic and ocular
comorbidities, body mass index [BMI], and smoking history
available from the appointments immediately prior to surgery. Mean
preoperative best-corrected visual acuity (BCVA) for cohorts were
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
compared and the significance of differences between race, gender,
insurance, and comorbidity groups was assessed using analysis of
variance. The relationships between BMI, smoking pack-years, and
BCVA were assessed through linear regression. Significant variables
were included in a multivariable regression model. The model was
then reduced using a stepwise selection procedure.
Results: In univariable analyses of variance, insurance (uninsured,
public, private) and race (white, black, other) were the two
sociodemographic variables with significant differences between
groups (p<0.0001 and p=0.0005, respectively). Pair-wise significant
differences in mean preoperative BCVA were found for private
(LogMAR 0.451 [Snellen~20/55]) versus public (0.679 [20/75],
p=0.0001); private versus uninsured (0.872 [20/150], p=0.0003);
white (0.465 [20/60]) versus black (0.674 [20/75], p=0.0008); and
white versus other race (0.728 [20/105], p=0.0138). There was no
significant difference in BCVA between public and uninsured, black
and other race, or men and women, and no strong correlations
between BCVA and BMI or smoking pack-years. In a multivariate
regression model adjusting for age, significant comorbidities from
univariable analyses (diabetes, age-related macular degeneration, and
hypertension), and other vision-impairing conditions, insurance and
race remained significant (p=0.0056, 0.0038) with the directionality
the same as for the univariable analyses.
Conclusions: In this study, patients with private insurance and those
of white race independently presented with better preoperative
BCVA, on average, than their respective counterparts at the time of
cataract surgery. This may represent a disparity in access to care or
utilizing the care based on insurance and race variables. Larger
studies are needed to confirm these preliminary findings.
Commercial Relationships: Michelle Oboite, None; Sandra
Stinnett, None; Alan N. Carlson, None; Natalie A. Afshari, None
Support: Research to Prevent Blindness
Program Number: 858 Poster Board Number: B0082
Presentation Time: 1:00 PM - 2:45 PM
PRECOG: Validating the early assessment of vision after
cataract surgery
Nathan G. Congdon1, 3, Xixi Yan1, Van C. Lansingh2, Ving F. Chan5,
Andreas Mueller6, Ling Jin1, Mirjam E. Meltzer1, Sasipriya
Karumanchi7, Chunhong Guan4, Alemayehu Sisay3. 1Preventive
Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, China;
2
IAPB, Miami, FL; 3ORBIS, New York, NY; 4Fred Hollows, Sydney,
NSW, Australia; 5BHVI, Durban, South Africa; 6WHO WPRO
Office, Manila, Philippines; 7Aravind, Madurai, India.
Purpose: Poor post-operative follow-up after cataract surgery makes
it difficult in many developing areas to assess outcomes several
weeks after surgery, as commonly recommended. We sought to
validate early vision measurement as an alternative for assessing
surgical quality by comparing vision at hospital discharge with that
measured > 50 days later.
Methods: Each of 40 centers in 11 countries in Asia, Africa and
Latin America recruited 50-100 consecutive patients aged > 30 years
without ocular co-morbidities who were undergoing surgery for agerelated cataract (ECCE, phacoemulsification or small-incision
[SICS]). Centers included small rural clinics and large urban
hospitals. Corrected (BCVA) and uncorrected (UCVA) vision in the
operative eye were recorded before surgery, at discharge (< 4 days
post-operatively) and > 50 days post-operatively. Vision was
examined in clinic for patients returning spontaneously, patients not
returning by 2 months were contacted by phone and/or offered
transportation help, and remaining patients were examined at home.
Results: Among 3712 participants (62% SICS, 84.1% with preoperative UCVA <= 6/60 in the operative eye), 92.8% had follow-up
vision data, and only 44% returned spontaneously to clinic. Final (>
50 days) UCVA was >= 6/18 in 66.7%. The 90th, 75th, 50th and 25th
%ile values for proportion of patients with discharge UCVA >= 6/18
were 71.8%, 59.1%, 40.0% and 30.8% respectively. Discharge and
final UCVA were highly-correlated (Spearman r = 0.59). When
hospitals were ranked by proportion of patients with UCVA >= 6/18,
rankings based on discharge UCVA were highly-correlated with
those based on final UCVA (r = 0.55). This correlation was not
improved by using BCVA (r = 0.54) or dropping patients (10%)
undergoing ECCE (r = 0.50). Eliminating the 20% of patients with
worst discharge UCVA at each hospital improved the correlation to
0.65. When dividing hospitals into Good (top 25% by proportion with
UCVA >= 6/18), Medium (middle 50%) and Poor (bottom 25%),
rankings based on discharge and final VA were the same in 26/40
(65%) of hospitals, and no hospital was ranked Good at discharge and
Poor at final assessment or vice-versa.
Conclusions: Recording uncorrected vision at hospital discharge is a
simple tool for even small, rural clinics performing ECCE to
accurately assess cataract surgical quality where follow-up rates are
low. These data suggest standards for discharge vision outcomes.
Commercial Relationships: Nathan G. Congdon, None; Xixi Yan,
None; Van C. Lansingh, International Agency for the Prevention of
Blindness (E); Ving F. Chan, None; Andreas Mueller, None; Ling
Jin, None; Mirjam E. Meltzer, None; Sasipriya Karumanchi,
None; Chunhong Guan, None; Alemayehu Sisay, None
Support: China Thousand Man Plan
Program Number: 859 Poster Board Number: B0083
Presentation Time: 1:00 PM - 2:45 PM
The impact of first and second eye cataract surgery on
hospitalisation from injuries due to a fall: a whole population
study
Lynn Meuleners1, 3, Michelle Fraser1, 3, Jonathon Ng3, 2, Nigel
Morlet3, 2. 1Curtin Monash Accident Research Centre, Curtin
University, Perth, WA, Australia; 2Centre for Population Health,
University of Western Australia, Perth, WA, Australia; 3Eye and
Vision Epidemiology Research, Perth, WA, Australia.
Purpose: To assess the risk of an injury due to a fall among adults
aged 60+ years before first eye cataract surgery, between first and
second eye surgery and after second eye surgery.
Methods: A retrospective cohort study was undertaken using linked
data from the Western Australian Hospital Morbidity Data System
and the Western Australian Death Registry from 2001 to 2008.
Poisson regression analysis based on generalised estimating
equations (GEE) was undertaken with each person as the unit of
analysis, to compare the frequency of falls two years before first eye,
and two years after second eye cataract surgery. To investigate the
association of timing of cataract surgery and falls risk, follow up time
was divided into three “cataract exposure” periods of time unique to
each individual; the two years prior to first eye cataract surgery, the
time between first and second cataract surgery and two years after the
second cataract surgery. The follow-up was censored accordingly for
those who died during the study period.
Results: There were 28,396 individuals aged 60+ years who
underwent bilateral cataract surgery in Western Australian between
2001 and 2008. Of this group 1,094 (3.85%) individuals experienced
1,220 injuries due to a fall during the study period. The risk of injury
due to a fall doubled (risk ratio 2.14, 95% confidence interval 1.82 to
2.51) between first and second eye cataract surgery compared to the
two years before first eye surgery. There was a 34% increase in the
number of falls in the two years after second eye cataract surgery
compared to the two years before first eye cataract surgery (1.34,
1.16 to 1.55). There was a progressive increase of a fall-related injury
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
with increasing age with the risk in those aged 85+ years 6.84 times
(3.93 to 11.93) that of the 60-64 years age group. Women (2.24, 1.91
to 2.63); and those with at least one comorbidity (2.84, 2.46 to 3.29)
were also at significantly increased risk of injury due to a fall. Those
who were married (RR 0.30, 95% CI 0.60-0.80) had a reduced risk of
an injury due to a fall.
Conclusions: There may be an increased risk of falls after cataract
surgery which ophthalmologists should consider when discussing
risks and benefits of cataract surgery. This has important implications
for the timely provision of second eye cataract surgery for older
adults.
Commercial Relationships: Lynn Meuleners, None; Michelle
Fraser, None; Jonathon Ng, None; Nigel Morlet, None
Support: Australian Research Council Discovery Grant
Program Number: 860 Poster Board Number: B0084
Presentation Time: 1:00 PM - 2:45 PM
Prevalence of Corneal Astigmatism in a Cataract Population
David Curragh1, 2, Patrick Hassett2. 1Ophthalmology, NIMDTA,
Belfast, United Kingdom; 2Ophthalmology, Western Health and
Social Care Trust, Londonderry, United Kingdom.
Purpose: To determine the prevalence of corneal astigmatism in a
cataract population to aid cataract surgeons with their options for
correcting astigmatism and assess the demand for toric intraocular
lenses.
Methods: Keratometric data was collected for all patients who
attended for routine cataract surgery at two different sites between
January 2008 and December 2011. Data was analysed
retrospectively.
Results: Data was complied for 1105 eyes of 941 patients. Results
revealed a mean corneal astigmatism of 1.13 ± 0.91. The corneal
astigmatism was 0.50D or less in 283 eyes (25.6%), between 0.51 D
and 1.00 D in 374 (38%) and between 1.01 and 1.50D in 193 eyes
(17.5%). It was 1.50D or less in 850 eyes (76.9%) and more than 2.00
D in 138 eyes (12.5%), more than 2.50 D in 80 eyes (7.24%), more
than 3.00D in 41 eyes (3.71%) and more than 3.50 D in 28 eyes
(2.53%).
Conclusions: Of patients selected for routine cataract surgery, 40.5%
of eyes had more than 1.00 D of corneal astigmatism and 12.5% had
more and 2.00D. 3.7% had more than 3.00D and 2.53% had more
than 3.50D of corneal astigmatism. This shows the potential demand
for toric intraocular lens insertion in this population.
Commercial Relationships: David Curragh, None; Patrick
Hassett, None
Program Number: 861 Poster Board Number: B0085
Presentation Time: 1:00 PM - 2:45 PM
Contrast acuity in eyes with different types of lens opacity
mai takahashi1, Hiromi Osada1, Norihiro Mita1, Eri Shibuya1,
Natsuko Hatsusaka1, Yoriko Takahashi1, Yasuo Sakamoto2, Kazuyuki
Sasaki1, Eri Kubo1, Hiroshi Sasaki1. 1Ophthalmology, kanazawa
medical university, Ishikawa, Japan; 2Visual Science Course,
Department of Rehabilitation, Faculty of Medical Science and
Welfare, Tohoku Bunka Gakuen University, Miyagi, Japan.
Purpose: To compare the best corrected visual acuity (BCVA),
daytime contrast acuity (DCA), and evening contrast acuity (ECA) in
eyes with cortical (COR), nuclear (NUC), posterior subcapsular
cataracts (PSC), retrodots (RD) and water clefts (WC) with those in
eyes with transparent lenses.
Methods: The 523 eyes of 430 subjects (177 males, 253 females, age
69.5±8.2 yrs) who were examined for cataract surgery in Kanazawa
Medical University hospital or participated in Monzen Eye Study
from 2006 to 2011, were enrolled in this study. COR, NUC and PSC
were graded according to WHO classification system. COR was
categorized CEN+/- by opacity within/outside the central 3 mm
diameter area of the pupil. WC was similarly categorized WC
(CEN+/-). RD was classified into four grades by quantity and area of
RD in the 3 mm diameter area: grade 1, less than 5 RD; grade 2, less
than 25% of the area; grade3, less than 50%; and grade 4, 50% or
more. The number of eyes by cataract type was: 46, COR (CEN-);
155, COR (CEN+); 32, NUC; 13, PSC; 84, RD; 43, WC (CEN+); 22,
WC (CEN-); and 128 transparent. Opacities were judged by one
observer. Contrast vision was measured using CAT2000 (NEITZ) for
25% DCA and ECA.
Results: BCVA was significantly worse in eyes with COR (CEN+),
NUC grade 1 and over, PSC, RD grade 2 and over, and WC (CEN+)
than in those with transparent lenses age 60s (ANOVA p<0.05).
DCA and ECA were significantly worse in eyes with NUC grade 1
and over, COR (CEN+), PSC grade 2 and over, RD 4 (for DCA), RD
3 and over (for ECA) and WC (CEN+) than in those with transparent
lenses age 60s (ANOVA p<0.05).
Conclusions: There is a relationship between severity, type of lens
opacity, and BCA, DCA and ECA. This information is very useful to
inform indication of cataract surgery.
Commercial Relationships: mai takahashi, None; Hiromi Osada,
None; Norihiro Mita, None; Eri Shibuya, None; Natsuko
Hatsusaka, None; Yoriko Takahashi, None; Yasuo Sakamoto,
None; Kazuyuki Sasaki, None; Eri Kubo, None; Hiroshi Sasaki,
None
Program Number: 862 Poster Board Number: B0086
Presentation Time: 1:00 PM - 2:45 PM
Visual Outcomes of Intraocular Lens Exchange and
Repositioning
Raisa Epistola1, 2, Deana Choi1, Mark A. Slabaugh1. 1University of
Washington, Seattle, WA; 2Temple University, Philadelphia, PA.
Purpose: To evaluate the indications and outcomes of intraocular
lens exchange and repositioning. To determine whether exchange of
anterior chamber intraocular lens versus posterior chamber
intraocular lens affects visual outcome.
Methods: We analyzed a retrospective case series of patients with
intraocular lens exchange or repositioning performed at the
University of Washington and Harborview Medical Center over an
eight year period. Medical records were reviewed to obtain clinical
and demographic data. Patients without vision at post-operative
month one were excluded.
Results: 49 eyes of 46 patients who underwent intraocular lens
exchange or repositioning were identified and included. 21 patients
(45.7%) were female and 25 (54.3%) were male. Surgery was
performed by seven different surgeons: two retina surgeons (ELC,
GAV) and five anterior segment surgeons (TTS, PPC, MAS, MCW,
RCM). Average age was 57.3 (range 12-89) years at time of lens
exchange. Anterior chamber lenses were exchanged or repositioned
in 8 (16%) eyes and posterior chamber lenses in 41 (84%) eyes.
Interval between initial intraocular lens placement and lens
exchange/repositioning was 108 (+/- 107) months in the anterior
chamber intraocular lens group and 31.9 (+/- 416) months in the
posterior chamber intraocular lens group. Mean change in visual
acuity -0.922 (+/- 1.190) in the ACIOL group and -0.305 (+/-0.696)
in the PCIOL group (p=0.193). The most common reason for IOL
exchange/repositioning in ACIOL group was malposition causing
pseudophakic bullous keratopathy (PBK) and IOL
dislocation/decentration in the PCIOL group.
Conclusions: In this series of patients , there was no significant
difference in visual outcomes when explanting ACIOLs versus
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
PCIOLs. IOL exchange/repositioning is a safe and effective surgery
that is associated with improved or stable visual acuity.
Commercial Relationships: Raisa Epistola, None; Deana Choi,
None; Mark A. Slabaugh, None
Support: D. Franklin Milam MD Fellows Support Fund, unrestricted
grant from Research to Prevent Blindness
Program Number: 863 Poster Board Number: B0087
Presentation Time: 1:00 PM - 2:45 PM
Factors Influencing Visual Function in Eyes with Retrodots by
Difference in Size
Nagai Kota1, 2, Norihiro Mita2, Natsuko Hatsusaka2, Ryumon
Honda3, Kazuyuki Sasaki4, 5, Hiroshi Sasaki2, 4. 1Nagai Eye Clinic,
Ibaraki, Japan; 2ophthalmology, Kanazawa Medical University,
Uchinada, Japan; 3Nursing, Kanazawa Medical University, Uchinada,
Japan; 4Division of Vision Research for Environmental Health,
Kanazawa Medical University, Uchinada, Japan; 5Rehabilitation
Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen
University, Sendai, Japan.
Purpose: Presence of retrodots (RD) occupying 25% of the area of
the 3mm diameter central pupil zone causes reduced contrast
sensitivity and occupying 50% impairs vision. However, size of each
RD differs. We examined the influence of size of RD under the same
total area occupied.
Methods: Participants aged ≧60 yrs old of the Monzen Eye Study
(MES), 2006 to 2012, were graded for RD; 261 participants 432 eyes
(mean±SD age : 69.5±5.1yrs) had transparent lenses (T): 52 cases, 82
eyes (69.5±6.8 yrs) had fewer than four RD in the 3 mm diameter
zone (Grade RD1): and 11 cases, 18 eyes (68.6±8.1 yrs) had RD
occupying up to 25% of the 3mm diameter zone (Grade RD2); and 5
cases, 5 eyes (74±5.3 yrs) RD occupied from 25% to 50% of the
3mm diameter zone (Grade RD3).
Lenses under mydriasis, were graded for RD and classified by RD
size (Small(S): ≦50μm; Medium(M) ≥50μm ≦300μm;
Large(L)≥300μm) from retroillumination images by anterior eye
segment analysis system (EAS-1000, NIDEK). A point spread
function analyzer (PSF-1000, TOPCON) was used to measure retinal
image contrast (RIC) under condition of best corrected refractive
error with mydriasis, through Landolt ring simulation with 3mm
entrance pupils. Wavefront analyzer (9000PW, TOPCON) was used
to measure ocular total HOA (μm) with 4mm pupils.
Results: Comparing average RIC in RD with that in T there was no
significant difference among RD1 sizes S and M, but it was
significantly lower in size L (P<0.0001). Among RD2, RIC in sizes
M and L were significantly lower than in T.(P<0.0001) There was no
significant difference in RIC among size groups of RD3. There were
no significant differences among all groups in total HOA, coma,
trefoil and spherical aberration.
Conclusions: In eyes with RD, total area occupied by RD is an
important factor in visual function. However, size of RD also plays a
role as larger RD decreases visual function more.
Commercial Relationships: Nagai Kota, None; Norihiro Mita,
None; Natsuko Hatsusaka, None; Ryumon Honda, None;
Kazuyuki Sasaki, None; Hiroshi Sasaki, None
Program Number: 864 Poster Board Number: B0088
Presentation Time: 1:00 PM - 2:45 PM
Correlating visual function and size of area opacified by
retrodots based on retro-illumination photography
Hiroshi Sasaki, Norihiro Mita, Natsuko Hatsusaka, Eri Shibuya, Mai
Sasaki, mai takahashi, Yoriko Takahashi, Hiromi Osada, Kazuyuki
Sasaki, Eri Kubo. Department of Ophthalmology, Kanazawa Medical
University, Uchinada, Japan.
Purpose: To consider the relationship between area opacified by
retrodots (RD) and visual function (best corrected visual acuity
(BCVA), retinal image contrast (RIC), and high-order aberration).
Methods: Subjects comprised 140 right eyes with RD (average age
69.6±7.1 yrs) excluding other types of cataract including three main
types (nuclear, cortical and posterior subcapsular cataract), water
clefts and lens opacities which may affect vision, and non-cataractous
eye disease, among participants of Monzen Eye Study (Monzen,
Wajima City, Ishikawa, Japan) from 2006 to 2012. The area
opacified by RD within the 3 mm diameter area of the pupil center
(under maximal mydriasis by tropicamide) was measured with
anterior eye segment analysis system (EAS-100, Nidek). RIC with
the 3 mm diameter pupil and total high-order aberrations (corneal,
internal, ocular) with the 4 mm diameter pupil were measured by PSF
analyzer (PSF-1000, Topcon) and wavefront analyzer (KR9000PW,
Topcon), respectively. RIC was measure for low, middle and high
frequency with optotypes 0.081logMAR, 0.423logMAR and
0.008logMAR.
Results: Size of area opacified by RD was positively correlated with
BCVA (logMAR) (p<0.05). BCVA was 0logMAR and 0.2logMAR
for areas of RD 10% and 25%, respectively. There was a negative
correlation between size of area opacified by RD and RIC for all
three optotypes (p<0.05). RIC deteriorated by 10% as RD area
increased by 10%. There was no significant correlation between area
of RD and corneal, internal and ocular total high-order aberrations.
Conclusions: Within the area of 3 mm diameter of the pupil center,
over 10% opacification by RD reduces VA to less than 0logMAR and
RIC by 10%. However, a 10% opacification does not affect highorder aberration.
Commercial Relationships: Hiroshi Sasaki, None; Norihiro Mita,
None; Natsuko Hatsusaka, None; Eri Shibuya, None; Mai Sasaki,
None; mai takahashi, None; Yoriko Takahashi, None; Hiromi
Osada, None; Kazuyuki Sasaki, None; Eri Kubo, None
Program Number: 865 Poster Board Number: B0089
Presentation Time: 1:00 PM - 2:45 PM
Donor Cornea Characteristics in Relation to Microbiologic
Culture Results and Postkeratoplasty Infections
Vandana C. Reddy1, 2, Rafael de Melo Franco2, Maria A. Woodward2,
Indu Vadakkepattath3, Michael O'Keefe3, Roni M. Shtein2.
1
Ophthalmology, Emory University, Atlanta, GA; 2Ophthalmology,
University of Michigan, Ann Arbor, MI; 3Information Technology,
Midwire Systems, Ann Arbor, MI.
Purpose: To assess characteristics of donor corneal tissues with
positive scleral rim cultures and postkeratoplasty infections.
Methods: Retrospective review of 2,681 consecutive corneal
transplants with donor scleral rim bacterial cultures performed from
1997-2011 at a single center. Data collected included: donor cornea
characteristics from the eye-bank database, surgery performed,
microbiology laboratory reports, and post-operative course. Statistical
analysis was performed with SAS 9.3.
Results: Of 2,681 transplants, there were 72 (2.7%) with positive
cultures of the donor scleral rim. None of those patients developed
clinical infection. The two most common organisms cultured were
coagulase negative staphylococcus (23%) and candida (18%). There
was 1 (0.04%) case of endophthalmitis and 5 (0.2%) cases of keratitis
seen within the first 90 days after surgery, all with negative scleral
rim cultures. There was no statistically significant difference in the
rate of positive cultures in DSAEK (2.6%) versus PKP (2.4%) tissue,
p = 0.79. There was no statistically significant difference in the rate
of postkeratoplasty infection in DSAEK versus PKP tissue, p = 0.70.
There were no statistically significant differences in donor
characteristics of the tissues with positive scleral rim cultures or
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
postkeratoplasty infections, including age, sex, race, death to
procurement time, or death to surgery time. There were also no
statistically significant differences in corneal tissue characteristics,
including corneal thickness, endothelial cell density, or tissue type
(whole cornea versus pre-cut).
Conclusions: In this cohort of 2,681 corneal transplants there were
no donor or corneal tissue characteristics that correlated with positive
donor scleral rim cultures or postkeratoplasty infection. Interestingly,
there was no relationship between positive donor scleral rim culture
and postkeratoplasty infections.
Commercial Relationships: Vandana C. Reddy, None; Rafael de
Melo Franco, None; Maria A. Woodward, None; Indu
Vadakkepattath, None; Michael O'Keefe, Midwire Systems (E);
Roni M. Shtein, None
Support: National Eye Institute K23 (EY017885)
Program Number: 866 Poster Board Number: B0090
Presentation Time: 1:00 PM - 2:45 PM
Geomapping Ophthalmomyiasis using Google Earth: Utilizing
Geographic Information Systems in Ophthalmology
Omar Ozgur, Paul Latkany, David Della Rocca, Robert Della Rocca,
Elizabeth Maher. Ophthalmology, New York Eye and Ear Infirmary,
NEW YORK, NY.
Purpose: Of all myiasis cases reported (infestations of living tissue
by the eggs or larvae of flies) 5% are ophthalmomyiasis (infestations
in and around the eye). The authors analyze the literature and
demonstrate the ability to graphically map cases of ophthalmomyiasis
utilizing Google Earth by using free online tools for Geographic
Information Systems (GIS). Our primary outcome is the number of
reports that have sufficiently detailed geospatial data to construct a
meta-analysis and to represent those cases on an interactive map.
Methods: A PubMed search identified a list of ophthalmomyiasis
cases which was exported as an XML file. A free software program,
pubmed2xl, was used to convert this XML file to a Microsoft Excel
file. Only 188 articles comprising 569 cases had adequate geographic
information to geocode the location data to yield a latitude and
longitude (using a GoogleMapping.xlsm), as required by Google
Earth. Finally a KML file was constructed utilizing a free tool,
XLS2KML.xls, which could be opened within Google Earth.
Results: Of 409 published reports of ophthalmomyiasis on PubMed,
188 articles (46%) had sufficient geographic data to permit mapping,
comprising 569 cases. The specific site affected is described as
conjunctiva in 191 cases (33%), eyelid in 10 (2%), cornea in 1 (less
than 1%), orbit in 25 (4%), ophthalmomyiasis interna in 30 (5%),
ophthalmomyiasis externa in 140 (25%), unspecified in 158 (28%)
and multiple sites in 14 (2%). There are 53 countries that reported
cases, with the top being from Libya with 121 cases (21%), Italy with
69 (12%), and India with 62 (11%). Interestingly, of 25 orbital cases,
16 cases (64%) are related to orbital carcinoma.
When the final KML file, derived from free online tools, is opened in
Google Earth, any user can successfully view complete PubMed
information on an interactive and customizable map, allowing further
analysis of the intersection of disease and geography.
Conclusions: Our demonstration shows that GIS integration may be
useful for the analysis of ophthalmomyiasis and can provide a novel
user interface at minimum cost. However, the current reporting of
geospatial data requires further standardization.
Fig 1. Google Earth with ophthalmomyiasis cases mapped, displaying
PubMed information.
Fig 2. Ophthalmomyiasis cases by country.
Commercial Relationships: Omar Ozgur, None; Paul Latkany,
None; David Della Rocca, None; Robert Della Rocca, None;
Elizabeth Maher, None
Program Number: 867 Poster Board Number: B0091
Presentation Time: 1:00 PM - 2:45 PM
Infectious Keratitis in Mexico: 10 year experience in corneal
scrapes
Enrique O. Graue-Hernández1, Julio C. Hernandez-Camarena1,
Patricia Chirinos-Saldaña1, Alejandro Navas1, Arturo J. RamirezMiranda1, Mariana Ortiz-Casas2, Nadia Luz López-Espinosa2, Lizet
Vizuet-García2, Victor M. Bautista2. 1Cornea/Enfermedades Externas,
Instituto de Oftalmologia, Mexico, Mexico; 2Ocular Microbiology
and Proteomics, Instituto de Oftalmología "Conde de Valenciana",
Mexico City, Mexico.
Purpose: To report the distribution, microbiologic trends and
antibiotic sensitivity patterns of the infectious keratitis in a ten year
period in Mexico City.
Methods: Retrospective study, samples were obtained from corneas
with diagnosis of infectious keratitis in the period January 2002 December 2011. Results of cultures, stains and antibiograms were
analyzed.
Results: A total of 1638 consecutive corneal scrapings were taken
during the 10 years of the study. A pathogen was recovered in 616
samples (38%), with bacterial keratitis accounting for 544 of the
positive cultures (88%). The total number of Gram positives and
Gram negatives were 412 and 132, respectively. We detected a non
significant increasing trend in Gram negative isolates (P=0.11). The
most common isolated pathogen was Staphylococcus epidermidis and
the most common Gram-negative bacteria was Pseudomonas
aeruginosa. Methicillin resistant Staphylococcus aureus (MRSA) was
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
present in 45.2% of the S aureus isolates; meanwhile 53.7%
coagulase-negative Staphylococcus isolates were Methicillin resistant
(MRCNS). There was a trend toward increasing in vitro resistance to
methicillin from 20.8% in the first 5 years of the study to 79.2% for
the last five 5 years (P=0.35). P aeruginosa resistance to ceftazidime
increased from 11.1% in the first 5 year period to 88.9% for the last
five years of the study (P=0.01). The overall sensitivity for
vancomycin of MRSA was 87.5%, while 99.6% of the MRCNS
where sensitive. The overall sensitivity of bacterial isolates for
ciprofloxacin was 86.7%.
Conclusions: There was a non-significant increase in the recovered
Gram positive and Gram negative microorganisms over time. We
observed an increased resistance to methicillin in almost a half of the
MRSA and MRCNS isolates. Ceftazidime resistant P aeruginosa
isolates increased to nearly 90% in the 5 last years of the study,
suggesting that this antibiotic is not an ideal empiric treatment.
Vancomycin resistant microorganisms accounted for 9.9% of all
Gram-positive isolates, while 13.3% of all the bacterial isolates were
resistant to quinolones; justifying the latter as monotherapy broad
spectrum empirical treatment for bacterial keratitis.
Commercial Relationships: Enrique O. Graue-Hernández, None;
Julio C. Hernandez-Camarena, None; Patricia Chirinos-Saldaña,
None; Alejandro Navas, None; Arturo J. Ramirez-Miranda, Carl
Zeiss Meditec (R); Mariana Ortiz-Casas, None; Nadia Luz LópezEspinosa, None; Lizet Vizuet-García, None; Victor M. Bautista,
None
Program Number: 868 Poster Board Number: B0092
Presentation Time: 1:00 PM - 2:45 PM
Incision height and trichiasis recurrence in bilamellar tarsal
rotation surgery
Shannath L. Merbs1, Kathleen C. Oktavec1, Sandra D. Cassard1,
Beatriz E. Munoz1, Sheila K. West1, Emily W. Gower2. 1Wilmer Eye
Institute, Johns Hopkins Univ, Baltimore, MD; 2Wake Forest
University, Winston-Salem, NC.
Purpose: The bilamellar tarsal rotation (BLTR) procedure is
commonly used for correction of trichiasis secondary to trachoma. It
consists of making a full-thickness incision and rotating the distal
eyelid fragment by suture placement. The WHO manual instructs the
BLTR surgeon to make the incision 3 mm above the eyelid margin,
although to our knowledge, the ideal incision height has never been
investigated. The goal of this study is to investigate the impact that
incision height has on recurrence.
Methods: Data from the Partnership for the Rapid Elimination of
Trachoma (PRET) Surgery trial in southern Tanzania were used in
this study. This study compared the new TT clamp with standard
instrumentation. At their 1 yr visit, 145 sequential participants (245
eyelids) from the Tandahimba district were examined in September
2010 over 4 consecutive days. One observer everted each study
eyelid and, using a Castroviejo caliper, measured the incision height
from the incision scar on the tarsal surface to the edge of the upper
eyelid margin. Incision height measurements for the nasal, central
and temporal sections of the upper eyelid were recorded and were
compared to recurrence location at 1 yr. Adjusting for randomization
of instrument assignment, the odds of location-specific recurrence
comparing incision heights of < 4.5 mm with those ≥ 4.5 mm was
determined.
Results: 77 eyelids had recurrence. The most common location for
recurrence was central. In bivariate analyses, the odds of central
recurrence was significantly higher when the incision height was <4.5
nasally (OR: 3.1 95% CI: 1.4-6.6), centrally (OR: 2.2; 1.1-4.3), or
temporally (OR: 2.1; 1.1-4.0). Furthermore, central recurrence was
more common when the nasal height was less than the temporal
incision height. In multivariate analyses, central height < 4.5 mm and
severe baseline severity were independently associated with central
recurrence.
Conclusions: Several studies have suggested that in addition to
concurrent infection and inflammation, surgical technique may
contribute to trichiasis recurrence and other adverse outcomes. Here
we demonstrate that an incision height < 4.5 mm measured at 1 year
after surgery is more likely to result in trichiasis recurrence than an
incision height ≥ 4.5 mm. Given these findings and the current
recommendation for an incision height of 3 mm, further study into
the optimum incision height to minimize trichiasis recurrence is
warranted.
Commercial Relationships: Shannath L. Merbs, None; Kathleen
C. Oktavec, None; Sandra D. Cassard, None; Beatriz E. Munoz,
None; Sheila K. West, None; Emily W. Gower, None
Support: Bill and Melinda Gates Foundation , RPB
Clinical Trial: NCT00886015
Program Number: 869 Poster Board Number: B0093
Presentation Time: 1:00 PM - 2:45 PM
The Epidemiology of Lower Eyelid Trachomatous Trichiasis
among Upper Eyelid Trichiasis Surgery Patients
Sandra D. Cassard1, Shannath L. Merbs1, Jennifer C. Harding1,
Beatriz E. Munoz1, Sheila K. West1, Emily W. Gower2, 1.
1
Ophthalmology, Johns Hopkins School of Medicine, Baltimore,
MD; 2Epidemiology and Prevention and Ophthlamology, Wake
Forest School of Medicine, Winston-Salem, NC.
Purpose: Little is known about the epidemiology of lower eyelid
trachomatous trichiasis. This study was conducted to determine risk
factors for the development of lower eyelid trichiasis within 1 or 2
years of initial upper eyelid trichiasis surgery.
Methods: Participants enrolled in the Partnership for the Rapid
Elimination of Trachoma Surgery Trial were examined 1 and 2 years
after surgery to correct upper eyelid trichiasis. Ocular exams included
assessment of the presence of lower eyelid trichiasis. Participants
with and without lower eyelid trichiasis at 2 years after upper eyelid
surgery were compared on demographic and baseline ocular
characteristics. In addition, participants with lower eyelid trichiasis at
1 year and 2 years following upper eyelid surgery were compared to
those who developed it between 1 and 2 years (incident lower eyelid
trichiasis). Multivariable models, controlling for within participant
correlations, were constructed to assess risk factors for lower eyelid
trichiasis.
Results: 2718 eyes of 1673 participants were evaluated 2 years after
upper eyelid trichiasis surgery. 316 eyes (11.6%) had lower eyelid
trichiasis at the 2 year follow-up visit. Of these, 218 (69.0%) also had
lower eyelid trichiasis at 1 year and 98 (31.0%) developed it between
the 1 and 2 year follow-up visits. The likelihood of lower eyelid
trichiasis at 2 years increased with increasing baseline severity of
upper eyelid trichiasis (p<0.0001). Trichiatic lashes originating from
the nasal aspect of the upper eyelid at baseline were independently
associated with an increased risk of lower eyelid trichiasis at 2 years
after controlling for locations of other trichiatic lashes at baseline,
age, gender and baseline severity of upper eyelid trichiasis
(p=0.0009). Presence of nasal upper eyelid trichiatic lashes at
baseline and older age were independently associated with having
lower eyelid trichiasis by 1 year compared to those with incident
lower eyelid trichiasis between 1 and 2 years (p=0.024 and p=0.048,
respectively), controlling for other baseline covariates noted above.
Conclusions: Surgical programs to correct trachomatous trichiasis
typically are aimed at rectifying upper eyelid trichiasis. Lower eyelid
trichiasis is common and should be integrated into surgical programs
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
and trichiasis research. Upper eyelid trichiasis in the nasal aspect may
predict future development of lower lid trichiasis.
Commercial Relationships: Sandra D. Cassard, None; Shannath
L. Merbs, None; Jennifer C. Harding, None; Beatriz E. Munoz,
None; Sheila K. West, None; Emily W. Gower, None
Support: Bill and Melinda Gates Foundation, Research to Prevent
Blindness, Beaver-Visitec International Inc (formerly BD MedicalOphthalmic Systems)
Clinical Trial: NCT00886015
Program Number: 870 Poster Board Number: B0094
Presentation Time: 1:00 PM - 2:45 PM
Outcomes of Repeat Trichiasis Surgery
Emily W. Gower1, Sandra D. Cassard2, Shannath L. Merbs2, Jennifer
C. Harding2, Beatriz E. Munoz2, Sheila K. West2. 1Epidemiology and
Prevention, Wake Forest University, Winston-Salem, NC; 2Wilmer
Eye Institute, Johns Hopkins Medicine, Baltimore, MD.
Purpose: Recurrence following initial trachomatous trichiasis
surgery is common. Many surgical programs highly recommend
repeat surgery for individuals with recurrence. However, data are
limited on the outcomes of repeat surgery. The goal of this study was
to evaluate these outcomes.
Methods: The Partnership for Rapid Elimination of Trachoma
Surgery Trial enrolled individuals in southern Tanzania undergoing
first-time surgery in at least one eye. Participants were randomized to
standard BLTR surgery or BLTR surgery using the TT clamp and
followed for two years. Those who developed trichiasis recurrence
during the trial were offered repeat surgery using standard
instrumentation at the end of the 2-year trial. All individuals living in
the Mtwara district of Tanzania who had repeat surgery were
followed 6 months later and evaluated for second trichiasis
recurrence and eyelid contour abnormality.
Results: 140 eyes underwent repeat surgery and were evaluated 6
months after second operation. 42% (n=59) had recurrence at 6
months. The severity of second recurrence was the same as or worse
than the first recurrence in 45% of those with second recurrence.
After controlling for operating surgeon, the only significant predictor
of second recurrence, was severity of first recurrence. Baseline
trichiasis severity did not predict second recurrence.
63 (45%) second surgeries resulted in an eyelid contour abnormality,
with half being moderate or severe abnormalities. 1/3 of those with
an eyelid contour abnormality after repeat surgery also had trichiasis
recurrence again. 33 of the 63 eyes with eyelid contour abnormalities
did not have a contour abnormality prior to second surgery.
Conclusions: Repeat trichiasis surgery often leads to poor outcomes,
and in some the post-surgical eyelid status is worse than it was
immediately prior to second surgery. Methods for improving repeat
trichiasis surgery outcomes need to be developed. In addition,
surgical programs need to examine whether repeat surgeries are an
effective use of limited resources. Repeat trichiasis surgery often
leads to poor outcomes.
Commercial Relationships: Emily W. Gower, None; Sandra D.
Cassard, None; Shannath L. Merbs, None; Jennifer C. Harding,
None; Beatriz E. Munoz, None; Sheila K. West, None
Support: Bill and Melinda Gates Foundation, Research to Prevent
Blindness, Beaver-Visitec
Clinical Trial: NCT00886015
Program Number: 871 Poster Board Number: B0095
Presentation Time: 1:00 PM - 2:45 PM
Decline of ocular Chlamydia trachomatis infection and follicular
trachoma with annual rounds of mass treatment in mesoendemic
communities in Tanzania
Jennifer S. Lee1, Beatriz E. Munoz1, Harran A. Mkocha2, Charlotte
Gaydos3, Sheila K. West1. 1Dana Center for Preventive
Ophthalmology, Wilmer Eye Institute, Johns Hopkins University,
Baltimore, MD; 2Kongwa Trachoma Project, Kongwa, United
Republic of Tanzania; 3Division of Infectious Diseases, Department
of Medicine, Johns Hopkins University, Baltimore, MD.
Purpose: The World Health Organization (WHO) recommends mass
drug administration (MDA) with azithromycin in communities with a
baseline prevalence of follicular trachoma (TF) of 10% or higher, but
there is little evidence speaking to the number of annual rounds of
treatment required to sustainably reduce C. trachomatis infection and
TF to levels at which MDA is no longer required. The aim of this
study was to examine the prevalence of C. trachomatis infection and
TF over time in a mesoendemic setting.
Methods: Forty-eight communities with mesoendemic trachoma in
Kongwa District, Tanzania were selected for annual MDA and
monitored over 24-48 months. Prior to each annual round of
treatment, 100 children aged up to nine years from each community
were randomly selected for examination. Presence of ocular C.
trachomatis infection was detected using the Roche AMPLICOR
PCR assay and active trachoma was identified by standardized field
graders using the WHO simplified grading system. Treatment
coverage in children was above 80% in all communities for every
treatment round. Infection and disease prevalence was estimated over
time using random effects models to account for clustering at the
community level.
Results: The median baseline prevalence of C. trachomatis infection
in the 48 communities was 15.5% (IQR: 6.5-26.5%), with an average
decline of 3.2% per year. The median baseline prevalence of TF was
20.0% (IQR: 13.0-36.5%), with an average decline of 5.4% per year.
According to our models, it would require five rounds of MDA to
reduce prevalence of infection to 0%, and four rounds of treatment to
reduce prevalence of TF to 5%.
Conclusions: The study findings suggest that, in mesoendemic
settings, four rounds of MDA may be required to reduce prevalence
of TF to 5%, a level at which trachoma would no longer considered a
public health threat.
Commercial Relationships: Jennifer S. Lee, None; Beatriz E.
Munoz, None; Harran A. Mkocha, None; Charlotte Gaydos,
Hologic GenProbe (F), Cepheid (F); Sheila K. West, None
Support: The Bill & Melinda Gates Foundation
Program Number: 872 Poster Board Number: B0096
Presentation Time: 1:00 PM - 2:45 PM
Corneal Transplantation in Mexico: Future Perspectives
Aida Jimenez-Corona1, Alejandro Claros2, Arturo J. RamirezMiranda2, Alejandro Navas2, Tito Ramirez-Luquín2, Victor M.
Boullosa2, Enrique O. Graue-Hernández2. 1Diabetes and
Cardiovascular Risk Research Unit, National Institute of Public
Health, Mexico, City, Mexico; 2Department of Cornea And
Refractive Surgery, Instituto de Oftalmologia Conde de Valenciana,
Mexico, City, Mexico.
Purpose: To analyze the current trends of corneal transplantation in
Mexico and to predict corneal transplantation necessity and
diagnostic for 2050
Methods: Methods: The National Transplant Registry contains all
the available information about cornea transplant in Mexico. We
performed a retrospective analysis of the entire dataset from October
1994 to May 31, 2010 (28,749 registries). Diagnoses were
reclassified according to the EBAA classification (1993). All
registries available in the database with information on whether the
patient had received or not a graft were included.
Using data from 2005 to 2009 from the National Graft Registry and
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
information from the National Population Council, we calculated
incident cases and rate of corneal transplantation for years 2020,
2030, 2040 and 2050. Finally, to calculate the number of expected
grafts, we considered the median age and interquartile range (IQR) at
the time of transplantation together with life expectancy at birth.
Statistical analysis was performed with STATA 9.
Results: Results: The sample included 27,825 subjects (15,387 and
12,438 women). Mean age was 44.5 years in men and 50.5 years in
women (p<0.001). To cover annual needs in year 2020 a total of
6,139 corneal transplants would need to be performed, with a rate
transplantation of 5.3 per 100,000 inhabitants. For year 2050 this
number would increase to 11,127 corneal transplants with a rate
transplantation of 9.1 per 100,000 inhabitants. For bullous
kertopathy, the median age for corneal transplantation in 2005 was
45.2 years. Considering a median of graft survival of 8 years, 50% of
patients would need at least 2 procedures in their lifetime (IQR 0-5).
For keratoconus patients with a median age of 45 in 2005 and a
median graft survival of 19 years, a regraft would be required at least
once (IQR 0-2) in their lifetime.
Conclusions: Conclusion: The epidemiological profile of corneal
blindness can change significantly in the following decades;
therefore, adequate policies and resources need to be allocated to
corneal transplant and eye banking programs. Corneal transplantation
must thus be considered as a public health priority.
Commercial Relationships: Aida Jimenez-Corona, None;
Alejandro Claros, None; Arturo J. Ramirez-Miranda, Carl Zeiss
Meditec (R); Alejandro Navas, None; Tito Ramirez-Luquín, None;
Victor M. Boullosa, None; Enrique O. Graue-Hernández, None
Program Number: 873 Poster Board Number: B0097
Presentation Time: 1:00 PM - 2:45 PM
Scleritis Associated with Relapsing Polychondritis
Luis Gonzalez1, 2, Maite Sainz de la Maza3, Nicolas Molina-Prat3,
Daniel Rojas Crutchik3, Priyanka P. Doctor4, Joseph Tauber5, C.
Stephen Foster1, 2. 1Massachusetts Eye Research and Surgery
Institution, Cambridge, MA; 2Ocular Immunology and Uveitis
Foundation, Cambridge, MA; 3Institute Clinic of Ophthalmology,
Hospital Clinic of Barcelona, Barcelona, Spain; 4Bay View Clinic,
Mumbai, India; 5Tauber Eye Center, Kansas City, MO.
Purpose: To evaluate clinical features, ocular complications, and
successful therapeutic regimens in patients with scleritis associated
with relapsing polychondritis (RP).
Methods: Records of 13 scleritis patients with RP were analyzed and
compared with those of 111 scleritis patients with other connective
tissue diseases.
Results: Scleritis patients with RP were 8 women and 5 men with a
mean age of 50 years (range, 22 to 76 years). Ten patients had diffuse
scleritis, 1 had necrotizing scleritis, and 2 had necrotizing scleritis
and posterior scleritis. Ocular complications included anterior uveitis
(5), peripheral keratitis (2), glaucoma (1), optic neuritis (3) and
decrease of vision (5, 3 of them with legal blindness, p<0.001).
Scleritis was the initial manifestation whose study led to the
diagnosis of RP in 8 of the 13 patients (62%). Five patients (38%)
had one or more systemic disorders, including systemic vasculitis (3),
rheumatoid arthritis (1), systemic lupus erythematosus (1), and
ankylosing spondylitis (AS) (2) (p<0.001); these disorders antedated
the RP by a mean of 9 years (2-21). Two patients developed scleritis
associated with RP while on infliximab (INFLI) due to their AS with
uveitis; changing to adalimumab did not solve the problem. All 13
patients had recurrent scleritis. Successful therapeutic regimens
included cyclosphosphamide (6), methotrexate (3), azathioprine (2),
mycophenolate mofetil (1), and INFLI (1).
Conclusions: Scleritis associated with RP may be a severe disease
often associated with ocular complications which may lead to
decrease of vision and even blindness. Scleritis may be the initial
manifestation whose study leads to the diagnosis of RP. About 38%
of patients will have another systemic disorder, the most frequent
being systemic vasculitis. Scleritis associated with RP most often will
require immunomodulatory therapy, mainly alkylating or
antimetabolite agents, or biologic response modifier drugs, mainly
anti-TNFα. However, occasionally, scleritis associated with RP may
be an adverse event secondary to the use of anti-TNFα.
Commercial Relationships: Luis Gonzalez, Ra Pharmaceuticals,
Inc (C); Maite Sainz de la Maza, Allergan (C), Alcon, Labs (R),
Merck Sharp and Dohme (R); Nicolas Molina-Prat, None; Daniel
Rojas Crutchik, None; Priyanka P. Doctor, None; Joseph Tauber,
Allergan (C), Bausch & Lomb (C), Eyegate (C), eleven Bio (C),
Biolase (C); C. Stephen Foster, Abbott Medical Optics (C), Abbott
Medical Optics (F), Alcon Laboratories, Inc. (C), Alcon Laboratories,
Inc. (F), Allergan, Inc. (C), Allergan, Inc. (F), Eyegate
Pharmaceuticals, Inc. (I), Eyegate Pharmaceuticals, Inc. (F), IOP
Opthalmics (C), Ista Pharmaceuticals (C), Lux Biosciences, Inc. (C),
Lux Biosciences, Inc. (F), Novartis Pharmaceuticals Corporation (C),
Novartis Pharmaceuticals Corporation (F), XOMA Ltd (C)
Program Number: 874 Poster Board Number: B0098
Presentation Time: 1:00 PM - 2:45 PM
Pachymetry Average in a Hispanic Population
Judith Zavala1, Jorge E. Valdez1, Ubaldo Martínez2, Carlos-Alberto
Rodríguez-Barrientos1, Guillermo Mendoza1. 1Ophthalmology
Research Chair, Tecnologico de Monterrey, Monterrey, Mexico;
2
Tecnologico de Monterrey, Monterrey, Mexico.
Purpose: To asses a reference for central corneal thickness in a
Hispanic population and correlate this data to another evaluable
variables.
Methods: A retrospective analysis was performed on 93 patients
randomly selected from the Instituto de Oftalmología y Ciencias
Visuales, Tec Salud (Monterrey, México). We obtained data
regarding age, corneal curvature, and the spherical equivalent. The
Pearson method of correlation was used to analyze the variables. The
averages and ranges were calculated to establish the average central
corneal thickness and its distribution with normality tests AndersonDarling, Shapiro-Wilk and Kolmogorov-Smirnov
Results: We obtained a corneal thickness average of 545.69 ±
36.88μm in both eyes. The distribution curve of pachymetry showed
a bimodal distribution at 540μm and 580μm. The Anderson-Darling
test concluded with a p-value = 0.006, the Shapiro-Wilk test with a pvalue = 0.043 and the Kolmogorov-Smirnov with a p-value = 0.010.
The Pearson correlation method showed a correlation between age
and pachymetry of -0.080, pachymetry and keratometry of 0.099, and
pachymetry with spherical equivalent of 0.033. The correlation
between age and keratometry was -0.259, age and spherical
equivalent of 0.519, and keratometry and spherical equivalent of 0.20. The population studied was 57% men and 43% women, with an
average age of 32.5 years.
Conclusions: This study provides information about corneal
thickness average in a Hispanic population. The theory about possible
correlation between corneal thickness and age, sex, and spherical
equivalent could not be verified in this study. However, it was
possible to determine that there is not normal distribution. In order to
obtain a more representative statistic study, we need to analyze more
patient data given that there is very little information available
describing pachymetry among Mexican population.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Judith Zavala, None; Jorge E.
Valdez, None; Ubaldo Martínez, None; Carlos-Alberto
Rodríguez-Barrientos, None; Guillermo Mendoza, None
Program Number: 875 Poster Board Number: B0099
Presentation Time: 1:00 PM - 2:45 PM
Molecular Detection of etiologic agents of infectious blepharitis
and its association with systemic diseases
Ingrid V. Gonzalez Leon1, Oscar Fernandez-Vizcaya1, Maria F.
Mena-Castell2, Cecilia Chavez-España2, Victor MoctezumaBaltazar2, Atzin Robles-Contreras2, Hector J. Perez-Cano2. 1Cornea,
HOL, Mexico, Mexico; 2Biomedical Research Center, Fundación
Hospital Nuestra Señora de la Luz, Mexico City, Mexico.
Purpose: Investigate the association among infectious blepharitis and
systemic diseases through an epidemiological study, using
conventional techniques and molecular biology tools.
Methods: We have studied 100 blepharitis cases and 31 control cases
that were randomly chosen. Clinical history was obtained from
questioning. The interval of age was from 4 to 81 years old. 4 to 6
eyelashes from each eye were taken from each individual in order to
search for Demodex folliculorum under light microscopy. 100
scraping palpebral sample were taken to extract DNA and identify
bacteria and fungus using PCR technique. The results were analyzed
using Kruskal-Wallis test and Student t test, a p<0.05 was considered
as a statistically significant difference.
Results: In both groups of studies, the female gender was more
common, representing 58% in blepharitis cases (BC) and 51.6% in
control cases (CC) and mainly between the 60th and 70th decade of
life (26%). From the 100 blepharitis cases, 49% were posterior
blepharitis, 25% meibomitis, 17% squamous blepharitis, 5% anterior
blepharitis and 4% blepharoconjuntivitis. In the microbiologic study
we found D. folliculorum: 34% in BC against 12.9% in CC,
p=0.0122. We found in BC that the microbiological agents were:
Bacteria 40%, D. folliculorum 8%, Fungus 0%; and co-infections:
Bacteria / D. follicolorum 22%, Bacteria / Fungus 7%, Fungus / D.
folliculorum 2% and Bacteria / Fungus / D. folliculorum 2%.
With respect to systemic diseases, only Diabetes Mellitus type 2 was
significantly related to blepharitis with p=0.0265.
Conclusions: This study is about infection blepharitis and systemic
diseases associated, and we found an association only with diabetes
mellitus type 2. It is necessary to perform various studies to define
the common immunological mechanism involved in both pathologies.
Commercial Relationships: Ingrid V. Gonzalez Leon, None;
Oscar Fernandez-Vizcaya, None; Maria F. Mena-Castell, None;
Cecilia Chavez-España, None; Victor Moctezuma-Baltazar, None;
Atzin Robles-Contreras, None; Hector J. Perez-Cano, None
Support: None in the Support field below
Program Number: 876 Poster Board Number: B0100
Presentation Time: 1:00 PM - 2:45 PM
Clinical and Microbiological Profile of infectious Keratitis in
Children
AURELIANO MORENO-ANDRADE, Arturo J. Ramirez-Miranda,
Alejandro Navas, Julio C. Hernandez-Camarena, Lizet VizuetGarcía, Carolina Gaona-Juárez, Victor M. Bautista, Mariana OrtizCasas, Luis Antonio Bautista-Hernandez, Enrique O. GraueHernández. Cornea and Refractive Surgery, Instituto de Oftalmologia
"Conde de Valenciana", Mexico City, Mexico.
Purpose: To describe the clinical profile, risk factors and
microbiological profile of infectious keratitis in children.
Methods: Retrospective and descriptive study of pediatric patients
with diagnosis of infectious keratitis attended at Ophthalmology
Institute between January 2006 and December 2011. Demographics,
predisposing factors and clinical signs were recorded.
Results: 41 eyes of 41 patients with infectious keratitis. Fifty-one
percent were males. Mean age was 8.73 years + 5.14. Time between
the onset of symptoms and ophthalmological examination was 12.7
days + 18.71. Seventy eight percent showed predisposing factors;
ocular trauma was the most common (25%). Mean visual acuity at
discharge logMAR 0.76 + 0.64 (20/115) was significantly better than
mean visual acuity at admission logMAR 1.49 + 1.15 (20/618), p <
0.05. Visual axis involvement was registered in 63.2%, anterior
chamber reaction in 31.6% and hypopyon in 15.8%. Positivity of
cultures was 34.1%. The most commonly isolated microorganisms
were gram-positive cocci (27%); Staphylococcus epidermidis (10%)
was the most common gram-positive microorganism found. Two
strains of Pseudomonas aeruginosa were also isolated.
Staphylococcus sp. isolates were sensitive to gentamicin, vancomycin
and ciprofloxacin and resistant to sulfamethoxazole. Multiple
antibiotic resistances were found in almost all Staphylococcus sp.
isolates. The two strains of Pseudomonas aeruginosa were sensitive
to gentamicin and resistant to ciprofloxacin and ceftazidime.
Conclusions: In children, ocular trauma is the principal predisposing
factor for infectious keratitis. Responsible factors for visual
impairment may be visual axis involvement, delay in
ophthalmological care, inadequate adherence to treatment and low
positivity of cultures. The most common microorganism,
Staphylococcus sp., showed multiple-antibiotic resistance in the
majority of cases. Pseudomonas aeruginosa isolates were resistant to
ceftazidime, considered as first line drug in gram-negative keratitis.
Apparent resurgence of susceptibility to gentamicin was observed.
Commercial Relationships: AURELIANO MORENOANDRADE, None; Arturo J. Ramirez-Miranda, Carl Zeiss
Meditec (R); Alejandro Navas, None; Julio C. HernandezCamarena, None; Lizet Vizuet-García, None; Carolina GaonaJuárez, None; Victor M. Bautista, None; Mariana Ortiz-Casas,
None; Luis Antonio Bautista-Hernandez, None; Enrique O.
Graue-Hernández, None
Program Number: 877 Poster Board Number: B0101
Presentation Time: 1:00 PM - 2:45 PM
Prevalence of dry eye disease in elderly individuals of the French
population (the MONTRACHET Study)
Aurore Muselier-Mathieu1, Cyril Meillon1, Caroline Fiet2, Sandrine
Vinault2, Christine Binquet2, Benigne Mathieu1, Christophe Tzourio3,
Alain M. Bron1, Catherine P. Garcher1. 1Ophthalmology, University
Hospital, Dijon, France; 2Epidemiology, University Hospital, Dijon,
France; 3Epidemiology, Inserm U708, University Hospital, Bordeaux,
France.
Purpose: To report the prevalence of dry eye in a large populationbased sample of French individuals older than 75 years.
Methods: About 9000 individuals 65 years and older were included
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
in the 3C cohort study since 1999 in 3 French cities (Bordeaux, Dijon
and Montpellier). In Dijon, an additional ophthalmic examination
was performed 10 years after the initial inclusions to assess the
relation between systemic age-related diseases and eye diseases in the
MONTRACHET Study (Maculopathy Optic Nerve nuTRition
neurovAsCular and HEarT diseases). Dry eye symptoms were
collected with self reported history of dry eye symptoms, use of
topical medications and evaluated by the Ocular Surface Disease
Index (OSDI) questionnaire. Every patient underwent ophthalmic
evaluation which included Schirmer I test without anesthesia, tear
film break up time measurement and fluorescein cornea1 staining
evaluation. Prevalence of dry eye was evaluated with subjective
criteria (history and OSDI questionnaire) and objective criteria.
Results: One thousand and twenty four subjects were included in the
study. Mean age was 83.7 ± 3.8 years old. 62.9% of the patients were
women (644). Prevalence of dry eye is reported in Tables 1 and 2. (Δ
: Variable; BUT : Break-Up-Time; Fluo : Fluorescein staining; - :
Négative; + : Positive)
Conclusions: As reported in the literature, this study shows wide
variations in dry eye prevalence depending on the sign or symptoms
considered.
Table 1
Table 2
Commercial Relationships: Aurore Muselier-Mathieu, None;
Cyril Meillon, None; Caroline Fiet, None; Sandrine Vinault,
None; Christine Binquet, None; Benigne Mathieu, None;
Christophe Tzourio, None; Alain M. Bron, Allergan (C), Bausch
Lomb (C), Horus (F), Théa (C); Catherine P. Garcher, Alcon (C),
Allergan (C), Baush and Lomb (C), Bayer Pharma (C), Novartis (C),
Laboratoire Théa (C)
Clinical Trial: 2009-A00448-49
Program Number: 878 Poster Board Number: B0102
Presentation Time: 1:00 PM - 2:45 PM
INCIDENCE OF CORNEAL DYSTROPHIES AT NUESTRA
SEÑORA DE LA LUZ HOSPITAL FOUNDATION, A 5 YEAREPIDEMIOLOGICAL REVIEW
Manuel García1, Oscar Baca2, Alejandro Babayan3, Cristina
Pacheco-Del-Valle4, Regina Velasco5. 1Cornea, Fundación Hospital
Nuestra Señora de la Luz, Distrito Federal, Mexico; 2cornea,
Fundacion Hospital de la Luz, Distrito Federal, Mexico; 3Cornea,
Fundacion Hospital de la Luz, Distrito Federal, Mexico; 4cornea,
Fundacion Hospital de la Luz, Distrito Federal, Mexico; 5cornea,
Fundacion Hospital de la Luz, Distrito Federal, Mexico.
Purpose: This study sought to investigate the cumulative incidence
of corneal dystrophies at Nuestra Señora de la Luz Hospital
Foundation in a period of 5 years.
Methods: We conducted a database of patients diagnosed with
corneal dystrophy, which included patient name, file number, age,
gender and date of diagnosis. Descriptive analysis was performed of
the population and cumulative incidence was determined using Excel
2007.
Results: During the study period, a total of 87 patients were
diagnosed with some form of corneal dystrophy out of 14,780 total
patients. The cumulative incidence of corneal dystrophy is 0.5% over
a period of five years. Fuchs' endothelial dystrophy was the most
diagnosed with 44 (50.5%) patients, followed by lattice with 8 (9.1%)
patients, granular type 1 with 6 (6.8%) patients. Fuchs endothelial
dystrophy showed the highest age of presentation at 69.6 years and
congenital hereditary endothelial dystrophy showed the lowest at
11.3 years. The year with the highest incidence was 2009 with
0.77%, and in 2012 was presented the lowest incidence of 0.44%.
Conclusions: The risk of corneal dystrophy in a population of 14,780
patients is 0.5%. Fuchs' dystrophy occupies a large proportion, which
suggests its relevance in the population tested.
Commercial Relationships: Manuel García, None; Oscar Baca,
None; Alejandro Babayan, None; Cristina Pacheco-Del-Valle,
None; Regina Velasco, None
Support: None in support field
Program Number: 879 Poster Board Number: B0103
Presentation Time: 1:00 PM - 2:45 PM
Clinical outcomes and prognostic factors associated with
Acanthamoeba keratitis treated with pentamidine isethionate
Jane Y. Huang, Hiroaki Ozaki, Naoyasu Umeda, Aki Fuchigami,
Masahiko Kozawa, Eiichi Uchio. Ophthalmology, Fukuoka Univ
School of Medicine, Fukuoka, Japan.
Purpose: To describe the clinical characterics, time of presentation,
risk factors, treatment, outcomes, and prognostic factors on a series
of Acanthamoeba keratits (AK) treated with pentamidine isethionate
at our institution. This is also a first report on a series of AK cases
treated with pentamidine isethionate.
Methods: Retrospective study of 24 patients 26 eyes diagnosed with
AK from April 1, 2006 to November 19, 2012. All eyes underwent
adjunctive treatment with pentamidine isethionate and had a complete
follow-up data. A review of all patients including gender, age, time to
diagnosis, use of cortiocosteroid before diagnosis, combination of
bacterial or fungal infections, diagnostic method, initial visual acuity,
duration of pentamidine isethionate treatment, side effects, and final
visual acuity was performed. Treatment failure was defined as AK
recurrence or requiring a therapeutic deep anterior lamellar
keratoplasty (DALK). Predicting risk factors were analyzed.
Results: Symptom onset was greatest in September. AK was
diagnosed by culture or typical clinical presentation of AK. Age
ranged from 18 to 64 years old (average 30.0±12.3). The study
included 11 women and 13 men and the follow up time was 1 to 60
months (average 13.8±18.6). All were tertiary patients with the time
to AK diagnosis ranging from 5 to 60 days (average 21.3±13.0).
Forty-two percent of the eyes were previously diagnosed with
herpetic keratitis and 58% of the eyes were treated with corticosteroid
eye drops. Five eyes had combined bacterial or fungal infections.
Twenty-two eyes (84.6%) were contact lens users. Average
hospitalization time was 26.9±21.7days. Averaged duration of
pentamidine isethionate treatment was 9.8±3.5days and no serious
side effects occurred. Visual acuity improved from
1.41logMAR±1.00logMAR to 0.19logMAR±0.34logMAR. Initial
clinical manifestation of stromal involvement such as ring infiltration
or endothothelial plaque formation was a significant factor for
treatment failure.
Conclusions: Symptom onset was greatest in September. Soft
contact lens users tend to have a risk of infection and failure is likely
to be associated with stromal involvement. The average
hospitalization time was 26.9±21.7days. A larger prospective
population-based comparative study is required to further confirm the
efficacy of pentamidine isethionate.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Jane Y. Huang, None; Hiroaki Ozaki,
None; Naoyasu Umeda, None; Aki Fuchigami, None; Masahiko
Kozawa, None; Eiichi Uchio, None
Program Number: 880 Poster Board Number: B0104
Presentation Time: 1:00 PM - 2:45 PM
Genetic diversity among Acanthamoeba sp. isolated from
clinically suspected cases of Amoebic keratitis patients attending
a tertiary care hospital and proteomic differntiation between the
trophozoite and cyst stage of Acanthamoeba
Himansu S. Behera1, Gita Satpathy1, Anita Panda2, Pooja
Bandivadekar2, Niranjan Nayak1, Tushar Agarwal2, Murugesan
Vanathi2. 1Ocular Microbiology, AIIMS, New Delhi, India; 2Corneal
and Ocular Surface Disorders, AIIMS, NewDelhi, India.
Purpose: To detect the genotypes of Acanthamoeba spp. isolates
from patients of clinically suspected amoebic keratitis and proteomic
characterisation of trophozoite and cyst stages
Methods: Corneal scrapings from clinically suspected amoebic
keratitis(AK) patients (107) attending our tertiary care hospital during
last 2 years were subjected to culture on 2% non- nutrient agar plates
overlaid with E.coli. DNA isolation followed by PCR assay was
performed for amplification of DF3 region (280bp) of 18S rRNA
gene of Acanthamoeba spp.. PCR products were sequenced and
aligned using software CLUSTAL W. Phylogenetic tree
reconstructions was performed with phylogenetic computer program
MEGA4 using neighbour-joining method as well as UPGMA
anakysis. The cultured trophozoites were encysted in laboratory
conditions and the whole cell lysates of both the stages were
subjected to SDS-PAGE and two dimensional gel electrophoresis.
Results: Acanthamoeba spp. was isolated from 18 of the 107
(16.82%)suspected cases of Amoebic Keratitis (AK). From the
phylogenetic analysis of the nucleotide sequences, it was evident that
16 isolates clustered in one group, belonging to Genotype T4 . Two
isolates formed an unique cluster . SDS-PAGE results shows clear
differences between trophozoite and cyst stages. Two proteins of
35KDa and 80KDa were more expressed in cyst stages compared to
trophozoites.
Conclusions: Most of the Acanthamoeba eye infections were due to
T4 genotype. Using the present method, 2 of the isolates did not
cluster with any known genotype. Proteomic differences between
trophozoite and cyst stages could be deciphered
Commercial Relationships: Himansu S. Behera, None; Gita
Satpathy, None; Anita Panda, None; Pooja Bandivadekar, None;
Niranjan Nayak, None; Tushar Agarwal, None; Murugesan
Vanathi, None
Support: Council of Scientific and Industrial Research, INDIA
Program Number: 881 Poster Board Number: B0105
Presentation Time: 1:00 PM - 2:45 PM
The Proctor experience with Acanthamoeba Keratitis from 1996
- 2012
Elizabeth M. Grace, Vicky Cevallos, Todd P. Margolis, Nisha
Acharya, Thomas M. Lietman, Jeremy D. Keenan. F. I. Proctor
Foundation, University of California, San Francisco, San Francisco,
CA.
Purpose: To describe the clinical presentation, management, and
outcomes of patients with Acanthamoeba keratitis (AK) in the Bay
Area before and after the most recent AK epidemic beginning in
2004-2005.
Methods: Retrospective review of all patients with culture proven
Acanthamoeba keratitis from 1996 to 2012 at the Francis I. Proctor
Foundation.
Results: Forty-one patients were identified with 42 eyes
demonstrating culture proven AK. Annually there were 0 to 3 AK
cases from 1996-2004, and 3 to 6 cases from 2005-2011. The number
of microbiology positive AK cases has increased since 2005 and
shows a significant trend (p=0.003) that has not remitted since the
epidemic. The duration of symptoms (weeks) prior to culture-proven
AK diagnosis was not statistically different from 1996-2004 (median
4, IQR 3-6) and 2005-2012 (median 4, IQR 2-5.5); Wilcoxon test
(p=0.45). The visual acuity at presentation was not significantly
different from pre-2005 (median log MAR = 1.35, IQR 0.4-1.75) and
2005 to present (median log MAR = 0.7, IQR 0.4-1.7); Wilcoxon test
(p=0.69).
Conclusions: Since the most recent epidemic of Acanthamoeba
keratitis in 2004-2005, there has been an increased number of
culture-proven AK that has not decreased to pre-epidemic levels in
the Bay Area. Both before and after 2005, patients continue to endure
a median of 4 weeks of symptoms prior to AK diagnosis and present
with significant visual acuity morbidity. Thus even with the increased
awareness of AK, ophthalmologists do not appear to be diagnosing
the disease any earlier in its course. More investigation is needed to
elucidate the environmental or microbial changes behind the newly
increased incidence of Acanthamoeba keratitis.
Commercial Relationships: Elizabeth M. Grace, None; Vicky
Cevallos, None; Todd P. Margolis, Peregrine (C), UCSF (P); Nisha
Acharya, None; Thomas M. Lietman, None; Jeremy D. Keenan,
None
Program Number: 882 Poster Board Number: B0106
Presentation Time: 1:00 PM - 2:45 PM
Familial Corneal Patterns in Pellucid Marginal Degeneration
(PMD): Uncovering a Possible Etiology
Hajirah N. Saeed, Charles S. Bouchard. Ophthalmology, Loyola
University Medical Center, Maywood, IL.
Purpose: The most common of the non-inflammatory ectatic corneal
diseases is keratoconus (KC). Another such disease is PMD. There is
controversy over PMD and KC being distinct disease entities versus a
continuum of corneal disease sharing the same pathogenetic
mechanism of corneal ectasia.
After our case report of a possible hereditary component in PMD last
year, we developed a protocol to prospectively study the clinical
signs, disease progression, and possible hereditary patterns of PMD
in patients and their family members. As such, the purpose of this
study is to assess tomographic and topographic signs of PMD in
patients with an established diagnosis of PMD as well as their family
members, and to investigate the possible genetic origins of PMD via
whole exome sequencing.
Methods: Five patients with a diagnosis of PMD as well as their
first-degree relatives underwent Pentacam imaging. A total of 14
participants were included in this study. Pentacam imaging was
evaluated for abnormalities using the Belin-Ambrosio enhanced
ectasia display. Participants also had blood drawn for subsequent
genetic analysis via whole exome sequencing. Other variables that
were assessed included history of allergies and eye rubbing.
Results: Two of the five families had members other than the
proband who demonstrated abnormal imaging. Two of these family
members demonstrated clinical signs of disease requiring surgical or
other intervention. Four of the five probands had a history of
vigorous eye rubbing. Three out of five had environmental allergies.
It was also noted that four of the five families that participated had a
member with a developmental disability.
Whole exome sequencing of blood obtained on all participants was
pending at the time of this submission.
Conclusions: This study illustrates a possible hereditary component
to PMD and warrants further investigation. Environmental influences
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
as allergies and eye rubbing seem to be significant variables in PMD.
Genetic analysis of blood samples from both probands and their
family members will help to elucidate any genetic component as
well. This analysis via whole exome sequencing is currently in
process.
The incidence of developmental disabilities in the family members of
patients with PMD also warrants further investigation. In sequencing
DNA we hope to determine what link, if any, exists between PMD
and certain developmental abnormalities.
Commercial Relationships: Hajirah N. Saeed, Illinois Society for
the Prevention of Blindness (F), Richard A Perritt Charitable
Foundation (F); Charles S. Bouchard, None
Support: Illinois Society for the Prevention of Blindness, Richard A.
Perritt Charitable Foundation
Program Number: 883 Poster Board Number: B0107
Presentation Time: 1:00 PM - 2:45 PM
Cytokines in tear fluid of patients undergoing keratoplasty
Aki Fuchigami1, Kyoko Nakajima2, Jane Y. Huang1, Masahiko
Kozawa1, Eiichi Uchio1. 1Ophthalmology, Fukuoka University
School of Medicine, Fukuoka, Japan; 2Frontier Medical Science,
Fukuoka University School of Medicine, Fukuoka, Japan.
Purpose: Graft rejection greatly influences the prognosis of corneal
transplantation. There is no quantitative method of predicting signs of
rejection at present. Cytokines in tear fluid over time were
investigated and the correlation with the occurrence of rejection was
investigated.
Methods: This is a prospective study. All patients underwent
keratoplasties from August, 2011 to May, 2012 in Fukuoka
University Hospital were included in the study. There were 6 cases of
penetrating keratoplasty (PKP) and 2 cases of lamellar keratoplasty
(LKP). Eighteen normal subjects were used as controls. All
operations were conducted by the same surgeon. Tear fluid was
extracted by the Schirmer method on preoperative day, on
postoperative day 1, day 7, first month, third month, and sixth month
respectively. Control subjects were healthy individuals without ocular
or systemic infections or allergies. Tear fluid extraction was
performed by adding 0.01M phosphate buffer pH7.2. Measurement
of cytokines was carried out by the BDTM Cytometric Beads Array
system (CBA) and BDTM FACS Canto II according to the
manufacturer’s instructions. The concentrations of seven
inflammatory cytokines (IL-2, IL-4, IL-6, IL-10, TNF, IFN-γ, and IL17A) were measured.
Results: The concentration of IL-6 was significantly higher in the
cases of PKP (p = 0.03 ) and LKP on postoperative day 1. There was
no increased in levels of other cytokines. Concentration of IL-6 was
lowered to the preoperative level at first month. However
concentration of IL-6 was increased again in the rejection group.
Three rejection cases occurred after PKP (2 in the third month, and 1
in the sixth month). All concentrations of cytokines increased in the
acute period of rejection. Only IL-10 was remarkably decreased in
the chronic phase.
Conclusions: The concentration of IL-6 was significantly higher on
the postoperative day 1, and it took one month until the level
normalized. IL-6 level increased at the time of rejection and IL-10
level decreased at the same time. IL-6 and IL-10 could be used as
markers for keratoplasty rejection in human tears. However, more
cases should be required to confirm the efficiency of cytokine
measurement in tear fluids as a predictor of clinical status.
Commercial Relationships: Aki Fuchigami, None; Kyoko
Nakajima, None; Jane Y. Huang, None; Masahiko Kozawa, None;
Eiichi Uchio, None
Program Number: 884 Poster Board Number: B0108
Presentation Time: 1:00 PM - 2:45 PM
National Survey of Pellucid Marginal Corneal Degeneration in
Japan
Jun Shimazaki1, 3, Naoyuki Maeda2, Osamu Hieda6, Yuichi Ohashi4,
Akira Murakami5, Kohji Nishida2, Kazuo Tsubota3. 1Department of
Ophthalmology, Tokyo Dental College, Ichikawa, Japan;
2
Department of Ophthalmology, Osaka Univ Graduate Sch of Med,
Osaka, Japan; 3Department of Ophthalmology, Keio University
School of Medicine, Tokyo, Japan; 4Department of Ophthalmology,
Ehime University, Matsuyama, Japan; 5Department of
Ophthalmology, Juntendo University, Tokyo, Japan; 6Department of
Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto,
Japan.
Purpose: Pellucid marginal corneal degeneration (PMCD) is a rare,
progressive ecstatic disorder characterized by thinning of peripheral
cornea. Early detection of the disorder is important to avoid
keratectasia following refractive surgery. However, there is no
diagnostic criterion, and large-scale clinical reports have been scarce.
Here, we report a result of national survey on PMCD in Japan.
Methods: We sent questionnaire to all members of the Japan Cornea
Society. The questionnaire included demographic and clinical
findings of PMCD and its suspects. Eyes with a history of corneal
surgery, active inflammation, and other corneal diseases were
excluded.
Results: There were responses from 27 medical facilities, and data of
320 patients (527 eyes) were collected. They were 240 males and 80
females, with a mean age of 38.9 ± 10.6 years. Approximately 32 %
of cases showed unilateral involvement, and 97 (30.3%) of them had
allergic diseases such as asthma, atopic dermatitis, seasonal allergic
rhinitis or conjunctivitis. Hard contact lenses were the most common
optical correction devise (61%), followed by soft contact lenses
(18%), and glasses (12%). Approximately half of them (51%) had
more than 20/20 corrected visual acuity and only 4% showed less
than 20/200. We classified them into following 3 categories; 1)
Classical PMCD; presence of band-shaped peripheral corneal
thinning detected either by slit-lamp biomicroscopy or pachymetric
map (n=145 eyes), 2) PMCD suspects; Eyes with “crab claw pattern”
in corneal topography without presence of obvious peripheral
thinning (n=266 eyes), and 3) Others (n=116 eyes). There were no
significant differences among the three groups neither in
demographic profile nor ophthalmic findings including the
topographic patterns.
Conclusions: We conducted a largest scale of clinical survey of
PMCD and its suspects. In our series, we observed a male
predominance, relatively high incidence of unilateral involvement
and associated allergic diseases. Corneal topography was used most
commonly in diagnosis, however, “crab claw pattern” in topography
itself seemed to have limited diagnostic value. As it is likely that
there is an overlap with other diseases such as keratoconus, further
refinements in diagnostic methods are needed.
Commercial Relationships: Jun Shimazaki, Santen Pharmaceutical
Co. (F), Otsuka Pharmaceutical Co. (F), Abott Medical Optics (F);
Naoyuki Maeda, Topcon (F), Santen (R), Otsuka (R), Oculus (R),
HOYA (R); Osamu Hieda, None; Yuichi Ohashi, None; Akira
Murakami, SEED(Japan) JP4855782 (P), SEED(Japan) JP5132958
(P); Kohji Nishida, Alcon (C), Alcon (F), HOYA (F), Senju (F),
Pfizer (F), Santen (F), Osaka University (P); Kazuo Tsubota,
AcuFocus, Inc (C), Allergan (F), Bausch Lomb Surgical (C),
Functional visual acuity meter (P), JiNS (P), Kissei (F), Kowa (F),
Santen, Inc. (F), Otsuka (F), Pfizer (C), Thea (C), Echo Denki (P),
Nidek (F), Ophtecs (F), Wakasa Seikatsu (F), CEPT Company (P)
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Support: Grant from Ministry of Health, Labour and Welfare, Japan
(22140901)
Program Number: 885 Poster Board Number: B0109
Presentation Time: 1:00 PM - 2:45 PM
Topometric Indices In Unilateral Keratoconus Patients
oktay diner1, Volkan Hurmeric2, Osman M. Ceylan4, Umit Yolcu3.
1
Ophthalmology, GATA, Ankara, Turkey; 2ophthalmology, GATA,
Ankara, Turkey; 3ophthalmology, GATA, Ankara, Turkey;
4
ophthalmology, GATA, Ankara, Turkey.
Purpose: The healthy eye of a unilateral keratoconus (KC) patient is
an ideal model to study pre-ectatic parameters of the cornea. These
eyes are accepted to be susceptible to develop KC with sufficient
follow-up time. Because of this reason, detailed evaluation of these
eyes may help us to better understand pre-ectatic topographic risk
factors. In this study, we have evaluated topometric indices of
unilateral KC patients with a Scheimpflug camera and compared
these results with KC eyes and healthy controls.
Methods: A retrospectively chart review was performed. The
differential diagnosis of the eyes with unilateral KC, form fruste KC
and KC was made with Scheimpflug camera parameters. The results
were compared with healthy, form fruste and KC eyes. Corneal
topography, thickness map, curvature maps, anterior-posterior
elevation maps, and enhanced ectasia display results were compared.
P value less than 0.05 was considered statistically significant
Results: Three hundred and fifty patients were diagnosed with
keratoconus. In our cohort, 4.85 % of our patients had unilateral
keratoconus (17 patients). These patients had normal topography and
elevation maps in one eye (Group-1) and clinically significant KC in
the fellow eye. Forty patients had form fruste keratoconus in one eye
(Group-2) and clinically significant KC in the fellow eye. Right eyes
of 25 healthy refractive surgery candidates were randomly selected as
controls (Group-3).
There were statically significant differences in minimum corneal
thickness, central corneal thickness, minimum and maximum average
progression indexes, enhanced ectasia display deviations (Dp, Dt, D)
and index of highest asymmetry parameters between 3 groups
(p<0,05). The difference between minimum, maximum and average
pachymetry progression indices of normal eyes of unilateral
keratoconus group and healthy controls was statistically significant
(p<0,05).
Conclusions: Our study demonstrates that the healthy eyes of
patients with unilateral KC demonstrated normal tomographic and
elevation pattern. Enhanced ectasia scores of these eyes were also
within normal limits. Interestingly minimum, maximum and average
pachymetry progression indices of healthy eyes with unilateral KC
were statistically significantly different from that of healthy controls.
Commercial Relationships: oktay diner, None; Volkan Hurmeric,
None; Osman M. Ceylan, None; Umit Yolcu, None
Support: None in the Support field below
Program Number: 886 Poster Board Number: B0110
Presentation Time: 1:00 PM - 2:45 PM
Acute and long term ocular manifestations of Stevens-Johnson
syndrome and toxic epidermal necrolysis syndrome in children
Caroline Catt1, 2, Kamiar Mireskandari1, 2, Asim Ali1, 2. 1Department
of Ophthalmology, Hospital for Sick Children, Toronto, ON, Canada;
2
Department of Ophthalmology and Vision Sciences, University of
Toronto, Toronto, ON, Canada.
Purpose: Stevens-Johnson syndrome (SJS), toxic epidermal
necrolysis syndrome (TENS) and overlap syndrome (SJS/TENS) are
rare but serious diseases with potentially devastating ocular sequelae.
There is little information in the current literature about the ocular
manifestations of these diseases in children. The purpose of this study
is to describe the acute and long term clinical features and visual
acuity outcomes in this group of patients.
Methods: This is a retrospective cohort study of all children admitted
to a tertiary paediatric referral centre with a diagnosis of SJS, TENS,
or SJS/TENS between June 1 2001 and June 1 2011. Demographic
information, detailed clinical findings at every ocular examination
during admission and after discharge were obtained from medical
records.
Results: Thirty-six patients were identified for inclusion (20 SJS, 9
SJS/TENS, 7 TENS). Ocular involvement was acutely present in 29
(80.6%) patients. It was severe in 5 (13.9%), moderate in 13 (36.1%)
and mild in 11 (30.6%). Conjunctivitis and conjunctival epithelial
defects were common manifestations in the acute phase. Conjunctival
membranes and corneal epithelial defects affected a third of all
patients. Corneal melt and opacification were observed in one patient
each and three required amniotic membrane grafts. Of these 36
patients, 17 had at least one clinical review after discharge from
hospital. The mean duration of follow-up was 26.9 months.The most
frequent clinical findings after discharge from hospital included
episodic conjunctivitis, dry eye and meibomian gland dysfunction.
Corneal opacification was seen in 4 (23.5%) and corneal
vascularization in 3 (17.6%) patients after 2.3 months and 9 months
respectively. Limbal stem cell failure developed in 3 and new
symblephara in 6 patients after discharge. Four were managed with a
Boston scleral lens and one required surgical correction of lid
malposition. At final review, all had a Snellen visual acuity at least
20/40 in their better eye. Three had a visual acuity of less than 20/40
in their worse eye.
Conclusions: Most paediatric patients with SJS, SJS/TENS and
TENS have acute ocular involvement, which is potentially vision
threatening in 13.9%. In children, ocular sequelae may not develop
until many months after discharge. This finding emphasizes the
importance of long term ophthalmic follow-up for all children with
SJS, SJS/TENS and TENS.
Commercial Relationships: Caroline Catt, None; Kamiar
Mireskandari, None; Asim Ali, None
Program Number: 887 Poster Board Number: B0111
Presentation Time: 1:00 PM - 2:45 PM
Persistent Corneal Epithelial Defect After Pars Plana Vitrectomy
Chi-Chin Sun1, 2, Hsi-Fu Chen1, Ling Yeung1. 1Ophthalmology,
Chang Gung Memorial Hospital, Keelung, Taiwan; 2Chinese
Medicine, Chang Gung University, Taoyuan, Taiwan.
Purpose: To investigate the incidence, risk factors and clinical
course of persistent corneal epithelial defects (PCED) after pars plana
vitrectomy.
Methods: This study reviewed retrospectively 426 consecutive
patients (511 eyes) underwent PPV between January 1, 2008 and
December 31, 2011 at Chang Gung Memorial Hospital, Keelung,
Taiwan. All patients underwent PPV with handheld contact lens
viewing system. Exclusion criteria were: 1. Patients with corneal
edema or epithelial disturbance before vitrectomy; 2. Surgical
indications of infectious endophthalmitis, globe rupture and ocular
perforation or penetrating injury with or without intraocular foreign
body. Eyes of corneal complications (103 eyes) were identified as
presence of corneal epithelial defects (ED), corneal edema or
superficial punctate keratopathy (SPK) at least one week after
vitrectomy. Twenty-one eyes developed PCED for corneal ED
persisting more than 2 weeks despite conventional treatments. The
demographic, preoperative, intra-operative, and postoperative data
were compared between PCED and non-PCED corneal complication
groups to investigate the risk factors.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Results: Post-op corneal complications developed in 56 of 248
(22.6%) diabetic eyes. The diabetics predisposed to post-op corneal
ED (P=0.021), and SPK (P=0.022), but not to corneal edema
(P=0.925). The eyes with PCED in this study had poor final visual
acuity, with 23.8% of eyes (5/21 eyes) in PCED group having visual
acuity of 20/200 or better as compared with 51.2% of eyes (42/82
eyes) in non-PCED corneal complication group (P=0.024). Logistic
regression analysis demonstrated that diabetes mellitus (P=0.024),
use of C3F8 (P<0.001), and first-year-resident assistant (P=0.032)
were the statistically significant risk factors for PCED after PPV.
When taking nonphakic eyes (41 eyes) into consideration, intravitreal
C3F8 tamponade was significantly (P=0.001) associated with PCED
(60%, 6/10 eyes) compared with non-PCED corneal complications
(6.5%, 2/31 eyes).
Conclusions: The overall incidence of PCED after PPV was 4.8% in
our study. Diabetes mellitus, intravitreal tamponade with C3F8, and
first-year-resident assistant of handheld viewing lens are risk factors
for PCED after PPV. PCED after PPV was correlated with poor
postoperative visual outcomes. Early and aggressive management is
necessary for patients presenting corneal epithelial defects after
vitrectomy in order to prevent miserable complications.
Commercial Relationships: Chi-Chin Sun, None; Hsi-Fu Chen,
None; Ling Yeung, None
Program Number: 888 Poster Board Number: B0112
Presentation Time: 1:00 PM - 2:45 PM
Ophthalmology/Optometry Allergic Rhinoconjunctivitis Patient
Treatment; The Allergies, Immunotherapy &
RhinoconjunctivitiS (AIRS) Provider Survey
Leonard Bielory1, 9, Mark Dykewicz2, Timothy Craig3, Michael
Blaiss4, Bryan Leatherman5, David Skoner8, Nancy E. Smith6, F.
Allen-Ramey7. 1Rutgers University, New Brunswick, NJ; 2Wake
Forrest Baptist Health, Winston-Salem, NC; 3Division of Pulmonary,
Allergy and Critical Care, Penn State University, Winston-Salem,
PA; 4Allergy & Asthma Care, Germantown, TN; 5Coastal ENT
Associates, Gulfport, MS; 6Global Health Outcomes, Merck & Co.,
Inc, Whitehouse Station, NJ; 7Global Health Outcomes, Merck &
Co., Inc, West Point, PA; 8Pediatrics, West Penn Allegheny Health
System, Cranberry Township, PA; 9Robert Wood Johnson University
Hospital, New Brunswick, NJ.
Purpose: Allergic Rhinoconjunctivitis (ARC) is one of the most
common chronic diseases in the US and specific immunotherapy
(SIT) is one of the most effective therapies. The AIRS survey was
designed to assess providers' perceptions of patient symptomatology,
allergy testing and treatment.
Methods: A telephone survey was administered to 500 healthcare
providers offering outpatient care to >1 ARC patient per week.
Providers were randomly selected from professional society lists
stratified by specialty to yield completed surveys from 100
Allergy/Immunology, 100 Otolaryngologists (ENTs), 75 Family
Medicine, 75 Pediatrics and 50 Ophthalmology/Optometry providers
along with 50 Nurse Practitioners (NP) and 50 Physician Assistants
(PA).
Results: Ophthalmology/Optometry (OPH/OPT) providers reported
managing an average of 15 adult (≥18 years) and 6 pediatric (<18
years) ARC patients/ week; with the most common complaint
reported being ocular symptoms. Sixty-two per cent watery or teary
eyes,and 24% red eyes. Nasal symptoms were reported less
frequently by all providers with 58% reporting nasal congestion, 35%
runny nose, 27% repeated sneezing, 16% post-nasal drip, 12% nasal
itching and 14% cough. All provider groups reported ocular
symptoms more frequently than nasal symptoms, with the exception
of ENT providers. In addition, OPH/OPT reported the most
infrequent use of allergy diagnostic testing such as skin or blood tests
at 4% of patients.
OPH/ OPT reported similar severity of patients to that of other
provider groups with 96% reporting at least a moderate amount of
impact on their patients' quality of life (QOL). However, a sizeable
proportion of OPH/OPT (14%) do not refer or provide specific
immunotherapy (SIT), as compared to other provider groups (< 5%),
although 70% of OPH/OPT believed that SIT was more efficacious
than symptomatic medications.
Conclusions: Eye care specialists commonly see patients with ARC
and appreciate the benefits of immunotherapy. As compared to some
other provider groups, eye care specialists perform allergy testing
infrequently and are less likely to recommend SIT or refer
unresponsive patients to another healthcare provider. Education of
ophthalmologists/optometrists on effectiveness of immunotherapy
may improve patient outcomes since SIT alleviates all symptoms of
ARC including ocular symptoms.
Commercial Relationships: Leonard Bielory, Merck (C), Allergan
(C), Bausch & Lomb (C); Mark Dykewicz, Merck (C); Timothy
Craig, Merck (C); Michael Blaiss, Merck (C), GSK (R),
AstraZeneca (R), Meda (R), Sunovion (R), Takeda (R), Genentech
(R), Teva (R), Proctor and Gamble (C), Nestle's (R), Pfizer (C), PMD
Healthcare (C), Sanofi (C); Bryan Leatherman, Merck (C),
Sunovion (C), Teva (C), Alk Abello (C); David Skoner, Greer
Laboratories (F), Novartis (R), Merck (R), GlaxoSmithKline (R),
Teva (R), Sunovion (R), Istavvision (C); Nancy E. Smith, None; F.
Allen-Ramey, Merck & Co., Inc. (E)
Program Number: 889 Poster Board Number: B0113
Presentation Time: 1:00 PM - 2:45 PM
Epidemiology of Scleritis and Episcleritis: Results from the
Pacific Ocular Inflammation Study
Gelareh Homayounfar1, Vivien M. Tham2, Natalie Nardone1, John V.
Parker3, Aleli C. Vinoya3, Aileen R. Uchida3, Nisha Acharya1, 4. 1F.I.
Proctor Foundation, University of California, San Francisco, San
Francisco, CA; 2Department of Ophthalmology, Kaiser Permanente
Hawaii, Honolulu, HI; 3Center for Health Research, Kaiser
Permanente Hawaii, Honolulu, HI; 4Department of Ophthalmology,
University of California, San Francisco, San Francisco, CA.
Purpose: Population-based studies of scleritis and episcleritis are
lacking. We aimed to ascertain the incidence of scleritis and
episcleritis in a Hawaiian population, describe variations by age,
gender, and race, and compare clinical characteristics of both
conditions.
Methods: All electronic medical records for enrollees in Kaiser
Permanente Hawaii (n =217,061) from 1/1/2006 to 12/31/2007 were
searched for International Classification of Diseases, 9th Edition
(ICD9) codes associated with ocular inflammation. Chart review was
conducted to verify a clinical diagnosis of scleritis or episcleritis.
Confirmed cases were used to calculate incidence rates per 100,000
person-years. Ninety-five percent confidence intervals (CI) were
calculated for each incidence rate, including age-, gender-, and racespecific rates, assuming a Poisson distribution. Data on clinical
characteristics were compared between scleritis and episcleritis cases
using Fisher’s exact test.
Results: Of 217,061 eligible patients, 17 incident scleritis cases and
93 incident episcleritis cases were confirmed. The overall incidence
rates of scleritis and episcleritis were 3.9 and 21.4 cases per 100,000
person-years, respectively, (95% CI: 2.3-6.3, 17.3-26.3). Women
were found to have higher incidence rates of scleritis and episcleritis
(p=0.04, p=0.06). Pacific Islanders were the most underrepresented
racial group among cases of scleritis and episcleritis (p=0.005,
p≤0.001). Blacks had the highest incidence of scleritis (p≤0.001).
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Compared to all others, Asians had a higher incidence of scleritis and
episcleritis (p≤0.001, p≤0.001), as did Caucasians (p=0.08, p≤0.001).
A comparison of clinical characteristics of scleritis and episcleritis
was notable for a higher proportion of patients with rheumatoid
arthritis in those with scleritis (p≤0.001); a higher rate of ocular
complications in scleritis (p=0.02); and more frequent prescriptions
of mydriatic eye drops, systemic immunosuppressants, including
systemic steroids, and topical steroids (p=0.02, 0.005, 0.03, 0.05,
respectively) to scleritis patients.
Conclusions: These results provide a population-based estimate of
the incidence of scleritis and episcleritis in a diverse population and
highlight differences in demographic and clinical characteristics.
Commercial Relationships: Gelareh Homayounfar, None; Vivien
M. Tham, None; Natalie Nardone, None; John V. Parker, None;
Aleli C. Vinoya, None; Aileen R. Uchida, None; Nisha Acharya,
None
Support: Ms. Homayounfar is supported by the Doris Duke Clinical
Research Fellowship. Dr. Acharya is supported by National Eye
Institute grant K23EY017897 and a Research to Prevent Blindness
Career Development Award. This research was also supported by
That Man May See Foundation. The UCSF Department of
Ophthalmology is supported by National Eye Institute grant
EY06190 and an unrestricted grant from the Research to Prevent
Blindness Foundation. The sponsors or funding organizations had no
role in the design or conduct of this research.
Program Number: 890 Poster Board Number: B0114
Presentation Time: 1:00 PM - 2:45 PM
Indications for and causes of enucleation in a rural United States
population
Daniel W. Upton, Xiaoqin Tang, Tamara R. Vrabec, Wells
Reinheimer. Ophthalmology, Geisinger Health System, Danville, PA.
Purpose: Although indications for and causes of enucleation have
been studied, the rural westernized population has eluded evaluation.
The purpose of this investigation was to evaluate enucleation in a
rural central and northeast Pennsylvania population, identify
differences from urban populations, and explore potential
improvements in rural health care which may decrease the need for
this end stage procedure.
Methods: A retrospective clinicopathologic review of all
enucleations, eviscerations, and exenterations (n=96) within the
Geisinger Health System between January 1, 2000 and December 31,
2010 was performed.
Results: Enucleations were categorized according to surgical
indication and pathologic diagnosis. Indications included blind
painful eye (79%), malignancy (12%), cosmesis (5%), and risk of
sympathetic ophthalmia (4%). Pathologic diagnoses included trauma
(37%), infection (17%), inflammation (7%), malignancy (12%),
glaucoma (8%), corneal disease (7%), and other (12%). Overall mean
age (56.8 years), age at surgery for trauma (46.3 years), and age at
surgery for infection and inflammation (68.0 years) were older than
previous data. Univarient analysis demonstrated, as in urban
populations, enucleations for trauma had younger age (p=0.001),
larger implant size (p=0.016), associated alcohol use (p <0.024) and
male gender (p<0.001). In contrast, at this rural center enucleations
for endophthalmitis were more prevalent and effected primarily
elderly patients (12/14) and were related to recent or remote surgical
intervention (10/14). Finally, half of all endophthalmitis cases (7/14)
were either initially treated by non-ophthalmologists in their local
community or presented several days to weeks after initial symptoms
which included redness, pain, and/or vision loss.
Conclusions: There are similarities and differences in the
demographics of enucleation in urban centers and this rural
community. Improvements in rural health care systems including
increasing awareness of the importance of protective eyewear,
seeking prompt care for signs and symptoms of ocular inflammation,
lowering threshold for specialty care referral, and providing low cost
transportation particularly for the elderly may decrease the
prevalence of enucleation.
Commercial Relationships: Daniel W. Upton, None; Xiaoqin
Tang, None; Tamara R. Vrabec, None; Wells Reinheimer, None
Program Number: 891 Poster Board Number: B0115
Presentation Time: 1:00 PM - 2:45 PM
Anterior Chamber Angles measured by van Herick’s Method
and Anterior Segment Optical Coherence Tomography (OPKO
Spectral OCT SLO™) in Patients seen in Optometric Practice in
Norway
Frode Larsen1, Knut Luraas2, Per O. Lundmark1. 1Optometry and
Visual Science, Faculty of Health Sciences, Buskerud University
College, Kongsberg, Norway; 2Rjukan Synssenter Optometry,
Rjukan, Norway.
Purpose: To investigate i) the distribution of anterior chamber angles
measured by means of van Herick’s method and anterior segment
optical coherence (AS-OCT) in optometric patients in Norway, ii) the
agreement between these methods for angle measurements.
Methods: 300 patients over the age of 18 and with no general- or
ocular pathology were consecutively enrolled from two optometric
practices in Norway during a period of 8 months. All underwent a
full optometric examination followed by standardized measurements
of the temporal- and nasal anterior chamber angle (ACA) using van
Herick’s method and AS-OCT (OPKO Spectral OCT SLO™) in
randomized order by two experienced optometrists. ACA was graded
and the peripheral chamber depth (PCD) was estimated in quarter
steps of the corneal thickness by van Herick’s method. The trabeculoiris angle (TIA) was measured in degrees (deg) with AS-OCT using
the integrated analyze software (v.1.87) and averaged for 3 scans.
Temporal- and nasal ACAs were analyzed separately for both eyes.
Analyses of distribution and correlation were by descriptive- and
Pearson and Spearman statistics. Agreement of detection of narrow
angles (<= 20 deg) between the two methods was tested using kappa
statistics.
Results: 3 months into the study 156 eyes of 78 patients were
included (F: 54, mean age 56.2 yrs). Mean temporal- and nasal TIA
was 28.1 deg (range 3.5 - 58.1) and 27.7 deg (range 6.6 - 61.0),
respectively while the distribution of ACA grading (G) with
corresponding mean TIA was G0: 0 %, G1: 1.9 % (7.7 deg), G2: 9.0
% (22.5 deg), G3: 31.4 % (24.7 deg) and G4: 57.7 % (31.6 deg) for
the temporal segment and G0: 0 %, G1: 0.6 % (8.3 deg), G2: 8.3 %
(19.0 deg), G3: 31.4 % (25.1 deg) and G4: 59.6 % (31.6 deg) for the
nasal segment. TIA correlated significantly with ACA grading r =
0.36 - 0.40 (p < 0.01) and with PCD measurement r = 0.51 - 0.60 (p <
0.01). Kappa was 0.28 and 0.24 for temporal and nasal segments,
respectively.
Conclusions: This is the first report on the distribution of chamber
angles measured by means of van Herick’s method and AS-OCT in
optometric practice in Norway. Results indicate that measurements of
ACA with AS-OCT correlate with gradings of ACA and
measurements of PCD with van Herick’s method, however, with poor
agreement between the methods for discrimination of narrow angles.
Commercial Relationships: Frode Larsen, None; Knut Luraas,
None; Per O. Lundmark, None
Program Number: 892 Poster Board Number: B0116
Presentation Time: 1:00 PM - 2:45 PM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Effects of tropicamide and phenylephrine on iris dilation and
blood pressure in adults with and without hypertension
Julian Tokarev1, 2, Elena Bitrian2, Richard Manka2, 3. 1University of
Minnesota Medical School, White Bear Lake, MN; 2Department of
Ophthalmology, University of Minnesota, Minneapolis, MN;
3
Department of Ophthalmology, Hennepin County Medical Center,
Minneapolis, MN.
Purpose: To investigate the effect of common dilating eye drops
used for eye examination on systemic blood pressure (BP) in adults,
and how this may interact with history of hypertension and associated
medication use. The formulations examined, tropicamide 1% (T) and
tropicamide 1% & phenylephrine 2.5% (T+P), are used in eye care
settings the world over yet their systemic effects are not well
documented.
Methods: In this prospective randomized study, patients received a
single dose of either T or T+P. Immediately prior to instillation of
drops, an automated cuff obtained baseline BP and pupil size was
measured by slit lamp exam. A second reading was obtained 30
minutes after drops were given. Direct patient questioning and chart
review were used to gather medication and medical history data.
Results: 104 patients were included. Mean age was 52.89±15.15
(mean±SD) years, 59.6% of patients were females, 18.3% Caucasian,
43.3% African American, 25%% Hispanic, 3.8% Asian. For the first
analysis, patients were divided into two groups based on the dilating
agent they received: T, or T+P. Overall, average BP did not change
from baseline; mean arterial pressure (MAP) before dilation was
96.62±13.3mmHg and 96.8±12.67mmHg after dilation (p =0.8).
Those receiving T+P exhibited greater pupillary dilatation than T
alone, (3.67 mm vs. 4.26mm, p=0.02). This is attributable only to
treatment effect, since baseline pupil sizes did not differ between T
and T+P groups (p=0.9), yet pupil sizes 30 minutes after drop
instillation were greater for T+P (6.91mm±1.19mm) than for T alone
(6.33mm±0.93mm) (p=0.009).
Next, patients were divided into those diagnosed with hypertension
(HTN) and those without history of HTN (non-HTN). 93.7% of
patients with HTN were on antihypertensive medications at the time
of visit. Changes from baseline in MAP, systolic BP, diastolic BP,
heart rate, and pupil size were compared between HTN and non-HTN
groups. HTN patients’ pupils dilated to a greater extent in response to
T+P (+4.09±0.98mm) than T alone (+3.35mm±0.98mm) (p=0.03).
No other significant changes from baseline in the above parameters
were found between HTN and non-HTN groups.
Conclusions: Dilating eye drops containing T+P exert a stronger
mydriatic effect than T alone, especially in hypertensive patients
undergoing antihypertensive therapy. Neither formulation appears to
affect systemic blood pressure or heart rate.
Commercial Relationships: Julian Tokarev, None; Elena Bitrian,
None; Richard Manka, None
Program Number: 893 Poster Board Number: B0117
Presentation Time: 1:00 PM - 2:45 PM
Anterior vitrectomy at the time of cataract surgery: A wholepopulation study of the incidence and consequences
Jonathon Ng1, 3, Nigel Morlet2, 3, Antony Clark2, 3. 1School of
Population Health, The University of Western Australia, Nedlands,
WA, Australia; 2Department of Ophthalmology, Royal Perth
Hospital, Perth, WA, Australia; 3Eye & Vision Epidemiology
Research (EVER) Group, Perth, WA, Australia.
Purpose: To determine the incidence and consequences of anterior
vitrectomy during cataract surgery.
Methods: We used the Western Australian Data Linkage System to
identify patients that had cataract surgery in all public and private
hospitals in Western Australia in 1980-2001. Procedures that had an
anterior vitrectomy during cataract surgery were identified using
clinical procedure codes. Potential sight-threatening complications
were identified as those patients who underwent subsequent eye
surgery for the complication of interest following initial cataract
surgery. These potential cases were validated using the medical
record.
Results: There were 129,982 cataract surgeries performed with 1,342
(10.3%) requiring anterior vitrectomy. The incidence of anterior
vitrectomy varied from 5-13 per 1,000 procedures. There were two
peaks in incidence of anterior vitrectomy at the time of cataract
surgery; the early 1980s and early 1990s, which coincided with
transitions in surgical technique. A sight-threatening complication
subsequently occurred in 152 (11.3%) of the cataract surgeries
involving anterior vitrectomy. This included 50 (3.7%) retinal
detachments, 9 (0.7%) pseudophakic bullous keratopathy, 35 (2.6%)
IOL dislocations, 55 (4.1%) dropped nuclei and 6 (0.4%)
endophthalmitis cases.
Conclusions: Anterior vitrectomy rates mirror learning curves
associated with the adoption of new surgical techniques. Patients
requiring anterior vitrectomy had a higher risk of other
complications.
Commercial Relationships: Jonathon Ng, None; Nigel Morlet,
None; Antony Clark, None
Support: Australian National Health and Medical Research Council
Project Grant 303114
Program Number: 894 Poster Board Number: B0118
Presentation Time: 1:00 PM - 2:45 PM
Phenotyping and genotyping of Staphylococcus aureus on
ophthalmology clinic surfaces
Rachel E. Reem1, Joany Van Balen2, Armando E. Hoet2, 3, Colleen M.
Cebulla1. 1Ophthalmology, Ohio State University, Columbus, OH;
2
Veterinary Preventive Medicine, College of Veterinary Medicine,
The Ohio State University, Columbus, OH; 3Division of
Epidemiology, College of Public Health, The Ohio State University,
Columbus, OH.
Purpose: Methicillin susceptible and resistant Staphylococcus aureus
(MSSA and MRSA) are increasingly common pathogens in
ophthalmology. Thus, identification of contaminated surfaces is
necessary to establish appropriate prevention and control measures.
The purpose of this study was to screen ophthalmic clinic equipment
for MSSA and MRSA, to identify the most commonly contaminated
surfaces, and to further genotype and phenotype such isolates to
understand their epidemiology and origin.
Methods: A standardized environmental sampling method was used
to screen 12 randomly selected examination rooms, pooled in sets of
3, from 2 ophthalmology clinic buildings. The surfaces sampled in
each room were patient, staff and general public high contact
surfaces. Sampling was performed on a quarterly basis for 1 year.
Isolates were obtained and identified using standard microbiological
techniques. Antimicrobial resistance profiles, SCCmec typing, USA
typing and dendrogram analysis of pulsed-field gel electrophoresis
(PFGE) pulsotypes were used to characterize all S. aureus isolates.
Results: Of 112 total samples, 25 and 5 were MSSA and MRSA
positive, respectively. The top 3 contaminated surfaces were
doorknobs, computer keyboards, and slit lamp headrests. Molecular
analysis showed high diversity between the isolates (17 distinct
MSSA and 4 MRSA pulsotypes). Different surfaces in two separate
rooms were contaminated with the same pulsotype at the same
sampling time, suggesting possible cross-contamination. No single
surface remained consistently positive with the same pulsotype over
time. Three of the 5 MRSA isolates were CA-MRSA (SCCmec IV,
USA300) and two were HA-MRSA (SCCmec II, USA100). Multi-
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
drug resistance (resistant to 3 or more antimicrobial classes) was
found in 4/5 MRSA isolates.
Conclusions: This study demonstrates that S. aureus (MSSA and
MRSA) is present in the environment of a representative
ophthalmology clinic setting. The high diversity of strains found
indicates a constant introduction of clones over time. Doorknobs and
nearby door surfaces appear to play an important role in the room-toroom spread of S. aureus; hence, it is recommended to include them
in routine disinfection protocols. Nevertheless, the fact that no single
surface tested positive more than once for the same pulsotype
suggests that current disinfection procedures are effective in
preventing the spread of this increasingly prevalent bacterium.
Commercial Relationships: Rachel E. Reem, None; Joany Van
Balen, None; Armando E. Hoet, None; Colleen M. Cebulla, None
Program Number: 895 Poster Board Number: B0119
Presentation Time: 1:00 PM - 2:45 PM
Dietary Glycemic Index and Risk of Age-Related Cataract:
Findings from Andhra Pradesh Eye Disease Study
Rohit C. Khanna1, Suneetha Sapur1, 2, Krishnaiah Sannapaneni1,
Gullapalli N. Rao1. 1Allen Foster Research Centre for Community
Eye Health, International Centre for Advancement of Rural Eye care,
L V Prasad Eye Institute, Hyderabad, India; 2Akkshaya Foundation
Society, Hyderabad, India.
Purpose: To investigate the associations between the glycemic index
(GI) of various carbohydrate food groups (rice, wheat, jowar and
ragi) and cataract subtypes in the Andhra Pradesh Eye Disease Study
(APEDS) cohort from Southern India.
Methods: A population-based cross-sectional epidemiological study
(APEDS) was conducted between 1996-2000, wherein, a 95-item,
standardized food frequency questionnaire was administered by
trained professional in each household to ascertain data on nutrition.
Daily nutrient intakes were calculated according to the National
Institute of Nutrition (Government of India) guidelines. The data
were analyzed for participants (n = 3723) aged 40 years and above.
Lens Opacities Classification System-III was used for the diagnosis
of nuclear cataract and Wilmer classification for cortical and
posterior subcapsular cataracts. Univariable and multivariable logistic
regression models were used to study the associations, adjusted for
age, gender, socioeconomic status, place of residence, smoking, body
mass index (BMI), diabetes and hypertension.
Results: Participants with higher GI were significantly from an urban
location (p<0.001), who belonged to middle and higher
socioeconomic groups (p<0.001), had a history of smoking (p<0.001)
and higher BMI (p<0.001), consumed more carbohydrates (p<0.001)
and presented with systemic conditions of hypertension and diabetes
(P < 0.001). In multivariable logistic regression analysis, higher
quartiles (Q3) of GI showed significant associations with higher
prevalences of nuclear cataract (OR=1.83, 95% CI, 1.41 - 2.39),
mixed cataract (OR=2.12, 95% CI, 1.47-3.06) and any cataract
(OR=1.46, 95% CI, 1.14-1.87). Further, participants with intake of
rice alone were more prone to the increased risk of nuclear cataract
(OR=1.86, 95% CI, 1.47- 2.31) and any cataract (OR=1.53, 95% CI,
1.27 - 1.85).
Conclusions: A significant association was observed between food
(like rice) with higher GI and cataract (nuclear, mixed or any
cataract). Hence, cereals of less GI need to be included in daily food
consumption to reduce the prevalence of cataract burden in the state
of Andhra Pradesh in India.
Commercial Relationships: Rohit C. Khanna, None; Suneetha
Sapur, None; Krishnaiah Sannapaneni, None; Gullapalli N. Rao,
None
Program Number: 896 Poster Board Number: B0120
Presentation Time: 1:00 PM - 2:45 PM
Association between statin use and risk of developing cataracts
Nathan Carpenter1, 2, Samuel K. Lohstreter1, 2, Michelle Y. Cho1,
James R. Beal2. 1Ophthalmology, Altru Health System, Grand Forks,
ND; 2Medicine, University of North Dakota, Grand Forks, ND.
Purpose: The purpose of this study is to determine the association
between statin use and risk of developing cataracts. There is
conflicting evidence that the use of statins may increase the risk of
cataracts. Statins are widely prescribed to patients with various
medical histories to reduce the risk of cardiovascular disease and the
complications thereof.
Methods: A hospital-based case-control retrospective chart review
was conducted on patients with and without cataracts from 31
October 2010 through 31 October 2012. The subject population
resides predominantly from northeastern North Dakota and
northwestern Minnesota in the United States. Cases (n=34) were
subjects between ages 30-79 years diagnosed with cataracts. Controls
(n=29) were subjects ages 30-79 years seen at the same hospital for
an annual physical exam or annual eye exam without a cataract
diagnosis. Demographic and clinical characteristics of the subjects
abstracted from their medical charts included: age, sex, presence of
cataract, cataract grade, cataract type, visual acuity, statin use, statin
dose, statin duration, total cholesterol (TC), triglycerides (TG), high
density lipoprotein (HDL), low density lipoprotein (LDL), coronary
artery disease, hypertension, smoking history, race, and body mass
index. SPSS 20.0 for Windows was used to perform analysis. All
statistical tests were two-tailed with p<0.05 considered to be
significant. Institutional Review Boards of both Altru Health System
and the University of North Dakota approved the study.
Results: The mean age of subjects with cataracts versus those
without cataracts (66.7 ±8.1 vs. 60.8 ±13.7, p=0.047). The rate of
statin use in all subjects was 43% (27/63). The rate of statin use in
subjects with cataracts was 53% (18/34) and in subjects without
cataracts was 31% (9/29). No association between the use of statins
and cataracts was found (OR=2.5, 95% CI 0.89 to 7.04, p=0.082).
The mean visual acuity for subjects with statin use was worse (20/40)
than subjects with no statin use (20/32) with documented cataracts.
No significant differences were found between cases and controls for
gender, lipid panel (TC, TG, HDL, and LDL), coronary artery
disease, hypertension, smoking, or obesity.
Conclusions: The study indicates no association between statin use
and risk of developing cataracts.
Commercial Relationships: Nathan Carpenter, None; Samuel K.
Lohstreter, None; Michelle Y. Cho, None; James R. Beal, None
Program Number: 897 Poster Board Number: B0121
Presentation Time: 1:00 PM - 2:45 PM
Inflammatory and Oxidative Stress Markers and the 20-Year
Cumulative Incidence of Age-Related Cataract: the Beaver Dam
Eye Study
Barbara E. Klein1, Chelsea E. Myers1, Karen J. Cruickshanks2, 1,
Kristine E. Lee1, Ronald Klein1. 1Ophthalmology and Visual
Sciences, University of Wisconsin School of Medicine and Public
Health, Madison, WI; 2Population Health Sciences, University of
Wisconsin School of Medicine and Public Health, Madison, WI.
Purpose: To determine whether inflammatory and oxidative stress
markers are associated with the 20-year cumulative incidence of
types of age-related cataract.
Methods: A randomized sample (N=1597) of the Beaver Dam Eye
Study cohort was identified for assessment of 4 inflammatory
markers (serum high sensitivity C-reactive protein [CRP], tumor
necrosis factor-α [TNF-α], interleukin-6 [IL-6], and white blood cell
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
[WBC] count) and 2 oxidative stress markers (serum isoprostane and
total carbonyl content) at baseline, and were examined at 4 follow-up
exams spaced 5 years apart. Age-related cataract was assessed from
photographs of the lens.
Results: The 20-year cumulative incidence of any cataract was
54.1% and was 35.3%, 11.7% and 29.9% for nuclear, posterior
subcapsular cataract and cortical cataract, respectively. After
adjusting for age and sex, TNF-α (results reported as odds ratio for
trend per quartile, 95% confidence interval, P value; 1.23, 1.09-1.38,
P=0.0005) and IL-6 (1.27, 1.15-1.41, P<0.0001) were associated with
the incidence of any cataract. Stratifying by cataract type, IL-6 was
significantly associated with the incidence of nuclear cataract (1.15,
1.03-1.29, P=0.016); both IL-6 (1.24, 1.10-1.40, P=0.0004) and WBC
count (1.18, 1.05-1.32, P=0.006) were associated with the incidence
of cortical cataract; CRP (1.25, 1.05-1.48, P=0.01) was associated
with the incidence of posterior subcapsular cataract. Odds ratios and
significance levels were nearly identical after further adjustment for
other potential confounders.
Conclusions: Our findings provide modest support for an association
between markers of inflammation and the incidence of age-related
cataract over 20 years. It is possible that more specific information on
the cause of systemic inflammation would be useful in understanding
these relationships.
Commercial Relationships: Barbara E. Klein, None; Chelsea E.
Myers, None; Karen J. Cruickshanks, None; Kristine E. Lee,
None; Ronald Klein, None
Support: Supported by NIH-NEI grant EY06594 and Research to
Prevent Blindness (R Klein, BEK Klein, Senior Scientific
Investigator Awards)
Program Number: 898 Poster Board Number: B0122
Presentation Time: 1:00 PM - 2:45 PM
Prevalence of cataract and its main comorbidities in a Hispanic
population
JOSE A. NAVA1, 2, Alejandro Tamez1, Nelly A. Torres1, Jose D.
Martinez1, Juan F. Lozano-Ramirez1, Jorge E. Valdez1. 1Instituto de
Oftalmologia - Escuela de Medicina, Instituto Tecnologico y de
Estudios Superiores de Monterrey, Monterrey, Mexico; 2Instituto de
Oftalmologia, Centro Medico Zambrano Hellion, San Pedro Garza
Garcia, Mexico.
Purpose: To analyze the prevalence of cataract in a Hispanic
population and find its correlation with other pathologies.
Methods: We selected a random sample of 398 files from patients 40
years or older examined during the year 2010 in an ophthalmology
service in Monterrey, Mexico.
We evaluated the general prevalence of uni or bilateral cataract, as
well as its distribution by group age. We also analyze the relationship
between the presence of cataract and other pathologies.
Results: We observe a general prevalence of cataract of 8.29% (33
patients), 87.8% bilateral. The average age was 67 (32-89) years old.
We analyzed the prevalence of cataract by group age.
Of the 33 patients with cataract, 7 (21.2%) presented arterial
hypertension, being the main comorbidity found. Proliferative
diabetic retinopathy and pseudoexfoliation were found in 9% each.
Conclusions: The cataract prevalence in our group was within
expectations for our population. As expected, the prevalence of
cataract rises in relationship with the age. The prevalence of
comorbidities was 21%, being arterial hypertension the most
common. Diabetes mellitus presented prevalence similar to the
general population. The study must be enlarged to evaluate the
association of two or more comorbidities.
Commercial Relationships: JOSE A. NAVA, None; Alejandro
Tamez, None; Nelly A. Torres, None; Jose D. Martinez, None;
Juan F. Lozano-Ramirez, None; Jorge E. Valdez, None
Program Number: 899 Poster Board Number: B0123
Presentation Time: 1:00 PM - 2:45 PM
Role of ephrin genes in cortical cataract pathogenesis
Ekaterina Yonova1, Abhishek Nag1, Cristina Venturini2, 1, Pirro G.
Hysi1, Katie M. Williams1, Tim Spector1, Christopher J. Hammond1.
1
Twin Research and Genetic Epidemiology, King's College London,
London, United Kingdom; 2Institute of Ophthalmology, UCL,
London, United Kingdom.
Purpose: Although both common and rare variants in the EPHA2
gene were previously implicated in age-related cortical cataract
pathogenesis, little is known about the role of other genetic factors in
cortical cataract. The purpose of the study was to perform a genome
wide association study (GWAS) of cortical cataract to detect
common variants, and to analyze rare variants in any genes identified
in the GWAS from sequence data.
Methods: Cortical cataract was measured in sample of 2265 twins
over 50 years of age from the TwinsUK registry using
retroilumination images, and all individuals with lens opacity
covering more than 5% of the lens area were considered affected.
Genotypes were obtained using Illumina 610k and Illumina 317K
platforms, which were later imputed against the 1000 genomes SNP
panel. We performed a genome-wide logistic regression association
analysis of cortical cataract and common Single Nucleotide
Polymorphisms (SNPs), adjusting for age and family structure using
(Linkage and Association Modeling in Pedigrees) LAMP.
Additionally, we looked at association between rare variants in
associated genes using the SNP-set kernel association test (SKAT)
burden test on sequencing data.
Results: Variants near one of the ephrin (EPH) genes, EPHA4 on
chromosome 2q36.1, were highly associated with cortical cataract.
The most associated SNP was rs10932912 (p=1.5e-07), 46kb form
the end of the gene and is in a region predicted to harbour many
transcription factor binding sites. EPHA4 is a EPH-binding receptor
important for development of various tissues. Additionally, the
SKAT burden test for the same region gave p=0.0007. Examination
of associations in other EPH genes showed an association of nominal
significance for rs6669666 in the EPHB2 gene (p=0.012). The rare
variants burden test for this gene was not statistically significant.
EPHB2 gene is important for calcium signalling and cell guidance.
Conclusions: Our study provides further evidence that EPH genes
play a role in cortical cataract, EPHA4 and probably EPHB2 in
particular. Both these genes are expressed in lens epithelia and Ephb2
-/- murine knockouts develop early cortical cataract. These results
require replication, but suggest that further investigation of the roles
of EPH genes in maintenance of lens transparency should be further
investigated.
Commercial Relationships: Ekaterina Yonova, None; Abhishek
Nag, None; Cristina Venturini, None; Pirro G. Hysi, None; Katie
M. Williams, None; Tim Spector, None; Christopher J.
Hammond, None
234 Retina and Diabetic Retinopathy
Monday, May 06, 2013 8:30 AM-10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 1530-1573/C0020-C0063
Organizing Section: Clinical/Epidemiologic Research
Program Number: 1530 Poster Board Number: C0020
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Presentation Time: 8:30 AM - 10:15 AM
Retinal Microvascular Signs and Incident Cardiovascular Event
in Asians
Carol Y. Cheung1, 2, Wan Ting Tay1, Mohammad K. Ikram1, 2, Paul
Mitchell4, Jie Jin Wang4, 5, Charumathi Sabanayagam1, 3, E Shyong
Tai6, Tien Y. Wong1, 2. 1Singapore Eye Research Institute, Singapore,
Singapore; 2Department of Ophthalmology, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore;
3
Centre for Quantitative Medicine, Duke-NUS Graduate Medical
School, Singapore, Singapore; 4Centre for Vision Research,
University of Sydney, Sydney, NSW, Australia; 5Centre for Eye
Research Australia, University of Melbourne, Melbourne, VIC,
Australia; 6Department of Medicine, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore.
Purpose: Retinal microvascular signs may provide insights into the
structure and function of systemic small vessels that are associated
with cardiovascular diseases (CVD). Previous studies were conducted
in Western populations who have different CVD risk factor profile as
Asians. We investigated whether retinal microvascular signs are
predictive of CVD events in a multi-ethnic Asian cohort.
Methods: We conducted a prospective, population-based study in a
multi-ethnic Asian cohort (Malay, Chinese and Indian) aged ≥40
years at baseline using data from the Singapore Malay Eye Study and
the Singapore Prospective Study. Retinal microvascular signs were
assessed from baseline retinal photographs. Retinopathy was graded
using the modified Airlie House classification system. Retinal
vascular parameters (arteriolar caliber, venular caliber and fractal
dimension) were measured using computer-assisted programs to
quantify the retinal vessels widths and global geometric complexity
of the retinal vasculature. Incident CVD event was defined as newly
diagnosed clinical stroke or acute myocardial infarction (AMI) or
CVD death documented by National Registry of Diseases Office after
the baseline examination.
Results: A total of 5,644 participants were free of prevalent stroke
and AMI at baseline. During the follow-up (median 4.24 years), 250
(4.4%) and 124 (2.2%) participants developed a stroke/AMI and
CVD death, respectively. In Cox proportional-hazards models
adjusting for established risk factors (age, sex, race, systolic blood
pressure, diabetes, smoking, cholesterol and C-reactive protein),
presence of retinopathy (hazard ratio [HR] 1.70, [95% confidence
interval 1.19, 2.44]), narrower retinal arteriolar caliber (HR 1.14,
[1.00, 1.30], per standard deviation [SD] decrease), and wider retinal
venular caliber (HR 0.88, [0.77, 1.00], per SD decrease) were
independently associated with risk of CVD event. The C statistic was
not changed when these retinal signs were incorporated into the
model (C statistic 0.829 vs. 0.820, p=0.315). Retinal fractal
dimension was not associated with risk of CVD event.
Conclusions: Retinopathy, narrower retinal arteriolar caliber and
wider retinal venular caliber predict the risk of CVD events in
Asians, consistent with studies in Western countries, supporting a
role of microvascular pathology in CVD development. These retinal
signs, however, did not improve the discrimination of CVD risk
models significantly.
Commercial Relationships: Carol Y. Cheung, None; Wan Ting
Tay, None; Mohammad K. Ikram, None; Paul Mitchell, Novartis
(R), Bayer (R); Jie Jin Wang, None; Charumathi Sabanayagam,
None; E Shyong Tai, None; Tien Y. Wong, Allergan (C), Bayer (C),
Novartis (C), Pfizer (C), GSK (F), Roche (F)
Support: National Medical Research Council (NMRC)
R607/28/2008
Program Number: 1531 Poster Board Number: C0021
Presentation Time: 8:30 AM - 10:15 AM
Severity And Progression Of Diabetic Retinopathy In Type 2
Macular Telangiectasia (MacTel)
Simona Degli Esposti, Tunde Peto, Irene Leung, Ferenc B. Sallo,
Catherine A. Egan. NIHR Biomedical Research Centre for
Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust
and UCL Institute of Ophthalmology, London, United Kingdom.
Purpose: To assess the impact of diabetes on the characteristics of
Type 2 Macular Telangiectasia (MacTel).
Methods: Data from patients enrolled in the MacTel Natural History
Observation Study were analysed. Out of 409 patients, 145 had
documented evidence of diabetes at enrolment. Colour fundus
images, fluorescein angiography and OCT images were obtained
from all diabetic patients and were graded on the ETDRS scale for
severity of retinopathy and maculopathy. MacTel was graded for
disease characteristics. Diabetes status of 30 patients from a single
centre was analysed in detail. Diabetes was defined as uncontrolled
when HbA1C was more than 7%.
Results: MacTel patients with diabetes with early stages of MacTel
had worse visual acuity than those without diabetes (Stage 1: no
diabetes: 76.44±2.04, diabetes: 67.71±4.84, p=0.096; Stage 2: no
diabetes: 74.71±1.46, diabetes: 70.71±2.06, p=0.073, Stage 3: no
diabetes: 74.04±0.73, diabetes: 70.26±1.35, p=0.014; no difference in
Stage 4-5 MacTel). After adjustment for length of MacTel and
staging, patients with uncontrolled diabetes had significantly lower
visual acuity when entering the study compared to patients with no
history of diabetes despite having no difference in the severity of
diabetic retinopathy or maculopathy with the patients with controlled
diabetes (No diabetes 68.3±0.8 letters; diabetes controlled 66.3±1.3,
p=0.142; diabetes uncontrolled 64.3±1.6, p=0.018). During the up to
5-year follow-up, no patient developed proliferative diabetic
retinopathy; one patient (3.3%) developed maculopathy.
Mean age of the sub-cohort of 30 MacTel patients was 66.7±8.5
years. Mean duration of diabetes was 11.6±6.7 years and mean
HbA1c was 7.07±1.35%. Eighteen patients (60%) had family history
of diabetes. Thirteen patients (43.3%) used a single oral
hypoglycaemic medication, only 3 patients (10%) used insulin. Mean
body mass index (BMI) was 30.1±5.9.
Conclusions: There seems to be a relationship between MacTel and
diabetes. Diabetes mellitus seems to have a clinically meaningful
impact on visual acuity and progression of MacTel, especially in
early stages of the disease. On the other hand, patients with MacTel
and diabetes do not seem to develop treatable diabetic retinopathy or
maculopathy with the same rate as general diabetic population.
Patients usually have good glycaemic control with need of relatively
few medications.
Commercial Relationships: Simona Degli Esposti, None; Tunde
Peto, None; Irene Leung, None; Ferenc B. Sallo, None; Catherine
A. Egan, Bayer (S), Oculogics (S), Novartis (S), Allergan (S),
Novartis (F)
Support: Lowy Medical Research Foundation; NIHR Moorfields
Biomedical Research Centre
Program Number: 1532 Poster Board Number: C0022
Presentation Time: 8:30 AM - 10:15 AM
Association between Presence and Severity of Diabetic
Retinopathy and Coronary Artery Disease
Adam J. Plant1, Thomas H. Hong1, Annette Kifley1, Aravinda
Thiagalingam2, Paul Mitchell1. 1Ophthalmology, University of
Sydney, Sydney, NSW, Australia; 2Cardiology, Westmead
Millennium Institute, Sydney, NSW, Australia.
Purpose: Microvascular changes have increasingly been shown to be
associated with the presence of coronary artery disease. Thus, we
aimed to determine whether associations existed between diabetic
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
retinopathy (DR) and the severity of coronary artery disease as
detected by coronary angiography.
Methods: The Australian Heart Eye Study examined 1680
participants with suspected coronary artery disease with coronary
artery angiography, and six-field retinal photography. Of these, 567
participants were determined to have diabetes from either history or a
fasting glucose of ≥7.0mmol/L (126mg/dL). Presence and severity of
retinopathy was graded according to the Early Treatment Diabetic
Retinopathy Study (ETDRS) scale. Any DR, minimal nonproliferative DR (NPDR) or worse, and mild NPDR or worse were
defined as scores of >10, ≥20 and ≥35, respectively. A coronary
artery vessel score from 0 to 3, was calculated from the number of
vessels with significant stenosis, which was defined as ≥50% of the
vessel lumen. After adjusting for age, sex, duration of diabetes,
previous heart attack, hypertension, hypercholesterolemia, and
current smoking, ordinal regression modeling was used to estimate
the association between ETDRS scores and coronary artery vessel
scores. Odds ratios describe the risk of having a higher coronary
artery score in participants with DR, compared to those without DR.
Results: The mean age of participants was 63.67 years (Standard
Deviation ±10.85 years). 444 (83%) had a history of hypertension,
420 (78.8%) had a history of hypercholesterolemia, and 412 (72.7%)
were male. Mild NPDR or worse retinopathy (ETDRS score ≥35) in
at least 1 eye was associated with the severity of coronary vascular
disease (odds ratio, OR, 1.66; 95% confidence interval, CI, 1.032.69). More severe coronary artery disease was associated with
presence of any retinopathy in both eyes (OR 1.92, 95% CI 1.193.12), bilateral minimal NPDR or worse retinopathy(ETDRS score
≥20) (OR 2.04, 95% CI 1.17-3.56), and bilateral mild NPDR or
worse retinopathy(ETDRS score ≥35) (OR 2.14, 95% CI 1.10-4.17).
Conclusions: Stronger associations were found between bilateral DR
at all levels of severity and the severity of coronary artery disease
than with unilateral DR. This supports previous findings that
microvascular disease, particularly systemic microvascular changes
are associated with coronary artery disease.
Commercial Relationships: Adam J. Plant, None; Thomas H.
Hong, None; Annette Kifley, None; Aravinda Thiagalingam,
None; Paul Mitchell, Novartis (R), Bayer (R)
Support: NHMRC 571012
Program Number: 1533 Poster Board Number: C0023
Presentation Time: 8:30 AM - 10:15 AM
Novel and Traditional Biomarkers of Diabetic Retinopathy
Severity: Multi-category Classifications Modeling
Wan Ling Wong1, 2, Jialiang Li4, Xiang LI4, 3, Ecosse L. Lamoureux5,
3
, Carol Y. Cheung3, Tien Y. Wong3, 1. 1Department of
Ophthalmology, National University Health System, Singapore,
Singapore; 2Department of Ophthalmology, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore;
3
Singapore Eye Research Institute, Singapore National Eye Centre,
Singapore, Singapore; 4Department of Statistics and Applied
Probability, National University of Singapore, Singapore, Singapore;
5
Centre for Eye Research Australia, Royal Victorian Eye and Ear
Hospital, University of Melbourne, Melbourne, VIC, Australia.
Purpose: Most previous studies have examined biomarkers of
diabetic retinopathy (DR) based on absence or presence of disease.
We evaluated if novel biomarkers (serum creatinine, C-reactive
protein (CRP) and retinal vascular imaging parameters) add
discriminative value beyond traditional risk factors for identifying
increasing severity levels of DR.
Methods: We used data from the Singapore Malay Eye Study, a
population-based, survey of 3,280 (78.7% response) Malays aged 40
to 80 years. DR was graded from fundus photographs using the
modified Airline House classification system and categorized as
none/minimal (L1), mild/moderate (L2), and severe/vision
threatening (L3). Blood samples collected were measured for serum
creatinine and CRP. Retinal vascular parameters were measured
quantitatively using a semi-automated computer-based program.
Support Vector Machines (SVMs) is a machine learning method that
performs classification tasks by constructing hyper-planes in a multidimensional space to separate outcome categories. Hyper-volume
under the receiver operating characteristic curve manifold was used
as inputs to non-linear SVMs to assess the accuracy and
discrimination ability of novel biomarkers versus traditional risk
factors (age, gender, body mass index, systolic blood pressure,
hemoglobin A1c, low-density lipoprotein cholesterol and diabetes
duration) for classifying DR severity.
Results: 740 diabetic participants were analyzed (582 L1; 87 L2; 71
L3). The discrimination ability, which is the probability of correctly
classifying three random subjects from the population, each from one
of the three stages of DR severity using traditional risk factors was
62%. The addition of novel biomarkers (serum creatinine, CRP,
retinal venular tortuosity, fractal dimension, retinal arteriolar and
venular caliber) increased the overall discriminating power of DR
severity by 23% to 85%. Compared to traditional risk factors at
specific DR severity levels, serum creatinine and CRP together have
greater relative contribution (24%) to the increase in discriminatory
ability of L3 DR while retinal arteriolar diameter and fractal
dimension have greater relative contribution (22% and 10%
respectively) to L2 DR.
Conclusions: The addition of novel biomarkers of serum creatinine,
CRP and retinal vascular imaging parameters improves the
discrimination and classification accuracy of DR severity levels.
Commercial Relationships: Wan Ling Wong, None; Jialiang Li,
None; Xiang LI, None; Ecosse L. Lamoureux, None; Carol Y.
Cheung, None; Tien Y. Wong, Allergan (C), Bayer (C), Novartis
(C), Pfizer (C), GSK (F), Roche (F)
Program Number: 1534 Poster Board Number: C0024
Presentation Time: 8:30 AM - 10:15 AM
Diabetic retinopathy mobidity among known diabetics in urban
slums of Mumbai, India, are comparable to urban trends
anywhere in the world
Sunita Mohan1, Ashwini Rogiye1, Manish Sonawane1, Hemangi
Gawali1, Radhika Srinivasan1, Sundaram Natarajan2, Govindasamy
Kumaramanickavel1, Catherine A. McCarty3. 1Ophthalmology,
Aditya Jyot Foundation, Mumbai, India; 2Aditya Jyot Eye Hospital,
Mumbai, India; 3Essentia Institute of Rural Health, Duluth, MN.
Purpose: To evaluate the proportion of diabetic retinopathy (DR)
among self reported known type 2 diabetics mellitus (KD) patients
and study the risk factors associated with it in the urban slums of
Mumbai, India. KD was defined as clinical diagnosis of DM made
prior to the survey or patient using hypoglycemic medication, either
oral or insulin or both.
Methods: A cross sectional survey of eligible subjects aged 40 years
or above was conducted in four non-randomly selected wards of
urban slums of the city of Mumbai, Maharashtra state, India. Eligible
subjects were enumerated through a door to door survey by
community health workers. History of diabetes in terms of duration
and family history was elicited, height, weight, and blood pressure
were measured for all subjects. Screening camps were organised for
modern comprehensive ocular examinations including visual acuity
and anterior and posterior segments examination at the study areas by
experienced ophthalmologists.
Results: A total of 3596 eligible subjects were enumerated between
January - February 2012 in the study area. The prevalence of KD was
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
5.8% (n=230) and of diabetic retinopathy among the known diabetics
was 22.6% (n=52). Duration of diabetes and hypertension (p value
<0.05) were strongly associated with DR. The most common form of
retinopathy was non-proliferative DR, 94.2% (n=49) and sight
threatening retinopathy requiring intervention was 5.8% (n=3).
Conclusions: The proportion and morbidity of DR in self reported
KD in the urban slum Mumbai population was comparable to that of
the urban society anywhere in the world. Collectively, India being the
diabetic capital of the world, with its rapid urbanization and rising
number of slums with poor health surveillance, could spell a major
health disaster in the years to come.
Commercial Relationships: Sunita Mohan, None; Ashwini
Rogiye, None; Manish Sonawane, None; Hemangi Gawali, None;
Radhika Srinivasan, None; Sundaram Natarajan, None;
Govindasamy Kumaramanickavel, None; Catherine A. McCarty,
None
Support: Mumbai Diabetic Retinopathy Study WDF08-338
Program Number: 1535 Poster Board Number: C0025
Presentation Time: 8:30 AM - 10:15 AM
Meta-analysis examining the systemic safety profile of
intravitreal ranibizumab injections in AMD, RVO and DME
Robert L. Avery1, Steven F. Francom2, Phillip Lai2, Chad Melson3,
Sung B. Cha4, Lisa Tuomi2. 1California Retina Consultants, Santa
Barbara, CA; 2Genentech, Inc., South San Francisco, CA; 3Experis,
Cincinnati, OH; 4Novartis Pharma, Basel, Switzerland.
Purpose: Intravitreal ranibizumab is used to treat age-related macular
degeneration (AMD), retinal vein occlusion (RVO) and diabetic
macular edema (DME), with patient exposure exceeding 1.2 million
treatment-years since 2006. The purpose of this meta-analysis is to
better characterize the safety profiles of 0.3mg and 0.5mg
ranibizumab versus sham using a database containing Genentech and
Novartis Phase II, III and IIIb clinical trials.
Methods: The pooled safety database includes 22 studies and 10,300
patients (mean follow-up time 15.9 mo; maximum, 64.2 mo; Table 2)
and incorporates patient-level dosing information (drug exposure),
demographics, key baseline risk factors, and timing of events relative
to study initiation. All available adverse event information on
individual patients from time of randomization/enrollment to last
evaluation was included. Event rates were evaluated by indication
(AMD, RVO, and DME). Pairwise treatment comparisons (0.5mg vs
control [sham/PDT], 0.3mg vs control, and 0.5mg vs 0.3mg) were
performed for studies where both treatment arms were evaluated
(Table 1).
Results: Pairwise comparisons in DME for 0.5mg vs control showed
higher rates of death (1.6 vs 0.7, per 100 patient-years [pt-yrs]) and
wound healing complications (1.6 vs 0, per 100 pt-yrs); for 0.3mg vs
control, a higher rate of death (1.6 vs 0.7, per 100 pt-yrs); and for
0.5mg vs 0.3mg, higher rates of death (2.4 vs 1.6, per 100 pt-yrs),
stroke (2.0 vs 0.7, per 100 pt-yrs) and wound healing complications
(1.3 vs 0.5, per 100 pt-yrs). These imbalances were not seen in AMD
or RVO patients. No rate imbalances were seen in any indication for
other key systemic events including myocardial infarction,
cardiovascular events, hemorrhage, gastrointestinal perforation,
hypertension and proteinuria.
Conclusions: This meta-analysis represents the largest
comprehensive evaluation of ranibizumab safety data to date. These
data indicate a safety profile consistent with the previously-reported
safety profile of ranibizumab from individual randomized, controlled
clinical trials; however, the results of any meta-analyses should be
interpreted with caution due to their inherent limitations.
Commercial Relationships: Robert L. Avery, Alcon (C), Allergan
(C), Genentech (C), Novartis (C), Notal Vision (C), Ophthotech (C),
Replenish (C), Regeneron (C), Alexion (I), QLT (C), I-Tech JV
Development (I), alergan (F), genentech (F), genentech (R), allergan
(R), novartis (R), replenish (P), novartis (I), replenish (I), regenenron
(I), regenenron (R); Steven F. Francom, Genentech (E); Phillip Lai,
Genentech (E); Chad Melson, Genentech (C); Sung B. Cha,
Novartis Pharma (E); Lisa Tuomi, Genentech (E)
Program Number: 1536 Poster Board Number: C0026
Presentation Time: 8:30 AM - 10:15 AM
Prevalence and risk factors for Diabetic Retinopathy In an
Urban Chinese population: The Singapore Chinese Eye Study
Gavin S. Tan1, 2, Mohammad K. Ikram1, 2, Yingfeng Zheng1, 6, Merwyn
Chew1, Ching-Yu Cheng1, 2, Ecosse L. Lamoureux3, 1, Paul Mitchell4,
Jie Wang4, 3, E Shyong Tai5, Tien Y. Wong1, 2. 1Singapore Eye
research Institute, Singapore National Eye Centre, Singapore,
Singapore; 2Department of Ophthalmology, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore;
3
Centre for Eye Research Australia, University of Melbourne,
Melbourne, VIC, Australia; 4Centre for Vision Research, University
of Sydney, Sydney, NSW, Australia; 5Department of Endocrinology,
Yong Loo Lin School of Medicine, National University of Singapore,
Singapore, Singapore; 6State Key Laboratory of Ophthalmology,
Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou,
China.
Purpose: To describe the prevalence and risk factors for diabetic
retinopathy (DR) in an urban Chinese population in Singapore
Methods: A population-based study was conducted in 3,353
(response rate: 72.8%) Chinese, aged 40-80+ years, living in
Singapore. Participants underwent a comprehensive ocular
examination. Diabetes was defined in persons with random plasma
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
glucose ≥200mg/dl (11.1mmol/l), hemoglobin A1c[hbA1c] ≥6.5%,
self-reported physician-diagnosed diabetes, or the use of glucose
lowering medication. Retinal photographs, taken from both eyes,
were graded for the presence and severity of DR using the modified
Airlie House classification system. Vision-threatening diabetic
retinopathy (VTDR) was defined as severe non-proliferative DR,
proliferative DR or clinically significant macular edema. Agestandardized prevalence estimates were calculated using the 2010
Singapore adult population.
Results: The age-standardized prevalence of diabetes was 16.3%
(95% confidence interval [CI] 14.9,17.8), with 581 persons who had
diabetes and gradable photos for analysis of DR. The agestandardized prevalence was 26.1% (95% CI 20.8, 32.7) for any DR,
6.0% (95% CI 3.7, 9.8) for any macular edema and 7.0% (95% CI
4.5, 10.9) for VTDR. The age-standardized prevalence for minimal
DR, mild DR, moderate DR and severe or worse DR was 8.6%,
5.9%, 7.3% and 4.2% respectively. In multivariate analysis,
independent risk factors for any DR were, longer diabetes duration
(odds ratio [OR] 2.38, 95% CI 1.83, 3.09; per decade increase),
higher hbA1c (OR 1.22, 95% CI 1.04, 1.42 per % increase), higher
systolic blood pressure (OR 1.25, 95% CI 1.11, 1.41; per 10mmHg
increase), chronic kidney disease (OR 2.36, 95% CI 1.22, 4.56),
lower education (OR 2.47, 95% CI 1.42, 4.29; elementary school or
lower). Age (OR 0.59, 95% CI 0.44, 0.79; per decade increase) and
axial length (OR 0.79, 95% CI 0.65, 0.95 per mm increase) were
protective against any DR. Both VTDR and macular edema were
associated with longer diabetes duration, higher hbA1c and higher
systolic blood pressure. Older age was protective in macular edema.
Conclusions: One quarter of Chinese persons with diabetes in
Singapore have DR and 1 in 14 have vision-threatening stages of
retinopathy. Similar to other studies, classic risk factors explain the
majority of risk of DR and axial length was found to be protective.
Commercial Relationships: Gavin S. Tan, None; Mohammad K.
Ikram, None; Yingfeng Zheng, None; Merwyn Chew, None;
Ching-Yu Cheng, None; Ecosse L. Lamoureux, None; Paul
Mitchell, Novartis (R), Bayer (R); Jie Wang, None; E Shyong Tai,
None; Tien Y. Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer
(C), GSK (F), Roche (F)
Support: This study was supported by the Biomedical Research
Council (BMRC), 08/1/35/19/550, Singapore
Program Number: 1537 Poster Board Number: C0027
Presentation Time: 8:30 AM - 10:15 AM
Major Risk Factors of Diabetic Retinopathy and their Relative
Importance: a Meta-analysis Pooling Data from Individual
Subjects in 13 Studies
Jing Xie1, Barbara E. Klein2, Jonathan Shaw3, Miho Yasuda4,
Jacqueline M. Dekker5, Tarun Sharma6, Korapat Mayurasakorn7,
Viswanathan Mohan8, Ecosse L. Lamoureux1, 9, Tien Y. Wong1, 9.
1
Department of Ophthalmology, Centre for Eye Research, Royal
Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia;
2
Department of Ophthalmology and Visual Sciences, University of
Wisconsin School of Medicine and Public Health, Madison, WV;
3
Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia;
4
Department of Ophthalmology, Graduate School of Medical
Sciences, Kyushu University, Fukuoka, Japan; 5Department of
Epidemiology and Biostatistics, the EMGO Institute for Health and
Care Research, VU University Medical Center, Amsterdam,
Netherlands; 6Shri Bhagwan Mahavir Vitreoretinal Services, Tamil
Nadu, India; 7Department of Social Medicine, Samutsakhon General
Hospital, Samutsakhon, Thailand; 8Department of Ophthalmology,
Madras Diabetes Research Foundation, Chennai, India; 9Singapore
Eye Research Institute, Singapore National Eye Centre, National
University of Singapore, Singapore, Singapore.
Purpose: To determine the major risk factors for diabetic retinopathy
(DR) and their relative importance in over 7000 adults with type 2
diabetes, using participant-level data pooled from 13 populationbased studies.
Methods: A systematic literature review was conducted to identify
population-based studies that used retinal photographs to ascertain
DR and reported risk factors associated with DR for subjects with
type 2 diabetes. Investigators of identified studies were contacted and
asked to provide, from subjects with type 2 diabetes mellitus,
individual participant data on the presence or absence of DR and
known potential risk factors (age, gender, race, smoking, systolic
blood pressure, hypertension medication, diabetes treatment, duration
of diabetes, HbA1c, and total cholesterol). Data from all study
subjects were pooled and a meta-analysis was conducted using Stata.
Commonality analysis was performed in R to partition the regression
effects of the major risk factors into unique and common effects
using the pooled individual patient data. Unique effect identifies how
much variance is unique to a given risk factor and common effect
identifies the joint effects among risk factors.
Results: Thirteen studies were identified comprising 7397 subjects
aged 40+ years with type 2 diabetes mellitus. The pooled prevalence
of any DR was 24.1% (95% confidence interval [CI] 23.1%-25.1%.
After controlling for known risk factors, age (per year, Odds ratio
[OR] 1.23, 95% CI 1.04-1.45), systolic blood pressure (per 1 mmHg
increase, OR 1.01, 95% CI 1.01-1.01), duration of diabetes (per year,
OR 1.07, 95% CI 1.06-1.09), HbA1c (per %, OR 1.23, 95% CI 1.041.45) were associated with the presence of DR. Commonality
analysis identified the most important risk factor for DR as duration
of diabetes, explaining 4.9% and 4.8% of unique and common
variances of DR, respectively. The unique and common contribution
of HbA1c to DR was 3.37% and 1.52%, respectively. Forty-six
percent of the total explained variation in DR was due to joint effect
among the four major risk factors.
Conclusions: While diabetes duration, glycemic and blood pressure
control are associated with prevalent DR in type 2 diabetes, each
factor alone explain low amounts of the variability.
Commercial Relationships: Jing Xie, None; Barbara E. Klein,
None; Jonathan Shaw, None; Miho Yasuda, None; Jacqueline M.
Dekker, None; Tarun Sharma, None; Korapat Mayurasakorn,
None; Viswanathan Mohan, None; Ecosse L. Lamoureux, None;
Tien Y. Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer (C),
GSK (F), Roche (F)
Support: Global Health Outcome Research, Allergan, Inc (Irvine,
CA), The National Institutes of Health grant(EY-06594 )
Program Number: 1538 Poster Board Number: C0028
Presentation Time: 8:30 AM - 10:15 AM
Chronic Kidney Disease and Diabetic Retinopathy in an Asian
population
Charumathi Sabanayagam1, 5, Mohammad K. Ikram1, 4, Huang
Huiqi1, Paul Mitchell6, 7, Jie Wang6, 7, Su Chi Lim2, Ecosse L.
Lamoureux8, 1, E Shyong Tai3, 5, Tien Y. Wong1, 4. 1Singapore Eye
Research Institute, Singapore, Singapore; 2Khoo Teck Puat Hospital,
Singapore, Singapore; 3Department of Medicine, National University
of Singapore, Singapore, Singapore; 4Ophthalmology, National
University of Singapore, Singapore, Singapore; 5Duke-NUS Graduate
Medical School, Singapore, Singapore; 6Department of
Ophthalmology, Centre for Vision Research, University of Sydney,
Australia, NSW, Australia; 7Westmead Millennium Institute,
Australia, NSW, Australia; 8Department of Ophthalmology, Centre
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
for Eye Research Australia, University of Melbourne, Australia, VIC,
Australia.
Purpose: Diabetic nephropathy (DN) is commonly associated with
diabetic retinopathy (DR). Few studies have demonstrated that
chronic kidney disease (CKD) defined as an estimated glomerular
filtration rate (eGFR) <60 mL/min/1.73m2 is associated with DR. We
hypothesized that the association between CKD and DR would be
stronger in the presence of microalbuminuria, an early marker of DN.
Methods: 301 participants with diabetes and of Chinese, Malay and
Indian ethnicity aged ≥40 years who participated in the Singapore
Prospective Study Program were included. Diabetes was defined
according to the recent American Diabetes Association guidelines.
Retinal photographs taken from both eyes were graded for DR using
the modified Airlie House Classification. Based on the presence of
CKD and micro/macroalbuminuria (urinary albumin-to-creatinine
ratio ≥30) we defined 4 categories: 1) no CKD and
normoalbuminuria (referent) 2) no CKD and
micro/macroalbuminuria 3) CKD and normoalbuminuria 4) CKD and
micro/macroalbuminuria. We calculated the odds ratios (OR) and
95% confidence interval (CI) of any-DR associated with CKD (n=
54) and micro/macroalbuminuria (n=116) separately and in
combination adjusting for potential confounders. We validated our
findings, using an independent cohort of Malay adults (n=265) with
similar methodology in Singapore.
Results: The prevalence of any-DR was 32.9% in the study
population. In separate models, micro/macroalbuminuria was
significantly associated with any-DR (OR [95% CI] = 2.27 [1.323.91]). However, CKD was not significantly associated with any-DR
(1.39 [0.70-2.77]). In the combination model, compared to the
referent group, the OR (95% CI) of any-DR were: 2.30 (1.26-4.19)
for no CKD and micro/macroalbuminuria, 1.38 (0.49-3.87) for CKD
and normoalbuminuria, 2.73 [1.10-6.77] for CKD and
micro/macroalbuminuria. Similar findings for any-DR were observed
in the replication cohort (3.86 [1.34-9.09] for no CKD and
micro/macroalbuminuria, 1.89 (0.56-6.06) for CKD and
normoalbuminuria, 4.86 [1.91-12.36] for CKD and
micro/macroalbuminuria.
Conclusions: We found that in a multi-ethnic sample of Asian adults,
CKD is strongly associated with DR in the presence of
micro/macroalbuminuria. Our findings suggest that in the presence of
micro/macroalbuminuria, CKD is more likely to be due to DN and
therefore more closely associated with DR suggesting a common
microvascular pathogenesis.
Commercial Relationships: Charumathi Sabanayagam, None;
Mohammad K. Ikram, None; Huang Huiqi, None; Paul Mitchell,
Novartis (R), Bayer (R); Jie Wang, None; Su Chi Lim, None;
Ecosse L. Lamoureux, None; E Shyong Tai, None; Tien Y. Wong,
Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche
(F)
Support: BMRC Grant 03/1/27/18/216 (SP2) and NMRC Grants
0838/2004, NMRC TA, R927/36/2012 (CS)
Program Number: 1539 Poster Board Number: C0029
Presentation Time: 8:30 AM - 10:15 AM
Impact of Sociodemographic Factors and Glycosylated
Hemoglobin on the Incidence of Diabetic Macular Edema in a
Large Nationwide Sample
Mehnaz Khan, Nidhi Talwar, Joshua D. Stein. Kellogg Eye Cnter,
Ann Arbor, MI.
Purpose: To determine the extent to which sociodemographic factors
and glucose control affect the incidence of developing diabetic
macular edema (DME).
Methods: All enrollees with diabetes mellitus age ≥ 30 years who
were continuously enrolled in a large managed care network for at
least three years and had one or more visits to an eye-care provider
were identified. Enrollees with pre-existing DME were excluded.
Incidence rates of DME were determined for individuals of different
sociodemographic backgrounds and for persons with different
baseline levels of glycosylated hemoglobin (HbA1c).
Results: Of the 447407 individuals in the medical plan who met the
inclusion criteria, 6473 persons (0.63%) developed DME. The DME
incidence rate increased from 0.34% among 30-40 year olds to 0.89%
among 70-80 year olds. Blacks (0.78%) and Latinos (0.68%) had
higher incidence rates of DME relative to whites (0.62%) and Asians
(0.55%). Enrollees with college diplomas had lower DME incidence
than those with < high school education (0.57% vs. 0.74%).
Likewise, those with incomes <$30,000 had a higher incidence of
DME compared to those earning over $125,000 (0.76% vs. 0.56%).
DME incidence rose dramatically among those with poor glucose
control from 0.24% for those with an HbA1c of 6-7 to 0.90% for
those with an HbA1c of 9-10, to 1.27%for those with an HbA1c of
11-12. Compared to those with HbA1cs of 6-7, persons with HbA1cs
of 11-12 had > 5 fold increased risk of developing DME (RR=5.23,
2.77-9.86).
Conclusions: Incidence of DME is influenced by sociodemographic
factors as well as baseline HbA1c levels. The DME incidence
estimates generated from this analysis can be used to make
projections of the number of patients in the United States who will
develop DME over the next 10 years and to help health policymakers anticipate the resources that will be required to care for
persons who develop DME in the coming years.
Commercial Relationships: Mehnaz Khan, None; Nidhi Talwar,
None; Joshua D. Stein, University of Michigan - time to next
glaucoma test algorithm patent (P)
Support: Grant P30DK092926 (MCDTR) from the National Institute
of Diabetes and Digestive and Kidney Diseases, National Eye
Institute K23 Mentored Clinician Scientist Award (1K23EY01951101), Research to Prevent Blindness "Physician Scientist Award",
unrestricted grant from Research to Prevent Blindness
Program Number: 1540 Poster Board Number: C0030
Presentation Time: 8:30 AM - 10:15 AM
Risk Factors Associated with Diabetic Macular Edema: A
Longitudinal Analysis of 447,407 Persons with Diabetes in a U.S.
Managed Care Network
Nidhi Talwar, Mehnaz Khan, Thomas W. Gardner, Joshua D. Stein.
Department of Ophthalmology and Visual Sciences, University of
Michigan, Ann Arbor, MI.
Purpose: To determine risk factors associated with development of a
diabetic macular edema (DME) among a large group of enrollees in a
large managed care network throughout the United States.
Methods: All beneficiaries with a diagnosis of diabetes, age ≥30
years, who were continuously enrolled for ≥3 years in a nationwide
managed care network from 2001-2011, and with ≥1 visit to an eyecare provider during that time were identified. Non-incident cases of
DME were excluded. Multivariable Cox regression analyses were
performed to identify socio-demographic factors, ocular and nonocular conditions that were associated with the development of a
DME.
Results: Of the 447407 enrollees who met the inclusion criteria,
6473 (1.45%) developed DME over 5.3 ± 2.0 years. After adjustment
for confounding factors, blacks (adjusted hazard ratio (HR)=1.14,
95% confidence interval (CI) 1.04-1.26, p=0.0074) and Latinos
(HR=1.28, 95% CI 1.16-1.42, p<0.0001) had an increased hazard of
developing DME relative to whites. Individuals with diabetic
neuropathy (HR=1.59, 95% CI 1.50-1.69, p<0.0001) or diabetic
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
nephropathy (HR=1.41, 95% CI 1.32-1.50, p<0.0001) were also more
likely to develop DME compared to those without these conditions.
Compared to those with no hypertension, persons with uncomplicated
hypertension had a 25% increased hazard of DME (HR=1.25, 95%
CI 1.11-1.40, p=0.0002), and those with end-organ damage caused by
hypertension had a 45% increased hazard of developing DME
(HR=1.45, 95% CI 1.28-1.64, p<0.0001). Those with hyperlipidemia
had a reduced risk for DME (HR=0.81, 95% CI 0.73-0.91,
p=0.0002). The hazard of DME was almost doubled for those with
type I diabetes (HR=1.97, 95% CI 1.85-2.09, p<0.0001). The
baseline value of HbA1c lab test was also a significant predictor, with
each unit increase in the measured value associated with a 16%
increase in the hazard for DME (HR=1.16, 95% CI 1.09-1.24,
p<0.0001).
Conclusions: Our study has identified several risk factors that are
associated with development of DME. These risk factors can be
incorporated into a risk calculator to educate patients of their risk of
DME and the impact of modifiable risk factors on risk of DME.
Commercial Relationships: Nidhi Talwar, None; Mehnaz Khan,
None; Thomas W. Gardner, Kalvista (C), Aerpio (C), Akebia (C),
Penn State University (P); Joshua D. Stein, University of Michigan time to next glaucoma test algorithm patent (P)
Support: Grant P30DK092926 (MCDTR) from the National Institute
of Diabetes and Digestive and Kidney Diseases, National Eye
Institute K23 Mentored Clinician Scientist Award (1K23EY01951101), Research to Prevent Blindness “Physician Scientist Award”,
unrestricted grant from Research to Prevent Blindness, EY20852,
Taubman Institute, RPB Physician-Scholar Award
Program Number: 1541 Poster Board Number: C0031
Presentation Time: 8:30 AM - 10:15 AM
Twenty Years On. More or Less Diabetic Retinopathy at
Diagnosis of Type 2 Diabetes?
Ahmed Sallam, Irene M. Stratton, Steve Aldington, Mark G. Histed,
Peter H. Scanlon. Diabetic Retinopathy Research Group,
Gloucestershire Hospitals NHS Trust, Cheltenham, United Kingdom.
Purpose: To compare characteristics of patients newly diagnosed
with Type 2 diabetes mellitus with those recruited to UK Prospective
Diabetes Study (UKPDS), a large-scale clinical trial on 5102 people
newly diagnosed with Type 2 diabetes between 1978 and1990
Methods: In England the Diabetic Eye Screening programme advises
annual digital retinal screening for everyone aged 12 or above. Data
were collected for patients on the screening register of
Gloucestershire Programme in UK. Grading outcomes were extracted
from the screening programme database and clinical information
extracted from primary care records for those diagnosed with Type 2
diabetes between 2005 and 2012. Clinical characteristics and diabetic
retinopathy (DR) grading outcomes from Gloucestershire patients
aged 65 or below were compared with data from patients in UKPDS.
Results: Data were available for 2,070 men and 1,375 women of
whom 1,403 (68%) men and 990 (72%) women had no retinopathy.
Of those with DR, 20% had microaneurysms in one eye, 9% had
microaneurysms in both eyes and 2% had more advanced retinopathy
that required referral to the hospital eye service defined as moderate
to severe non proliferative DR equivalent to levels 43 - 53 on the
Early Treatment Diabetic Retinopathy Study (ETDRS) scale;
proliferative DR equivalent to a minimum of ETDRS level 61 or the
presence of 2-dimensional photographic markers of diabetic
maculopathy, specifically exudate within 1 disc diameter (DD) of the
centre of the fovea, circinate or group of exudates within the macula
or any microaneurysm or haemorrhage within 1DD of the centre of
the fovea but only if associated with VA of worse than 0.3 LogMAR.
There was more retinopathy in men than women (p=0.0033). Patients
were of similar age to those in UKPDS but had lower HbA1c (mean
difference -1.8%), higher systolic and diastolic blood pressure (+7
and+2 mmHg, respectively) and were heavier (BMI +4 kg/m2).
Proportionately more in UKPDS had DR (39% men and 34%
women) and more had referable DR (15% and 11%, p<0.0001).
Conclusions: Patients in this screening programme have lower rates
of any DR and referable DR, and are less hyperglycaemic. However
they have higher blood pressure and are heavier than those recruited
to UKPDS. This has implications for screening programs and risk
estimation.
Commercial Relationships: Ahmed Sallam, None; Irene M.
Stratton, None; Steve Aldington, None; Mark G. Histed, None;
Peter H. Scanlon, None
Program Number: 1542 Poster Board Number: C0032
Presentation Time: 8:30 AM - 10:15 AM
Prevalence and Progression of Diabetic Retinopathy in Rural
China: The Handan Eye Study
Wang Fenghua1, Yuanbo Liang2, Jie Jin Wang3, Tien Y. Wong4,
Ningli Wang1. 1Ophthalmology, Beijing Tongren Eye Center,
Beijing, China; 2Ophthalmology and Visual Sciences, The Chinese
University of Hong Kong, Hong Kong, China; 3University of Sydney,
Sydney, VIC, Australia; 4Singapore Eye Research Institute,
Singapore, Singapore.
Purpose: To describe the age- and gender-specific prevalence,
characteristics and 6 years’ progression of diabetic retinopathy (DR)
in a rural population in northern China.
Methods: 6830 Han Chinese aged 30 years and older from 13
villages of Yongnian County, Handan city, Hebei province,were
examined during the year 2006-2007. Participants were subsequently
invited to attend 6-year follow-up exams in 2012. All participants
underwent a standardized interview, a comprehensive eye
examination and fasting blood glucose testing according to the
American Diabetes Association diagnostic criteria (fasting plasma
glucose ≥7.0 mmol/l). Retinal photographs obtained after pupil
dilation were graded for presence and severity of DR according to the
modified Early Treatment Diabetic Retinopathy Study (ETDRS)
classification system.
Results: Of the 6830 eligible individuals participating in the study,
5597 (81.9%) had fasting blood glucose results available. Of these,
387 (6.9%) participants were diagnosed with diabetes mellitus,
including 247 newly diagnosed subjects (NDM) and 140 known
diabetic subjects (KDM). The overall prevalence of DR was 43.1%
(95% CI: 38.1, 48.4) and was higher in persons with KDM (65.2%)
than NDM (33.5%). The prevalence of proliferative DR, macular
edema and vision-threatening retinopathy were 1.6%, 5.2% and 6.3%
respectively, with 12.1% with KDM having untreated visionthreatening DR. In multiple logistic regression models for all diabetic
participants, independent risk factors for DR were longer duration of
diabetes (OR 3.07, 95% CI:1.94, 4.85, per 5 years of duration),
higher FPG levels (OR 1.17; 95% CI: 1.08, 1.27, per mmol/l
increase) and higher systolic blood pressure (OR 1.22; 95% CI: 1.08,
1.37, per 10 mmHg increase). The 6-year incidence and progression
of diabetic retinopathy are being analyzing now.
Conclusions: Our study reports a high prevalence of DR among
adults 30 years and older with diabetes in rural China. Based on
estimates obtained from our study, we projected that in rural China,
21.1 million persons aged 30+ years have diabetes and 9.2 million
have DR, including 1.3 million with vision-threatening DR. In rural
Chinese persons with diabetes, longer diabetes duration,
hyperglycemia and elevated blood pressure are risk factors for
DR.There is a pressing need for appropriate screening and
management of diabetes and its complications in rural China.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Wang Fenghua, None; Yuanbo
Liang, None; Jie Jin Wang, None; Tien Y. Wong, Allergan (C),
Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche (F); Ningli
Wang, None
Support: This study was supported by National Basic Research
Program of China (973 Program)(No.2007CB512201) from the
Ministry of Science and Technology of the P.R. China, the Program
of Health Policy for blindness prevention from P.R. China,, Partially
founded by the Key Technologies R&D Program(No.2006-10903
)from Bureau of Science and Technology of Handan city, P.R. China.
With additional supports from Beijing Tongren Hospital and key
discipline fund of Bureau of Health, Handan city, P.R. China
Program Number: 1543 Poster Board Number: C0033
Presentation Time: 8:30 AM - 10:15 AM
Cost of a Community-Based Diabetic Retinopathy Screening
Program
Margaret Byrne1, 3, Byron L. Lam2, Dorothy F. Parker3, Manuel
Ocasio1, Jenelle Lin1, David J. Lee1, 3. 1Epidemiology and Public
Health, University of Miami, Miami, FL; 2Bascom Palmer Eye
Institute, University of Miami, Miami, FL; 3Sylvester Comprehensive
Cancer Center, University of Miami, Miami, FL.
Purpose: To assess the costs associated with a community-based
program to screen adults for diabetic retinopathy.
Methods: As part of a multi-center national research initiative, vision
screening for diabetics was offered at a community health center in a
low socioeconomic area of Miami-Dade County. A non-mydriatic
fundus camera was used to screen for diabetic retinopathy. Visual
acuity was also tested. Fundus photos were transmitted electronically
to and graded at a remote reading center. Referrals for clinical care
were made when needed. Data were collected on start-up costs, such
as equipment, and on continuing costs, including personnel, fees for
reading retinal scans, and supplies. Costs associated with research
were not included. Total costs, cost per person screened and per
referral were calculated. Start-up costs were distributed over the total
number of individuals planned to be screened (500) and per referral,
for a conservative assessment of total cost per screening and referral.
For sensitivity analyses, we assumed a 3 and 5 year life-span for
equipment and recalculated cost per screening and referral.
Results: In the first 9 months, 477 adults were screened. This
included 210 (44%) blacks, 260 (55%), Hispanics, 306 (64%)
women, and 73 (15%) current smokers. The average age of
participants was 55.8 years (sd 9.5) and average time since a diabetes
diagnosis of 9.6 years (sd 8.3). 79% had no health insurance, 44%
had not had an eye exam in the last 2 years, and 10% had never had
an eye exam. Referrals were made for 121 abnormal scans. The table
shows start-up and continuing costs, and continuing costs per scan
and per referral. Total cost of the intervention to date is $85,714.
Distributing all start-up costs among the 477 participants, cost per
screening was $177 and the cost per patient referred was $708. With
the less conservative assumption that the camera and equipment will
last 3 years, the estimated cost per screening was $135 and cost per
problem detected was $531; with a 5 year assumption, estimates were
$129 and $507 respectively.
Conclusions: Among the participants screened, the majority did not
have health insurance, many had not had a recent eye exam, and
follow-up referrals were needed for 25%, demonstrating the need for
this type of screening program. The relatively low cost of the
program, particularly per referral, illustrates that such a communitybased screening intervention could be widely adopted.
Commercial Relationships: Margaret Byrne, None; Byron L.
Lam, None; Dorothy F. Parker, None; Manuel Ocasio, None;
Jenelle Lin, None; David J. Lee, None
Support: CDC contract U58DP002652-02
Program Number: 1544 Poster Board Number: C0034
Presentation Time: 8:30 AM - 10:15 AM
Factors that contribute to vision-related quality of life scores in
patients with diabetic retinopathy
Roxanne Crosby-Nwaobi1, Angus Forbes1, Sobha Sivaprasad2.
1
Florence Nightingale School of Nursing and Midwifery, King's
College London, London, United Kingdom; 2Laser and Retinal Unit,
King's College Hospital, London, United Kingdom.
Purpose: To determine the impact of severity of diabetic retinopathy
(DR), visual acuity and diabetes related stress on vision related
quality of life in patients with diabetic retinopathy.
Methods: 372 men and women with T2D were stratified by severity
of DR into no retinopathy and proliferative diabetic retinopathy
(PDR). Each subject underwent tests of diabetes related distress
(PAID), vision-related quality of life (NEI-VFQ25), best corrected
visual acuity (BCVA)[logMAR], ophthalmic and physical
examination. Bivariate analysis between categories of DR; linear
regression was conducted for the NEI-VFQ-25 by DR severity
adjusting for age, gender, HbA1c and PAID were conducted using
SPSS v17.
Results: The mean NEI-VFQ-25 for the PDR group was significantly
lower when compared to the group with no retinopathy, 86.2±10.7 vs.
75.8±20.4, p=<0.001, where lower score=decreased vision-related
quality of life. BCVA (0.09±0.13 vs. 0.19±0.21, p< 0.001) and
HbA1c (8.0±1.8 vs. 8.7±2.0, p=0.007) were also significantly
different between the two groups of retinopathy. PAID was not
significant between the groups. NEI-VFQ-25 was inversely
correlated to logMAR BCVA (r=-0.052, p<0.001) and PAID (r=0.219, p<0.001). Gender differences were found for NEI-VFQ-25 by
DR severity; men showed significantly higher NEI-VFQ-25 scores
when compared to women (no retinopathy: 88.8±9.5 vs. 88.3±11.3,
p=0.002 and PDR: 79.4±19.7 vs. 71.4±20.4, p=0.030). On full
adjustment of the model, NEI-VFQ-25 was significantly associated
with severity of retinopathy (no retinopathy: 84.3±1.1 vs. PDR:
79.0±191.2, p<0.001) with BCVA accounting for 20% of the
variance in the model.
Conclusions: NEI-VFQ-25 is independently associated with severity
of DR and visual acuity only accounts for 20% of the variance.
Commercial Relationships: Roxanne Crosby-Nwaobi, None;
Angus Forbes, None; Sobha Sivaprasad, Allergan (F), Bayer (F),
Novartis (F)
Support: King's College Research and Development Initiative Grant
2009
Program Number: 1545 Poster Board Number: C0035
Presentation Time: 8:30 AM - 10:15 AM
Epidemiological study of diabetic retinopathy in community
diabetic care program in Beijing urban area
Yanhong Zou1, Qian Li1, Ning Zhang1, Wei Jia2, Xipu Liu2, 1. 1First
Hospital of Tsinghua University, Beijing, China; 2Sekwa Eye
Hospital, Beijing, China.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Purpose: To investigate the prevalence and risk factors of diabetic
retinopathy (DR) in type 2 diabetes patients in community diabetic
care program in Beijing urban area.
Methods: Four community health clinics were selected randomly
from Desheng Community Health Center in Beijing. Based on the
health records, type 2 diabetes patients, who have participated in
community diabetic care program and visited the community health
clinics regularly during the past half year, were enrolled into this
study. Appointments of eye examination were made through
telephone calls. An investigation group including three eye
physicians or nurses conducted the survey in the local health clinics.
Patient demographics and medical history were collected. Two-field
45 degree color fundus images were taken through an undilated pupil.
Visual acuity and anterior segment of the eyes were also checked. A
questionnaire survey about community care was conducted face to
face. The retina was graded using Scottish Diabetic Retinopathy
Grading System 2003. Data collection was secured with the EpiData
and statistical analysis was performed using the R software.
Results: A total of 720 patients were enrolled in the study from
November 2011 to May 2012. Among them, 519 (72.1%)
participated in the survey. The mean age of the patients was 69.3
years (60.4-78.2), the mean duration of diabetes was 11.2 years (2.819.6), and the mean level of random blood glucose was 9.4 mmol/L
(5.9-12.9). Good quality photos were taken in 85.8% (445/519) of the
right eye and 88.1% of the left eye. Among all the eyes with qualified
photos, there were 76.2% without any DR, 16.6% with mild
nonproliferative DR (R1), and 7.2% with referable DR. Only 477
patients (91.9%) with qualified retina photos in at least one eye were
included in the logistic regression analysis. Logistic regression
revealed that the duration of diabetes and the level of systemic blood
pressure were positively associated with the present of diabetic
retinopathy. No significant relation was found between DR and
community interventions.
Conclusions: Duration of diabetes is one of the main risk factors of
diabetic retinopathy in this study which suggests that close
observation is required for patients with long duration. Optimal
control of blood pressure is also important for reducing retinopathy in
community diabetic care.
Commercial Relationships: Yanhong Zou, None; Qian Li, None;
Ning Zhang, None; Wei Jia, None; Xipu Liu, None
Support: Capital Medical Science Research and Development Fund
(2009-2034) Tsinghua-Yue-Yuen medical Science Fund (grant
20240000564)
Program Number: 1546 Poster Board Number: C0036
Presentation Time: 8:30 AM - 10:15 AM
Cost-utility analysis of screening program for diabetic
retinopathy in Japan: a probabilistic Markov modeling study
Ryo Kawasaki1, Yoko Akune2, Yoshimune Hiratsuka3, Masakazu
Yamada2. 1Dept of Public Health/Dept of Ophthalmology, Yamagata
University, Yamagata, Japan; 2National Institute of Sensory Organs,,
National Tokyo Med Center, Tokyo, Japan; 3National Institute of
Public Health, Saitama, Japan.
Purpose: To evaluate the cost-effectiveness of screening program for
diabetic retinopathy through the estimation of the incremental costs
per Quality Adjusted Life Years (QALYs) gained using the best
available clinical data and scenario in Japan.
Methods: We framed a Markov model with a probabilistic cohort
analysis to calculate the incremental costs per QALY gained by
implementing screening program for diabetic retinopathy in Japan. A
one-year cycle length and a population size of 50000 with 50 years
time horizon (age 40 to 90 years old) were applied. Best available
clinical data were collected from publications and a model was
designed with data on the course of diabetic retinopathy including
diagnosis, treatment and visual outcomes. We then simulated
uncertainties using univariate and probabilistic sensitivity analysis.
Results: In base-case analysis, screening program for diabetic
retinopathy was associated with incremental costs of Japanese yen
(JPY) 5147 (US$64.6) and incremental effectiveness of 0.0054
QALYs per one screened person. The incremental cost effectiveness
ratio (ICER) was JPY 944,981 (US$11,857) per QALY. Although
reduction of low vision was modest (-5%), our simulation
demonstrated significant reduction in persons with blindness (-16%)
by screening for diabetic retinopathy. Our sensitivity analysis
demonstrated that the most cost-effective screening program for
diabetic retinopathy in Japan was to start screening at age of 53 years
old with less than 5 years interval up to 84 years old.
Conclusions: Screening program for diabetic retinopathy in Japan is
cost-effective even allowing for the uncertainty of the known
variability that exists in estimates of costs, utilities, and
complications rate. Further studies are warranted to determine the
most effective screening strategy for preventing blindness from
diabetic retinopathy.
Commercial Relationships: Ryo Kawasaki, None; Yoko Akune,
None; Yoshimune Hiratsuka, None; Masakazu Yamada, None
Support: Supported by a grant from the Ministry of Health, Labor,
and Welfare, Japan.
Program Number: 1547 Poster Board Number: C0037
Presentation Time: 8:30 AM - 10:15 AM
A Multi-Center Study of Diabetes Eye Screening in Community
Settings in the United States
Cynthia Owsley1, David S. Friedman2, Julia A. Haller3, David J.
Lee4, Jinan Saaddine5. 1Ophthalmology, Univ of Alabama at
Birmingham, Birmingham, AL; 2Ophthalmology, Johns Hopkins
University, Baltimore, MD; 3Ophthalmology, Wills Eye Institute,
Philadelphia, PA; 4Epidemiology & Public Health, University of
Miami, Miami, FL; 5Division of Diabetes Translation, Centers for
Disease Control & Prevention, Atlanta, GA.
Purpose: To examine the feasibility of using non-invasive, nonmydriatic fundus imaging in community-based clinic and pharmacy
settings to screen for diabetic retinopathy (DR) among persons
diagnosed with diabetes from underserved populations.
Methods: Five study settings were identified through CDC’s
INSIGHT Collaborative Research Network: 2 primary health care
clinics (community health center, Miami; county hospital clinic,
Birmingham AL) and 3 pharmacies (Philadelphia; Baltimore;
Mountain Air NM). Persons with diabetes presenting at these settings
were invited to participate in a DR screening consisting of nonmydriatic fundus imaging performed by trained technicians. Images
were electronically transmitted to the Wills Eye Telemedicine
Reading Center and graded by trained staff using a system based on
the UK National Health Service’s classification for DR. Results were
relayed to site coordinators who notified participants of results. Those
with positive findings were recommended to seek comprehensive eye
care in a timely fashion; guidance was provided to participants who
needed assistance in accessing follow-up eye care.
Results: To date a total of 1,515 persons were screened (M age 54,
SD 10). Race/ethnicity was 63% Black, 19% Hispanic, 11% White,
7% other. Self-reported time since diabetes diagnosis averaged 9
years. 43% reported that their most recent dilated eye exam was ≥2
years ago. 22% had DR (any type) in at least one eye, the vast
majority being background DR (93%). Likelihood of DR increased
with diabetes duration (p<.0001). The DR prevalence was higher in
patients seen in clinic than in pharmacy settings (24% vs. 16%,
p=.0004), regardless of race/ethnicity. DR prevalence was unrelated
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
to recency of self-reported dilated eye exam. Other ocular lesions
(OL) (e.g., cataract, hypertensive retinopathy) were noted by graders,
with 44% of participants having OLs in at least one eye; half had
cataract. 12% of images were deemed unreadable by the reading
center, which was unrelated to cataract presence.
Conclusions: Diabetic retinopathy was detected in about 1 in 4
persons with diabetes screened in these primary care clinic and
pharmacy settings serving underserved populations. We are currently
examining the rate of follow-up comprehensive eye care in those who
screened positive and collecting participants’ feedback on the
screening process.
Commercial Relationships: Cynthia Owsley, Genentech (F), Patent
Licensed to: MacuLogix (P), Allergan (R); David S. Friedman,
Alcon (C), Bausch & Lomb (C), Merck (C), QLT, Inc (C), Allergan
(C), Nidek (C); Julia A. Haller, Allergan (F), Advanced Cell
Technology (C), Regeneron (C), Merck (C), Second Sight (C),
KalVista (C), ThromboGenics (C), Optimedica (I); David J. Lee,
None; Jinan Saaddine, None
Support: CDC (5U58DP002651, 1U58DP002652, 5U58DP002653,
1U58DP002655), Alcon Research Institute, EyeSight Foundation of
Alabama, Research to Prevent Blindness, Buck Trust, Nidek
Program Number: 1548 Poster Board Number: C0038
Presentation Time: 8:30 AM - 10:15 AM
Effectiveness of Telemedicine Strategies for Diabetic Retinopathy
Screening: A Systematic Review
Andrea C. Coronado1, 2, Hargurinder Singh1, 2, John Costella1,
Monali Malvankar2, 1, Bin Xie1, William G. Hodge2, 1. 1Epidemiology
& Biostatistics, Western University, London, ON, Canada; 2Ivey Eye
Group, St. Joseph's Hospital, Western University, London, ON,
Canada.
Purpose: Telemedicine has been described as a promising alternative
that facilitates compliance to healthcare guidelines regardless of
geographic constraints, promoting consistency of health services
delivery. To evaluate whether the existing evidence justifies the
implementation of telemedicine programs for diabetic retinopathy
screening, we conducted a systematic review of diagnostic accuracy
of telemedical tools for diabetic retinopathy screening in adults.
Methods: Search strategy A structured search was conducted among
six databases (Medline, EMBASE, CINAHL, BIOSIS, Web of
Science, Cochrane library) from January 1998 to July 2012, with no
language or study design restrictions. Subject headings and free text
terms were tailored to each of the electronic databases. Searches were
supplemented by handsearching the bibliographies of included
studies; grey literature was also consulted.Screening & data
collection First, titles and abstracts were reviewed to identify
potentially relevant articles. Next, full-text articles from included
citations were retrieved to closely assess inclusion and exclusion
criteria. Two reviewers independently assessed all citations and
disagreements were solved by discussion. Remaining discrepancies
were reconciled by an ophthalmologist. A single reviewer performed
the data collection using predefined data fields, and data abstraction
was audited by a second reviewer. QUADAS-2 guidelines were used
to assess methodological quality of included studies.
Results: 1060 articles were screened, from which 156 were
shortlisted for full-text assessment. Using pre-specified inclusion and
exclusion criteria, 27 studies were deemed relevant for this review.
Data were divided into two subgroups according to detection criteria
(any retinopathy or referable retinopathy). For detection of any
retinopathy, sensitivity and specificity were 84.7% (95% CI: 79%90%) and 93.1% (95% CI: 89.7%-96.4%), respectively. For detection
of referable retinopathy, values were 86.4% (95% CI: 83.1%-89.6%)
and 92.1% (95% CI: 89.5%-94.7%), respectively.
Conclusions: Diagnostic accuracy of telemedicine strategies for
diabetic retinopathy screening meets British Diabetic Association
recommendations (sensitivity 80%, specificity 95%), although
specificity was slightly lower. Results from the referable retinopathy
subgroup should be cautiously interpreted, since studies used diverse
grading guidelines.
Commercial Relationships: Andrea C. Coronado, None;
Hargurinder Singh, None; John Costella, None; Monali
Malvankar, None; Bin Xie, None; William G. Hodge, None
Support: Ontario Innovation Fund
Program Number: 1549 Poster Board Number: C0039
Presentation Time: 8:30 AM - 10:15 AM
Long-term comparative effectiveness of telemedicine to detect
diabetic retinopathy
Steven L. Mansberger1, 2, Stuart K. Gardiner1, Shaban Demirel1,
Thomas Becker2. 1Devers Eye Institute, Portland, OR; 2Public Health
and Preventive Medicine, Oregon Health & Science University,
Portland, OR.
Purpose: To determine the long-term comparative effectiveness of
telemedicine for providing diabetic retinopathy screening exams in
community health clinics with a high proportion of minorities
including American Indian/Alaska Natives.
Methods: We enrolled 567 participants with diabetes into a
multicenter, randomized controlled trial with a staged intervention.
We assigned diabetic participants to one of two groups: 1)
telemedicine with a non-mydriatic camera in a primary medical
clinic; or 2) traditional surveillance with an eye care provider. After
two years, the trial offered telemedicine to all participants. We
determined the proportion of diabetic retinopathy screening exams
during each year after enrollment using an intention-to-treat analysis.
We graded diabetic retinopathy using a validated scale from Stage 0
(none) to Stage 4 (proliferative diabetic retinopathy).
Results: The Telemedicine group (n=296) was more likely to receive
a diabetic screening exam when compared to the Traditional
Surveillance group (n=271) during Year 1 (91.9 vs. 43.9%, P<.001),
and Year 2 (53.0 vs. 33.2%, P<.001). However, after the trial offered
telemedicine to both groups, the proportion of diabetic screening
exams was similar between groups for the subsequent years (Year 3,
44.3 vs. 39.5%, P=.25; Year 4, 45.9 vs. 46.1%, P=.96; Year 5, 47.6
vs. 51.3%, P=.38). Using a cut-off of ‘moderate diabetic retinopathy
or worse’ as requiring referral to an ophthalmologist, only 8.3%,
6.2%, 3.9%, 6.4%, and 5.2% of participant would require referral
during Year 1, 2, 3, 4, and 5, respectively.
Conclusions: Telemedicine in the primary medical clinic using nonmydriatic cameras increased the proportion of participants who
obtained diabetic screening exams when compared to traditional
surveillance, and most patients did not have levels of diabetic
retinopathy requiring a referral to an ophthalmologist. Telemedicine
may be a more effective way to screen patients for diabetic
retinopathy, and to triage further evaluation with an eye care provider
when compared to traditional surveillance by an eye care provider.
The staged intervention suggests that telemedicine would increase the
proportion of diabetic screening exams over the long-term, but the
decrease in the proportion of diabetic screening exam in both groups
suggests that other barriers to diabetic screening exist even when
telemedicine is available.
Commercial Relationships: Steven L. Mansberger, Merck (R),
Alcon (C), Allergan (C), Allergan (F), Merck (F), Santen (C),
Glaukos (C); Stuart K. Gardiner, Allergan (R); Shaban Demirel,
Carl Zeiss Meditec (F), Heidelberg Engineering (R), Heidelberg
Engineering (F); Thomas Becker, None
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Support: NEI 5 K23 EY0155501-01, The Centers for Disease
Control and Prevention (CDC U48DP000024-01 and
1U48DP002673-01)
Clinical Trial: NCT01364129
Program Number: 1550 Poster Board Number: C0040
Presentation Time: 8:30 AM - 10:15 AM
Teleretinal Screening in Mexico: a Pilot Project as part of a
Comprehensive Diabetes Care Clinic in Monterrey, México
Gilberto Zamora1, Javier A. Lozano2, Richard VanNess1, Sheila C.
Nemeth1, Omar Meza2, Eduardo Martiñón2, Elizabeth McGrew1,
Peter Soliz3. 1VisionQuest Biomedical, LLC, Albuquerque, NM;
2
Clínicas del Azúcar S.A.P.I. de C.V., Monterrey, Mexico;
3
Ophthalmology and Visual Sciences, University of Iowa, Iowa City,
IA.
Purpose: To conduct a proof of feasibility study for teleretinal
screening services in a comprehensive diabetes care clinic in
Monterrey, México.
Methods: A pilot project between VisionQuest Biomedical and
Clínicas del Azúcar provides teleretinal screening services to the
clinic’s patient members, who all have diabetes. Patients are imaged
using a teleretinal screening system for assessment of diabetic
retinopathy as part of their standard of care. The retinal camera is a
Canon CR 2, 45-degree, non-mydriatic camera. The imaging protocol
includes two images of the retina, one macula-centered and one
optic-disc-centered, and one anterior image, for each eye. Images are
uploaded automatically to a web-based PACS. Images are read
according to the International Clinical Diabetic Retinopathy Grading
Scale. Preliminary readings are provided by a certified ophthalmic
medical technologist in Albuquerque (USA) within 48 hours.
Licensed chronic disease medical doctors at Clínicas del Azúcar
perform the final reading, sign off on all reports, and manage followup care for patients. Reports are entered into the patient’s EMR and
used as part of a comprehensive diabetes care model that includes
consultation with a psychologist, a nutritionist, and a chronic disease
specialist, as well as diabetic foot screenings, blood work, and access
to diabetes-friendly groceries. Follow up with ophthalmology for
high-risk cases is arranged by the clinic.
Results: Total number of cases: 350.
Percentage of findings by DR grade: no DR (39%), Mild DR (20%),
Moderate DR (21%), Moderate DR with probable CSME (3%),
Severe DR (5%), PDR (4%), S/Laser PDR (8%).
Other Findings: Hypertensive Retinopathy (20%)
Conclusions: The first phase of our pilot project demonstrates that it
is feasible and effective to establish a teleretinal screening service in
Mexico as part of a new model for comprehensive diabetes care
unlike anything in México or others parts of the world.
Commercial Relationships: Gilberto Zamora, VisionQuest
Biomedical LLC (E); Javier A. Lozano, Clinicas del Azucar (E);
Richard VanNess, VisionQuest i-Rx (E); Sheila C. Nemeth,
Visionquest Biomedical LLC (E); Omar Meza, CLINICAS DEL
AZUCAR (E); Eduardo Martiñón, clinicas del azucar (E);
Elizabeth McGrew, VisionQuest Biomedical (E); Peter Soliz,
VisionQuest Biomedical LLC (I)
Program Number: 1551 Poster Board Number: C0041
Presentation Time: 8:30 AM - 10:15 AM
Developing Best Practices for Analyzing Real-World Data in
Vision Care: Comparison of Approaches for Imputing Ethnicity
from a High Volume Urban Vision Clinic
Julia A. Haller1, 2, Yang Dai1, 2, Philip P. Storey1, Lisa A. Hark1, 2,
Laura Pizzi2, 1, Benjamin Leiby2, 1, Ann P. Murchison1, 2.
1
Ophthalmology, Wills Eye Institute, Philadelphia, PA; 2Thomas
Jefferson University, Philadelphia, PA.
Purpose: To compare methodologies for determining ethnicity from
clinical and administrative data in an urban ophthalmology clinic.
Methods: Using data from 19,165 patients with self-reported
ethnicity and home address, we compared the accuracy of three
methodologies for imputing ethnicity of patients enrolled into a
retrospective chart review research study: 1) surname analysis based
on tabulation from the 2000 U.S. Census 2) geocoding analysis based
on block coding from the 2010 U.S. Census 3) a previously published
approach involving combination of surname and geocoding.
Results: Overall agreement of imputed and self-reported ethnicity
was fair for surname analysis (kappa=0.23), moderate for geocoding
(kappa=0.58), and strong for the combined model (kappa=0.76).
Surname analysis was able to determine Asian ethnicity (sensitivity
(SE) 80%; positive predictive value (PPV) 77%) and Latino ethnicity
(SE 78%; PPV 68%) with reasonable accuracy but had poor
reliability for Caucasians (SE 12%; PPV 92%) and AfricanAmericans (SE 96%; PPV 47%). Geocoding was able to determine
African-American ethnicity (SE 74%; PPV 89%) and Caucasian
ethnicity (SE 91%; PPV 70%) with reasonable accuracy, but had
poor reliability for Asians (SE 10%; PPV 26%) and Latinos (SE
35%; PPV 41%). The Bayesian approach determined AfricanAmerican (SE 84%; PPV 94%), Caucasian (SE 92%; PPV 82%),
Asian (SE 83%; PPV 79%) and Latino (SE 77%; PPV 71%) ethnicity
with the highest accuracy of the three methods.
Conclusions: A methodology combining surname analysis and
geocoded Census tract data to determine ethnicity is a valid and
accurate means of imputing African-American, Caucasian, Asian and
Latino ethnicity. The combined approach is superior to the other
methods tested and is ideally suited for research purposes of realworld clinical and administrative data in an ophthalmology setting.
Commercial Relationships: Julia A. Haller, Allergan (F),
Advanced Cell Technology (C), Regeneron (C), Merck (C), Second
Sight (C), KalVista (C), ThromboGenics (C), Optimedica (I); Yang
Dai, None; Philip P. Storey, None; Lisa A. Hark, None; Laura
Pizzi, None; Benjamin Leiby, None; Ann P. Murchison, None
Support: Centers For Disease Control and Prevention U58DP002655
Program Number: 1552 Poster Board Number: C0042
Presentation Time: 8:30 AM - 10:15 AM
Non-mydriatic fundus camera screening for diabetic retinopathy
in a Northern California safety-net setting
Brian Toy1, 2, Shelley Day2, 1. 1Santa Clara Valley Medical Center,
San Jose, CA; 2Ophthalmology, Stanford University, Palo Alto, CA.
Purpose: To describe the prevalence and treatment trends of diabetic
retinopathy (DR) in a safety net population in Santa Clara County,
CA, based on non-mydriatic fundus photography screening, and to
determine their association with patient demographic and clinical
factors.
Methods: A cross-sectional study was conducted on 8198 patients
aged 25 to 84 with diabetes, who presented to Santa Clara Valley
Medical Center for non-mydriatic fundus photography screening for
DR between 2008 and 2012. Patients were graded on the presence
and severity of DR. Prevalence of DR was calculated. Differences in
the prevalence and treatment of DR based on race, age, sex, insurance
status, whether the patient had a primary care provider (PCP) or
diabetes care manager (DCM), duration of diabetes, HgbA1c, bodymass index, and treatment with insulin or oral agents, were tested by
generalized linear model (GLM) Chi-square. GLM regression was
performed to determine the odds ratio (OR) and 95% confidence
intervals (CI) for DR and laser photocoagulation or vitreoretinal
surgery for DR, in association with putative risk factors.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Results: In our population, the prevalence of any DR was 28.2%,
with clinically significant DR present in 4.3% of patients. Significant
independent predictors of clinically significant DR were longer
duration of diabetes (OR 1.03, p=0.005), higher HgbA1c (OR 1.22,
p=0.001), Hispanic race (OR 1.70, p=0.04), and having a primary
care provider or diabetes care manager (OR 0.63, p=0.02).
Significant predictors of laser or surgical treatment for DR included
significant retinopathy seen on retinal photography (OR 21.6,
p<0.001), longer duration of diabetes (OR 1.01, p=0.01), and higher
HgbA1c (OR 1.35, p=0.001). Having a PCP/DCM was significantly
associated (OR 1.20, p=0.02) with timely focal laser
photocoagulation.
Conclusions: Our study provides data on the prevalence of diabetic
retinopathy in a large safety net population residing in Santa Clara
County, CA. Longer duration of diabetes, higher HgbA1c, and
Hispanic race were significant predictors of retinopathy. Having a
primary care provider or diabetes care manager was a significant
negative predictor for clinically significant DR and a significant
positive predictor for timely laser photocoagulation, suggesting the
importance of the medical home in diabetes management, retinal
screening and timely referral to ophthalmic care.
Commercial Relationships: Brian Toy, None; Shelley Day, None
Program Number: 1553 Poster Board Number: C0043
Presentation Time: 8:30 AM - 10:15 AM
Ocular Conditions of Diabetics and Non-Diabetics in a Primary
Care Setting
Richard VanNess1, Gilberto Zamora1, Sheila C. Nemeth1, Elizabeth
McGrew1, Wendall C. Bauman3, Son Nguyen4, Peter Soliz1, 2.
1
VisionQuest Biomedical, LLC, Albuquerque, NM; 2Ophthalmology
and Visual Sciences, University of Iowa, Iowa City, IA; 3Retina
Institute of South Texas, San Antonio, TX; 4CommuniCare Health
Centers, San Antonio, TX.
Purpose: To present results of eye disease findings by a teleretinal
evaluation project in a primary care setting in South Texas.
Ultimately, the goal is to implement computer-based retinal
screening.
Methods: VisionQuest Biomedical and CommuniCare Health
Centers formed an alliance to provide the first teleretinal evaluation
service as part of a research study to build a database of cases in a
primarily Hispanic populated region and to provide diabetic retinal
screening to underserved populations in South Texas (TX). Patients
were referred for retinal screening by their primary care physician at
Communicare, and images were acquired on-site after their regular
examination, or by appointment at a later date. VisionQuest applied
an imaging protocol that uses a 45-degree non-mydriatic camera to
acquire three color images of each eye, two fundus images (maculacentered and optic disc-centered), and an anterior image. Cases were
graded online by a network of licensed optometrists and
ophthalmologists .
Results: Table 1 breaks down the data into diabetic and non-diabetic
groups, and presents the number of individuals with and without
findings. Over half of the diabetics had some findings, twice the level
of eye disease as the non-diabetic population. Nevertheless, nearly
one in four non-diabetics were was found to have some form of eye
disease.
Table 2 breaks down the findings subgroup into four classes: diabetic
retinopathy (DR), hypertensive retinopathy (HTN), cataracts, and
drusen. While the focus of the screening had been on diabetic
retinopathy (24.6% of diabetics), risk factors for chronic hypertension
were found in nearly 19.1% of the diabetics and 10% of the nondiabetics. Of the undiagnosed diabetics, 3.2% presented with
retinopathy. The percentage of unreadable cases was 4.5%.
Conclusions: A wide spectrum of ocular diseases other than diabetic
retinopathy was found through retinal screening. Implementing a
routine eye screening for retinopathy in a primary care setting offers
the opportunity to detect ocular diseases as well as other health
complications such as hypertension.
Commercial Relationships: Richard VanNess, VisionQuest i-Rx
(E); Gilberto Zamora, VisionQuest Biomedical LLC (E); Sheila C.
Nemeth, Visionquest Biomedical LLC (E); Elizabeth McGrew,
VisionQuest Biomedical (E); Wendall C. Bauman, VisionQuest
Biomedical, LLC (C), VisionQuest i-Rx, Inc (S); Son Nguyen, None;
Peter Soliz, VisionQuest Biomedical LLC (I)
Support: NIH Grant 1RC3EY020749
Program Number: 1554 Poster Board Number: C0044
Presentation Time: 8:30 AM - 10:15 AM
A Ten-Year Retrospective Epidemiological Study of Retinal Vein
Occlusions in a Large Urban Public Hospital
Brendan Butler1, Lisa Park1, Shantan Reddy2, 1. 1Ophthalmology,
New York University, New York, NY; 2Ophthalmology, DuPage
Medical Group, Downers Grove, IL.
Purpose: Investigate the epidemiology of retinal vein occlusion
(RVO) in a large urban public hospital, Bellevue Hospital Center
(BHC), over a ten-year period from 2000 to 2010. Incidents of RVO
were stratified as central (CRVO), branch (BRVO), and hemi-retinal
vein occlusions (HRVO). Age at time of diagnosis, gender, race, and
laterality were characterized among each group.
Methods: A query of BHC medical records from 1/1/2000 to
1/1/2010 for ICD-9 codes 362.35 and 362.36 resulted in the
collection of 141 patient charts (an additional 117 charts were
unavailable due to off-site location). Incidents of RVO were stratified
according to status as CRVO, BRVO, or HRVO. Age, gender, race,
and laterality were obtained from the medical records. Age at
presentation was compared using Student’s t-test with a p-value of
0.05.
Results: Of the 141 records collected, a clinical diagnosis of RVO
was made 136 times in 132 patients and 135 eyes. Of these 136
incidents, CRVO represented 35% (47 incidents), BRVO represented
52% (71), and HRVO represented 13% (18). The mean age at time of
diagnosis was 62 for CRVO, 64 for BRVO, and 57 for HRVO.
Differences in age among the groups were not significant (not
shown). CRVO had a slight male predominance in this study with
60% of incidents occurring in men. HRVO had an even greater male
predominance of 67%. BRVO had similar rates among men and
women (46% and 54%, respectively). The most prevalent racial
group among all groups was Hispanic patients, followed by Black
patients. Laterality was similar among all three types of RVO groups
with nearly equal proportions of right and left eyes affected (Table:
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Results).
Conclusions: In Bellevue Hospital Center, Hispanic patients were
the most commonly seen racial group with retinal vascular occlusive
events. This finding must be compared to the overall patient
population seen at BHC which may reveal whether the incidence of
RVO is significantly increased in this population or whether this
finding simply reflects the demographics of the clinic population.
Regardless, this finding is useful in targeting our patient population
for preventative measures that may lower their risk for retinal
vascular disease.
magnification ranged from 0° to 10.4° (70% <5°, mean 3.6°±3.1°)
with researcher 1 and (and?) 0.2° to 8.9° (64%<5°, mean 3.9°±2.6°)
with researcher 2. There was no statistical significance difference
between researchers.
Conclusions: The small mean difference of angle values at different
magnifications, and good correlation between researcher angles made
it possible to use angle as a measure of vein narrowing. However,
accuracy and precision of the measurement requires improvement.
Commercial Relationships: Brendan Butler, None; Lisa Park,
None; Shantan Reddy, None
Program Number: 1555 Poster Board Number: C0045
Presentation Time: 8:30 AM - 10:15 AM
The Angle as a Measure of the Vein Narrowing at Retinal
Arteriovenous Crossings
Huiyuan Liang1, Qingyuan Liang2. 1University of Toronto, Toronto,
ON, Canada; 2Ophthalmology, St. Michael's Hospital, Toronto, ON,
Canada.
Purpose: The narrowing of the retinal vein at an arteriovenous (AV)
crossing is thought to be associated with branch retinal vein occlusion
(BRVO). Monitoring the progress of vein narrowing on a patient’s
fundus photos is a possible predictor of the risk of BRVO. Direct
comparison of the venous caliber measured on the fundus photos may
be the simplest way to do so. However, fundus photos taken at
different times may have different magnifications which may result
in different vein caliber readings, making comparison difficult. The
degree of vein narrowing can be defined with an angle which is
theoretically not affected by magnification. This study is to explore
the consistency of the vein narrowing angles measured from the
fundus photos of the same eyes at different magnifications.
Methods: A retrospective case-series study included 33 BRVO eyes
(OD 16, OS 17) of 30 patients (male 15, female 15, age 45-88 years,
mean age 67.9±11.6 years). Each eye had two fluorescein
angiographic photos of post pole: one of 30° field (higher
magnification), and another of 50° field (lower magnification) (Fig.
1,2). All photos were digitally enhanced by increasing sharpness to
more clearly define the vasculature edges. One non-BRVO AV
crossing showing visible vein narrowing was selected in each eye.
The narrowing angle of the vein proximal to AV crossing was
manually marked and measured three times on the digital photos
using computer by two researchers separately. The mean of the three
measurements was the value of vein narrowing. The differences
between angles at different magnifications, and measured by the
different researchers were analysed. Smaller angle discrepancy
indicated better agreement.
Results: The difference of the angle values with different
Commercial Relationships: Huiyuan Liang, None; Qingyuan
Liang, None
Program Number: 1556 Poster Board Number: C0046
Presentation Time: 8:30 AM - 10:15 AM
Venous Collateral Circulation between Superior and Inferior
Halves of the Retina May Be Normal Cross-raphe Drainage
Qingyuan Liang1, Huiyuan Liang2, David T. Wong1, 2.
1
Ophthalmology, St Michael's Hospital, Toronto, ON, Canada;
2
University of Toronto, Toronto, ON, Canada.
Purpose: Retinal venous collateral was initially defined as the
vessels which mostly developed after branch retinal vein occlusion
(BRVO) in the framework of existing retinal vascular network, and
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
originated from the retinal capillary bed, joining obstructed to
nonobstructed adjacent vessels, or by-passing obstructions in a single
vessel. Recently, this type of collateral between superior and inferior
arcades was observed on normal human retina with functional imager
(RFI). Retinal artery occlusion (RAO) is a unique situation which
eliminates venous filling from the occluded supplying artery in
fluorescein angiogram, thus revealing the potential filling from the
other sources. This study is to investigate if the possible venous
collaterals can be demonstrated in RAO and then compare them to
those in BRVO if the collateral exists.
Methods: A case-series study was done to retrospectively analyze
the fluorescein angiograms of 60 branch or central RAO and 441
BRVO eyes.
Results: In RAO, 21 eyes (35%, OD 15, OS 6) showed 1 or more
venous vessels in the non-perfusion retina with cross-raphe
fluorescein filling. The vessels were all branches from the superior or
inferior vein trunks and mostly temporal to the macula. They were
connected via the capillary network near the horizontal raphe to the
corresponding veins from the opposite vein trunks in the nonoccluded retina. The filling was from the veins in the normal retina to
the capillaries at raphe and drained into the collateral vessels in the
occluded retina. In BRVO, 276 eyes (63%, OD 150, OS 126) showed
venous collaterals which were similar in formation and location to
those in RAO but appeared more dilated and tortuous.
Conclusions: The venous collaterals in RAO eyes appear to be
normal vein branches. The possibility exists that the collateral
circulation is pre-existing cross-raphe drainage in normal eye
although this study cannot rule out that it developed after RAO. In
BRVO, such collaterals are more prominent due to visualization of
the dilated capillary and veins.
Commercial Relationships: Qingyuan Liang, None; Huiyuan
Liang, None; David T. Wong, Novartis (C), Alcon (C), Bayer (C)
Program Number: 1557 Poster Board Number: C0047
Presentation Time: 8:30 AM - 10:15 AM
Observational and Surgical Course of Vitreomacular Traction
Syndrome
Adam Carver, Robert Leonard. Dean McGee Eye Institute,
Oklahoma City, OK.
Purpose: This study analyzed the course of surgical and conservative
management of vitreomacular traction syndrome (VMT). There is a
paucity of literature evaluating observed VMT cases.
Methods: This case-control study is a retrospective chart review of
75 symptomatic cases VMT, followed over the available course of
the disease. Patients were divided primarily into those requiring
surgical intervention and those that were observed. Data collected
included patient demographics, visual acuity, and OCT results.
Results: Average age of VMT patients was 69.4 yrs., and 72.0%
were female. Overall, 37.3% (28/75) of patients required surgical
intervention. Excluding all surgical cases, spontaneous resolution was
seen in 40.4% (19/47) of observed cases. Averaging all cases of
VMT showed a statistically significant increase in vision (20/49 to
20/36, p = 0.015), and the observed cases of VMT did not get worse
(20/37 vs. 20/31, p = 0.1307). When comparing cystic changes on
OCT, the surgical group showed statistical significance (96.2% vs.
23.1%, p = 0.0109). 10.8% (8/75) of VMT patients progressed to a
macular hole.
Conclusions: VMT is primarily a disease of females in the sixth
decade. Symptomatic observed cases of VMT not meeting surgical
criteria did not get worse, and these cases can be safely observed.
Mean visual acuity compared among different groups, from
presentation to end of the observed period. Statistical significance,
p<0.05. Comparisons were only made within the same group. Results
expressed as ± standard error of the mean (SEM).
Percent of patients with cystic changes on OCT is compared within
groups, from presentation to end of observed period. Statistical
significance, p<0.05. Comparisons were only made within the same
group. Results expressed as ±SEM.
Commercial Relationships: Adam Carver, None; Robert
Leonard, None
Support: This research supported in part by an unrestricted grant
from Research to Prevent Blindness to the University of Oklahoma
Department of Ophthalmology, grant number C6152320.
Program Number: 1558 Poster Board Number: C0048
Presentation Time: 8:30 AM - 10:15 AM
The Relationship of Retinopathy Signs and Chronic Kidney
Disease in Persons without Diabetes: the Singapore Epidemiology
of Eye Disease (SEED) Study
Merwyn Chew1, 2, Charumathi Sabanayagam1, Wan Ting Tay1, Su
Chi Lim3, E Shyong Tai4, Tien Yin Wong1, 2. 1Ophthalmology,
Singapore Eye Research Institute, Singapore, Singapore;
2
Ophthalmology, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore; 3Diabetes Centre,
Khoo Teck Puat Hospital, Singapore, Singapore; 4Medicine, Yong
Loo Lin School of Medicine, National University of Singapore,
Singapore, Singapore.
Purpose: To describe the associations between non-diabetic
retinopathy (NDR) and chronic kidney disease (CKD) in a
multiethnic Asian population without diabetes.
Methods: We examined 7228 adults of Chinese, Malay and Indian
ethnicity aged 40-80 years who participated in the population-based
Singapore Epidemiology of Eye Disease (SEED) study, and who
were free of diabetes mellitus. Diabetes was defined as having a
random blood glucose of ≥ 11.1 mmol/L, a known history of diabetes
or diabetic medication use. Digital fundus photographs of both eyes
were taken using a retinal camera and assessed by trained graders for
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
the presence of retinopathy using the modified Airlie House
classification system. CKD was defined as an estimated glomerular
filtration rate (eGFR) <60 ml/min per 1.73m2. eGFR was also
analyzed as a continuous variable and in categories (<60, 45-59,
<45). The associations between CKD, eGFR and NDR were
examined using multivariate logistic regression models adjusted for
traditional cardiovascular risk factors.
Results: There were 7088 (98.1%) participants with gradable fundus
photographs and complete eGFR data, of which 647 (9.1%) had CKD
and 359 (5.1%) had NDR. The presence of CKD was significantly
associated with increased odds of NDR (Odds ratio [OR] 1.46; 95%
Confidence Interval [CI] 1.02, 2.09), hemorrhages and/or
microaneurysms (OR 1.53; 95%CI 1.06, 2.19) and hard exudates (OR
5.98; 95%CI 1.22, 29.42) in multivariate models. In analysis
stratified by ethnicity, the association between CKD and NDR was
consistently present in all three ethnic groups. In separate
multivariate models, lower eGFR (<45) compared to having no CKD
(eGFR>60) was associated with increased odds of NDR (OR 2.19;
95% CI 1.27, 3.75), hemorrhages and/or microaneurysms (OR 2.51;
95%CI 1.47, 4.27) and hard exudates (OR 19.49; 95%CI 3.37,
112.92). Likewise, the odds of having NDR were 1.25 (95%CI 1.10,
1.43) per standard deviation decrease in eGFR.
Conclusions: CKD is a significant risk factor for retinopathy in
persons without diabetes. This suggests common pathophysiological
mechanisms involving the microvasculature in the kidney and eye in
the general population.
Commercial Relationships: Merwyn Chew, None; Charumathi
Sabanayagam, None; Wan Ting Tay, None; Su Chi Lim, None; E
Shyong Tai, None; Tien Yin Wong, Allergan (C), Bayer (C),
Novartis (C), Pfizer (C), GSK (F), Roche (F)
Support: This study was supported by the Singapore Ministry of
Health’s National Medical Research Council Grants No.
NMRC/0796/2003, NMRC/STaR/0003/2008,
NMRC/CG/SERI/2010, and Biomedical Research Council Grant No.
BMRC/08/1/35/19/550.
Program Number: 1559 Poster Board Number: C0049
Presentation Time: 8:30 AM - 10:15 AM
German Health Services Research Study: Estimated Prevalence
and Incidence of Pathologic Myopia and Lack of Classification of
different Stages of Pathologic Myopia
Marc Schargus1, Daniel Pauleikhoff2, Gisela Haeusser-Fruh4,
Mathias M. Maier3. 1Department of Ophthalmology, Univiversity
Hospital, Wuerzburg, Germany; 2Eye Department, St. Francis
Hospital, Muenster, Germany; 3Klinikum rechts der Isar Department
and Polyclinic of Ophthalmology, Technical University Munich,
Munich, Germany; 4Clinical Research, Novartis Pharma, Nuermberg,
Germany.
Purpose: Currently, there are no data available in Germany on
prevalence, incidence and treatment of pathologic myopia (PM)/high
myopia and its complications. Additionally, there are different
definitions of PM and its classification of severity and complications
in the literature. Hence, the purpose of this study was to estimate the
number of patients with different severity stages of PM in a clearly
categorized scheme.
Methods: Health services survey with randomly selected
ophthalmologists throughout Germany. Physicians were asked about
diagnosis, monitoring of PM and health care situation. They were
further asked to categorize myopic eyes into: 1. PM without macular
degeneration (MD) and choroidal neovascularisation (CNV), 2. PM
with MD and without CNV, or 3. CNV secondary to PM. Calculated
prevalence/incidence were based on the number of patients reported
by the participating ophthalmologists.
Results: 340 ophthalmologists took part (84.4% practice-based
ophthalmologists, 11.8% retina specialists, 2.6% others) This reflects
the real distribution of ophthalmologists throughout Germany.
Overall patient number throughout these ophthalmologists was
estimated at 2,146.398 patients per year. Based on the total number of
patients per year and practice, the estimated prevalence of patients
with myopia was calculated at 26.5% and with high myopia (>6D) at
3.4%. Of those, the prevalence/incidence of patients with PM
(without MD and CNV) was calculated at 1.9%/0.6%, with PM and
MD at 0.6%/0.2%, and with CNV secondary to PM at 0.2%/0.08%.
The vast majority of physicians (93%) cited anti-VEGF injection as
their most preferred treatment option for patients with CNV
secondary to PM.
Conclusions: Estimated patient numbers were much higher than
expected and varied considerably between physicians. This may be
explained by double counting of patients by the different physicians
to which patients had been referred to, the unequal grades of
physician specialisation as well as by possibly underlying
uncertainties regarding definitions, nomenclature and staging of
PM/high myopia. Harmonised definitions, recommendation on
diagnosis, disease information and continuous training on PM are
required, as well as detailed epidemiological data from other
countries for international comparisons.
Commercial Relationships: Marc Schargus, None; Daniel
Pauleikhoff, None; Gisela Haeusser-Fruh, Novartis Pharma (E);
Mathias M. Maier, None
Program Number: 1560 Poster Board Number: C0050
Presentation Time: 8:30 AM - 10:15 AM
Negative Electroretinograms in the Military Personnel
Complaining Night Blindness in the Military
Mustafa Eren1, Gungor Sobaci2, Yusuf Uysal3, Uzeyir Erdem4.
1
Ophthalmology, GATA, Ankara, Turkey; 2ophthalmology, Gata,
Ankara, Turkey; 3Ophthalmology, Gata, Ankara, Turkey;
4
Ophthalmology, Gata, Ankara, Turkey.
Purpose: To assess the frequency of negative waveform
electroretinograms (ERGs) complaining night blindness in a tertiary
referral center for Turkish Armed Forces.
Methods: Retrospective chart review of all patients who had an ERG
performed for differential diagnosis of night blindness at the
electrophysiology clinic at GATA Military Medical Academy,
Ankara, Turkey, from January 2003 through December 2012, were
included in the study. Patients with b-wave amplitude ≤ a-wave
amplitude during the dark-adapted bright flash recording, in at least
one eye, were identified as having a “negative ERG”. Clinical
information, such as age, symptoms, best corrected visual acuity
(BCVA), and diagnoses were recorded for these patients when
available.
Results: A total of 2495 male patients underwent ERG testing during
the last decade Age ranged from 15 to 40 years. All were man.
BCVA ranged from 0.1 to 0.0.Of those, 102 patients had a negative
ERG, for a frequency of .4%. Of those patients, the most common
diagnoses associated with a negative ERG were congenital stationary
night blindness (CSNB, n = 93) in 91.%, X-linked retinoschisis
(XLRS, n = 7).in 6.8%, high myopia (15 dpt) in 1%, and muscular
dystrophies in 1%.
Conclusions: The overall frequency of negative ERGs in this
retrospective review was 4.%.CSNB appear to be the most likely
diagnoses among male military personnel who had a negative ERG
Commercial Relationships: Mustafa Eren, None; Gungor Sobaci,
None; Yusuf Uysal, None; Uzeyir Erdem, None
Program Number: 1561 Poster Board Number: C0051
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Presentation Time: 8:30 AM - 10:15 AM
Gestational Diabetes Mellitus (GDM) and Changes in Retinal
Microvasculature 6 months after Delivery
Lingjun Li1, 2, Carol Y. Cheung2, Mohammad K. Ikram2, 1, Seang-Mei
Saw1, 2, Tien Y. Wong2, 1. 1Saw Swee Hock School of Public Health,
National University of Singapore, Singapore, Singapore; 2Singapore
Eye Research Institute, Singapore National Eye Centre, Singapore,
Singapore.
Purpose: Gestational diabetes mellitus (GDM) is associated with
long-term risk of diabetes in pregnant women. Although the exact
mechanisms are unknown, a role for the microcirculation has been
implicated. We examined mid-pregnancy GDM and changes in the
retinal microvasculature in a cohort of Singapore pregnant women 6
months after delivery.
Methods: Pregnant women aged 18-46 years were recruited during
their early pregnancy from the Growing Up in Singapore Towards
Healthy Outcomes (GUSTO) study and followed up 6 months after
delivery. Blood pressure, anthropometric measurements, fasting
plasma glucose level, 2-hr plasma glucose level were measured at the
26 weeks gestation week following a standardized protocol.
Questionnaires on socio-economic status and life style were
ascertained by trained clinic staff. GDM were diagnosed if fasting
plasma glucose was >or=7.0 mmol/l or 2h plasma glucose was
>or=7.8 mmol/l, by using OGTT data according to WHO guideline,.
Retinal photography was examined at 26 weeks gestation and 6
months after delivery. Quantitative retinal vascular parameters were
assessed by a semi-automated computer program (Singapore I Vessel
Assessment [SIVA], version 3.0). Changes of retinal vascular
parameters are defined as percentage changes in retinal vascular
parameters between 6 months after delivery and 26 weeks gestation.
Results: Among the 280 pregnant women who included in this study,
47 (16.8%) were diagnosed as GDM at 26 weeks gestation. In
multivariate analysis, GDM patients tended to have more changes in
retinal arteriolar widening than non-GDM subjects (35.16% vs.
31.48%, p trend <0 0.01). Even though GDM was associated with 26
weeks smaller retinal arteriolar fractal dimension (1.206 vs. 1.228 Df,
p trend < 0.01) and smaller retinal venular fractal dimension (1.210
vs. 1.227 Df, p trend = 0.02) than non-GDM subjects, these
associations were attenuated after delivery.
Conclusions: GDM was associated with postnatal early retinal
vascular changes consistent with risk of type 2 diabetes. Our finding
suggested a possible impact of GDM on the microcirculation during
pregnancy, which may be a pathophysiologic pathway for evidence
on the development of future metabolic diseases in women.
Commercial Relationships: Lingjun Li, None; Carol Y. Cheung,
None; Mohammad K. Ikram, None; Seang-Mei Saw, None; Tien
Y. Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK
(F), Roche (F)
Support: None.
Program Number: 1562 Poster Board Number: C0052
Presentation Time: 8:30 AM - 10:15 AM
Ethnic disparity in prevalence of retinal vein occlusions amongst
older Australians - the Melbourne Collaborative Cohort Study
Khin Zaw Aung, Galina A. Makeyeva, Madeleine K. Adams, Elaine
W. Chong, Paul N. Baird, Robyn H. Guymer, Liubov D. Robman.
Department of Ophthalmology, Centre for Eye Research Australia,
Royal Victorian Eye & Ear Hospital, Melbourne, VIC, Australia.
Purpose: To determine the prevalence and potential risk factors of
retinal vein occlusion (RVO) in a large ethnically diverse population
of older Australians examined in one setting of a single cohort
Methods: The non-mydriatic digital colour retinal images of 21,241
participants from the Melbourne Collaborative Cohort Study
(MCCS), which examined the role of diet, lifestyle and genetic
predispositions in the causation of common chronic diseases, were
assessed for the presence of central or branch retinal vein occlusion
(CRVO or BRVO, respectively).. Eighty six percent of participants
were of Anglo-Celtic origin born in Australia/New Zealand or United
Kingdom, the remainder were migrants from Greece, Italy or Malta
(Southern European origin). Non-mydriatic digital retinal
photography was implemented by the Centre for Eye Research
Australia at MCCS follow up (2003-2007); anthropometric data
collection, laboratory tests and comprehensive questionnaires
regarding lifestyle, dietary intakes and health condition were
completed by the Cancer Council Victoria between 1990 and 1994.
Results: The overall prevalence of RVO was 0.5% (n=104) (95% CI
0.4, 0.6). RVO was strongly associated with increasing age (p
<0.001), and RVO prevalence was different for those of Southern
European origin (0.8%) and Anglo-Celtic origin (0.4%) (Chi sq
p=0.01). In multivariate logistic regression model, adjusted for age
and sex, the factors significantly associated with increased odd of
RVO were higher blood pressure Odd Ratio (ORs) 1.57 [95% CI,
1.02,2.42], p = 0.04, current smoker ORs 2.09, [95% CI, 1.17, 3.73],
p=0.01 and Southern European origin, ORs 1.58 [95% CI, 1.00,
2.53], p = 0.05. No association was detected between RVO and high
cholesterol levels, diabetes, history of angina, heart attack, stroke,
body mass index or waist-hip-ratio.
Conclusions: The adjusted prevalence of RVO in the Melbourne
Collaborative Cohort study, participants of Southern European origin
is about 1.6 times higher than amongst those of Anglo-Celtic origin,
which may reflect genetic or lifestyle differences and require further
investigation. This is the first direct comparison of the RVO
prevalence between participants of Anglo-Celtic and Southern
European origin examined in one setting, using the same
methodology.
Commercial Relationships: Khin Zaw Aung, None; Galina A.
Makeyeva, None; Madeleine K. Adams, None; Elaine W. Chong,
None; Paul N. Baird, None; Robyn H. Guymer, Ellex Pty Ltd (F),
Novartis (C), Bayer (C), Novartis (R); Liubov D. Robman, None
Support: The National Health & Medical Research Council of
Australia (NHMRC) Program Grant 209057, Capacity Building
Grant 251533 and Enabling Grant 396414, Centre for Eye Research
Australia is a recipient of the NHMRC Centre for Clinical Research
Excellence Grant 529923 and receive Operational Infrastructure
Support from the Victorian Government
Program Number: 1563 Poster Board Number: C0053
Presentation Time: 8:30 AM - 10:15 AM
Subretinal neovascularisation in Macular Telangiectasia type 2:
Baseline characteristics and progression over two years
Konstantinos Balaskas1, 5, Ferenc B. Sallo1, 2, Irene Leung1, Daniela
Florea1, Alan C. Bird3, Tunde Peto4. 1Department of Research and
Development, Moorfields Eye Hospital, London, United Kingdom;
2
UCL Institute of Ophthalmology, London, United Kingdom;
3
Inherited Eye Disease, Moorfields Eye Hospital, London, United
Kingdom; 4NIHR Biomedical Research Centre for Ophthalmology,
Moorfields Eye Hospital, London, United Kingdom; 5Medical Retina
Service, Moorfields Eye Hospital, London, United Kingdom.
Purpose: The development of a subretinal neovascular complex
constitutes a late vision threatening complication in Macular
Telangiectasia (MacTel) type 2. Little is known as regards natural
history of these lesions. In the present study we aim at identifying
prevalence and baseline characteristics of neovascular complexes in
patients with MacTel type 2 and assess progression over a two-year
period.
Methods: We evaluated morphological characteristics from fundus
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
images and fluorecein angiograms (FA) of patients enrolled in the
MacTel Study between 2005 and 2011 and had at least 2 years of
follow-up. Patients at Gass Classification stage 5 of disease
progression, defined as the presence of active neovascular complex
and/or scar, were included in subsequent analysis. Reported findings
included laterality, foveal involvement, presence of pigment or
crystals, lesion size as well as their progression over 2 years.
Results: 62 eyes of 40 patients (out of a total of 970 eyes of 499
patients) were classified as stage 5 MacTel type 2, of which 22
patients had bilateral involvement. 44 eyes presented with inactive
scars at baseline, while 18 had active NV. Of active lesions 4 were
partially fibrosed. The fovea was affected in 38 cases, though only 6
out of 18 active NV complexes extended to the fovea. Lesion size
evaluated on FA ranged between 0.25 and 4 disc diameters (DD) with
a median of 1.5 DD. Pigment plaques were present in 50 (out of 62
eyes) and in 10 (out of 18) eyes with active NV. Crystals were
identified in 8 eyes in total of which 3 in eyes with active NV. At 2
years 14 out of 18 cases of active NV at baseline had evolved into an
inactive scar, of which 10 presented enlargement of lesion with a
median difference in size of 0.5 DD. 5 eyes (out of 8) with active NV
without pigment plaques had progressed to scarring with pigment at 2
years. Of 24 eyes with extrafoveal lesions, the fovea remained
uninvolved in 23 cases at 2 years.
Conclusions: The prevalence of stage 5 disease in MacTel 2 is low
(6.4%). There is a low degree of symmetry in cases with bilateral
involvement. Foveal involvement by scarred lesions is significant,
though only one third of active NV extend to the fovea. Moreover the
chance of extension to the fovea at two years is small. Presence of
pigment plaques is common at baseline and becomes increasingly so
both in size and number of affected eyes after 2 years.
Commercial Relationships: Konstantinos Balaskas, None; Ferenc
B. Sallo, None; Irene Leung, None; Daniela Florea, None; Alan C.
Bird, None; Tunde Peto, None
Support: Lowy Medical Research Institute (LMRI) and the National
Institute of Health Research (EGAC 1004)
Program Number: 1564 Poster Board Number: C0054
Presentation Time: 8:30 AM - 10:15 AM
Diagnostic disparities in testing for hydroxychloroquine (HCQ)related ocular toxicity
Victor A. Chen, Maria Carolina Ortube, Steven Nusinowitz, Michael
B. Gorin. Retinal Disorders and Ophthalmic Genetics Division, Jules
Stein Eye Institute, Los Angeles, CA.
Purpose: The early detection of drug induced HCQ toxicity is
paramount in preventing permanent blindness. The recent AAO
guidelines describe several tests, including multifocal
electroretinogram (mfERG), central automated perimetry (eg
Humphrey 10-2 fields (HVF), or macular optical coherence
tomography (OCT) as screening tools for HCQ induced toxicity. The
purpose of this study was to determine the extent to which the
different tests agree in their identification of those patients with
toxicity due to HCQ.
Methods: Retrospective review of records and diagnostic studies of
HCQ patients undergoing surveillance for drug-related retinal
toxicity. Exclusion criteria included patients with glaucoma, retinal
dystrophy, or diabetic retinopathy.
Results: Sixty-nine patients with prior or current use of HCQ use
were evaluated. Of the 19 patients who had at least mfERG and HVF
studies, 9 cases (all with < 6 years (yrs) of exposure) did not show
abnormalities on HVF and mfERG testing. Four patients had
abnormal HVF and mfERG studies after > 10 years of exposure with
presumed toxicity. Six individuals demonstrated disparities between
their mfERG and HVF test results.
(see table below)
Conclusions: These cases with disparate findings between mfERG
and HVF testing for HCQ-related toxicity raise the possibility that a
single testing modality may not be sufficient for screening of drugrelated retinal toxicity. These unique cases also suggest that HCQtoxicity may involve a more complex mechanism of action, not
simply affecting the RPE, but might include retinal and optic nerve
dysfunction.
Commercial Relationships: Victor A. Chen, None; Maria
Carolina Ortube, None; Steven Nusinowitz, None; Michael B.
Gorin, University of Pittsburgh (P)
Support: Research to Prevent Blindness, N.Y. N.Y.
Program Number: 1565 Poster Board Number: C0055
Presentation Time: 8:30 AM - 10:15 AM
Prevalence and risk factors of retinal vein occlusion in Asian
Indians - comparative study between Singapore and India
Mayuri Bhargava1, 2, Victor Koh1, 2, Carol Y. Cheung1, 2, Wan Ling
Wong1, Jie Wang3, 4, Paul Mitchell4, Tin Aung1, 2, Tien Y. Wong1, 2.
1
Singapore Eye Research Institute, Singapore, Singapore;
2
Department of Ophthalmology, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore; 3Department
of Epidemiology and Public Health, Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore;
4
Centre for Eye Research Australia, University of Melbourne,
Australia, Singapore, Singapore.
Purpose: To describe the prevalence of retinal vein occlusion (RVO)
and its risk factors in Asian Indians - comparative study between
Singapore and India
Methods: The Singapore Indian Eye (SINDI) Study is a populationbased survey of 3,400 Indians aged between 40 to 80 years staying in
urban Singapore. A comprehensive ophthalmic examination,
standardized interviews and laboratory blood tests were performed.
Digital retinal fundus photographs were assessed for the presence of
RVO following the definitions used in the Blue Mountains Eye
Study. The results were compared to the Central Indian Eye and
Medical Study (CIEMS), a population-based study performed in rural
Central India comprising 3424 Indians aged 30 years and above.
Results: A total of 3,173 persons [mean age 57.8 ± (SD) 10.1 years
and 50.2% male] provided data in this study. The overall prevalence
of retinal vein occlusion was 0.82% (n = 26) (95% confidence
interval [CI] 0.71- 0.89%) - 23 branch and 4 central RVO. Older age
(odds ratio [OR] 1.05; 95% CI: 1.02, 1.07, per year increase),
increasing systolic blood pressure (OR 1.02; 95% CI: 1.01, 1.03, per
mmHg increase), hypertension (OR 2.60; 95% CI: 1.22, 5.51), ocular
perfusion pressure (OR 1.06; 95% CI: 1.01, 1.12, per mmHg
increase) and disc area (OR 2.84; 95% CI: 1.217, 6.33, per mm2
increase) were significantly associated with RVO. There was no
significant association between RVO with mass body index,
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
cholesterol, blood glucose, smoking, history of strokes or myocardial
infarction. Compared to CIEMS, the association between RVO with
older age and hypertension was consistent but no association with
disc size was found.
Conclusions: RVOs were detected in 0.82% of the Indian population
in Singapore. This was similar to the results of CIEMS (0.76%).
Significant factors associated with RVOs in an urban Indian
population were older age, increasing systolic blood pressure,
hypertension, increasing ocular perfusion pressure and larger disc
area.
Commercial Relationships: Mayuri Bhargava, None; Victor Koh,
None; Carol Y. Cheung, None; Wan Ling Wong, None; Jie Wang,
None; Paul Mitchell, Novartis (R), Bayer (R); Tin Aung, Alcon (R),
Alcon (C), Alcon (F), Allergan (R), Allergan (C), Carl Zeiss Meditec
(F), Carl Zeiss Meditec (R), Ellex (F), Ellex (R), Santen (R); Tien Y.
Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F),
Roche (F)
Support: Biomedical Research Council (BMRC), 08/1/35/19/550,
Singapore
Program Number: 1566 Poster Board Number: C0056
Presentation Time: 8:30 AM - 10:15 AM
Longitudinal Changes in Blood Pressure and Retinal
Vasculature: The Singapore Malay Eye Study
Michelle Lim1, 2, Carol Y. Cheung1, 3, Lingjun Li1, 3, Jie Wang2, 5,
Mohammad K. Ikram1, 4, Ecosse L. Lamoureux1, 2, Ching-Yu Cheng1,
3
, Tien Y. Wong1, 4. 1Singapore Eye Research Institute, Singapore,
Singapore; 2Centre for Eye Research Australia, Melbourne, VIC,
Australia; 3Saw Swee Hock School Public Health, National
University of Singapore, Singapore, Singapore; 4Department of
Ophthalmology, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore, Singapore; 5Centre for Vision
Research, University of Sydney, Sydney, NSW, Australia.
Purpose: Retinal vascular changes, reflecting more generalized
microcirculatory alternations, are closely associated with blood
pressure (BP) and risk of hypertension. We examined the association
between longitudinal changes in retinal vasculature measures and BP
in a cohort of Singapore Malays.
Methods: The Singapore Malay Eye Study examined 3280 persons
of Malay ethnicity aged between 40 to 80 years at baseline (20042006) and a 6-year follow-up is currently being conducted (20102013). Identical retinal vascular and BP parameters were measured at
both visits following a standardized protocol. Retinal vascular indices
including vessel caliber, bifurcation, tortuosity and fractal dimension,
were measured using a computer-assisted program (Singapore I
Vessel Assessment [SIVA]). The percentage changes in retinal
vascular parameters, systolic (SBP), diastolic (DBP) and mean
arterial blood pressure (MABP) were defined as the ratio of
difference between first and second visits relative to the first visit.
Participants were classified as having normal BP or pre-hypertension,
mild hypertension or severe hypertension.
Results: Among the 1507 participants who have returned for followup examinations, 88 participants who had normal BP status at
baseline were selected for analysis. Among these, 38 (43.2%)
developed incident mild or severe hypertension. The mean (standard
deviation [SD], interquartile range [IQR]) changes in SBP, DBP and
MABP were 5.75% (10.95, -3.38% to 14.45%), 4.21% (10.49, IQR 2.98% to 9.85%) and 4.85% (9.12, IQR -2.39% to 11.76%),
respectively. In multiple regression analysis, after adjusting for age
and gender; each 10% decrease in arteriolar caliber change and each
10% increase in retinal arteriolar branching coefficient change was
borderline associated with a 2.68% (p =0.050) increase and a 1.19%
(p =0.050) increase in MABP change, respectively. Each 10%
decrease both in total fractal dimension change and in arteriolar
fractal dimension change was associated with a 10.27% increase
(p=0.039) and a 7.66% (p =0.023) increase in DBP change,
respectively. No significant associations were found with other
retinal vascular parameters.
Conclusions: Longitudinal changes in retinal arteriolar caliber,
bifurcation and fractal dimension are correlated with changes in BP,
providing further evidence that retinal vascular parameters track BP
changes over time.
Commercial Relationships: Michelle Lim, None; Carol Y.
Cheung, None; Lingjun Li, None; Jie Wang, None; Mohammad
K. Ikram, None; Ecosse L. Lamoureux, None; Ching-Yu Cheng,
None; Tien Y. Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer
(C), GSK (F), Roche (F)
Support: National Medical Research Council (NMRC),
NMRC/1249/2010, Singapore
Program Number: 1567 Poster Board Number: C0057
Presentation Time: 8:30 AM - 10:15 AM
Genotype-phenotype analysis of male subjects affected by
choroideremia
Paul Freund, Mira Furgoch, Ian M. MacDonald. Dept. of
Ophthalmology, University of Alberta, Edmonton, AB, Canada.
Purpose: To identify possible genotype-phenotype correlations in the
rate of progression of choroideremia (CHM). CHM is a progressive
X-linked retinal degeneration caused by mutations in the CHM gene
encoding Rab escort protein-1 (REP-1). No specific genotypephenotype correlation has been established to explain the rate of
progression of the disease, which varies significantly between
affected individuals.
Methods: Genotypes and linked clinical data were reviewed from 71
CHM affected males registered with eyeGene™ (National Eye
Institute, NIH) and those in a database at the University of Alberta.
Mutations were identified by direct sequencing of all 15 CHM exons
and flanking splice sites. Age at assessment, visual acuity converted
to logMAR, and the width of continuous visual field across the
horizontal meridian (GVF III-4e or HVF III isopters) was recorded.
Only data from the right eye were included, as were multiple entries
from families carrying the same mutation. Statistical correlations
were assessed with multiple linear regression analysis in SPSS 20
(IBM).
Results: Analysis of CHM genotypes showed that 59% of CHM
mutations were nonsense mutations or frameshift mutations resulting
in premature truncation. The mutation detection rate in our sample
was 89%. Of note, genotyping detected five previously unreported
missense mutations (p.L80F, p.Q273H, p.M443V, p.L457P, and
p.L550P). Interestingly, 24% of detected mutations were located in
exon 6, which contains only 6% of the coding sequence.
No statistically significant genotype-phenotype relationships were
elucidated. In our cross-sectional sample, visual acuity deteriorated in
the 5th decade. Visual fields variably remained intact until the 3rd
decade, after which all affected males had severely narrowed visual
fields.
Conclusions: In our sample, variation in male CHM phenotypes
cannot be explained only by mutations in CHM, suggesting that
unknown genetic modifiers or environmental factors may play roles
in the onset and progression of CHM. Our description of the observed
age-related visual field changes will provide clinicians with
prognostic information and natural history data to assist in the
selection of participants in upcoming gene therapy trials for CHM.
Further investigation of the novel missense mutations may be
warranted to understand their effects on expression of REP-1,
prenylation of Rab proteins and intracellular trafficking.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Paul Freund, None; Mira Furgoch,
None; Ian M. MacDonald, None
Support: CIHR Team Grant with partnered funding from Foundation
Fighting Blindness Canada and The Choroideremia Research
Foundation Canada, Inc
Program Number: 1568 Poster Board Number: C0058
Presentation Time: 8:30 AM - 10:15 AM
The Prevalence of Retinal Cysts in an Aging Population: the
Beaver Dam Eye Study
Stacy M. Meuer, Chelsea E. Myers, Ronald Klein, Barbara E. Klein.
Ophthalmology and Visual Sciences, University of Wisconsin School
of Medicine and Public Health, Madison, WI.
Purpose: To describe the prevalence of macular and paravascular
retinal cysts in a population-based study of older adults.
Methods: There were 1913 participants aged 63 to 102 years at the
20-year Beaver Dam Eye Study examination phase, of which 1547
persons (3075 eyes) had gradable 3D-OCT scans of the macula. The
presence of retinal cysts was determined by standardized grading of
the macular scans. Height, weight, blood pressure, visual acuity,
ocular biometry, and intraocular pressure were measured, and a
detailed medical history was obtained. Stereoscopic photos of 3
standard fields (7 fields in people with diabetes) were graded
according to a standard protocol for retinal diseases.
Results: At least 1 macular cyst was found in 102 eyes (92
participants) for a prevalence rate of 6%. Of these, 86% had more
than 1 cyst. Cysts were found most often in the center circle (81%)
and ranged in size from 28 to 498 µm (mean 130 µm). Age
(p<0.001), but not gender was associated with the presence of a
macular cyst. Adjusting for age and gender, the presence of late stage
age-related macular degeneration, epiretinal membrane (ERM),
macular holes, increasing diabetic retinopathy severity, macular
edema, retinal vein occlusions and history or cataract surgery were all
associated (p<0.05) with prevalent macular cysts. Visual acuity
(p<0.0001) and contrast sensitivity (p<0.0001) decreased in the
presence of a greater number and larger-sized macular cysts.
Paravascular cysts were more common with a prevalence rate of 20%
(360 eyes in 308 people). They were not related to age, gender, visual
acuity or any of the ocular diseases associated with macular cysts,
except for presence of ERM (p=0.004). Paravascular cysts were
associated with a longer axial length (p=0.002) and a more myopic
refraction (p=0.0006).
Conclusions: Macular cysts are associated with decreased visual
acuity and many age-related retinal diseases. While paravascular
cysts do not have an impact on vision, they are related to longer axial
length. Further follow-up of this population will allow better
understanding of the natural history of cysts and their associations
with retinal diseases.
Commercial Relationships: Stacy M. Meuer, None; Chelsea E.
Myers, None; Ronald Klein, None; Barbara E. Klein, None
Support: Supported by NIH-NEI grant EY06594 and Research to
Prevent Blindness (R Klein, BEK Klein, Senior Scientific
Investigator Awards)
School of Medicine, National University of Singapore, Singapore,
Singapore; 3Saw Swee Hock School of Public Health, National
University of Singapore, Singapore, Singapore; 4Centre for
Quantitative Medicine, Office of Clinical Sciences, Duke-NUS
Graduate Medical School, Singapore, Singapore; 5Centre for Eye
Research Australia, University of Melbourne, Royal Victorian Eye
and Ear Hospital, Melbourne, VIC, Australia.
Purpose: To determine ocular and systemic factors influencing
macular thickness measured by spectral-domain optical coherence
tomography (SD-OCT) in a population-based sample of Chinese
adults.
Methods: The Singapore Chinese Eye Study is a population-based
study in adult Chinese aged 40 to 80 years. All participants
underwent a comprehensive eye examination and a standardized
interview. A SD-OCT (Cirrus HD-OCT, software version 6.0, Carl
Zeiss Meditec, Dublin, CA) with 200 x 200 macular cube scan
protocol was used to measure the macular thickness (foveal, average
inner, average outer and total average thicknesses). Healthy eyes
were defined as eyes with logMAR visual acuity ≤ 0.5, no evidence
of macular or vitreoretinal diseases, previous retinal or refractive
surgery, past history of intraocular surgery, neurological diseases or
glaucoma. Linear regression analyses were performed to study the
effects of various ocular and systemic factors on macular thickness.
Results: A total of 490 healthy eyes from 490 Chinese subjects were
analysed. The mean (standard deviation) age of the subjects was
53.17 (6.14) years and 50.0% of them were men. The mean central (1
mm diameter), inner (3 mm diameter) and outer (6 mm diameter)
macular thicknesses were 250.38 (20.58) µm, 319.33 (14.40) µm and
276.67 (11.94) µm, respectively. The total average macular thickness
was 280.25 (11.42) µm and the macular cube volume was 10.09
(0.41) mm3. The central, average inner, total average macular
thicknesses and macular cube volume were significantly greater in
men than in women (p < 0.005). In multiple linear regression
analysis, age was inversely correlated with macular thickness (β = 0.35, p<0.001), after adjusting for gender, diastolic blood pressure,
axial length and nuclear opalescence. In addition, increased axial
length (AL) was associated with thicker foveal thickness (3.31 mm
increase per mm increase in AL, p <0.001) but thinner total average
macular thickness (2.27 mm decrease per mm increase in AL, p
<0.001).
Conclusions: Older age, female gender and longer AL were
independently associated with thinner average inner, average outer
and total average macular thicknesses (except AL for average inner
macular thickness). These factors should be taken into consideration
when interpreting macular thickness measurements with SD-OCT.
Commercial Relationships: PREETI GUPTA, None; Elizabeth
Sidhartha, None; Yih Chung Tham, None; Jiemin Liao, None;
Ching-Yu Cheng, None; Tien Y. Wong, Allergan (C), Bayer (C),
Novartis (C), Pfizer (C), GSK (F), Roche (F); Tin Aung, Alcon (R),
Alcon (C), Alcon (F), Allergan (R), Allergan (C), Carl Zeiss Meditec
(F), Carl Zeiss Meditec (R), Ellex (F), Ellex (R), Santen (R); Carol
Y. Cheung, None
Support: Biomedical Research council (BMRC), 08/1/35/19/550
Program Number: 1569 Poster Board Number: C0059
Presentation Time: 8:30 AM - 10:15 AM
Determinants of Macular Thickness using Spectral Domain
Optical Coherence Tomography in Healthy Eyes: the Singapore
Chinese Eye Study
PREETI GUPTA1, 2, Elizabeth Sidhartha1, 2, Yih Chung Tham1, 2,
Jiemin Liao1, Ching-Yu Cheng1, 3, Tien Y. Wong1, 5, Tin Aung1, 2,
Carol Y. Cheung1, 4. 1Ophthalmology, Singapore Eye Research
Institute, Singapore, Singapore; 2Ophthalmology, Yong Loo Lin
Program Number: 1570 Poster Board Number: C0060
Presentation Time: 8:30 AM - 10:15 AM
Risk of Central Serous Chorioretinopathy in Adults Prescribed
Oral Corticosteroids
Der-Chong Tsai1, 2, Shih Jen Chen3, Pesus Chou1, Hsin-Bang Leu4.
1
Institute of Public Health, National Yang-Ming University, Taipei,
Taiwan; 2Department of Ophthalmology, National Yang-Ming
University Hospital, Yilan, Taiwan; 3Department of Ophthalmology,
Taipei Veterans General Hospital, Taipei, Taiwan; 4Healthcare and
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Management Center, Taipei Veterans General Hospital, Taipei,
Taiwan.
Purpose: To investigate the incidence and risk factors of central
serous chorioretinopathy (CSCR) in those using oral corticosteroids
in Taiwan.
Methods: From the Taiwan National Health Insurance Research
Database, all adults who were repetitively prescribed oral
corticosteroids between 2000 and 2008 were included as the study
cohort. Of those, cases were identified as the subjects who were
newly diagnosed with CSCR. Subjects matched for age, gender and
the time of enrollment were randomly selected as the controls. Using
International Classification of Diseases, Ninth Revision, Clinical
Modification diagnostic codes, CSCR cases were identified and the
incidence of CSCR calculated. Use of corticosteroids was compared
between the cases and controls. Multivariate regressions were used to
analyze the potential risk factors for CSCR.
Results: Among 142,035 oral corticosteroids users, 320 cases of
CSCR were identified and 1,554 matched controls were randomly
selected. The incidence rate of CSCR was 44.4 (95% confidence
interval [CI], 39.5-49.3) cases per 100 000 person-years. Multivariate
Poisson regression showed that male patients and those aged 35 to 44
years had significantly higher incidence rates of CSCR. There were
no differences in either median dosage or mean duration of systemic
corticosteroid treatment between the cases and controls. After
adjusting for other confounders, current use of oral corticosteroids
was found to be significantly associated with the risk of CSCR (odds
ratio = 2.42; 95% CI, 1.49-3.90). CSCR patients with higher average
daily dosages were more likely to have shorter latency period (p for
lineal trend <0.001).
Conclusions: The present study is the firstly to report an estimate of
the incidence of CSCR among adults prescribed oral corticosteroids
in Taiwan. Male gender, middle age, and current use of oral
corticosteroids were found to be the risk factors for CSCR.
Commercial Relationships: Der-Chong Tsai, None; Shih Jen
Chen, None; Pesus Chou, None; Hsin-Bang Leu, None
Support: The present study was partly supported by research grants
from RD 2010-028 and RD2011-020 from National Yang-Ming
University Hospital, Yilan, Taiwan; V99B1-011, V99C1-125, and
V100B-013 from Taipei Veterans General Hospital, Taipei, Taiwan;
CI-97-13 and CI-98-16 from the Yen Tjing Ling Medical Foundation,
Taipei, Taiwan; NSC 100-2314-B-075-055 from the National Science
Council, and NSC-99-2911-I-009-101 from the UST-UCSD
International Center of Excellence in Advanced Bio-engineering
sponsored by the Taiwan National Science Council I-RiCE Program.
Program Number: 1571 Poster Board Number: C0061
Presentation Time: 8:30 AM - 10:15 AM
Ocular Findings In Aplastic Anemia: Multicenter Study and
Literature review
Ramzi Alameddine1, Ahmad M. Mansour1, 2, Jong Wook Lee4, Seung
Ah Yahng3, Kyu Seop Kim4, Maha Shahin5, Nelson Hamerschlak6,
Rubens Belfort Neto7, Shree K. Kurup8. 1Ophthalmology, American
University of Beirut, Beirut, Lebanon; 2Ophthalmology, Rafic Hariri
University Hospital, Beirut, Lebanon; 3Division of HematologyCatholic Blood and Marrow Transplantation Center, Seoul St Mary's
Hospital, The Catholic University of Korea, Seoul, Republic of
Korea; 4Ophthalmology, Seoul St Mary's Hospital, The Catholic
University of Korea, Seoul, Republic of Korea; 5Ophthalmology,
Mansoura University, Mansoura City, Egypt; 6Oncology &
Hematology Program, Instituto Israelita de Ensino e Pesquisa Albert
Einstein, São Paulo, Brazil; 7Vision Institute, Hospital São Paulo,
Federal University of São Paulo, São Paulo, Brazil; 8Ophthalmology,
Wake Forest University Baptist Medical Center, Winston-Salem, NC.
Purpose: Aplastic anemia (AA) is rare disease with few reports on
ophthalmic manifestations. Ocular findings are described in a large
series along with a literature review
Methods: Retrospective case review of cases in one center, The
Catholic University of Korea. A literature review is also presented
from 1958 to 2010 of cases with aplastic anemia not receiving any
surgical therapy with addition of cases from 4 medical centers
Results: Of 719 AA patients collected, 269 patients had eye
examination among them 156 patients had funduscopy and 37
patients had retinal findings (retinal hemorrhage) (23.7%). These 37
patients were studied in detail: 7 had unilateral retinal hemorrhage
and 30 had bilateral retinal hemorrhage; mean age was 37.5 years
(16-69 range) with 25 men and 12 women; mean hemoglobin was 6.6
g/dl(range2.7-12.6 g/dl) and platelet count 18.8 x109/l (range4-157
x109/l); central retinal vein occlusion-like picture occurred in 9
patients and these had similar rheology to rest of subjects; optic disc
edema, cotton wool spots, macular edema and dry eyes occurred in 2,
3, 5 and 3 patients respectively. The ocular findings in 200 patients in
the literature with aplastic anemia included retinal hemorrhages in
56%, subhyaloid or vitreous hemorrhage in 9%, peripheral retinal
vasculopathy in 5.5%, cotton-wool spots, Sjögren’s syndrome, or
optic disc edema in 4% each. Prevalence of retinopathy among series
of aplastic anemic patients varied from 20% to 28.3%. Retinopathy
was observed in 69% of patients with concomitant severe anemia
(hemoglobin level below 8 g/100ml) and severe thrombocytopenia
(platelet count below 50,000/mm3)
Conclusions: Retinal hemorrhage is the commonest ocular finding as
it occurs in 23.7% of AA patients in the current series. Central retinal
vein occlusion-like picture is the second most frequent finding
occurring in 4.5% of AA patients and its occurrence is not related to a
more severe rheology. The presence of ocular findings relates to the
severity of anemia and the concomitance with thrombocytopenia
Commercial Relationships: Ramzi Alameddine, None; Ahmad M.
Mansour, None; Jong Wook Lee, None; Seung Ah Yahng, None;
Kyu Seop Kim, None; Maha Shahin, None; Nelson Hamerschlak,
None; Rubens Belfort Neto, None; Shree K. Kurup, Abbott (F),
Allergan (F), Regeneron (F), Lux Bio (F)
Program Number: 1572 Poster Board Number: C0062
Presentation Time: 8:30 AM - 10:15 AM
Frequency and risk factors of retinal hemorrhages in adult
Chinese in rural and urban China
Liang Xu1, Ya Xing Wang1, Jin Qiong Zhou1, Jost B. Jonas2, 1.
1
Beijing Institute of Ophthalmology, Beijing Tongren Hospital,
Beijing, China; 2Ophthalmology, Medical Faculty Mannheim,
Manheim, Germany.
Purpose: To describe the prevalence and associations of retinal
hemorrhages (RH) in adult Chinese.
Methods: The Beijing Eye Study 2011 was a population-based study
held in urban and rural Beijing. A total of 3468 participants were
enrolled with mean age of 64.6±6.8 years. Detailed eye and
systematic examinations were applied. Two photos per eye were
taken using 45° fundus camera, centered in either macula or the optic
disc. Any retinal hemorrhages were recorded.
Results: 3437 subjects (99.1%) or 6836 eyes had gradable fundus
photographs. RH were observed in 435 participants (12.7%±1.0%) or
518 eyes (7.6± 2.2%). RH were located in optic disc (9.5%),
peripapillary area (37.5%), macula (24.3%), periphery areas (6.4%),
or diffused area (22.4%). The causes for RH were attributed to
diabetic retinopathy (35.3%), retinal vein occlusion (12.2%),
Posterior Vitreous Detachment (4.4%), glaucoma (2,5%), age-related
macular degeneration (1.5%), and other diseases (0.4%). However
causes fro 43.6% of the RH could not be clearly found. The presence
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
of RH with unclear reasons was associated with systolic blood
pressure (P<0.001), refractive error (P<0.001), and body mess index
(P=0.003).
Conclusions: RH was present in 12.7% adult Chinese population,
half of which were related to certain ophthalmological disorders. The
RH with unknown causes might be a hint of systematic diseases.
Commercial Relationships: Liang Xu, None; Ya Xing Wang,
None; Jin Qiong Zhou, None; Jost B. Jonas, Allergan (C), MSD
(C), Alimera (C), CellMed AG (P)
Support: National Natural Science Foundation of China
Support: The Australian Heart Eye Study was supported by the
Australian National Health & Medical Research Council (Grant No.
571012).
Program Number: 1573 Poster Board Number: C0063
Presentation Time: 8:30 AM - 10:15 AM
Retinal Microvascular Caliber and Coronary Artery Stenoses
Bamini Gopinath1, Adam J. Plant1, Aravinda Thiagalingam2, George
Burlutsky1, Tien Y. Wong3, 4, Paul Mitchell1. 1Centre for Vision
Research, University of Sydney, Sydney, NSW, Australia; 2Centre
for Heart Research, University of Sydney, Sydney, NSW, Australia;
3
Centre for Eye Research Australia, University of Melbourne,
Sydney, VIC, Australia; 4Singapore Eye Research Institute, National
University of Singapore, Singapore, Singapore.
Purpose: Microvascular mechanisms are increasingly recognised as
being involved in a significant proportion of coronary artery disease
(CAD) cases, but the exact role and contribution is unclear. In the
current study, we aimed to determine whether retinal microvascular
structural changes are associated with severity of CAD as assessed by
coronary angiography.
Methods: The Australian Heart Eye Study examined 1116 patients
(mean age 60.9±11.4 years) presenting for evaluation of potential
CAD by coronary angiography during 2009-12 at Westmead
Hospital, Sydney, Australia. Retinal images were taken and retinal
vessel caliber was quantified using validated computer-based
methods. Routine diagnostic invasive angiography was performed 6
hours fasting. A vessel score was calculated based on the number of
vessels with significant obstructive coronary disease. This definition
was used for the left main coronary artery, right coronary, left
anterior descending and left circumflex arteries. Scores ranged from 0
to 3, depending on the number of vessels with greater than 50%
stenoses. Left main artery stenosis was scored as double vessel
disease.
Results: After adjusting for age, sex, ethnicity, fellow vessel caliber,
previous history of diabetes and acute myocardial infarction,
participants with narrower retinal arteriolar caliber (i.e. comparing
smallest versus largest arteriolar caliber quartile) were more likely to
have stenoses ≥50% in any of the vessels, odds ratio, OR 1.54 (95%
CI 1.02-2.33). Additionally, patients with narrower retinal arteriolar
caliber were more likely to have 3 vessels with greater than 50%
stenoses, OR 1.56 (95% CI 1.15-2.12) than those with wider
arteriolar caliber, while patients with wider retinal venules
(comparing largest versus smallest quartile) were more likely to have
stenoses ≥50% in any of the vessels, OR 1.93 (95% CI 1.24-3.00)
than those with narrower venular caliber.
Conclusions: Retinal arteriolar caliber narrowing and venular
widening were associated with the severity of angiographicallydocumented coronary artery stenoses. These findings provide further
understanding of the role of microvascular mechanisms in CAD and
suggest retinal imaging may be a measure of subclinical CAD.
Commercial Relationships: Bamini Gopinath, None; Adam J.
Plant, None; Aravinda Thiagalingam, None; George Burlutsky,
None; Tien Y. Wong, Allergan (C), Bayer (C), Novartis (C), Pfizer
(C), GSK (F), Roche (F); Paul Mitchell, Novartis (R), Bayer (R)
Program Number: 1733
Presentation Time: 11:00 AM - 11:15 AM
The Consortium for Refractive Error and Myopia (CREAM)
Identifies Four New Loci for Ocular Axial Length and
Demonstrates Shared Loci for Axial Length and Refractive Error
through Genome-Wide Association Studies
Ching-Yu Cheng1, 2, Maria Schache3, Mohammad K. Ikram1, 2,
Jeremy A. Guggenheim4, Dwight Stambolian5, Caroline C. Klaver6, 7,
Yik-Ying Teo8, 9, Seang-Mei Saw8, 1, Paul N. Baird3, 10. 1Department of
Ophthalmology, National University of Singapore and National
University Health System, Singapore, Singapore; 2Singapore Eye
Research Institute, Singapore, Singapore; 3Ocular Genetics Unit,
Centre for Eye Research Australia, University of Melbourne, Royal
Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; 4Centre
for Myopia Research, School of Optometry, The Hong Kong
Polytechnic University, Hong Kong, Hong Kong; 5Department of
Ophthalmology, University of Pennsylvania, Philadelphia, PA;
6
Department of Ophthalmology, Erasmus Medical Center,
Rotterdam, Netherlands; 7Department of Epidemiology, Erasmus
Medical Center, Rotterdam, Netherlands; 8Saw Swee Hock School of
Public Health, National University of Singapore, Singapore,
Singapore; 9Department of Statistics and Applied Probability,
National University of Singapore, Singapore, Singapore;
10
Department of Ophthalmology, Centre for Eye Research Australia,
University of Melbourne, Royal Victorian Eye and Ear Hospital,
Melbourne, VIC, Australia.
Purpose: To identify genetic variants influencing ocular axial length
(AL) through a large-scale meta-analysis of genome-wide association
studies (GWAS).
Methods: The Consortium for Refractive Error and Myopia
(CREAM) conducted the largest international GWAS meta-analysis
of AL, combining 14,287 Caucasians and 8,358 Asians in 18 cohorts
from Europe, Australia and Asia. AL was measured using either
optical laser interferometry or A-scan ultrasound biometry.
Refraction was measured by auto-refractor and/or subjective
refraction. Spherical equivalent was calculated as the sphere plus half
of the cylinder. Study individuals were genotyped using either
Illumina or Affymetrix platforms. Each study performed SNP
imputation using the genotyped data, together with HapMap Phase II
ethnically matched reference panels. Identified genes were screened
for ocular tissue expression in experimental myopic mouse models
and human eyes.
Results: A total of six loci influencing AL at genome-wide
significance level (P < 5 x 10-8) were identified. Four of these loci are
novel, including RSPO1 (rs4074961, P = 3.97 x 10-13), C3orf26
(rs9811920, P = 4.85 x 10-11), LAMA2 (rs12193446, P = 1.24 x 10-8)
and ZNRF3 (rs12321, P = 4.08 x 10-8). We also confirmed the AL
locus at 1q41 previously identified in Asian populations (ZC3H11B,
rs994767; P = 9.62 x 10-12) and the known locus associated with
myopia at 15q14 locus (GJD2, rs11073058, P = 4.34 x 10-11).
Furthermore, we assessed the effect of these loci on spherical
equivalent in 17 independent cohorts comprised of 21,897 individuals
245 Genetic Epidemiology: GWAS and SNPs Around the World
Monday, May 06, 2013 11:00 AM-12:45 PM
615-617 Paper Session
Program #/Board # Range: 1733-1739
Organizing Section: Clinical/Epidemiologic Research
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
through the CREAM. Significant associations (P < 0.05) were
identified for GJD2 (rs11073058, P =1.66 x 10-8), LAMA2
(rs12193446, P = 3.58 x 10-10), and ZC3H11B (rs994767; P = 0.013).
Differential gene expression in ocular tissues was also observed in
lens induced myopia mouse experiments and human ocular tissues.
Conclusions: Newly identified genes enhance our understanding of
genetic factors of AL and myopia. In particular, two of these genes
(RSPO1 and ZNRF3) are involved in the Wnt signaling pathway.
Additionally, this study provides direct evidence of shared genes,
GJD2, ZC3H11B and LAMA2, influencing both axial length and
refraction.
Commercial Relationships: Ching-Yu Cheng, None; Maria
Schache, None; Mohammad K. Ikram, None; Jeremy A.
Guggenheim, None; Dwight Stambolian, None; Caroline C.
Klaver, Bayer (F), Novartis (F), Topcon (F); Yik-Ying Teo, None;
Seang-Mei Saw, None; Paul N. Baird, None
Support: The study was supported by funds from Asia, Australia,
Europe and USA.
Program Number: 1734
Presentation Time: 11:15 AM - 11:30 AM
Heritability Estimation of Axial Length and Refractive Error
Explained by Genome-Wide Single Nucleotide Polymorphisms
Masahiro Miyake1, 2, Kenji Yamashiro1, Hideo Nakanishi1, 2, Isao
Nakata1, 2, Yumiko Akagi-Kurashige1, 2, Kyoko Kumagai1, Akitaka
Tsujikawa1, Ryo Yamada2, Fumihiko Matsuda2, Nagahisa
Yoshimura1. 1Department of Ophthalmology, Kyoto Univ Grad Sch
of Medicine, Sakyoku, Kyoto City, Japan; 2Center for Genomic
Medicine, Kyoto Univ Grad Sch of Medicine, Sakyoku, Kyoto City,
Japan.
Purpose: Genome-wide association study (GWAS) is a powerful
strategy which has identified numerous loci associated with diseases.
However, although many GWASs have been conducted on high
myopia, single nucleotide polymorphisms (SNPs) identified in them
can explain only a small fraction of narrow-meaning heritability
estimated by family studies or twin studies. Thus, we examined if
SNPs typed in the GWAS can explain narrow-meaning heritability of
AL and SE.
Methods: The Nagahama cohort study is an ongoing communitybased cohort study, which consists of 9,804 individuals from
Nagahama city, Japan. We used 3,748 individuals who are genotyped
and imputed for 1,751,558 SNPs. After pruning potential relatives,
2171 individuals were finally included. Heritability is defined as a
fraction of variance explained by all SNPs to that of the target
phenotype, i.e. AL and SE. We estimated both variance explained by
all SNPs and variance explained by SNPs in each chromosome by a
linear mixed model proposed by Yang J. et al. (Nature Genetics,
2010). Age, sex, and height were included in the model as covariates.
Results: For AL and SE, heritability (± standard error) explained by
all SNPs were 40.0% (± 21.2) and 61.1% (± 24.8), respectively.
While the top contributor for AL was chromosome 1 explaining
11.0%, no contribution was observed in chromosome 3, 7, and 11.
Though five chromosomes contributed to heritability of SE
explaining more than 5.0% respectively, ten chromosomes exhibited
less than 0.5% of contribution.
Conclusions: Since the estimated heritability in this study is larger
than the heritability explained by previously reported SNPs, GWAS
still has a potential to identify more causative loci. The difference
from the heritability estimated by family or twin study would be due
to the rare variants or structural variations. SE is more common-SNPdriven than AL, and responsible chromosome of SE heritability is
deviated.
Commercial Relationships: Masahiro Miyake, None; Kenji
Yamashiro, None; Hideo Nakanishi, None; Isao Nakata, None;
Yumiko Akagi-Kurashige, None; Kyoko Kumagai, None; Akitaka
Tsujikawa, Pfizer (F); Ryo Yamada, None; Fumihiko Matsuda,
None; Nagahisa Yoshimura, Canon (C), Canon (F), Nidek (C),
Topcon (F), PCT/JP2011/073160 (P)
Program Number: 1735
Presentation Time: 11:30 AM - 11:45 AM
Meta-analysis of functional enrichment results from five GWAS
studies reveals biological processes involved in human refractive
variation
Robert Wojciechowski1, 2, Konrad Oexle3, Claire L. Simpson2, Joan
E. Bailey-Wilson2, Jugnoo S. Rahi4, Christopher J. Hammond6,
Dwight Stambolian7, Pirro G. Hysi5. 1Epidemiology, Johns Hopkins
School of Public Health, Baltimore, MD; 2Inherited Disease Research
Branch, National Human Genome Research Institute, Baltimore, MD;
3
Institute of Human Genetics, Technische Universität München,
Munich, Germany; 4Institutes of Child Health and Ophthalmology,
University College London, London, United Kingdom; 5Twin
Research & Genetic Epidemiology, King's College London, London,
United Kingdom; 6Ophthalmology, King's College London, London,
United Kingdom; 7Ophthalogy-Stellar Chance Lab, University of
Pennsylvania, Philadelphia, PA.
Purpose: Genomewide Association Studies (GWAS) have been
successful in identifying a handful of susceptibility loci for myopia
and ocular refraction. However, these loci account for a small
proportion of the heritability of refraction within populations. We
combined two methods to increase power to detect variants and
relevant gene sets responsible for refraction: gene set enrichment
analysis and GWAS meta-analysis.
Methods: : GWAS for spherical equivalent refraction were
performed in five adult cohorts of European ancestry: AREDS,
KORA, Framingham Eye Study, Twins UK, and the 1958 British
cohort. All SNPs with variance inflation-corrected p-values≤10e-3
were extracted and annotated by their nearest gene. Redundant genes
were removed to produce sets of unique genes for each study.
Enrichment analysis of gene lists was performed using the DAVID
clustering tool with gene ontology (GO) terms as annotation
categories. Exact enrichment p-values from all studies were
combined in a meta-analysis using Fisher’s combined probability
test.
Results: Enrichment analysis with medium clustering stringency was
conducted using the three main GO categories: biological process
(BP); cellular component (CC); and molecular function (MF). For
BP, the most highly enriched GO terms included: cell and biological
adhesion; synaptic and nerve impulse transmission; ion transport; and
cell-cell signaling (all meta-p<10e-25). For CC, the top 4 GO terms
included the plasma membrane (all meta-p<10e-40). Enriched CC
terms also included: synapse; cell projection; and extracellular matrix
(all meta-p<10e-14). For MF, the most highly significant terms
involved ion channel or transmembrane transporter activity (all metap<10e-15).
Conclusions: Our meta-enrichment analyses of refraction reveal a
robust picture of the biological processes involved in human
refractive variation. The enriched ontological categories are
biologically plausible and remarkably similar across studies. We
show that combined systems-based approaches can more fully
characterize the genetic architecture of refractive error in human
populations. Specifically, genes involved in synaptic and cell
signaling, ion transport and cell adhesion appear to be particularly
important in refraction. Consistent with these biological processes,
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
plasma membrane constituents are significantly overrepresented in
refraction-mediating systems.
Commercial Relationships: Robert Wojciechowski, None;
Konrad Oexle, None; Claire L. Simpson, None; Joan E. BaileyWilson, None; Jugnoo S. Rahi, None; Christopher J. Hammond,
None; Dwight Stambolian, None; Pirro G. Hysi, None
Support: Intramural Funds of the National Human Genome Research
Institute
Program Number: 1736
Presentation Time: 11:45 AM - 12:00 PM
Genome-wide Meta-Analyses Of Multi-Ethnic Cohorts Identify
Multiple New Susceptibility Loci For Refractive Error And
Myopia
Virginie J. Verhoeven1, Pirro G. Hysi2, Robert Wojciechowski3, 4,
Jeremy A. Guggenheim5, Seang-Mei Saw6, 7, Joan E. Bailey-Wilson3,
Dwight Stambolian8, Caroline C. Klaver1, Christopher J. Hammond2.
1
Ophthalmology/Epidemiology, Erasmus Medical Center, Rotterdam,
Netherlands; 2Twin Research and Genetic Epidemiology, King’s
College London School of Medicine, London, United Kingdom;
3
Inherited Disease Research Branch, National Human Genome
Research Institute, National Institutes of Health, Baltimore, MD;
4
Epidemiology, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD; 5Centre for Myopia Research, School of Optometry,
The Hong Kong Polytechnic University, Hong Kong, Hong Kong;
6
Saw Swee Hock School of Public Health and department of
Ophthalmology, National University Health Systems, National
University of Singapore, Singapore, Singapore; 7Singapore Eye
Research Institute, Singapore National Eye Centre, Singapore,
Singapore; 8Ophthalmology, University of Pennsylvania,
Philadelphia, PA.
Purpose: Refractive error is the most common eye disorder
worldwide, and a prominent cause of blindness. Myopia affects over
30% of Caucasian populations, and up to 80% of Asians. We aimed
to identify multiple genetic loci that explain the genetic architecture
of refractive error.
Methods: The Consortium for Refractive Error and Myopia
(CREAM) conducted genome-wide meta-analyses including 37,382
individuals from 27 Caucasian studies, and 8,376 from 5 Asian
cohorts. Identified variants were used for genetic risk score
assessment.
Results: We identified 16 new loci for refractive error in Caucasians,
of which 10 were shared with Asians. Combined analysis revealed 8
additional new loci. The new loci include genes with function in
neurotransmission (GRIA4), ion channels (KCNQ5), retinoic acid
metabolism (RDH5), extracellular matrix remodeling (LAMA2,
BMP2), and eye development (SIX6, PRSS56). We also confirmed
previously reported associations with GJD2 (top SNP rs524952;
Pcombined=1.44x10-15) and RASGRF1. Risk score analysis using
associated SNPs showed a ten-fold increased risk of myopia for
subjects with the highest genetic load.
Conclusions: Our results, accumulated across independent studies
from four continents, considerably advance understanding of
mechanisms involved in refractive error and myopia.
Commercial Relationships: Virginie J. Verhoeven, None; Pirro G.
Hysi, None; Robert Wojciechowski, None; Jeremy A.
Guggenheim, None; Seang-Mei Saw, None; Joan E. BaileyWilson, None; Dwight Stambolian, None; Caroline C. Klaver,
Bayer (F), Novartis (F), Topcon (F); Christopher J. Hammond,
None
Program Number: 1737
Presentation Time: 12:00 PM - 12:15 PM
International meta-analysis of genetic factors influencing
intraocular pressure: the International Glaucoma Genetics
Consortium Study
Pirro G. Hysi1, Ching-Yu Cheng2, Tin Aung2, Jamie E. Craig6,
Christopher J. Hammond1, Andrew J. Lotery5, Norbert Pfeiffer4,
Cornelia M. van Duijn3, Ananth C. Viswanathan8, Janey L. Wiggs7.
1
Twin Research & Genetic Epidemiology, King's College London,
London, United Kingdom; 2Eye Research Institute, National
University of Singapore, Singapore, Singapore; 3Department of
Epidemiology and Clinical Genetics, Erasmus University Medical
Centre, Rotterdam, Netherlands; 4Department of Ophthalmology,
Johannes Gutenberg University Medical Centre, Mainz, Germany;
5
Clinical Neurosciences Research Grouping, Clinical and
Experimental Sciences, Faculty of Medicine, University of
Southampton, Southampton General Hospital, Southampton,
Southampton, United Kingdom; 6Department of Ophthalmology,
Flinders University, Adelaide, SA, Australia; 7Department of
Ophthalmology, Mass Eye & Ear Infirmary, Harvard Medical
School, Harvard University, Boston, MA; 8UCL Institute of
Ophthalmology, University College London, London, United
Kingdom.
Purpose: . Intraocular Pressure (IOP) is a major predictor of
glaucoma and currently the only modifiable risk factor in the
management of Primary Open Angle Glaucoma. Genome-wide
association studies (GWAS) have, to date, identified some common
genetic variants associated with IOP (TMCO1, GAS7) and with
glaucoma (CDKN2AB, TMCO1, CAV1/2), but only explain a
fraction of the heritability of these traits. The International Glaucoma
Genetics Consortium (IGGC) aims to identify further genes and
genetic pathways that influence IOP, by increasing sample sizes
through international GWAS meta-analyses.
Methods: GWAS of 2.5 million Single Nucleotide Polymorphisms
(SNPs) present in the HapMap2 databases were individually carried
out in each of the 15 centers which at the time of submission were
contributing to the IGGC IOP project. Association was done using a
linear regression model with IOP as an outcome and SNPs as a
predictor, adjusting for age and sex. Genetic associations observed
for each locus at individual centers were then meta-analyzed together.
Results: Meta-analysis of data from 28,712 participating subjects
found strong associations with a number of genetic loci, some of
which have been previously described in the literature in relation to
glaucoma or IOP. The strongest associations were observed for two
genetic loci, within the genetic sequences of the CAV1 (p= 4.8x1009 for rs10258482) and the GAS7 genes (p=5.5x10-11 for
rs9913911) respectively. Interestingly only suggestive association
with IOP was observed for the TMCO1 locus (p=4.7x10-07 for
rs6696454). Novel loci were also associated on chromosomes 9 and
11 at genome-wide significance level.
Conclusions: The IGGC IOP study is an ongoing project that has
confirmed existing and discovered new genetic loci that influence
intraocular pressure in the general population.
Commercial Relationships: Pirro G. Hysi, None; Ching-Yu
Cheng, None; Tin Aung, Alcon (R), Alcon (C), Alcon (F), Allergan
(R), Allergan (C), Carl Zeiss Meditec (F), Carl Zeiss Meditec (R),
Ellex (F), Ellex (R), Santen (R); Jamie E. Craig, None; Christopher
J. Hammond, None; Andrew J. Lotery, Novartis (F), Bayer (R);
Norbert Pfeiffer, Sensimed AG (F), Sensimed AG (R), MSD (F),
MSD (R), Alcon (F), Allergan (F), Novartis (F), Novartis (R), Bayer
(F), Heidelberg Engineering (F), Bausch&Lomb (F), BoehringerIngelheim (F), Carl Zeiss Meditech (F), Chibret (F), Nidek (F), Pfizer
(F), Santen (F), Santen (R), Topcon (F), Ivantis Inc (F), Ivantis Inc
(R); Cornelia M. van Duijn, None; Ananth C. Viswanathan, None;
Janey L. Wiggs, None
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Support: N/A
Program Number: 1738
Presentation Time: 12:15 PM - 12:30 PM
An International Genome-Wide Association Study of GlaucomaRelated Optic Disc Parameters in 18,000 Caucasians: the
International Glaucoma Genetics Consortium
Henriet Springelkamp1, Rene Hoehn2, Christopher J. Hammond3,
Alex W. Hewitt4, Caroline C. Klaver1, Stuart MacGregor5, David A.
Mackey6, Paul Mitchell7, Tien Y. Wong8, Cornelia M. van Duijn9.
1
Ophthalmology & Epidemiology, Erasmus Medical Center,
Rotterdam, Netherlands; 2Department of Ophthalmology, University
Medical Center Mainz, Mainz, Germany; 3Department of Twin
Research and Genetic Epidemiology, King’s College London School
of Medicine, St Thomas’ Hospital, London, United Kingdom;
4
Centre for Eye Research Australia, University of Melbourne, Royal
Victorian Eye and Ear Hospital, Melbourne, VIC, Australia;
5
Queensland Institute of Medical Research, Brisbane, QLD,
Australia; 6Lions Eye Institute, University of Western Australia,
Centre for Ophthalmology and Visual Science, Perth, WA, Australia;
7
Centre for Vision Research, Department of Ophthalmology and
Westmead Millennium Institute, University of Sydney, Westmead,
United Kingdom; 8Singapore Eye Research Institute, National
University of Singapore, Singapore, Singapore; 9Epidemiology,
Erasmus Medical Center, Rotterdam, Netherlands.
Purpose: Glaucoma is a progressive optic neuropathy and a leading
cause of irreversible blindness worldwide. There has been rapid
progress in identifying genes involved in glaucoma or related optic
nerve pathology. The goal of this study was to identify new genes
associated with optic disc parameters.
Methods: We conducted an international meta-analysis of genomewide association studies (GWAS) testing 2.5 million single
nucleotide polymorphisms in ± 18,000 Caucasians from 9 different
cohorts within the International Glaucoma Genetics Consortium. The
outcomes were adjusted for age and sex and included vertical cupdisc ratio (VCDR), disc area (DA), cup area (CA) and rim area (RA).
Results: New genome-wide significant loci (p<5x10-8) were
identified on chromosome (chr.) 1 (DA and RA), 3 (VCDR and CA),
6 (VCDR and CA [different loci]), 10 (VCDR and CA), 11 (VCDR
and CA), 17 (RA) and 20 (VCDR). These new loci are located in or
near genes with different functions. There were 3 genes involved in
the pathogenesis of breast cancer (on chr. 6, 17 and CHEK2 [see
later]). The gene on chr. 1 may play a role in peripheral actin
formation and the promoting of cytoskeletal reorganization. COL8A1
(chr.3) is part of a collagen pathway recently implicated in an in
press GWAS meta-analysis of corneal thickness and a component of
the Descemet’s membrane. The gene on chr. 6 (VCDR) is essential
for the targeting of vesicles to the plasma membrane. The other
region on chr. 6 (CA) contains, beside 2 genes which may play a role
in breast cancer cells, one gene involved in central nervous system
defects. The gene on chr. 10 plays a role in various processes: cell
growth, differentiation and gene expression. The chr. 11 gene has
been associated with patients with scleroderma and/or Sjogren’s
syndrome. It is suggested that the gene on chr. 20 may play a role in
promoting and maintaining of ganglion cell growth. We also found
several genome-wide significant loci in or near genes, which were
previously published (CDC7/TGFB3, CDKN2B, ATOH7, TMTC2,
SIX1, SALL1, CHEK2).
Conclusions: Our meta-analysis revealed several new loci associated
with one or more optic disc endophenotypes of glaucoma. The
functions of these new genes vary from regulation of corneal
thickness to (ganglion) cell growth. The data highlight the complex
etiology of optic nerve changes in glaucoma.
Commercial Relationships: Henriet Springelkamp, None; Rene
Hoehn, None; Christopher J. Hammond, None; Alex W. Hewitt,
None; Caroline C. Klaver, Bayer (F), Novartis (F), Topcon (F);
Stuart MacGregor, None; David A. Mackey, None; Paul Mitchell,
Novartis (R), Bayer (R); Tien Y. Wong, Allergan (C), Bayer (C),
Novartis (C), Pfizer (C), GSK (F), Roche (F); Cornelia M. van
Duijn, None
Program Number: 1739
Presentation Time: 12:30 PM - 12:45 PM
Methylation landscape of ocular tissue and their correlation to
peripheral leucocytes
Alex W. Hewitt1, 2, Jihoon E. Joo3, Jie Wang1, Jamie E. Craig4,
Richard Saffery3. 1Department of Ophthalmology, Centre for Eye
Research Australia, Surrey Hills, VIC, Australia; 2Lions Eye
Institute, University of Western Australia, Perth, WA, Australia;
3
Murdoch Childrens Research Institute, The Royal Children’s
Hospital, Melbourne, VIC, Australia; 4Department of
Ophthalmology, Flinders University of South Australia, Adelaide,
SA, Australia.
Purpose: The aim of this study was to investigate the whole genome
methylation profiles of ocular tissues. In comparing this profile to
unfractionated blood samples from the same individuals, we also
sought to investigate the utility of leucocyte DNA methylation in the
study of ocular disease.
Methods: Whole blood from the subclavian vein and whole eyes
(N=##?) were obtained post-mortem. DNA was extracted from whole
blood as well as neurosensory retina, retinal pigment epithelium
(RPE)/choroid and optic nerve tissue. Following bisulfite conversion
samples were hybridized to Illumina Infinium HumanMethylation450
BeadChips according to the manufacture’s protocols. Data were
analysed using R v2.15.1.
Results: Following QC a total of 464,993 CpG sites common to all
samples were used for subsequent analysis. Unstructured hierarchical
clustering of all CpG sites for each sample revealed well-defined
groupings across individual tissue subtypes. Despite this discrete
clustering, there was generally a strong correlation between
methylation profiles, across all tissues from each individual (median
(range) Pearsons corr=0.923 (0.851-0.991)). Over 250,000 CpG sites
were found to have similar methylation levels (beta <0.2 or beta
>0.8) across different tissues in the same individuals, with a further
~18,000 sites having similar methylation profiles in all ocular tissue
only.
Conclusions: Our results reveals a strong correlation between the
methylation status of peripheral blood leukocytes and different ocular
tissues, highlighting the utility of using whole blood to study
potential epigenetic changes in ophthalmic disease. These results are
particularly encouraging for research where non-end organ tissue is
difficult to obtain. An improved understanding of the epigenetic
landscape of ocular tissue will have important ramifications for
regenerative medicine and ongoing dissection of gene-environment
interactions in eye disease.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Genome-wide CpG site inter-tissue and inter-sample relationships. A)
Hierarchical clustergram across all samples. Individuals are
represented by their corresponding code, B) Scatter plot of individual
CpG sites mean methylation levels across different tissue.
Commercial Relationships: Alex W. Hewitt, None; Jihoon E. Joo,
None; Jie Wang, None; Jamie E. Craig, None; Richard Saffery,
None
Support: NHMRC ECF 1037838; AHAF; ORIA
279 Retinal Health and Diabetic Retinopathy: Evidence for
Mechanisms, Treatment, and Risk
Monday, May 06, 2013 2:45 PM-4:30 PM
615-617 Paper Session
Program #/Board # Range: 2168-2174
Organizing Section: Clinical/Epidemiologic Research
Program Number: 2168
Presentation Time: 2:45 PM - 3:00 PM
The Relationship between Axial Length, Retinal Function, and
Oxygen Consumption: A Potential Protective Mechanism in
Diabetic Retinopathy
Ryan Man1, Ecosse L. Lamoureux1, 2, Yamna Taouk1, Jing Xie1,
Jonathan E. Noonan1, Ryo Kawasaki1, Jie Wang1, 3, Chi D. Luu1.
1
Centre for Eye Research Australia, University of Melbourne, East
Melbourne, VIC, Australia; 2Singapore Eye Research Institute,
Singapore, Singapore; 3Centre for Vision Research, Westmead
Millenium institute, Sydney, NSW, Australia.
Purpose: A longer axial length (AL) has been shown to be protective
for diabetic retinopathy (DR) although the mechanisms involved
remain unclear. In this study, we evaluated the associations between
AL, retinal function, and oxygen (O2) consumption to determine
whether a decrease in retinal function in eyes with longer AL is
associated with a reduction in metabolic demand; a hypothetical
mechanism for the protective effect of an increased AL in DR
development.
Methods: 36 healthy individuals with a range of AL (21.89 28.35mm) were recruited. AL, retinal function (determined by
multifocal electroretinography [mfERG]) and O2 consumption
(difference between arteriolar and venular O2 saturation levels), were
measured in the right eye of each participant. Linear regression
models were used to assess the associations of AL with mfERG P1
amplitudes and O2 consumption. Regression coefficients values (β),
derived from path regression analysis models, were then used to
explore the direct and indirect effects (via retinal function) of AL on
O2 consumption.
Results: Longer AL was associated with reduced O2 consumption
(per mm increase in AL: β = -1.37, 95% confidence interval [CI]: 1.95 to -0.77) and decreased retinal function (per mm increase in AL
associated with changes in central amplitude: β= -0.18, 95% CI: -0.23
to -0.13; and peripheral amplitude: β= -0.47, 95% CI: -0.61 to -0.32).
Increased retinal function was also associated with increased O2
consumption (per unit increased central amplitude: β = 0.39, 95% CI:
0.28 to 0.50; per unit increased peripheral amplitude: β = 1.06, 95%
CI: 0.78 to 1.33). Path analysis including AL, retinal function and O2
consumption showed that AL had little direct influence on O2
consumption (β-= 0.004 and 0.06, respectively, in models with
central and peripheral amplitudes as the intermediate variable)
whereas the indirect effects on O2 consumption via changes in retinal
function were greater (β= -0.62 and β= -0.68, respectively, in the
same two models).
Conclusions: Eyes with longer AL have lower O2 consumption. The
reduction in O2 demand is explained by the parallel reduction in
retinal function. These findings are consistent with the hypothesis
that the reduced O2 consumption in eyes with longer AL may help to
reduce the risk of DR.
Commercial Relationships: Ryan Man, None; Ecosse L.
Lamoureux, None; Yamna Taouk, None; Jing Xie, None;
Jonathan E. Noonan, None; Ryo Kawasaki, None; Jie Wang,
None; Chi D. Luu, None
Program Number: 2169
Presentation Time: 3:00 PM - 3:15 PM
A Population Based ultra wide-field digital image grading study
for AMD-like pathologies at the peripheral retina
Imre Lengyel1, Fridbert Jonasson3, Gudbar Thorleifsson4, Adrienne
Csutak5, Tunde Peto2. 1Ocular Biology and Therapeutics, UCL
Institute of Ophthalmology, London, United Kingdom; 2Reading
centre, NIHR Biomedical Research Centre for Ophthalmology, at
Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of
Ophthalmology, London, United Kingdom; 3Department of
Ophthalmology, Landspitali University Hospital, Reykjavik, Iceland;
4
DECODE, Reykjavik, Iceland; 5Department of Ophthalmology,
University of Debrecen, Debrecen, Hungary.
Purpose: Our understanding of the relevance of peripheral
pathologies in general and in Age Related Macular Degeneration
(AMD) in particular is limited by the lack of detailed peripheral
imaging studies.The purpose of this study was to investigate
potention relationships between macular and peripheral pathologies
with genetic variation in an aged population.
Methods: This is a cross-sectional study of a random population
sample as part of the 12 year follow-up of the Reykjavik Eye Study
in Iceland. Ultra wide field (up to 200°) color and autofluorescence
(AF) images were taken of 573 subjects aged 62 years or older using
the Optos P200C AF laser scanning ophthalmoscope. Macular and
peripheral changes were graded using a grid developed for this
imaging modality. Presence or absence of hard, crystalline and soft
drusen, retinal pigment epithelial changes, choroidal
neovascularisation and atrophy and hypo-and hyperfluorescence were
graded of the peripheral retina and these were correlated with genetic
variation.
Results: 18.9% of the eyes examined were free of pathologies both in
the macula and the periphery. There were eyes with pathology only in
the macula (13.6%) or only in the periphery (10.1%) while
pathologies at both locations were the most frequent (57.4%), with
the majority of pathologies being in the far periphery (zone 5). No
patient with end-stage disease in the macula had normal periphery.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
The genetic analysis confirmed previously reported associations
between high risk macular phenotypes with rs10737680 and
rs10490924 polymorphisms OR = 2.17 (P = 0.032) and 3.25 (P =
0.00010). No genetic association was found for peripheral
phenotypes in this population.
Conclusions: Phenotyping retinal periphery confirmed the presence
of wide ranging sub-RPE deposit formation in the periphery even in
those without central sight threatening disease. There was no
genotypic association with peripheral retinal changes in our samples.
Commercial Relationships: Imre Lengyel, UCL Business (P);
Fridbert Jonasson, None; Gudbar Thorleifsson, deCode Genetics
(E); Adrienne Csutak, None; Tunde Peto, None
Support: The research was supported by the Bill Brown Charitable
Trust, Moorfields Eye Hospital Special Trustees, UCL Graduate
School Research Projects Fund, Mercer Fund from Fight for Sight
and the NIHR.The project was part-funded by an unrestricted grant
from OPTOS plc. OPTOS plc participated in data collection by
providing an imaging team.
Program Number: 2170
Presentation Time: 3:15 PM - 3:30 PM
Potential Targets for Preventative Eye Care Among those with
Diabetes
Fang Ko1, Susan Vitale2, David S. Friedman1, 3. 1Wilmer Eye
Institute, Johns Hopkins, Baltimore, MD; 2Division of Epidemiology
and Clinical Applications, National Eye Institute, Bethesda, MD;
3
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Purpose: The need for dilated eye exams is an important problem as
the prevalence of diabetes increases. We analyzed data from a
population-based study of US adults with diabetes to determine who
had received a dilated eye exam (DFE) in the past year, and what risk
factors are associated with not receiving an examination.
Methods: The National Health and Nutrition Examination Survey
(NHANES) examines a representative sample of the US noninstitutionalized population. In 2005-2008, 10,480 participants were
surveyed, and 1,298 reported having diabetes. These participants
received questionnaire, lab testing, physical examination, and visual
acuity measurement including autorefraction.
Results: 38% (95% confidence interval (CI) 31.4-43.2) of people
with diabetes living in the US reported not having a dilated fundus
exam (DFE) in the past year. Multivariable regression showed those
at greater risk for not receiving a dilated fundus exam in the past year
were younger (64% of participants age 20-39 years did not receive
DFE, odds ratio (OR) 2.66 [95% CI 1.36-5.20] as compared to age
≥65 years), lacked access to health care (80% did not receive DFE,
OR 6.40 [95% CI 1.57-26.06]), had no insurance (64% did not
receive DFE, OR 3.06 [95% CI 1.64-5.73]), and stated that a doctor
had not told them that their eyes were affected by diabetes (59.6%
did not receive DFE, OR 2.08 [95% CI 1.17-3.71]). Those with
diabetes longer-duration diabetes were no more likely to receive a
dilated eye exam than those with shorter duration (35% of those with
diabetes ≥10 years duration, and 39% of those with diabetes <10
years, did not receive an eye exam, p=0.14). Ethnicity, gender,
poverty, education less than high school, smoking, type of insurance,
and visual acuity were not significantly associated with receiving a
DFE.
Conclusions: Over a third of persons in the U.S. with diabetes, a
group at higher risk for ophthalmic complications, did not have an
eye exam in the past year. To increase screening rates, programs will
need to focus on those at greatest risk of not receiving a DFE,
including younger populations, those lacking access to eyecare
providers, those without health insurance, and those who may not be
aware of how diabetes affects their eyes.
Commercial Relationships: Fang Ko, None; Susan Vitale, None;
David S. Friedman, Alcon (C), Bausch & Lomb (C), Merck (C),
QLT, Inc (C), Allergan (C), Nidek (C)
Support: CDC grant 1U58DP002653-01
Program Number: 2171
Presentation Time: 3:30 PM - 3:45 PM
Epidemiology of retinopathy in African Americans with impaired
fasting glucose and type 2 diabetes in the Jackson Heart Study
Lucia Sobrin1, Alan Penman2, 3, Suzanne T. Hoadley4, James G.
Wilson2, Herman A. Taylor2, Ching J. Chen4. 1Retina/Uveitis,
Harvard Med Mass Eye & Ear Infirmary, Boston, MA; 2Medicine,
University of Mississippi Medical Center, Jackson, MS;
3
Biostatistics, University of Mississippi Medical Center, Jackson,
MS; 4Ophthalmology, University of Mississippi Medical Center,
Jackson, MS.
Purpose: To determine the prevalence and risk factors for
retinopathy in a population-based study of African Americans (AA)
with impaired fasting glucose (IFG) and type 2 diabetes (T2D).
Methods: Participants with IFG and T2D in the Jackson Heart Study
(JHS) were invited to participate in an ancillary study of retinopathy.
Dilated, bilateral, digital, seven-field fundus photography was
obtained in each participant. The photographs were scored by two
masked readers using the Early Treatment Diabetic Retinopathy
(ETDRS) adaptation of the modified Airlie House classification. Risk
factor measurements including duration of diabetes, hemoglobin A1C
(HbA1C), blood pressure, body mass index (BMI) and lipid levels
were obtained from each participant’s most recent JHS visit. Grade of
retinopathy was defined as the higher grade of the two eyes. Logistic
regression (SAS 9.3, SAS Institute Inc., Cary, NC) was used to
estimate the association between presence of any retinopathy
(ETDRS grade ≥ 14) and traditional risk factors.
Results: Three hundred and eighty-four participants with IFG and
515 participants with T2D were enrolled in this ancillary study of
retinopathy. The prevalence of any retinopathy among participants
with IFG was 9.8%. The overall prevalence rates of any retinopathy
and proliferative retinopathy were 37.3% and 5.5%, respectively, in
the participants with T2D. Among those with IFG, presence of
retinopathy was associated with a higher BMI (35.2 kg/m2 vs. 31.4
kg/m2, p=0.03). Among those with T2D, presence of retinopathy was
associated with a higher HbA1C level (6.8% vs. 6.2%, p=0.002) and
longer duration of diabetes (16.5 years vs. 8.9 years, p<0.0001).
Overall, the odds of having any retinopathy were 1.63 (95%
confidence interval: 1.08, 2.47) higher in participants with HbA1C ≥
6.5% compared with those with a HbA1C < 6.5%. No other
statistically significant associations with other traditional risk factors
were identified.
Conclusions: The prevalence rates of any retinopathy in AA with
IFG and T2D in the JHS are similar to those in other populations.
Among participants with IFG, higher BMI is a modifiable risk factor
for retinopathy that deserves further investigation. Duration of
diabetes and HbA1C level, the two most strongly associated
retinopathy risk factors in other ethnicities, were also associated with
retinopathy in JHS participants with T2D.
Commercial Relationships: Lucia Sobrin, None; Alan Penman,
None; Suzanne T. Hoadley, None; James G. Wilson, None;
Herman A. Taylor, None; Ching J. Chen, None
Support: Research to Prevent Blindness Career Development
Award, American Diabetes Association Clinical/Translational Award
1-11-CT-51, Massachusetts Lions Eye Research Fund, Harvard
Catalyst Faculty Fellowship, NEI K12 Harvard Vision Clinical
Scientist Development Program, Grant EY16335, Eleanor and Miles
Shore 50th Anniversary Fellowship. Sara Elizabeth O'Brien Trust
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Program Number: 2172
Presentation Time: 3:45 PM - 4:00 PM
Real-World Utilization of Anti-VEGFs in Diabetic Macular
Edema and Retinal Vein Occlusion: Injection Frequency, Patient
Monitoring, and Concomitant Therapy Use
Szilard Kiss1, Ying Liu2, Joseph Brown3, Nancy M. Holekamp4,
Arghavan Almony5, Joanna Campbell2, Jonathan W. Kowalski2.
1
Ophthalmology, Weill Cornell Medical College, New York, NY;
2
Allergan, Inc., Irvine, CA; 3IMS Health, Inc., Woodland Hills, CA;
4
Washington University School of Medicine, St. Louis, MO;
5
Carolina Eye Associates, Southern Pines, NC.
Purpose: Randomized controlled trials (RCTs) suggest that efficacy
of anti-VEGF therapies increases with more frequent treatment in
branch or central retinal vein occlusion (BRVO, CRVO) and diabetic
macular edema (DME). This retrospective analysis assesses realworld utilization of bevacizumab and ranibizumab in these
conditions.
Methods: A large national insurance database of medical claims
from approximately 80 health plans was analyzed. The sample
consisted of newly diagnosed patients who initiated anti-VEGF
therapies in 2008, 2009, or 2010 with at least 12-month follow-up.
The numbers of anti-VEGF injections, ophthalmologist visit days,
and ocular coherence tomography (OCT) exams in the first 12
months of anti-VEGF treatment were studied. The association
between laser or intravitreal triamcinolone (IVTA) use and the
number of anti-VEGF treatments was also assessed.
Results: 675 (BRVO), 480 (CRVO), and 1,907 (DME)
bevacizumab-treated patients met all inclusion/exclusion criteria,
with too few ranibizumab-treated patients for meaningful analysis.
For the 2008, 2009 and 2010 cohorts, mean numbers of bevacizumab
injections over 12 months remained low despite a slight increase over
time (BRVO: 2.5, 3.1, and 3.3; CRVO: 3.1, 3.1, and 3.5; DME: 2.2,
2.5, and 3.6). Mean ophthalmologist visit days were similarly low,
ranging between 5.1 and 5.6 (BRVO), 5.9 and 6.5 (CRVO), and 4.4
and 5.3 (DME); while mean OCT exams ranged from 3.7 to 3.9
(BRVO), 3.4 to 3.8 (CRVO), and 3.1 to 3.8 (DME). Across all year
cohorts, 44.4% (BRVO), 18.5% (CRVO), and 61.2% (DME) patients
received laser and/or IVTA. Patients treated with laser received
greater number of bevacizumab injections over 12 months in both
BRVO and DME cohorts (BRVO: 3.3 vs. 2.9; DME: 3.3 vs. 2.7;
p<0.05). Treatment with IVTA was positively associated with the
mean number of bevacizumab injections in DME (3.3 vs. 3.0,
p=0.04).
Conclusions: The numbers of bevacizumab injections BRVO,
CRVO and DME patients received in clinical practice were well
below those administered in major anti-VEGF RCTs, as were the
number of ophthalmologist visit days and OCT exams. Further
research is necessary to confirm these findings in larger ranibizumab
samples and to evaluate the impact of these real-world treatment
patterns on visual acuity outcomes.
Commercial Relationships: Szilard Kiss, Alcon (F), Alimera (F),
Alimera (C), Alimera (R), Allergan (F), Allergan (C), Allergan (R),
Genentech (F), Genentech (C), Genentech (R), Regeneron (F),
Regeneron (C), Regeneron (R), Optos (F), Optos (C), Optos (R),
Eytech (C), Merge/OIS (C), Merge/OIS (I); Ying Liu, Allergan, Inc.
(E), Allergan, Inc. (I); Joseph Brown, IMS Health (F); Nancy M.
Holekamp, Sequenom (C), Sequenom (R), Sequenom (F), Arctic Dx
(F), Allergan (C), Alimera (C), Notal Vision (C), Notal Vision (F),
Regeneron (C), Regeneron (R), Genentech (C), Genentech (R);
Arghavan Almony, None; Joanna Campbell, Allergan Inc (E);
Jonathan W. Kowalski, Allergan Inc (E)
Support: Allergan, Inc.
Program Number: 2173
Presentation Time: 4:00 PM - 4:15 PM
Are Routine Retinal Examinations useful for Patients with
Dementia?
Mark Wong1, Carol Y. Cheung1, 2, Yi-Ting Ong1, 3, Saima Hilal4, 5,
Yingfeng Zheng1, Merwyn Chew1, Philip Yap6, Dennis Seow7,
Christopher Chen4, 5, Tien Y. Wong1, 3. 1Singapore Eye Research
Institute, Singapore, Singapore; 2Centre for Quantitative Medicine,
Duke-NUS Graduate Medical School, Singapore, Singapore;
3
Department of Ophthalmology, Yong Yoo Lin School of Medicine,
Singapore, Singapore; 4Memory Aging and Cognition Centre,
National University Health System, Singapore, Singapore;
5
Department of Pharmacology, National University of Singapore,
Singapore, Singapore; 6Department of Geriatric Medicine,
KhooTeckPuat Hospital, Singapore, Singapore; 7Department of
Geriatric Medicine, Singapore General Hospital, Singapore,
Singapore.
Purpose: Persons with dementia may be less likely to complain of
symptoms of impaired vision and thus major eye diseases may be
under-diagnosed and under-treated. In this study, we aim to describe
the prevalence and awareness of vision-threatening eye diseases in a
cohort of patients with dementia.
Methods: We recruited clinically diagnosed demented patients from
3 study sites (dementia/memory clinics from the National University
of Hospital, Khoo Teck Puat Hospital and Singapore General
Hospital, Singapore). All patients underwent clinical neurologic and
neuropsychiatric assessment for dementia. We used a standardized
questionnaire to ascertain patients’ history of eye diseases from their
main caregiver. Retinal photographs were taken from all patients and
assessed by an ophthalmologist for presence of any retinal
pathologies. Patients were advised and referred if they required an
ophthalmology evaluation. The eye pathologies were then classified
into four categories of vision threatening eye diseases: age-related
macular degeneration (AMD), diabetic retinopathy, cataract (defined
based on media opacity from photographs), and glaucoma (defined
based on cup/disc ratio of >0.7).
Results: A total of 265 dementia patients were recruited of which
there were 255 with gradable retinal photographs. More than three
quarters (n=205, 76%) had at least one eye pathology based on signs
detected from the retinal photographs, with the majority (n=158,
63%) requiring a clinical ophthalmology assessment. Of the 205
patients with at least one eye pathology, nearly half (n=121, 47%)
had pathology which were previously undiagnosed. In terms of
specific vision-threatening eye disease, 173 (68%) patients had
cataracts, 53 (21%) had AMD, 41 (16%) had glaucoma, and 37
(15%) had diabetic retinopathy. Of these, 15% (29/173) of cataracts,
86% (46/53) of AMD, 78% (31/41) of glaucoma and 73% (27/37) of
diabetic retinopathy cases were previously been undiagnosed.
Conclusions: Three quarters of patients with dementia have visionthreatening eye pathology, of which half were undiagnosed. A
routine retinal examination identifying eye diseases and appropriate
referral would be beneficial to patients with dementia to preserve
vision.
Commercial Relationships: Mark Wong, None; Carol Y. Cheung,
None; Yi-Ting Ong, None; Saima Hilal, None; Yingfeng Zheng,
None; Merwyn Chew, None; Philip Yap, None; Dennis Seow,
None; Christopher Chen, GSK (F); Tien Y. Wong, Allergan (C),
Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche (F)
Program Number: 2174
Presentation Time: 4:15 PM - 4:30 PM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Vision-Threatening Diabetic Retinopathy and Incident
Cardiovascular Disease: A Systematic Review and Meta-Analysis
Mohammad K. Ikram1, Jing Xie2, Mary Frances Cotch3, Barbara E.
Klein4, Paul Mitchell5, Jonathan Shaw6, Rohit Varma7, Ecosse L.
Lamoureux2, Tien Y. Wong1. 1Singapore Eye Research Institute,
Singapore, Singapore; 2Centre for Eye Research Australia,
Melbourne, VIC, Australia; 3Division of Epidemiology and Clinical
Applications, National Eye Institute, Intramural Research Program,
National Institutes of Health, Bethesda, MD; 4Department of
Ophthalmology and Visual Sciences, University of Wisconsin School
of Medicine and Public Health, Madison, MD; 5Department of
Ophthalmology and Westmead Millenium Institute, Centre for Vision
Research, University of Sydney, Sydney, NSW, Australia; 6Baker IDI
Heart and Diabetes Institute, Melbourne, VIC, Australia;
7
Department of Ophthalmology and Visual Sciences, University of
Illinois College of Medicine at Chicago, Chicago, IL.
Purpose: To perform a meta-analysis on the association between
baseline vision-threatening diabetic retinopathy (VTDR) and incident
cardiovascular diseases (CVD) using individual participant data.
Methods: Following an extensive electronic and manual literature
search and personal correspondence with investigators, high quality
prospective population-based studies were included with data on
participants with photographic-based DR grading, adequate followup visits, and well-defined cardiovascular endpoints, namely
coronary heart disease (CHD) and/or stroke. VTDR was defined as
the presence of proliferative DR (PDR, ETDRS level ≥ 60) and/or
any diabetic macular edema (DME) in the worst eye.
Results: Of 1904 identified search titles, 8 studies met our inclusion
criteria and comprised of 6,343 subjects with diabetes mellitus type 2.
At baseline the prevalence was 10.6% for VTDR, 7.9% for PDR and
5.0% for DME. After a mean follow-up time of 5.9 years [range 3.2
to 10.1 years across studies], there were 1100 incident cases of firstever CVD events. The presence of VTDR was associated with risk of
incident CVD (age-sex-race adjusted incidence rate ratio [IRR] 1.39;
95% confidence interval [CI]: 1.16-1.67) and CHD (IRR 1.47; 95%
CI: 1.20-1.79). For fatal CVD and fatal CHD, the corresponding
IRRs were 2.33 (95% CI: 1.49-3.67) and 2.74 (95% CI: 1.74-4.32),
respectively. These associations persisted after multivariate
adjustment for vascular risk factors, including smoking, systolic
blood pressure, hypertension medication, triglyceride, body mass
index, duration of diabetes, treatment of diabetes and Hb1Ac. When
examining PDR and DME separately, both were related to an
increased risk of first-ever CVD (for PDR IRR: 1.28; 95% CI: 1.031.58 and for DME IRR 1.59; 95% CI: 1.20-2.10). The corresponding
HRs for fatal CVD were 1.85 (95% CI: 1.04-3.28) and 2.85 (95% CI:
1.43-5.68).
Conclusions: Persons with VTDR are at increased risk of incident
CVD including CHD compared to those without the condition. These
data suggest that persons with type 2 diabetes and VTDR should be
followed more closely by their physicians in an effort to prevent
CVD complications from occurring.
Commercial Relationships: Mohammad K. Ikram, None; Jing
Xie, None; Mary Frances Cotch, None; Barbara E. Klein, None;
Paul Mitchell, Novartis (R), Bayer (R); Jonathan Shaw, None;
Rohit Varma, Allergan (C), AqueSys (C), Genentech (C), Merck &
Co. Inc (C), Replenish (C), Genentech (F), National Eye Institute (F);
Ecosse L. Lamoureux, None; Tien Y. Wong, Allergan (C), Bayer
(C), Novartis (C), Pfizer (C), GSK (F), Roche (F)
307 Glaucoma Epidemiology: Teasing Out Mechanisms and
Understanding the Burden
Tuesday, May 07, 2013 8:30 AM-10:15 AM
615-617 Paper Session
Program #/Board # Range: 2651-2657
Organizing Section: Clinical/Epidemiologic Research
Program Number: 2651
Presentation Time: 8:30 AM - 8:45 AM
Clarifying the role of ATOH7 in glaucoma endophenotypes
Ananth C. Viswanathan1, 2, Cristina Venturini3, 4, Pirro G. Hysi4,
Abhishek Nag4, Ekaterina Yonova4, Jie Wang7, 8, Tien Y. Wong5, 6,
Paul R. Healey9, Paul Mitchell9, 8, Christopher J. Hammond4.
1
Glaucoma Service, Moorfields Eye Hospital, London, United
Kingdom; 2NIHR Biomedical Research Centre, Moorfields Eye
Hospital and UCL Institute of Ophthalmology, London, United
Kingdom; 3Genetics, UCL Institute of Ophthalmology, London,
United Kingdom; 4Twin Research and Genetic Epidemiology, King’s
College London St. Thomas’ Hospital, London, United Kingdom;
5
Epidemiology and Public Health, National University of Singapore,
Singapore, Singapore; 6Singapore Eye Research Institute, Singapore,
Singapore; 7Centre for Eye Research Australia (CERA) Department
of Ophthalmology, University of Melbourne, Melbourne, NSW,
Australia; 8Department of Ophthalmology, University of Sydney
Centre for Vision Research, Sydney, NSW, Australia; 9Department of
Ophthalmology, University of Sydney, Sydney, NSW, Australia.
Purpose: The ATOH7 gene has been previously associated with
glaucoma and glaucoma-related traits such as cup/disc ratio and optic
disc size. Cup/disc ratio is an important part of the glaucoma
phenotype, whereas the relationship between the disease and optic
disc size is weak and not well understood.
The aim of this study was to investigate whether ATOH7 is
associated primarily with cup/disc ratio or merely the size of the optic
disc.
Methods: We carried out a genome wide association study (GWAS)
on 1677 individuals over the age of 49 years from the Blue
Mountains Eye Study with quantitative measurements for vertical
disc diameter, vertical cup/disc ratio and intraocular pressure. The
analyses were run for a candidate region around rs7916697 where
ATOH7 gene lies. Three different linear regressions were performed
with PLINK. The first was for vertical disc diameter adjusted on age,
sex and intraocular pressure, the second for vertical cup/disc ratio
adjusted on age, sex and intraocular pressure and the third for
cup/disc ratio adjusted on age, sex, intraocular pressure and vertical
disc diameter. We performed a replication analysis on a separate
independent cohort of 1922 individuals (the TwinsUK cohort).
Results: After adjustments for confounders, a strong signal of
genome-wide significance was found at rs7916697 (beta=-3.779,
pvalue=1.678x10-8) for vertical disc diameter. In addition rs7916697
was significant for vertical cup/disc ratio (beta= -0.019, pvalue=
2.43x10-4), adjusted on age, sex and intraocular pressure. However,
the association signal at this SNP was not found in the analysis for
vertical cup/disc ratio adjusted on age, sex, intraocular pressure and
vertical disc diameter (beta=-0.007, pvalue= 0.148). Results were
similar in the replication TwinsUK cohort.
Conclusions: The association signals at rs7916697 on ATOH7 are
strong for vertical disc diameter and vertical cup/disc ratio, if the
latter is not adjusted on vertical disc diameter. However, the signal
for cup/disc ratio is lost when the analysis for cup/disc ratio is
adjusted on disc diameter. This study finds that ATOH7 is associated
with optic disc size but not cup/disc ratio.
Commercial Relationships: Ananth C. Viswanathan, None;
Cristina Venturini, None; Pirro G. Hysi, None; Abhishek Nag,
None; Ekaterina Yonova, None; Jie Wang, None; Tien Y. Wong,
Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
(F); Paul R. Healey, None; Paul Mitchell, Novartis (R), Bayer (R);
Christopher J. Hammond, None
Program Number: 2652
Presentation Time: 8:45 AM - 9:00 AM
Pseudoexfoliation: Normative Data and Associations. The Beijing
Eye Study 2011
Qisheng You1, Ya Xing Wang1, Liang Xu1, Jost B. Jonas2, 1. 1Beijing
Institute of Ophthalmology, Beijing Tongren Hospital, Capital
University of Medical Science, Beijing, China; 2Department of
Ophthalmology, Universitätsmedizin Mannheim, Medical Faculty
Mannheim, Heidelberg University, Mannheim, Germany.
Purpose: Pseudoexfoliation syndrome (PEX) is the most common
cause of secondary open angle glaucoma, and is associated with an
increased risk of lens zonule rupture during cataract surgery. The
reported prevalence of PEX varied from 0.2% to 30%. The purpose
of current study is to assess the prevalence and associations of PEX
in mainland China, where no PEX epidemiological data available yet.
Methods: Beijing Eye Study 2011 is a population-based crosssectional study. Out of 4403 eligible subjects with an age of 50+
years, 3468 (78.8%) individuals participated (mean age of 64.6+/-9.8
years; range: 50-93 years). All study participants underwent a
detailed ophthalmological examination. PEX was assessed by an
experienced ophthalmologist using slit-lamp biomicroscopy after
pupil dilation.
Results: Participants refusing pupil dilation, with aphakia,
pseudophakia, or severe corneal opacities were excluded. Definite
pseudoexfoliation was observed in 72/3022 subjects (2.38%, 95%
confidence interval (CI):1.84,2.93). Suspected PEX was detected in
104/3022 subjects (3.44%; 95%CI:2.8,4.1). The overall prevalence of
PEX (definite and suspected) was 5.82% (95%CI:4.99,6.66). In 80
(45.5%) subjects, PEX was detected bilaterally. PEX prevalence
increased from 1.1% in the age group of 50-54 years, to 3.5%, 5.7%,
and 11.8% in the age groups of 60-64 years, 70-74 years, and 80+
years, respectively. In multivariate analysis, presence of PEX was
significantly associated with older age (P<0.001; odds ratio (OR):
1.08 (95%CI:1.04,1.10)), shorter axial length (P=0.03; OR: 0.82
(95%CI:0.68,0.98)), and shallower anterior chamber (P=0.03; OR:
0.59 (95%CI:0.36,0.95)). PEX was not significantly (all P>0.05)
associated with gender, diabetes mellitus, blood pressure,
psychological depression, smoking, dyslipidemia, and body mass
index; nor with central corneal thickness, corneal diameter, optic
nerve head measurements, choroidal thickness, retinal vessel
diameters, early age-related macular degeneration and retinal vein
occlusion.
Conclusions: In a North Chinese population aged 50+ years,
prevalence of definite PEX was 2.38% (95%:1.84,2.93), suspect PEX
3.4% (95%CI:2.8,4.1) and overall PEX 5.82% (95%CI:4.99,6.66).
PEX was significantly associated with older age, shorter axial length
and shallower anterior chamber. The relationship between PEX and
glaucomatous optic neuropathy remained inconclusive.
Commercial Relationships: Qisheng You, None; Ya Xing Wang,
None; Liang Xu, None; Jost B. Jonas, Allergan (C), MSD (C),
Alimera (C), CellMed AG (P)
Program Number: 2653
Presentation Time: 9:00 AM - 9:15 AM
The association of pseudoexfoliation syndrome (PEX) with
cardiovascular (CVD) and cerebrovascular (CVA) disease: a
systematic review and meta-analysis
Helen Chung, Sourabh Arora, Karim F. Damji, Ezekiel Weis.
University of Alberta, Edmonton, AB, Canada.
Purpose: Pseudoexfoliation syndrome (PEX) is a systemic disorder
and evidence of its association with CVD and CVA is controversial.
The aim of this meta-analysis was to quantitatively summarize the
current body of literature on this association.
Methods: A comprehensive literature search within PubMed and
Embase was performed, as was a hand search of references. Studies
were included if they were published in English and reported
incidence of CVD and/or CVA among PEX and control groups.
Results: CVD included the diagnostic terms coronary artery disease,
ischemic heart disease, and angina. CVA included acute
cerebrovascular disease, stroke, and white matter hyperintensities on
MRI. After screening 1853 studies, 28 articles were reviewed, and 13
eligible studies were selected that reported patients from the
following populations: Turkish, Lithuanian, Australian, Norwegian,
Finnish, Croatian, Spanish, Indian, Greek, and American. Twelve
studies enrolling 8310 individuals with PEX evaluated CVD. Using a
random effects model, the summary odds ratio (OR) was 1.46 [1.131.89 95% confidence interval], p<0.01). For CVA using 5 studies,
there were 1036 PEX patients yielding a summary OR of 2.16 [1.164.03], p=0.02. For combined vascular events (CVE) using all 13
studies, there were 8346 PEX patients and 135,570 control patients
yielding a summary OR of 1.58 [1.31-1.91], p<0.0001 Metaregression in the CVD and CVE groups respectively was not
significant for age (p=0.29, 0.13), sex (p=0.82, 0.56), and study
design (p=0.20, 0.16). A similar analysis was not performed on CVA
studies, as this data was not identifiable in published studies.
Analysis for publication bias with Egger’s test was not significant for
studies reporting CVD, CVA, and CVE, respectively (p=0.78, 0.07,
0.13).
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Conclusions: There is strong evidence that PEX is significantly
associated with both cardiovascular and cerebrovascular disease in
the populations studied.
adjusted for typical scan score (TSS) to handle scans with atypical
retardation, and models with HRT parameters were adjusted for disc
area. Maximally adjusted models were further adjusted (linearly) for
IOP, axial length, age, sex, body mass index, height and systolic
blood pressure. Generalised estimating equations were used to
analyse data from both eyes of participants.
Results: Complete data were available from 8,615 eyes of 5,354
predominantly white participants. The mean age was 67yrs (48-89)
and 43% were men. Summary measures for the 8,615 eyes are shown
in Table 1. Table 2 summarises results from the regression analyses.
Higher CH was significantly associated with a larger rim area
(p<0.001), smaller linear CDR (p<0.001) and thicker RNFL
(p<0.001) in maximally adjusted models. Higher CH was associated
with lower NFI in crude analysis (p<0.001) but not following
maximal adjustment (p=0.18). Results were similar if adjustment was
for corneal-compensated IOP, rather than Goldmann-correlated
values.
Conclusions: In a population of British adults, higher CH was
significantly associated with RNFL and optic disc parameters in a
direction suggestive of a protective effect against glaucoma. This
may support the theory that corneal biomechanical measures reflect
lamina properties and thus glaucoma risk. Residual confounding by
IOP is another possible explanation for the association. Regression
coefficients were small, indicating a small effect.
Forest plots for published reports on the association of PEX with
CVD (A), CVA (B), and CVE (C).
Commercial Relationships: Helen Chung, None; Sourabh Arora,
None; Karim F. Damji, None; Ezekiel Weis, None
Program Number: 2654
Presentation Time: 9:15 AM - 9:30 AM
Corneal hysteresis and glaucoma-related quantitative traits in
the EPIC-Norfolk Eye Study
Anthony P. Khawaja1, Michelle P. Chan2, David C. Broadway3,
David F. Garway-Heath4, Robert Luben1, Kay-Tee Khaw1, Paul J.
Foster2, 4. 1Department of Public Health and Primary Care, University
of Cambridge, Cambridge, United Kingdom; 2Division of Genetics
and Epidemiology, UCL Institute of Ophthalmology, London, United
Kingdom; 3Department of Ophthalmology, Norfolk & Norwich
University Hospital, Norwich, United Kingdom; 4NIHR Biomedical
Research Centre, Moorfields Eye Hospital NHS Foundation Trust
and UCL Institute of Ophthalmology, London, United Kingdom.
Purpose: Controversy exists regarding whether corneal
biomechanical properties are related to glaucoma risk independently
of intraocular pressure. The aim of this study was to determine if an
association exists between corneal hysteresis (CH) and glaucomarelated quantitative traits in a population-based sample.
Methods: Ophthalmic examination took place cross-sectionally
between 2004-2011. Goldmann-correlated intraocular pressure (IOP)
and CH were measured using the Ocular Response Analyzer (single
best value from 3 readings). Average retinal nerve fibre layer (RNFL)
thickness and the nerve fibre indicator (NFI) were measured using the
GDxVCC (quality score ≥7). Optic disc rim area and linear cup-todisc ratio (CDR) were measured using the HRT II (topographic SD
≤40). Axial length was measured using the IOLMaster. Linear
regression models were used to examine the association between CH
and RNFL/disc parameters. Models with GDx parameters were
Commercial Relationships: Anthony P. Khawaja, None; Michelle
P. Chan, None; David C. Broadway, None; David F. GarwayHeath, Moorfields MDT (P), Carl Zeiss Meditec (F), Heidelberg
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Engineering (F), Reichert Technoloies (F), Ziemer Ophthalmic
Systems AG (F), Pfizer Inc (F), Allergan (F), Allergan (C), Allergan
(R), Alcon (C), Alcon (R), Bausch & Lomb (R), Merck (R), Santen
(R), Quark (C), Teva (C), Topcon (F), OptoVue (F); Robert Luben,
None; Kay-Tee Khaw, None; Paul J. Foster, Carl Zeiss Meditech
(F)
Program Number: 2655
Presentation Time: 9:30 AM - 9:45 AM
Glaucomatous progression in the African Descent and Glaucoma
Evaluation Study (ADAGES)
Linda M. Zangwill1, Naira Khachatryan1, Sonia Jain2, Feng He2,
Felipe A. Medeiros1, Christopher Bowd1, Renato Lisboa1, Robert N.
Weinreb1, Jeffrey M. Liebmann3, 4, Christopher A. Girkin5.
1
Ophthalmology, Hamilton Glaucoma Center, University of
California, San Diego, La Jolla, CA; 2Departmen of Family and
Preventive Medicine, University of Cailfornia, San Diego, La Jolla,
CA; 3New York University, New York, NY; 4Ophthalmology,
Einhorn Clinical Research Center, New York Eye and Ear Infirmary,
New York, NY; 5School of Medicine, University of AlabamaBirminghm, Birmingham, AL.
Purpose: To evaluate predictors of glaucomatous optic disc and
visual field progression in glaucoma patients.
Methods: Glaucoma patients enrolled in the African Descent and
Glaucoma Evaluation Study (ADAGES) and Diagnostic Innovations
in Glaucoma Study (DIGS) with repeatable visual field damage at
study entry followed for at least 2 years were included.
Glaucomatous progression was defined as the development of
Standard Automated Perimetry (SAP) Guided Progression Analysis
(GPA) “likely progression” or stereophotograph-based optic disc
deterioration identified by 2 independent graders. Age, gender, race,
IOP and baseline ocular risk factors including corneal thickness,
stereophotograph-based vertical cup-disc ratio and visual field MD
and PSD were evaluated in univariate and multivariable Cox
proportional hazards models to identify predictors of glaucomatous
progression.
Results: 458 eyes of 254 glaucoma patients (130 African descent and
124 European descent) were included. The median SAP MD at study
entry was -3.0db (range: -30.2 db to 1.4 db). The mean follow-up
time was 5.7 years (range: 2.4 to 9.5 years). 100 (39%) of the 254
glaucoma patients progressed in at least one eye. 66 of the patients
developed GPA visual field changes only, 19 developed optic
changes only and 15 developed both visual field and optic disc
changes during the follow-up period. The mean (+ SD) time to
progression was 4.8 + 1.9 years. The proportion of participants
progressing was similar in African descent (50/130, 38.9%) and
European descent (50/124, 40.3%) glaucoma patients. In
multivariable analysis, baseline IOP and stereophotograph based
vertical cup disc ratio were independently predictive of glaucomatous
progression.
Conclusions: In this subgroup of the ADAGES cohort with
glaucomatous visual field damage at study entry, a relatively large
proportion of African descent and European descent glaucoma
patients showed evidence of GPA visual field changes and/or optic
disc change.
Commercial Relationships: Linda M. Zangwill, Carl Zeiss
Meditec Inc (F), Heidelberg Engineering GmbH (F), Optovue Inc (F),
Topcon Medical Systems Inc (F), Nidek Inc (F); Naira
Khachatryan, None; Sonia Jain, None; Feng He, None; Felipe A.
Medeiros, Carl-Zeiss (F), Heidelberg Engineering (F), Topcon (F),
Alcon (F), Allergan (F), Sensimed (F), Reichert (F); Christopher
Bowd, None; Renato Lisboa, None; Robert N. Weinreb, Aerie (F),
Alcon (C), Allergan (C), Altheos (C), Amakem (C), Bausch&Lomb
(C), Carl Zeiss-Meditec (C), Genentech (F), Haag-Streit (F),
Heidelberg Engineering (F), Konan (F), Lumenis (F), National Eye
Institute (F), Nidek (F), Optovue (C), Quark (C), Solx (C), Topcon
(C); Jeffrey M. Liebmann, Alcon Laboratories, Inc. (C), Allergan,
Inc. (C), Allergan, Inc. (F), Carl Zeiss Meditech, Inc (F), Heidelberg
Engineering, GmbH (F), Topcon Medical Systems, Inc. (F), National
Eye Institute (F), New York Glaucoma Research Institute (F), SOLX,
Inc. (C), Bausch & Lomb, Inc (C), Diopsys, Inc. (C), Diopsys, Inc.
(F), Merz, Inc. (C), Glaukos, Inc. (C), Quark, Inc. (C); Christopher
A. Girkin, SOLX (F), Heidelberg Engineering (F)
Support: NEI Grant U10EY14267, EY019869, EY021818,
EY022039 and EY08208, EY11008, and EY13959; Eyesight
Foundation of Alabama; Alcon Laboratories Inc.; Allergan Inc.;
Pfizer Inc.; Merck Inc.; Santen Inc.; and the Edith C. Blum Research
Fund of the New York Glaucoma Research Institute, New York, NY,
Supported by an unrestricted grant from Research to Prevent
Blindness, New York, New York
Clinical Trial: NCT00221923
Program Number: 2656
Presentation Time: 9:45 AM - 10:00 AM
Number of People with Glaucoma in Asia in 2020 and 2040: A
Hierarchical Bayesian Meta-Analysis
Xiang LI1, 4, Errol W. Chan2, Jiemin Liao2, Tien Y. Wong2, 4, Tin
Aung2, 4, Ching-Yu Cheng2, 3. 1Department of Statistics and Applied
Probability, National University of Singapore, Singapore, Singapore;
2
Department of Ophthalmology, National University Health system,
Singapore, Singapore; 3Department of Ophthalmology, Yong Loo
Lin School of Medicine, National University of Singapore,
Singapore, Singapore; 4Singapore Eye Research Institute, National
Eye Centre, Singapore, Singapore.
Purpose: To update the prevalence of primary open angle glaucoma
(POAG) and primary angle-closure glaucoma (PACG) in Asia and
project the number of people with glaucoma in 2020 and 2040.
Methods: A systematic literature review was conducted to identify
all population-based studies of glaucoma in Asia and only studies
using standardized glaucoma diagnosis schemes were included in the
meta-analysis. Hierarchical Bayesian (HB) approaches were used to
determine the pooled prevalence of glaucoma, and examine the
difference in prevalence by gender, geographic regions and
urban/rural subgroups. The number of people with glaucoma in 2020
and 2040 was projected based on the database from the United
Nations World Population Prospects. The difference of Deviance
Information Criterion (dDIC) was calculated as a measure of
substantial evidence to support a prevalence difference if dDIC ≥ 5.
Otherwise, the posterior probability (PP) (PP close to 1 suggest
moderate evidence) of the difference in prevalence was used.
Results: We identified 21 studies (n = 64,046 individuals) conducted
between 1996 and 2010. The pooled prevalence for POAG, PACG
and total glaucoma were 2.01%, 0.89% and 2.96%, respectively.
Compared to males, females were less likely to have POAG (1.82%
vs. 2.51%, dDIC=21.8), but more likely to have PACG (1.07% vs.
0.57%, dDIC=40.2). Overall, the prevalence of glaucoma was higher
in males than females (2.91% vs. 3.30%, PP=0.98). The prevalence
of POAG was higher in urban than in rural environments (3.52% vs.
1.57%, PP=0.98). PACG is more prevalent in East Asia than South
Asia (1.22% vs. 0.65%, PP=0.99). The projected number of people
with glaucoma in Asia is 49.9 million in 2020 (POAG 76.1%), and
76.8 million in 2040 (POAG 69.6%) with balanced gender ratio
(females: 51.0%, 2020; 50.3%, 2040). Simulation study was
performed and showed that estimation using HB approach was
unbiased and the method of generalized estimating equations used in
previous studies overestimated the pooled prevalence.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Conclusions: The prevalence and incidence projections reflect the
significant burden of glaucoma in Asia. There is substantial evidence
to support the effect of gender and moderate evidence for geographic
regions and urban environments on the risk of glaucoma. These
estimates provide important information for the design and
implementation of eye care programs for glaucoma in Asia.
Commercial Relationships: Xiang LI, None; Errol W. Chan,
None; Jiemin Liao, None; Tien Y. Wong, Allergan (C), Bayer (C),
Novartis (C), Pfizer (C), GSK (F), Roche (F); Tin Aung, Alcon (R),
Alcon (C), Alcon (F), Allergan (R), Allergan (C), Carl Zeiss Meditec
(F), Carl Zeiss Meditec (R), Ellex (F), Ellex (R), Santen (R); ChingYu Cheng, None
Friedman, Alcon (C), Bausch & Lomb (C), Merck (C), QLT, Inc
(C), Allergan (C), Nidek (C)
Support: Centers for Disease Control and Prevention, Atlanta,
Georgia, no. U58DP002653
Program Number: 2657
Presentation Time: 10:00 AM - 10:15 AM
The Cost of Glaucoma Care Provided to a Sample of Medicare
Beneficiaries from 2002--2009
Harry Quigley1, Sandra D. Cassard1, Emily W. Gower2, Pradeep Y.
Ramulu1, Henry D. Jampel1, David S. Friedman1. 1Ophthalmology,
Johns Hopkins Wilmer Eye Inst, Baltimore, MD; 2Ophthalmology,
Wake Forest, Winston-Salem, NC.
Purpose: To estimate payments for glaucoma care among Medicare
beneficiaries from 2002 to 2009.
Methods: Data from a 5% random subsample of Medicare billing
information from the years 2002 through 2009 were collected from
the carrier, outpatient hospital, inpatient hospital and beneficiary
summary files. Medicare beneficiaries with both Parts A and B, fee
for service enrollment for > 1 month during the year, who had one of
a defined set of glaucoma diagnostic codes were included if they had
one glaucoma visit, glaucoma diagnostic test, or glaucoma
laser/surgical procedure. Groups coded as open angle, angle closure,
or other glaucoma were categorized separately. Claims were
classified into glaucoma care, other eye care and other medical care.
Results: In 2009, overall glaucoma payments were $37.4 million for
the 5% sample, for an overall estimated cost of $748.4 million, or
0.4% of all Medicare payments. Office visits comprised nearly onehalf of glaucoma-related costs, diagnostic testing was about onethird, and surgical and laser procedures were about 10% of costs
each. Coded OAG and OAG suspects accounted for 87.5% of
glaucoma costs, while cost per person was highest in other glaucoma,
followed by ACG, then OAG. Fewer than 3% of OAG patients were
estimated to undergo surgery and about 5% had laser trabeculoplasty
in 2009. Payments for ACG patients were headed by laser iridotomy
(35% of their total). Other glaucoma patients had the highest
proportion of costs devoted to surgery (26% of their total),
particularly tube—shunt surgeries. The non-glaucoma eye care for
glaucoma patients was 67% higher than that for glaucoma care,
chiefly related to cataract surgery and diagnosis/treatment of retinal
diseases. From 2002 to 2009, glaucoma care costs rose 30% (p<0.001
by test for linear trend) and the cost per person per year rose from
$197 to $228 (p<0.01 by test for linear trend), due to increased
reimbursement for visits, an increased number of OAG suspects,
more higher-level visits, and more laser and surgical procedures.
Conclusions: Payments for glaucoma were less than 1/200th of all
Medicare payments, increasing from 2002—2009 at less than the rate
of general or medical inflation. Cataract and retinal eye care for
glaucoma patients substantially exceeded the cost of their glaucoma
care. Visit charges represent the largest category of costs.
Commercial Relationships: Harry Quigley, Sensimed (C),
Genetech (C), Merck (C), Sucampo (C); Sandra D. Cassard, None;
Emily W. Gower, None; Pradeep Y. Ramulu, None; Henry D.
Jampel, Endo Optics (C), Sinexus (C), Allergan (C), Allergan (I),
Aerie Pharmaceutical (C), Transcend (C), Ivantis (C); David S.
Program Number: 3482 Poster Board Number: D0158
Presentation Time: 11:00 AM - 12:45 PM
Glaucoma and artificial tears
Rodrigo M. Torres1, 2, Pablo G. Lodolo1. 1Ocular Surface &
Immunology, Centro de Ojos Dr Lodolo, Parana, Entre Rios,
Argentina; 2Basic & Clinical Research, ROMAT, Colonia
Avellaneda, Entre Rios, Argentina.
Purpose: To review how many patients with glaucoma are using
artificial tears as a chronic treatment.
Methods: A retrospective clinical study was performed to review
clinical records from patients with diagnosis of glaucoma, between
January 2012 to November 2012. From each record, the follow data
were evaluated: sex, age, glaucoma topical treatment and if the
patient need to use artificial tears (at lease for 6 months). Also, a subgroup was performed to review the number of patients who have
been operated (trabeculectomy) and how many of them are using
artificial tears.
Results: From a total of 3272 clinical records, 167 (334 eyes) were
from patients with diagnosis of glaucoma (with topical eye drops for
glaucoma); 127 (254 eyes) were treated with glaucoma eye drops and
also artificial tears. The mean age from the patients were 63,8 yrs
with female prevalence (women: 112; men:55). A total of 15 patients
(23 eyes) underwent to trabeculectomy and all of them need to use
artificial tears; however, only one patient (2 eyes) still need to use
glaucoma eye drops.
Conclusions: Most of the patients (76%) with glaucoma are also
using artificial tears as a chronic treatment. This increase the real cost
of glaucoma treatment and remark the relevance to develop new
therapeutics for glaucoma. However, after trabeculectomy, patients
are still using artificial tears moreover than they don't need to use
glaucoma eye drops.
Commercial Relationships: Rodrigo M. Torres, None; Pablo G.
Lodolo, None
346 Glaucoma
Tuesday, May 07, 2013 11:00 AM-12:45 PM
Exhibit Hall Poster Session
Program #/Board # Range: 3482-3525/D0158-D0201
Organizing Section: Clinical/Epidemiologic Research
Program Number: 3483 Poster Board Number: D0159
Presentation Time: 11:00 AM - 12:45 PM
Which Scheimpflug parameters are most predictive in detecting
narrow anterior chamber angles?
Afsun Sahin, Zuhat Usalp, Nilgun Yildirim, Özge Bolluk, Ahmet Özer.
Department of Ophthalmology, Eskisehir Osmangazi University
Medical School, Eskisehir, Turkey.
Purpose: To find out which Scheimpflug parameters are most useful
in detecting narrow anterior chamber angles in Turkish subjects.
Methods: The study was conducted at the Eskisehir Osmangazi
University Medical School Department of Ophthalmology. One
hundred of fifty five patients who admitted to our clinic due to
refraction errors were included in the study. All patients underwent
ophthalmological examination including limbal anterior chamber
depth (van Herick), ultrasonic pachymetry, gonioscopy, and
Pentacam HR® (Oculus, Wetzlar, Germany) measurements.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Results: Three hundred and ten eyes of 155 patients were included in
the study. Ninety eight patients (% 63,2) were females, 57 (% 36,8)
were males. The mean age was 54,3 ±9,5 (40-80) years. The mean
central corneal thickness was 537,59±32,23 µm (441-643 µm) for
females and 536,73±32,71 µm (441-643 µm) for males (p>0.05).
Mean anterior chamber depth (ACD) assessed by Pentacam was
2,55±0,38mm in females and 2,69±0,34mm in males. The difference
was statistically significant (p<0,01). The mean ACD of females and
males were 2,55±0,38 mm and 2,69±0,34 mm (1,38-3,38 mm),
respectively (p<0,01). Mean anterior chamber angle (ACA) assessed
by Pentacam was 31,69°±6,22 in females and 33,07°±5,60 mm in
males. The difference was not statistically significant (p>0.05). The
mean ACA of all cases was 32,20°±6,02 (13,10-46,70). Mean
anterior chamber volume (ACV) assessed by Pentacam was
124,59±32,13 mm3 in females and 140,75±31,64 mm3 in males
(p<0,001). Fifteen out of 310 eyes were Schaffer grade 2, 224 were
grade 3, 71 were grade 4. The percentage of narrow angle eyes was
%4,8 (15/310). Considering gonioscopy as the gold standard, the
sensitivity and specificity of ACD values obtained by Pentacam
detecting narrow angles were 75% and %99, respectively. For
anterior chamber volume the sensitivity was 87% and specificity was
91%. For ACA sensitivity was 87% and specificity was 96%.
Conclusions: ACA, ACV and ACD values obtained by Pentacam
seem reliable parameters detecting narrow angled subjects. Since
Pentacam HR device is a non-contact, easy-to-use, short measuring
time method, it can be valuable in the diagnosis, treatment of
glaucoma patients.
Commercial Relationships: Afsun Sahin, None; Zuhat Usalp,
None; Nilgun Yildirim, None; Özge Bolluk, None; Ahmet Özer,
None
Support: Eskisehir Osmangazi University Scientific Research
Support Unit
Program Number: 3484 Poster Board Number: D0160
Presentation Time: 11:00 AM - 12:45 PM
Factors associated with the onset of treatment in fellow eyes in
the Collaborative Initial Glaucoma Treatment Study
David C. Musch1, 2, Leslie M. Niziol1, Brenda W. Gillespie3.
1
Ophthalmology & Visual Sciences, Univ of Michigan, Ann Arbor,
MI; 2Epidemiology, Univ of Michigan, Ann Arbor, MI; 3Biostatistics,
Univ of Michigan, Ann Arbor, MI.
Purpose: To describe the natural history of initially un-treated fellow
eyes of the Collaborative Initial Glaucoma Treatment Study (CIGTS)
participants and develop a predictive model for the initiation of
treatment for open-angle glaucoma (OAG) in such eyes.
Methods: 607 subjects with a new diagnosis of OAG in one or both
eyes were enrolled in the CIGTS. Although a study eye was
designated at baseline and randomized to receive either medical or
surgical treatment for OAG, fellow eyes were also closely monitored
and treated along with the study eye when protocol requirements for
treatment eligibility were met. Kaplan-Meier analyses were used to
estimate the time-related probability of fellow eye treatment for
OAG, and Cox regression was used to investigate predictive factors
of this same outcome.
Results: A total of 291 fellow eyes (48%) were initially treated along
with the study eye at baseline. Fellow eyes that were initially treated
had significantly worse baseline mean deviation (MD), higher IOP,
and were more likely to be from black participants than fellow eyes
not initially treated at baseline. Of the 316 fellow eyes not initially
treated, 193 (61%) never received treatment and 123 were eventually
treated for OAG. In the 316 initially untreated eyes, the probability of
fellow eye treatment for OAG at 1, 3, 5, and 7 years after
randomization was 0.17, 0.25, 0.33, and 0.39, respectively. Baseline
characteristics of these 316 fellow eyes that were significantly
associated with an increased hazard of treatment included older age,
glaucoma that failed to meet treatment criteria (vs. no glaucoma
diagnosis), higher IOP, and worse MD. Some of these effects either
decreased (glaucoma diagnosis and baseline MD) or increased (age)
in the strength of their predictive association with increasing time
from randomization.
Conclusions: Fellow eye treatment for OAG in the CIGTS was
common, with nearly half of eyes being treated at baseline and 68%
by 7 years of follow-up. This is consistent with the bilateral nature of
OAG. Likewise, the observed predictors of fellow eye treatment are
consistent with known predictors for OAG. Even within the confines
of a strict treatment protocol, it is clear that initially untreated fellow
eyes warrant close follow-up, and many will require treatment with
extended follow-up.
Commercial Relationships: David C. Musch, Glaukos (C),
AqueSys (C), InnFocus (C), Pfizer (F), DigiSight Technologies (C);
Leslie M. Niziol, Pfizer (F); Brenda W. Gillespie, None
Support: NIH/NEI Grant R21 EY020912; DCM is a recipient of the
RPB Lew R. Wasserman merit award
Clinical Trial: NCT00000149
Program Number: 3485 Poster Board Number: D0161
Presentation Time: 11:00 AM - 12:45 PM
Measures of Intraocular Pressure Variation and Risk of
Developing Open-angle Glaucoma: The Los Angeles Latino Eye
Study
Xuejuan Jiang1, 2, Rohit Varma1, 2, Mina Torres1, Stanley P. Azen2,
Brian A. Francis1, Vikas Chopra1, Betsy Bao-Thu Nguyen1. 1Doheny
Eye Institute, University of Southern California, Los Angeles, CA;
2
Preventive Medicine, University of Southern California, Los
Angeles, CA.
Purpose: To determine whether measures of intraocular pressure
(IOP) variation are associated with the development of open-angle
glaucoma (OAG) in an adult Latino population.
Methods: The Los Angeles Latino Eye Study is a population-based,
prospective cohort study of self-identified, 40+ years old Mexican
Americans residing in Los Angeles, California. For the current
analysis, a total of 3,666 study participants who were free of OAG at
the study baseline and had completed four-year follow-up clinical
examinations were included. Similarly designed interviews and
comprehensive ophthalmologic examinations were conducted at both
the baseline and the follow-up. OAG was defined as the presence of
an open angle and a glaucomatous visual field abnormality and/or
evidence of glaucomatous optic nerve damage in at least one eye.
Four different measures (mean, peak, standard deviation, and range)
of inter-visit IOP were derived from six IOP readings obtained at the
baseline visit and the four-year follow-up visit. Multivariate logistic
regression was performed to assess the association between the four
measures of inter-visit IOP and the risk of developing OAG in four
years.
Results: Among the four measures of inter-visit IOP, peak inter-visit
IOP was the best independent predictor of the incidence of OAG.
Further examination revealed that the association between inter-visit
IOP measures and incidence of OAG varied for individuals with
different levels of IOP. Among participants with low mean IOP (≤18
mmHg), higher levels of peak, standard deviation, and range of intervisit IOP were all significantly associated with a higher risk of
developing OAG (P<0.05), while mean IOP were not associated with
risk of developing OAG. Among participants with high mean IOP
(>18 mmHg), higher levels of mean and peak of inter-visit IOP were
significantly associated with higher risk of developing OAG, while
standard deviation and range of inter-visit IOP were not associated
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
with risk of developing OAG with or without adjustment for mean
IOP. Results were similar when participants were grouped according
to mean IOP <15 and ≥15 mmHg.
Conclusions: Overall, peak inter-visit IOP was the best predictor of
the incidence of OAG. Greater variation in IOP was associated with a
higher risk of developing OAG among individuals with low mean
IOP, but not among individuals with high mean IOP.
Commercial Relationships: Xuejuan Jiang, None; Rohit Varma,
Allergan (C), AqueSys (C), Genentech (C), Merck & Co. Inc (C),
Replenish (C), Genentech (F), National Eye Institute (F); Mina
Torres, None; Stanley P. Azen, None; Brian A. Francis, Allergan
(F), Merck (F), Neomedix (C), Endooptiks (C), Lumenis (F); Vikas
Chopra, Allergan, Inc. (C); Betsy Bao-Thu Nguyen, allergan (C)
Support: National Institutes of Health Grants NEI U10-EY-11753
and EY-03040 and an unrestricted grant from the Research to Prevent
Blindness, New York, New York, and Pfizer Inc. Rohit Varma is a
Research to Prevent Blindness Sybil B. Harrington Scholar.
Program Number: 3486 Poster Board Number: D0162
Presentation Time: 11:00 AM - 12:45 PM
THE AFRICAN DESCENT AND GLAUCOMA EVALUATION
STUDY (ADAGES): PREDICTORS OF GLAUCOMA
PROGRESSION IN GLAUCOMA SUSPECTS
Naira Khachatryan1, Atsuya Miki1, Sonia Jain2, Feng He2, Naama
Hammel1, Felipe A. Medeiros1, Robert N. Weinreb1, Jeffrey M.
Liebmann3, 4, Christopher A. Girkin5, Linda M. Zangwill1. 1Hamilton
Glaucoma Center, Department of Ophthalmology, University of
California, San Diego, La Jolla, CA; 2Department of Family and
Preventive Medicine, University of California, San Diego, La Jolla,
CA; 3Department of Ophthalmology, New York University School of
Medicine, New York, NY; 4Department of Ophthalmology, Einhorn
Clinical Research Center, New York Eye and Ear Infirmary, New
York, NY; 5Department of Ophthalmology, University of Alabama at
Birmingham, Birmingham, AL.
Purpose: To evaluate predictors of glaucomatous progression and to
assess racial differences in the incidence of repeatable glaucomatous
visual field (VF) damage in glaucoma suspects.
Methods: 786 eyes from 501 glaucoma suspects in the African
Descent and Glaucoma Evaluation Study, who had at least 2 years of
follow-up and at least 4 VF tests, were included. Glaucoma suspects
had a glaucomatous optic disc appearance (n=289) and/or elevated
intraocular pressure (n=211), but normal VF at study entry.
Conversion was defined as development of repeatable (3x) VF
damage. Age, gender, race and baseline ocular risk factors were
evaluated in multivariable logistic regressions to determine which of
those factors were predictive of VF conversion.
Results: 124 glaucoma suspects (24.8%) developed VF damage
(converts). A larger proportion of African descent (AD) participants
(56/179 (31.3%)) converted than European descent (ED) participants
(68/254 (21.1%)) (univariate OR=1.70; 95% CI: 1.12; 2.57). Mean
(95% CI) age at baseline for converts was 63.1 years (60.9; 65.3), for
non-converts 58.0 (56.8; 59.2) (p<0.0001). More participants with
glaucomatous appearing optic disc at baseline developed VF damage
than those with high IOP only (OR=2.25, 95% CI: 1.45; 3.50). Mean
(95% CI) stereophotograph-based vertical cup/disc ratio in converts
was 0.66 (0.63; 0.69), in non-converts was 0.62 (0.60; 0.64) (p=0.01).
Mean (95% CI) baseline VF PSD in converts was 1.87 (1.80; 1.94),
in non-converts 1.60 (1.56; 1.64) (p<0.0001). There was no
significant difference (p>0.05 for all comparisons) among converts
and non-converts in gender, follow up time, baseline IOP, perfusion
pressure, CCT, axial length, and HRT-based disc area.
In multivariable analysis, race was predictive of conversion
(OR=1.90; 95% CI: 1.16; 3.10) even after adjusting for age, gender,
glaucomatous optic disc appearance, vertical cup/disc ratio, disc area,
and baseline VF PSD and MD (p=0.0047). Also, age, glaucomatous
optic disc at baseline, and baseline VF PSD were predictive of VF
conversion.
Conclusions: In the ADAGES cohort, glaucoma suspects of AD are
twice as likely to develop VF loss as ED participants, even after
adjusting for disc size. In addition, older age, higher baseline VF
PSD, and a glaucomatous optic disc at baseline, each contribute to an
increased risk of future VF loss.
Commercial Relationships: Naira Khachatryan, None; Atsuya
Miki, NIDEK (C); Sonia Jain, None; Feng He, None; Naama
Hammel, None; Felipe A. Medeiros, Carl-Zeiss (F), Heidelberg
Engineering (F), Topcon (F), Alcon (F), Allergan (F), Sensimed (F),
Reichert (F); Robert N. Weinreb, Aerie (F), Alcon (C), Allergan
(C), Altheos (C), Amakem (C), Bausch&Lomb (C), Carl ZeissMeditec (C), Genentech (F), Haag-Streit (F), Heidelberg Engineering
(F), Konan (F), Lumenis (F), National Eye Institute (F), Nidek (F),
Optovue (C), Quark (C), Solx (C), Topcon (C); Jeffrey M.
Liebmann, Alcon Laboratories, Inc. (C), Allergan, Inc. (C),
Allergan, Inc. (F), Carl Zeiss Meditech, Inc (F), Heidelberg
Engineering, GmbH (F), Topcon Medical Systems, Inc. (F), National
Eye Institute (F), New York Glaucoma Research Institute (F), SOLX,
Inc. (C), Bausch & Lomb, Inc (C), Diopsys, Inc. (C), Diopsys, Inc.
(F), Merz, Inc. (C), Glaukos, Inc. (C), Quark, Inc. (C); Christopher
A. Girkin, SOLX (F), Heidelberg Engineering (F); Linda M.
Zangwill, Carl Zeiss Meditec Inc (F), Heidelberg Engineering GmbH
(F), Optovue Inc (F), Topcon Medical Systems Inc (F), Nidek Inc (F)
Support: Supported by National Eye Institute grants U10EY14267,
EY019869, EY021818, EY022039 and EY08208, EY11008, and
EY13959 and Eyesight Foundation of Alabama; Alcon Laboratories
Inc.; Allergan Inc.; Pfizer Inc.; Merck Inc.; Santen Inc.; and the Edith
C. Blum Research Fund of the New York Glaucoma Research
Institute, New York, NY, Supported by an unrestricted grant from
Research to Prevent Blindness, New York, New York
Clinical Trial: NCT00221923
Program Number: 3487 Poster Board Number: D0163
Presentation Time: 11:00 AM - 12:45 PM
Baseline Prognostic Factors Predict Rapid Progression
Jun Mo Lee1, Joseph Caprioli1, Kouros Nouri-Mahdavi1,
Abdelmonem Afifi2, Esteban Morales1, Meera Ramanathan1, Fei Yu1,
2
, Anne L. Coleman1, 3. 1ophthalmology, Jules Stein Eye Institute,
UCLA, Los Angeles, CA; 2biostatistics, School of public health at
UCLA, los angeles, CA; 3epidemiology, School of public health at
UCLA, los angeles, CA.
Purpose: To investigate baseline prognostic factors which predict
rapid progression of the visual field (VF) in primary open angle
glaucoma patients.
Methods: 767 eyes of 566 subjects from the Advanced Glaucoma
Intervention Study (AGIS) and the University of California at Los
Angeles’ (UCLA) Jules Stein Eye Institute with primary open angle
glaucoma were included. The VF rate of decay for each VF test
location was calculated with point-wise exponential regression (PER)
analysis and separated into fast and slow components. Subjects with a
fast component decay rate of 36%/year or faster were designated as
rapid progressors. See Table 1 for prognostic factors assessed in the
multiple regression model. For cross-validation of our logistic model,
we developed a sampling group containing 2/3 of the entire study
group and identified the rapid progressors to which we fitted the
same logistic model. We obtained the coefficient estimates and
applied them to the 1/3 test group. We calculated the probability of
being a rapid progressor for each eye in the test group and calculated
the area under curve (AUC) of the receiver operating characteristic
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
curve (ROC). After repeating this procedure 1,000 times, we
calculated the average AUC as cross-validation for the model.
Results: 222 eyes were identified as rapid progressors. The average
(±standard deviation) age was 65.93(±9.9) years in the rapid
progressors. Subjects with worse baseline MD (P<0.0001; odds
ratio[OR], 1.12; 95% confidence interval[CI], 1.09 to 1.16), greater
vertical C/D ratio at baseline (P=0.001; OR, 1.23; 95% CI, 1.09 to
1.39), and older age at baseline (P=0.030; OR, 1.23; 95% CI, 1.02 to
1.49) were more likely to have a fast VF component rate of 36%/year
or faster than did subjects without these characteristics.
Conclusions: Worse baseline MD had the highest association for
classifying the rapid progressors as defined by the VF fast component
worsening by 36%/year. Both increasing baseline vertical C/D ratio
and increasing age at baseline were also associated with this
classification.
Table 1. Results of multiple logistic regression using 11 the variables
Figure 1. The plot was the ROC curve of predicting rapid progressors
with a multiple logistic regression model. The sensitivity and
specificity were calculated based on the predicted probability of the
logistic model. Based on 1,000 AUC values, the predictive value of
the logistic model was 0.72.
Commercial Relationships: Jun Mo Lee, None; Joseph Caprioli,
Allergan Inc. (F), Allergan Inc. (C), Allergan Inc. (R); Kouros
Nouri-Mahdavi, Allergan (C); Abdelmonem Afifi, None; Esteban
Morales, None; Meera Ramanathan, None; Fei Yu, None; Anne L.
Coleman, None
Support: None in the Support
Program Number: 3488 Poster Board Number: D0164
Presentation Time: 11:00 AM - 12:45 PM
A Korea National Health and Nutrition Examination Survey
(KNHANES) (2009-2010)-based analysis of intraocular pressure
and associated systemic factors in a Korean population
Mi Jeung Kim1, 2, Ki Ho Park1, 2, Jin Wook Jeoung1, 2, Seok Hwan
Kim1, 3, Yun Jeong Choi2, Kyoung Nam Kim2. 1Ophthalmology, Seoul
National University College of Medicine, Seoul, Republic of Korea;
2
Ophthalmology, Seoul National University Hospital, Seoul,
Republic of Korea; 3Ophthalmology, Seoul National University
Boramae Hospital, Seoul, Republic of Korea.
Purpose: To examine the intraocular pressure (IOP) distribution and
its related systemic factors in a Korean population.
Methods: We obtained 2009-2010 data from the nationwide crosssectional KNHANES (n =17,901). After individuals under 19 years
of age or without IOP data for at least one eye were excluded, a total
of 13,431 subjects were enrolled. All of the participants 40 years of
age or older completed a comprehensive questionnaire and underwent
an ocular examination including measurement of IOP by Goldmann
applanation tonometry, as well as a systemic evaluation including
blood pressure measurements, anthropometry, and blood tests.
Results: The mean IOP in the right eye was 13.92 ± 2.74 mmHg, and
in the left, 13.93 ± 2.76 mmHg, showing no significant bilateral
difference (p = 0.234). Multiple regression analysis revealed that
lower IOP was correlated with older age (non-standardized beta (B) =
−0.008/year, p<0.0001). Higher IOP was significantly correlated with
higher myopic refractive error (0.107/diopter, p<0.0001), higher body
mass index (B = 0.040/BMI, p<0.0001), higher systolic blood
pressure (0.016/mmHg, p<0.0001), higher fasting plasma glucose
(0.004/mg/dl, p<0.0001), higher total cholesterol (0.003/mg/dl,
p<0.0001), and the male gender (0.239, p<0.0001).
Conclusions: This is the largest population-based study evaluating
IOP distribution in Korea. On this basis, it can be posited that in the
general Korean population, mean IOP decreases with aging and
increases with increasing myopic refractive error. Further, mean IOP
is significantly associated with systemic factors relating to
cardiovascular disease and metabolic syndrome.
Commercial Relationships: Mi Jeung Kim, None; Ki Ho Park,
None; Jin Wook Jeoung, None; Seok Hwan Kim, None; Yun
Jeong Choi, None; Kyoung Nam Kim, None
Program Number: 3489 Poster Board Number: D0165
Presentation Time: 11:00 AM - 12:45 PM
The association of Diurnal Intraocular Pressure (DIOP)
fluctuation and anterior chamber angle dimensions in patients
with primary angle closure, and the association with peripheral
anterior synechiae (PAS): The Investigating Management of
Angle Closure and Treatment (IMPACT) study
Laura Sanchez Parra1, Roger Buckley1, Shahina Pardhan1, Rupert R.
Bourne1, 2. 1Vision & Eye Research Unit, Postgraduate Medical
Institute, Anglia Ruskin University, Cambridge, United Kingdom;
2
Huntingdon Glaucoma & Diagnostic Research Centre,
Hinchingbrooke Hospital, Huntingdon, United Kingdom.
Purpose: To investigate the hypothesis that greater extent of PAS
and narrower values for Angle Opening Distance (AOD), Angle
Recess Area (ARA), Trabecular-Iris Space Area (TISA) and
Trabecular-Iris Angle (TIA), are associated with greater DIOP
fluctuation, using 3-dimensional swept-source anterior segment
optical coherence tomography (AS-OCT)
Methods: 40 Caucasian patients with a diagnosis of Primary Angle
Closure (PAC) and/or Primary Angle Closure Suspect (PACS) and
no ocular co-morbidity were recruited. IOP was measured hourly
from 9.00h to 16.00h with Goldmann applanation tonometry.
Fluctuation was defined as the difference between the maximum and
minimum IOP during that period.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
AOD, ARA, TISA and TIA were measured using the novel AS-OCT
(CASIA) in dark (0.3-0.5 lux) and light (170-200 lux) on the same
day of DIOP measurements and quantified in 8 different sections of
the angle (Superior, Superior-Nasal, Nasal, Inferior-Nasal, Inferior,
Inferior-Temporal, Temporal and Superior-Temporal) and at 500 and
700μm from the scleral spur
Results: DIOP fluctuation ranged between 1.50 mmHg and 14.50
mmHg (mean 5.92±2.82 mmHg).
Single predictor models were statistically significant for the majority
of angle parameters in Superior and Superior-Nasal sections, showing
standardized coefficients from -254 to -438, demonstrating an inverse
relationship between angle parameters and DIOP in these sections.
Additionally, the higher contribution to the multiple predictor models
was provided by negative standardised coefficients showing a similar
inverse relationship for the remaining angle sections. These models
were statistically significant (p<0.05) for AOD 750 (light), ARA 750
(light and dark), TISA 500 and 750 (light), TIA 500 (light) and TIA
750 (light and dark).
Single predictor models showed a statistically significant direct
association between the degree of PAS and IOP at every time
measurement of the DIOP excluding 12:00h IOP. An association
between DIOP fluctuation and PAS was not found.
Conclusions: Substantial changes in IOP occur throughout the day in
patients with occludable anterior chamber angles. Narrower angle
parameters are associated with greater diurnal fluctuation.
Commercial Relationships: Laura Sanchez Parra, Allergan Ltd
(F); Roger Buckley, None; Shahina Pardhan, None; Rupert R.
Bourne, Allergan Ltd (F)
Support: Allergan Ltd (unrestricted educational grant)
Clinical Trial: 8955
Program Number: 3490 Poster Board Number: D0166
Presentation Time: 11:00 AM - 12:45 PM
Female Reproductive Factors and Major Eye Diseases in Asian
Women - The Singapore Malay Eye Study
Janice Lam1, 2, Wan Ting Tay1, Tin Aung1, 3, Seang-Mei Saw1, 4, Tien
Y. Wong1, 2. 1Singapore Eye Research Institute, Singapore National
Eye Centre, Singapore, Singapore; 2Department of Ophthalmology,
National University Health System (NUHS), Singapore, Singapore;
3
Department of Ophthalmology, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore; 4Department
of Community, Occupational and Family Medicine, Yong Loo Lin
School of Medicine, National University of Singapore, Singapore,
Singapore.
Purpose: To examine the association of reproductive factors and
major eye diseases, including glaucoma, age-related macular
degeneration (AMD), diabetic retinopathy and cataract in Asian
women.
Methods: The Singapore Malay Eye Study is a population-based
cross-sectional epidemiological study which examined 3280 (78.7%
response) persons of Malay ethnicity aged 40 to 79 years, of which
1,704 were women. Information on reproductive factors and use of
hormone replacement therapy was collected using an intervieweradministered questionnaire. Glaucoma was defined according to
International Society for Geographical and Epidemiological
Ophthalmology criteria. Retinal photographs were taken from both
eyes, graded for AMD following the Wisconsin grading system and
diabetic retinopathy according to the modified Airlie House
classification system. Cataract was assessed by slit-lamp examination
and graded according to the Lens Opacity Classification System III
(LOCS III).
Results: Of the 1704 women in this study, 1176 (69%) reported
having experienced menopause by the time of the study, of which
1073 (91%) had natural menopause, 88 (7.5%) had hysterectomy and
9 (0.8%) due to other reasons. Hormone replacement therapy was
used by 70 (6%) of the women. Age of menopause was associated
with glaucoma; women who had menopause at 52 years or younger
were 3.5 times more likely to have glaucoma (95% CI 1.23-9.98, pvalue =0.02) than those with age of menopause 53 years and older.
Age of menopause was not associated with AMD (age-adjusted OR =
1.22, 95% CI 0.65 to 2.31), diabetic retinopathy (age-adjusted OR =
1.01, 95% CI 0.66 to 1.54) or cataract (age-adjusted OR = 1.38, 95%
CI 0.95 to 2.00). Use of hormone replacement therapy was not
associated with any of these four major eye diseases.
Conclusions: Women who had menopause at a younger age were
more likely to have glaucoma.
Commercial Relationships: Janice Lam, None; Wan Ting Tay,
None; Tin Aung, Alcon (R), Alcon (C), Alcon (F), Allergan (R),
Allergan (C), Carl Zeiss Meditec (F), Carl Zeiss Meditec (R), Ellex
(F), Ellex (R), Santen (R); Seang-Mei Saw, None; Tien Y. Wong,
Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche
(F)
Program Number: 3491 Poster Board Number: D0167
Presentation Time: 11:00 AM - 12:45 PM
Cost of glaucoma in the XXI century. Economic Analysis
Gabriel Lazcano-Gomez, Jesus Jimenez-Roman. GLAUCOMA,
APEC, Cuautitlan Izcalli, Mexico.
Purpose: To determine the economic cost of patients diagnosed with
primary open-angle glaucoma in medical monitoring over a 5 year
period.
Methods: Patients with POAG who had at least 5 years of follow up
were included. Data collected from the record included glaucoma
treatment, as well as number of hospital visits, diagnostic studies,
laser or surgical treatments for each patient in a 5 year period.
A questionnaire including study level, current employment status,
monthly income and monthly cost of glaucoma drops was answered
by all the patients. We calculated monthly cost for each brand name
of glaucoma drops. Costs of hospital visits, studies and treatments
were also calculated.
After reviewing the number of visits, studies and surgeries for each
patient, we multiplied them by the price obtained from the list of our
hospital costs, in order to know the total cost per patient over a 5 year
period.
Results: We included 462 patients with POAG, (86 men and 376
women). The average age was 70.04 ± 10.19 years. Total cost of
glaucoma drops per patient in 5 years was $2,899.69 ± $1,771.15,
while the cost referred by the patients was 3,368.65±$384.90. Total
cost per patient during 5 years period including direct costs (visit
cost, diagnosis studies, laser or surgical treatments and glaucoma
drops cost) and indirect costs (transportation cost) was $6,634.13 ±
$2,744.28. The income for each patient, in a 5 year period was
$15,959.20 ±$233.76.
A total of 245 patients (53%) were unemployed and from them, 51
patients (20%) because of the low visual acuity caused by glaucoma.
Conclusions: Monotherapy with prostaglandins analogue was the
most prescribed first therapy treatment at the time of diagnosis, but at
the end of the 5 year period, fixed combinations were the most
prescribed therapy.
This is important, as the total cost of drops represents 47.78% of the
total cost; followed by the cost on surgeries ($2,204.36±$421.12),
representing 36% of the total cost ($6,634.13±$2,744.28). We also
noted that almost 50% of the study population had a basic
educational level to intermediate (primary, secondary and technical
career).
Educational and labor conditions are the cause that the income
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
received by most patients, are very close to the minimum wage in our
country. Therefore, we conclude that 41% of the total income of
patients with POAG, is spent in the treatment of the disease, which is
a very high cost for such patients.
Commercial Relationships: Gabriel Lazcano-Gomez, None; Jesus
Jimenez-Roman, None
Program Number: 3492 Poster Board Number: D0168
Presentation Time: 11:00 AM - 12:45 PM
Association between Thyroid Conditions and Open-Angle
Glaucoma in the United States Medicare Population
Judy L. Chen1, 2, Fei Yu1, Flora Lum1, Anne L. Coleman1. 1Jules Stein
Eye Institute, Los Angeles, CA; 2David Geffen School of Medicine at
UCLA, Los Angeles, CA.
Purpose: To determine whether (1) thyroid conditions
(hyperthyroidism or hypothyroidism) are associated with open-angle
glaucoma (OAG) and (2) whether treatment of thyroid conditions is
associated with OAG in the United States Medicare population.
Methods: The 2010 Denominator and Physician/Supplier Part B files
for a 5% sample of Medicare beneficiaries were used to identify
patients with the diagnosis of thyroid conditions, including
hyperthyroidism or hypothyroidism, and OAG in 2010 using the
International Classification of Diseases version 9 (ICD-9) codes.
Surgical treatment of thyroid conditions in 2010 was identified using
the Current Procedural Terminology (CPT) codes. Potential
confounding factors examined included demographics, Charlson
Comorbidity Index (CCI) score, and systemic co-morbidities,
including rheumatoid arthritis and Parkinson’s disease. Adjusted odds
ratios (OR) of Medicare patients with a diagnosis of OAG during
2010 were estimated for any thyroid conditions and treatment of
thyroid conditions using multivariable logistic regression models
controlling for all potential confounding factors.
Results: In the 5% sample of Medicare beneficiaries in 2010, there
were 249945 (20.2%) patients diagnosed with thyroid conditions,
including 18364 (1.5%) with hyperthyroidism and 240899 (19.5%)
with hypothyroidism. Among them, 812 (0.3%) subjects had surgical
treatment for thyroid conditions. There were 96127 (7.8%) OAG
patients. Compared to those without any thyroid conditions, adjusted
OR (95% confidence interval [CI]) of having OAG was 1.12 (1.10,
1.14; p<0.0001) for all thyroid conditions, 1.14 (1.08, 1.20;
p<0.0001) for hyperthyroidism, and 1.12 (1.11, 1.14; p<0.0001) for
hypothyroidism. Compared to thyroid patients without surgical
treatment, adjusted OR (95% CI) of having OAG was 0.76 (0.58,
1.00; p=0.047) for thyroid patients who received surgical treatment.
Conclusions: Reports regarding the association between thyroid
conditions and OAG have been limited and inconsistent. This study
found that a diagnosis of any thyroid condition is associated with a
12% increased odds of OAG, and this association was similar for
hyperthyroidism and hypothyroidism. Among patients with thyroid
conditions, surgical treatment is associated with a 24% reduced odds
of OAG. Further prospective studies are warranted to investigate the
relationship between thyroid dysfunction and OAG.
Commercial Relationships: Judy L. Chen, None; Fei Yu, None;
Flora Lum, None; Anne L. Coleman, None
Support: Center for Eye Epidemiology, Jules Stein Eye Institute
Program Number: 3493 Poster Board Number: D0169
Presentation Time: 11:00 AM - 12:45 PM
Normal tension glaucoma prevalence in sleep apnea patients with
type 2 diabetes, interest of a new medical device Ru-Sleeping© in
ophthalmology
Corinne Dot, Emilie Agard, Hussam El Chehab, Ikrame Douma,
Guillaume Ract-Madoux, Olivier C. Coste. Ophthalmology, Hopital
Desgenettes, Lyon Cedex 03, France.
Purpose: To evaluate the prevalence of normal tension glaucoma
(NTG) in sleep apnea (SAS) patients with type 2 diabetes, and to
determine the predictive value of a new medical device RU-sleeping
© (Philips-respironics inc.) in the detection of SAS.
Methods: Prospective study of 90 patients. The patients were divided
into 3 groups: group 1: SAS (n = 28), group 2 SAS + type 2 diabetes
(n = 33), group 3 patients diagnosed NTG (n = 29). All patients
receive a dual recording RU-Sleeping© / polysomnography for the
diagnosis of SAS and a complete ophthalmologic examination in
group 1 and 2. . Group 3 has an Epworth test and RU-sleeping ©
registration of respiratory events.
Results: The mean age of patients was 50.5 years + / - 4.9 years, 65.5
+ / -6.4 years and 73.5 + / - 0.7 years, respectively in groups 1, 2 and
3. NTG prevalence in group 2 was 15.1% versus 32.1% in the control
group 1. The mean cup/disk measure in SAS groups (1 + 2) was 0.36.
The mean thickness of RNFL was 92.2 μm +/-6.9 in group 1 versus
92.6 μm +/- 0.8 in group 2 (p<0,001), with an I/S index of 1.03 +/-0.1
versus 1.03 +/- 0.4 in groups 1 and 2 (p<0,001). The positive
predictive value of RU-sleeping © for SAS screening was 86.6% in
group 1 and 91.3% in group 2, the apnea /hypopnea index (AHI) was
respectively of 44,4 / h and 41,2 / h (severe SAS). The prevalence of
SAS in group 3 was 32.1%, nearly half of them were severe (AHI>
30).As it has been previously reported, the prevalence of NTG in
SAS is higher than in the general population. Screening NTG should
not stop at clinical examination alone which could ignore 64% of
glaucoma patients on the sole criterion of the excavation. Conversely,
for NTG patients we follow, RU-sleeping © could be an interesting
medical device easy to use, lightweight and economic. It allows SAS
screening at home, with excellent positive predictive value for severe
SAS.
Conclusions: Diabetes does not appear to be a vascular risk factor in
combination with an additional SAS for the occurrence of a NTG in
this preliminary study. Our preliminary results suggest high
prevalences of NTG or SAS, a larger sample in this prospective study
will allow to confirm it in the future. Routine screening NTG should
be recommended to any patient SAS. Conversely, RU-sleeping ©
device could determine the NTG patients to take charge of a priority
because of severe presumed SAS.
Commercial Relationships: Corinne Dot, None; Emilie Agard,
None; Hussam El Chehab, None; Ikrame Douma, None;
Guillaume Ract-Madoux, None; Olivier C. Coste, Philips (F)
Clinical Trial: 2011-A00526-35
Program Number: 3494 Poster Board Number: D0170
Presentation Time: 11:00 AM - 12:45 PM
Patients with advanced glaucoma need different treatment
approach
Petja I. Vassileva, Yordanka Kirilova, Kameliya Naldzhieva.
University Eye Hospital ''Prof. Pashev', MU-Sofia', Sofia, Bulgaria.
Purpose: To discuss the main factors for different treatment
approach in patients with advanced glaucoma.
Methods: 23 patients (45-82 years old) referred and diagnosed with
advanced glaucoma for a period of 2 months were analyzed. All
patients underwent full eye exam and specialized diagnostic
procedures (SAP and Stratuss OCT analysis of optic disc and RNFL,
including imaging of lamina cribrosa stability and deformation).
Structure- function correspondence was evaluated. Diagnostic criteria
for advanced disease included decreased visual acuity, visual field
changes (-10/-20dB), large cupping and glaucoma progression during
a follow- up of 6 months.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Results: 23 patients of 87 patients referred to our clinic with
glaucoma were diagnosed with advanced stage of the disease. The
majority of patients (65%) were diagnosed with XFG, 22% - PACG,
9% - SG and 4% PAOG. The most important risk factors for
glaucoma progression were as follows: the clinical form of glaucoma,
early onset and longer duration of the disease, fluctuation of eye
pressure, age of the patients. Additional risk factors were exfoliation
syndrome, arterial hypotony and systemic cardiovascular problems.
Most rapid progression was diagnosed in patients with low tension
glaucoma and in chronic angle closure glaucoma. In these patients we
have offered more aggressive intraocular pressure lowering treatment
and considered earlier surgical intervention. Main criteria for the
different treatment approach: young age, advanced glaucomatous
changes at presentation, insufficient glaucoma control with multiple
medications. The glaucoma stage of the other eye was important
factor for the therapeutic decision, especially in unilateral glaucoma
blindness.
The majority of patients (87%) underwent surgical treatment:
immediate surgery on 4 pts (17%) and consecutive surgery on 10 pts
(44%). The rest of the patients were prescribed antiglaucomatous
medications because of serious operative risk from systemic disease.
Conclusions: Our clinical observations of patients with advanced
glaucoma demonstrated more rapid progression. Multiple
measurements and at multiple times were necessary as IOP is a
“moving target”. We must learn to identify those patients and they
should be offered different, more aggressive personalized glaucoma
therapy in order to prevent severe visual loss.
Commercial Relationships: Petja I. Vassileva, None; Yordanka
Kirilova, None; Kameliya Naldzhieva, None
Program Number: 3495 Poster Board Number: D0171
Presentation Time: 11:00 AM - 12:45 PM
Incidence of trabeculectomy related complications at various
Mitomycin C Concentrations from 1985 to 2010 in Olmsted
County, MN
Jessica A. Adefusika1, Cheryl L. Khanna2. 1Mayo Medical School,
Rochester, MN; 2Ophthalmology, Mayo Clinic, Rochester, MN.
Purpose: There have been increasing concerns over complications
occurring from trabeculectomy subsequently leading to a decrease in
this practice with a concurrent increase in tube-shunt procedures. In
this study, we determined the incidence of complications associated
with trabeculectomy without mitomycin C and at different mitomycin
C concentrations between 1985 through 2010 in Olmsted County,
MN.
Methods: This is a retrospective, population-based, longitudinal
study of residents of Olmsted County, Minnesota, who underwent a
trabeculectomy from 1985 to 2010. Complications related to
trabeculectomy and dose of mitomycin C are reported.
Results: Ten out of 361 patients who underwent trabeculectomy for
glaucoma treatment during the study time period were found to have
developed endophthalmitis. The incidence rate of endophthalmitis
post trabeculectomy was calculated as 2.7%.
Conclusions: The rate of endophthalmitis post trabeculectomy in
Olmsted County is lower than other published reports. We attribute
the low incidence rate of complications to the lower mitomycin C
concentration of 0.2mg/ml employed at this institution.
Commercial Relationships: Jessica A. Adefusika, None; Cheryl L.
Khanna, None
Program Number: 3496 Poster Board Number: D0172
Presentation Time: 11:00 AM - 12:45 PM
Clinical and Demographic features in patients with Primary
Open angle glaucoma in the Asociación Para Evitar la Ceguera
en México
maria garcia ibarra, Jesus Jimenez-Roman, Felix Gil Carrasco.
Asociación para Evitar la Ceguera en México, México City, Mexico.
Purpose: We analyze the clinical and demographic features found in
patients at the time of diagnosis of Primary Open Angle Glaucoma,
and evaluated if the systemic risk factors are associated with
glaucoma progression.
Methods: A descriptive, prospective, longitudinal and observational
study. We included all the patients with diagnosis of Primay Open
Angle Glaucoma (POAG) seen in the glaucoma service from
july/2010 to january/2012. They have been studied with a complete
ophthalmologic exploration included intraocular pressure and
gonioscopy and we asked the necessary data for the study. We
reported the visual fields (SITA-standard 24-2) results and corneal
topography (orbscan II).
Results: We included 480 eyes of 240 patients with a mean age of
66.28 years, 67.08% were female and 32.91% were male. The age
group that most patients had was 60-69 years.
Most of the patients (35.41%) have an incomplete basic school.
Family history of glaucoma was present in 27.5%. From the studied
eyes 34.58% were myopic. Diabetes Mellitus was present in 26.66%
and Systemic Arterial Hypertension in 36.25%. The 41.66% were
asymptomatic patients and 40% related decrease of visual acuity.
Ocular hypertension was present in 36 eyes (more than 21 mmHg).
167 eyes have a central corneal thickness less than 555 microns.
Irregular lamina cribosa was the most frequent features (301 eyes)
and 406 eyes have vertical cup-to-disc ratios greater than 0.7. Mild
damage was present in 207 eyes (43.12%), moderate damage in 73
eyes (15.20%) and severe damage in 122 eyes (25.41%). The most
frequent treatment used was prostaglandin analogue, indicated in
41.87% patients.
Conclusions: almost half of the patients go to our hospital in
advanced stages of disease; the socioeconomic conditions and low
standards of education in most of our patients are factors that may
contribute to late diagnosis. Our findings may help to understand the
most important features of the Mexican population associated with
OAG and the information obtained can be left for further research.
Commercial Relationships: maria garcia ibarra, None; Jesus
Jimenez-Roman, None; Felix Gil Carrasco, None
Program Number: 3497 Poster Board Number: D0173
Presentation Time: 11:00 AM - 12:45 PM
Correlation between decision to refer for glaucoma and diagnosis
of glaucoma
Preeti J. Thyparampil, Benjamin J. Frankfort, Silvia D. OrengoNania. Ophthalmology, Baylor College of Medicine, Houston, TX.
Purpose: To study whether patients referred from the optometry
service to the ophthalmology service, at the Veterans Affairs Hospital
in Houston, Texas, for suspected glaucoma have a high incidence of
treatment-requiring glaucoma.
Methods: A retrospective chart review was performed on 127
patients who presented as new patients to the optometry service of
the Eye Care Line at the Veterans Affairs Medical Center in Houston,
Texas. Patients were selected from a larger cohort according to
predetermined criteria for consideration for referral to the
ophthalmology service for glaucoma evaluation, which included IOP
≥ 22 in either eye, cup-to-disc ratio ≥ 0.6 in either eye, or cup-to-disc
asymmetry ≥ 0.2. Data examined included whether or not patients
were referred to the ophthalmology service, factors which correlated
with greater likelihood of referral, and final treatment decision.
Results: 32 patients were referred to the ophthalmology service. Of
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
these, 18 (56%) were treated for glaucoma. Of the 95 patients who
were not referred, 21 (22%) were treated for glaucoma. This
difference is statistically significant with chi-square testing (p value <
0.001). Ancillary testing was also more likely to be performed in
patients referred for glaucoma. Of patients referred for glaucoma
evaluation, 24/32 (75%) received Humphrey visual field testing and
25/32 (78%) received OCT RNFL or HRT tests. Of patients not
referred for glaucoma evaluation, 39/95 (41%) received Humphrey
visual field testing and 59/95 (62%) received OCT RNFL or HRT
tests. On average, referred patients were found to be older in age,
have higher maximum cup to disc ratio, higher inter-eye difference in
cup to disc ratio, higher IOP and higher inter-eye difference in IOP.
Of these age, maximum cup to disc ratio in either eye and higher
inter-eye difference in IOP were statistically significant. When
comparing patients who were referred to those who were not referred
but treated, highest cup to disc ratio in either eye was the only
statistically significant factor.
Conclusions: Patients who were referred to the ophthalmology
service from the optometry service had a higher probability of
treatment for glaucoma. Referred patients were also more likely to
receive ancillary testing as part of management. The decision to refer
was based primarily on differences in cup:disc ratio. IOP elevations
did not correlate significantly with likelihood of referral.
Commercial Relationships: Preeti J. Thyparampil, None;
Benjamin J. Frankfort, None; Silvia D. Orengo-Nania, None
Program Number: 3498 Poster Board Number: D0174
Presentation Time: 11:00 AM - 12:45 PM
Impact of Patient Comprehension on Treatment Success in
Glaucoma
Anjali Sheth1, Wendy A. Kirkland1, Sanna D. Ronkainen1, Carter N.
Kirk2, Sasikala Pillai2. 1Ophthalmology, Washington Hospital
Center/Georgetown University Hospital, Washington, DC;
2
Ophthalmology, Georgetown University School of Medicine,
Washington, DC.
Purpose: To evaluate the impact of patient education on compliance
and subsequently treatment success in glaucoma patients.
Methods: We formulated a 16 question survey for patients at
Washington Hospital Center’s glaucoma clinic.The survey included
15 multiple choice questions and one open ended question.Four
questions addressed patient knowledge regarding their disease, four
assessed core knowledge regarding glaucoma, five assessed doctorpatient education/communication, and three questions addressed
miscellaneous topics.
Results: A total of 92 patients completed the survey and were
included in the analysis. In regards to the 4 questions regarding
patient knowledge, there was no statistical difference in patients in
terms of target IOP in this category as outlined in Table 1. In terms of
core glaucoma knowledge (Table 2), 32% of patients believed
glaucoma was curable, 13% believed it was reversible and 98% knew
that glaucoma can lead to blindness. The highest proportion of
patients at target IOP were those that believed glaucoma led to
blindness, however this was not statistically significant. Finally,
patient education questions (Table 3) revealed that patients that had
remembered having glaucoma explained to them were at target IOP
compared to those that did not which was found to statistically
significant. In addition, statistical significance was demonstrated in
patients reaching target IOP where doctors observed instillation of
eye drops, as well as, when written schedules for their eye
medications were provided.
Conclusions: Our preliminary data shows a significant impact of
patient education on compliance and treatment success, highlighting
the importance of doctor-patient communication. Our data also
demonstrates that the most common reason for noncompliance is
forgetfulness; those that received written schedules were more likely
to reach target intraocular pressures. Most of our patient population
had never been watched and were not on target. This brings to light
the importance of ensuring patient understanding of not only their
disease, but also of treatment application. With this preliminary data,
we hope to emphasize the importance of patient education including
witnessing drop administration, creating a visual drop regimen
schedule, and informing our patients of the impact of non-compliance
on their disease to ultimately help improve compliance and better
achieve target intraocular pressure.
Commercial Relationships: Anjali Sheth, None; Wendy A.
Kirkland, None; Sanna D. Ronkainen, None; Carter N. Kirk,
None; Sasikala Pillai, None
Program Number: 3499 Poster Board Number: D0175
Presentation Time: 11:00 AM - 12:45 PM
Association between Myopia and Glaucoma in a Young Adult
Population
Mary Qiu1, Sophia Wang1, Kuldev Singh2, Shan C. Lin1.
1
Ophthalmology, University of California San Francisco, San
Francisco, CA; 2Ophthalmology, Stanford University, Satanford, CA.
Purpose: To investigate a possible association between myopia and
glaucoma risk in a young healthy adult population.
Methods: We performed a cross-sectional survey of 115 young
healthy graduate student volunteers from the University of California
San Francisco. Individuals who had previously undergone LASIK
were excluded. Subjects underwent a comprehensive ophthalmic
examination including visual acuity, refraction, slit lamp exam,
ophthalmoscopy, intraocular pressure measurement, A-scan
biometry, automated perimetry, and optic nerve and anterior segment
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
optical coherence tomography. The predictor variable was refractive
status and subjects were categorized into two groups: Group A emmetropia or mild myopia (0.99 to -2.99 D) and Group B moderate to severe myopia (>-3.00 D). Outcome variables included
intraocular pressure, retinal nerve fiber layer thickness, visual field
mean deviation and pattern deviation. In addition to a comparative
analysis of the mean value of each outcome variable between the two
groups, a multivariate linear regression model was created to examine
the independent association between spherical equivalent and each
outcome variable adjusting for potential confounders including age,
gender, and ethnicity.
Results: Mean age was 24.63 years and 61.74% of subjects were
female. 56 subjects with emmetropia or mild myopia (48.7%) were in
Group A and 59 subjects with moderate to severe myopia (51.3%)
were in Group B. In comparing Group A versus Group B, the mean
intraocular pressure was significantly lower (13.13 vs 14.68 mmHg,
p-value .0064), the mean retinal nerve fiber layer was significantly
thicker (110.00 vs 104.24 μm, p-value .0016), and the mean visual
field mean deviation and pattern deviation were significantly more
suspicious for abnormality (-0.34 vs -1.29 dB, p-value <.0001 and
1.46 vs 1.71 dB, p-value 0.02). After adjusting for age, gender, and
ethnicity using a multivariate linear regression, the regression
coefficients for the relationship between spherical equivalent and
each of the outcome variables remained statistically significant.
Conclusions: The association between greater myopia and higher
IOP, thinner retinal nerve fiber layer thickness, and more suspicious
visual field mean deviation and pattern deviation may represent
greater glaucoma risk among young myopes, consistent with findings
of increased glaucoma risk in older myopic populations from
previous studies.
Commercial Relationships: Mary Qiu, None; Sophia Wang,
None; Kuldev Singh, Alcon (C), Allergan (C), Santen (C), Bausch
and Lomb (C), Transcend (C), Ivantis (C), Sucampo (C), iScience
(C); Shan C. Lin, None
Support: This study was supported by core grant EY002162 from
the National Eye Institute, That Man May See, Inc, Research to
Prevent Blindness, and National Center for Advancing Translational
Sciences, National Institutes of Health, through UCSF-CTSI Grant
Number TL1 TR000144.
Program Number: 3500 Poster Board Number: D0176
Presentation Time: 11:00 AM - 12:45 PM
Medication possession ratio and its related factors among
Japanese glaucoma patients
Kazuyoshi Kitamura1, Hiroshi Yokomichi2, Zentaro Yamagata2, Kenji
Kashiwagi1. 1Ophthalmology, University of Yamanashi, Chuo, Japan;
2
Health Science, University of Yamanashi, Chuo, Japan.
Purpose: We aimed to investigate medication possession ratio
(MPR) and its related factor among Japanese glaucoma patients using
a health insurance database to clarify whether glaucoma patients used
prescribed eye drops appropriately.
Methods: Patients who were covered their medical expense by a
social health insurance were subject to this study. Including criteria
were followed; diagnosed glaucoma in 2008 or before, prescribed
same anti-glaucoma ophthalmic solutions since 2008 to 2011.
Patients who had any type of glaucoma surgeries during 2008 to 2011
were excluded. MPR values during January 2009 to December 2009
were calculated based on Japan medical Data Center Claim Data
Base, and effects to the MPR of age, sex, and the number of eye
drops used were also investigated.
Results: A total number of glaucoma patients satisfying the including
and excluding criteria were 899. Of these, patients who used
latanoprost ophthalmic solution only were most frequent. The MPR
and its related factors were investigated among these 223 patients
consisted of 122 males and 101 females. Mean MPR is 0.895 and
female showed higher MPR than male (p<0.05). Male patients
showed a significantly positive relation between the MPR and aging
(p<0.05), while female patients did a tendency (P=0.09). There was a
negative correlation between the number of anti-glaucoma
ophthalmic solutions and the MPR.
Conclusions: The MPR was poor in male and young glaucoma
patients, and the increase in number of anti-glaucoma ophthalmic
solutions negatively affects the MPR. It is necessary to consider these
risk factors and to prepare a proper solution for keeping the MPR
good.
Commercial Relationships: Kazuyoshi Kitamura, None; Hiroshi
Yokomichi, None; Zentaro Yamagata, None; Kenji Kashiwagi,
None
Program Number: 3501 Poster Board Number: D0177
Presentation Time: 11:00 AM - 12:45 PM
Analysis of hematological and biochemical data in normal
tension glaucoma patients
Morio Ueno1, Yoko Ikeda1, Kengo Yoshii2, Haruna Yoshikawa1, Yuko
Maruyama1, Kazuhiko Mori1, Kei Tashiro2, Shigeru Kinoshita1.
1
Department of Ophthalmology, Kyoto Prefectural University of
Medicine, Kyoto, Japan; 2Department of Genomic Medical Sciences,
Kyoto Prefectural University of Medicine, Kyoto, Japan.
Purpose: Recent studies have shown that normal tension glaucoma
(NTG) patients have more systemic disease compared with normal
subjects. The purpose of this present study was to analyze the
hematological and biochemical data of NTG patients and normal
control subjects, and then compare the differences between those two
sets of data.
Methods: This study involved 519 NTG patients (NTG group; 259
females and 260 males, mean age: 61.7±10.9 years) and 438 agematched normal controls (NC group; 220 females and 218 males,
mean age: 62.4±7.2 years) who consulted at the Glaucoma Clinic of
Kyoto Prefectural University of Medicine, Kyoto, Japan.
Hematological and biochemical data (23 parameters) were analyzed
and compared between the two groups using the Welch's t test.
Bonferroni’s correction was performed, and a p-value of <0.002 was
considered statistically significant. In addition, a comparison between
the females and males of both groups, respectively, was performed.
Results: Of the 23 parameters, a significant difference was found in
the following 6 parameters: Lactate Dehydrogenase (LDH), total
protein (T-Pro), albumin (Alb), glucose, triglyceride, mean
corpuscular hemoglobin concentration (MCHC), and platelet counts
(Plt). LDH, T-Pro and Plt were found to be significantly higher in the
NTG group than in the NC group. There were significant differences
in LDH and MCHC with females and LDH and triglyceride with
males, respectively.
Conclusions: The findings of this study show that NTG patients have
significant differences in the multiple parameters of blood serum data
compared with age-matched normal control subjects.
Commercial Relationships: Morio Ueno, None; Yoko Ikeda,
None; Kengo Yoshii, None; Haruna Yoshikawa, None; Yuko
Maruyama, None; Kazuhiko Mori, Ocular Instruments, Inc. (P),
Santen Pharmaceutical Co., Ltd. (P); Kei Tashiro, None; Shigeru
Kinoshita, Senju Pharmaceutical Co (P), Santen Pharmaceutical Co
(P), Otsuka Pharmaceutical Co (C), Alcon (R), AMO (R), HOYA (R)
Program Number: 3502 Poster Board Number: D0178
Presentation Time: 11:00 AM - 12:45 PM
Prevalence of Open-angle glaucoma in Vitrectomized Eyes. The
PR.O.V.E study
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
ANDREA GOVETTO1, Ramón Domínguez Fernández1, Maria Luisa
Landaluce1, Maria Teresa Alves Perez2, Ramon Lorente1.
1
Ophthalmology, Complexo Universitario Hospitalario de Ourense,
Ourense, Spain; 2Biostatistics, Complexo Universitario Hospitalario
de Ourense, Ourense, Spain.
Purpose: To estimate the prevalence of open-angle glaucoma (OAG)
after uncomplicated pars plana vitrectomy (PPV).
Methods: A retrospective chart review of all patients who underwent
PPV at our institution from January 2006 to January 2012 was made.
Patients operaded due to eye trauma, penetrating injuries,
endophthalmitis, uveitis and those who have preexisting glaucoma
were excluded from the study.
Telephone calls were made to all eligible patients. Those who
accepted to partecipate were invited to the Ourense University
Hospital for a comprehensive ophthalmic assessment, including best
corrected visual acuity testing, applanation tonometry, gonioscopy,
disc assessment, and Spectral-domain OCT scans of optic discs.
The diagnosis of OAG was made based on standardized criteria
modified from those used by the Rotterdam Study and Foster and
associates.
Results: Of 410 eligible patients, 174 accepted to participate to the
study. 18 patients did not complete the ophthalmic assessment. In
total, we evaluated 163 vitrectomized and 143 non-vitrectomized
eyes of 156 patients.
Of 163 vitrectomized eyes, 15 ( 8,9% ) developed OAG. Of 143 nonvitrectomized eyes, only 3 ( 2% ) develop OAG. This difference was
statistically significant ( p= 0,02 ).
We also compared the cup-to-disc ratio ( CDR ) and vertical cup-todisc ratio ( VCDR ) of vitrectomized and non-vitrectomized eyes of
92 patients, obtained by Spectral-domain OCT. For this analysis we
excluded all patients who underwent PPV in both eyes.
In vitrectomized eyes, mean CDR was 0,32 ( ±1,8 ) while mean
VCDR was 0,56 ( ± 1,8 ). In non-vitrectomized eyes, mean CDR was
0,28 ( ± 1,5 ) while mean VCDR was 0,51 ( ± 1,6 ). This difference
did not reach statistical significance.
Conclusions: In our study the prevalence of OAG in vitrectomized
eyes was higher compared to non-vitrectomized eyes. This difference
was statistically significant.
Commercial Relationships: ANDREA GOVETTO, None; Ramón
Domínguez Fernández, None; Maria Luisa Landaluce, None;
Maria Teresa Alves Perez, None; Ramon Lorente, None
Program Number: 3503 Poster Board Number: D0179
Presentation Time: 11:00 AM - 12:45 PM
CORRELATION BETWEEN CORNEAL AND OPTIC NERVE
HEAD PARAMETERS
Federico Saenz-Frances, Lara Borrego, Clara Berrozpe Villabona,
LAURA MORALES-FERNANDEZ, Jose M. Martinez de la Casa,
Julian Garcia-Feijoo. Glaucoma, Hospital Clínico Universitario San
Carlos, Madrid, Spain.
Purpose: To establish the correlation between corneal variables
(determined using the Pentacam) and optic nerve head (ONH)
variables (determined using the HRT) in a sample oh healthy
volunteers and another sample of patients diagnosed with primary
open angle glaucoma (POAG).
Methods: 75 healthy eyes and 73 eyes with POAG were examined.
Corneal variables analyzed were corneal volume (CVol), central
corneal thickness (CCT), overall corneal thickness (OvCT), the mean
thickness of a circular zone centered at the corneal apex of 1 mm
radius (zone I) and the mean thickness of several concentric rings,
also centered at the apex until the limbus, each of 1 mm width (zones
II to VI respectively); ONH variables were disc area (DAr), cup area
(CAr), rim area (RAr), cup to disc area ratio (CDRa), cup volume
(CVol), rim volume (RVol), mean cup depth (MCD), maximum cup
depth (MaCD), height variation contour (HVC), cup shape measure
(CSM), mean retinal nerve fiver layer (RNFL) thickness (MRNFL),
RNFL cross sectional area (RNFLAr), maximum contour elevation
(MCEle) and minimum contour depression (MCDep). Pearson
correlation between the set of corneal variables and the set of ONH
variables were obtained for both healthy and glaucomatous eyes.
Results: For the healthy group, significant Pearson correlations were:
CCT-DAr (-0.48; p<0.0001), Zone I-DAr (-0.503; p<0.0001), Zone
II-DAr (-0.443; p<0.0001) and Zone I-MCD (-0.359; p<0.0001); for
the POAG, significant correlations were: CCT-CDRa (-0.402;
p<0.0001), CCT-RVol (-0.385; p<0.0001), Zone I-CDRa (-0.418;
p<0.0001), Zone II-CDRa (-0.405; p=0.006), Zone I-CSM (-0.415;
p=0.002), Zone II-CSM (-0.405; p=0.01), Zone IV-HVC (0.378;
p=0.02); Zone V-HVC (0.388, p<0.0001).
Conclusions: For healthy subjects, there is a significant negative
correlation between central and paracentral corneal thicknesses with
optic disc area. For the POAG group, there is a significant negative
correlation between central and paracentral corneal thicknesses with
cup-disc ratio and cup shape measure and a positive correlation
between peripheral corneal thicknesses with height variation contour.
Commercial Relationships: Federico Saenz-Frances, None; Lara
Borrego, None; Clara Berrozpe Villabona, None; LAURA
MORALES-FERNANDEZ, None; Jose M. Martinez de la Casa,
None; Julian Garcia-Feijoo, Trancend (C), Ivantis (C), Glaukos (C),
MSD (C), Allergan (F), Pfizer (F), Alcon (C), Sensimed (F), Sylentis
(F), Bausch and Lomb (C)
Support: Supported in part by: Instituto de Salud Carlos III, “Red
temática de Investigación Cooperativa, Proyecto RD07/0062:
Patología ocular del envejecimiento, calidad visual y calidad de
vida.”
Program Number: 3504 Poster Board Number: D0180
Presentation Time: 11:00 AM - 12:45 PM
Anterior Chamber Depth and Lens Thickness in AfricanAmericans with Age-Related Long Anterior Zonules
Daniel K. Roberts1, 3, Bruce A. Teitelbaum1, David D. Castells1, Janis
E. Winters1, Jacob T. Wilensky2. 1Clinical Education, Illinois College
of Optometry, Chicago, IL; 2Ophthalmology, University of Illinois at
Chicago, Chicago, IL; 3Epidemiology and Biostatistics, University of
Illinois at Chicago, Chicago, IL.
Purpose: Long anterior zonules (LAZ) are characterized by zonular
fibers that extend more central than usual on the anterior lens capsule.
They cause a unique type of pigment dispersion and are associated
with female gender, older age, hyperopia, and shorter axial length.
Observations have suggested that LAZ may be a risk factor for angleclosure glaucoma, possibly in association with plateau iris
configuration. The purpose of this investigation was to evaluate
anterior chamber depth (ACD) and lens thickness (LT) in LAZ eyes
since there is need to further understand ocular dimensions in LAZ
eyes.
Methods: The eyes of 50 African-American females with LAZ were
compared to 50 controls who were matched on age (+/- 5 yrs), race,
sex, and refractive error (+/- 1.00 D). To obtain measurements on the
variables of interest, i.e., central ACD and LT, a-scan
ultrasonography (CompuScan LT Biometric Ultrasound System,
Storz Instrument Co.) was performed in a masked fashion. Right eyes
were used for analysis unless inclusion criteria were not met.
Results: Mean age +/- SD (range) of LAZ subjects was 67.1 +/- 7.6
yrs (52-85 yrs) and for controls it was 66.6 +/- 8.5 yrs (48-85 yrs).
Mean spherical-equivalent subjective refraction was +1.85 +/- 1.41 D
(-1.75 to +4.75 D) for cases and +1.94 +/- 1.31 D (-0.75 to +4.75 D)
for controls. Mean ACD for cases was 2.45 +/- 0.34 mm (1.81 to 3.06
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
mm) and 2.57 +/- 0.38 mm (1.83 to 3.44 mm) for controls. Mean LT
for cases was 4.94 +/- 0.43 mm (4.07 to 5.91 mm) and 4.83 +/- 0.45
mm (3.50 to 5.87 mm) for controls. Using conditional logistic
regression to control for any residual differences in age and refractive
error, no significant differences (P>0.1) were present between LAZ
eyes and control eyes relative to ACD and LT.
Conclusions: Our African-American female subjects with LAZ did
not exhibit clinically significant differences in central anterior
chamber depth and lens thickness as compared to age, sex, and
refractive error matched controls.
Commercial Relationships: Daniel K. Roberts, None; Bruce A.
Teitelbaum, None; David D. Castells, None; Janis E. Winters,
None; Jacob T. Wilensky, None
Support: NIH Grant K23 EY0181883, Fight-For-Sight, Prevent
Blindness America
Program Number: 3505 Poster Board Number: D0181
Presentation Time: 11:00 AM - 12:45 PM
Intraocular pressure and central corneal thickness in an old
French population: The MONRACHET study
Alain M. Bron1, 3, Anna Francoz1, Caroline Fiet2, Christine Binquet2,
Claire Bonython-Kopp2, Christophe Tzourio4, Niyazi Acar3, Lionel
Bretillon2, Catherine Creuzot-Garcher1, 3. 1Ophthalmology,
University Hospital, Dijon, France; 2Epidemiology, University
Hospital, Dijon, France; 3Eye and Nutrition Research Group, UMR
CSGA-1324 INRA-6265, CNRS-Université de Bourgogne-AgroSup,
Dijon, France; 4Epidemiology, University Hospital, Bordeaux,
France.
Purpose: To describe the distribution of intraocular pressure (IOP)
and central corneal thickness (CCT) in an old French population.
Methods: About 9000 individuals 65 years and older were included
in the 3C cohort study since 1999 in 3 French cities (Bordeaux, Dijon
and Montpellier). In Dijon, an additional ophthalmic examination
was performed 10 years after the initial inclusions to assess the
relation between systemic age-related diseases and eye diseases in the
MONTRACHET Study (Maculopathy Optic Nerve nuTRition
neurovAsCular and HEarT diseases). In this population-based study a
thorough eye examination and a questionnaire were undertaken in
each participant. Intraocular pressure (IOP) was measured with a
noncontact pneumotonometer and central corneal thickness (CCT)
was measured with an ultrasound pachymeter.
Results: Among the 1035 participants of the MONTRACHET study
only those without an ocular hypotensive treatment and those without
evidence of glaucoma based on optic disc photographs were
considered. Among these 911 individuals, 579 (64%) were female,
478 where phakic and the age was 82.2 ± 3.8 years. IOP in the right
eye and the left eye was 14.6 ± 3.2 and 14.8 ± 3.2 mmHg,
respectively, p = 0. 06. IOP decreased with age, (p < 0.01) and was
similar in males and females (p = 0.07). IOP was lower in
pseudophakic than in phakic participants 15.2 ± 3.2 and 15.4 ± 3.1
mmHg vs 13.9 ± 3.0 and 14.1 ± 3.1 mmHg for the right and the left
eye, respectively, p < 0.01.CCT in the right eye and the left eye was
553.4 ± 34.4 μm and 555.7 ± 34.7 μm, respectively, p < 0.01. CCT
was not influenced by the lens status and the refraction error. CCT
was correlated to the age and the IOP, p < 0.01.
Conclusions: Few population-based studies focused on very old
Caucasian subjects are available.
These preliminary results of the MONTRACHET study give some
specific aspects of IOP and CCT in elderly.
Commercial Relationships: Alain M. Bron, Allergan (C), Bausch
Lomb (C), Horus (F), Théa (C); Anna Francoz, None; Caroline
Fiet, None; Christine Binquet, None; Claire Bonython-Kopp,
None; Christophe Tzourio, None; Niyazi Acar, None; Lionel
Bretillon, None; Catherine Creuzot-Garcher, None
Support: Regional Council
Clinical Trial: 2009-A00448-49
Program Number: 3506 Poster Board Number: D0182
Presentation Time: 11:00 AM - 12:45 PM
The Ocular Hypertension Treatment Study (OHTS): Does
Higher Long-Term IOP Variability Increase Risk Of Developing
Primary Open Angle Glaucoma (POAG) in the Medication
Group?
Mae O. Gordon1, 2, Julia A. Beiser1, J. Phillip Miller2, Michael A.
Kass1, Feng Gao2. 1Ophthal & Vis Sciences, Washington Univ Sch
of Med, St Louis, MO; 2Division of Biostatistics, Washington Univ
Sch of Med, St Louis, MO.
Purpose: To determine if higher long-term IOP variability increases
the risk of developing POAG among participants in the OHTS
medication group (MED).
Methods: Analysis of baseline and follow-up IOP in 720 participants
randomized to topical ocular hypotensive medication. Indices of IOP
variability were: 1. standard deviation (SD), 2. maximum, 3. range, 4.
coefficient of variation (CV) and percent change from baseline.
Incident POAG was defined as confirmed visual field abnormality or
optic disc deterioration of clinically significant magnitude attributed
to POAG by an Endpoint Committee. Univariate and multivariate
time dependent Cox proportional hazards models were used to
estimate hazard ratios. Serial landmark models were used to estimate
the C-index averaged over time. Covariates in multivariate models
were baseline age, CCT, PSD, VCD and follow-up IOP.
Results: In the MED group, 111 of 720 participants developed
POAG in OHTS I and II (median f/up 13.0 yrs.); only SD (HR 1.21,
p=0.024) and CV (HR. 1.19, p=0.045) independently increased the
risk of developing POAG in multivariate models. The C-statistic was
0.755 for the “basic” multivariate model with covariates only and no
measures of IOP variability. After adding SD to the basic
multivariate model, the C-statistic increased from 0.755 to 0.766.
After adding CV to the basic multivariate model, the C-statistic
increased from 0.755 to 0.765.
Conclusions: In the MED group, higher long-term IOP variability,
specifically SD and CV, independently increased the risk of
developing POAG in the multivariate model. However, the addition
of either SD or CV to the multivariate model did little to improve its
predictive accuracy which was already at 0.755.
Commercial Relationships: Mae O. Gordon, None; Julia A.
Beiser, None; J. Phillip Miller, None; Michael A. Kass, None;
Feng Gao, None
Support: NIH and Natl Ctr on Minority Health and Health
Disparities Grants EY09341, 09307, & Core Grant 062687, ICTS
UL1 TR000448, Merck, Pfizer & unrestricted grant from RPB
Clinical Trial: nct00000125
Program Number: 3507 Poster Board Number: D0183
Presentation Time: 11:00 AM - 12:45 PM
What do patients know about glaucoma? Effects of education at
1 and 6 months after the program
Fabian S Lerner1, 2, Jaime I. Yankelevich3. 1Fundacion para el
Estudio del Glaucoma, Buenos Aires, Argentina; 2Postgraduate
Department, University Favaloro School of Medicine, Buenos Aires,
Argentina; 3Ophthalmology, University of Buenos Aires, Buenos
Aires, Argentina.
Purpose: To evaluate the knowledge glaucoma patients have about
their disease before, and 1 and 6 months after a detailed explanation.
Methods: Consecutive patients attending a glaucoma referral
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
practice were invited to participate. Those who accepted were
provided with a questionnaire addressing several issues of glaucoma
at baseline (B) and after 1 (M1) and 6 monhts (M6) of an explanation
of the disease: name of medications used, what are the medications
for?; what type of glaucoma do you have?; what is glaucoma: is it a
disease caused by high intraocular pressure (IOP)?, a disease of the
optic nerve?, a disease of the visual field? (any of these 3 was
considered a valid answer), a specific type of eye cancer?, an
inflammation of the eye?; what was your IOP in your last visit?; what
is considered an average IOP in the general population?; what may
happen if glaucoma is left untreated? Demographic questions were
also performed
Results: 54 patients (29 males) completed the questionnaire. 42.6%
completed primary school, 37% secondary school and 20.4% tertiary
studies. 11.1% had mild, 37% moderate and 51.9% severe glaucoma
(according to the Anderson, Hoddapp and Parrish scale); and 26%
had vision in only one eye. At B, M1 and M6 74%, 13.4% and 34.6%
(p<.001) of patients did not know the name of their medications and
81%, 21% (p<.001) and 20.4% (p<.005) the type of glaucoma, 61%,
3.8% and 2% (p<.001) did not know what was the purpose of
medication, 77.7%, 13.4% and 12.2% (p<.001) did not remember the
last IOP value and 66.6%, 23% and 10.4% (p<.001) did not know the
mean IOP in the population. However 90.7%, 98% and 93.8% did
know the consequences of glaucoma if left untreated. Level of
instruction was associated with a better knowledge in every question
(p<.001), while severity of damage was associated with worse
knowledge (p<.005).
Conclusions: Level of instruction was associated with a better, and
severity of damage with a worse knowledge of the disease in this
cohort of glaucoma patients. Education programs may be directed to
patients with less instruction and worse disease. Although responses
were better at M6 compared to B, some regression could be observed
at M6 compared to M1. Continuous education may be needed
Commercial Relationships: Fabian S Lerner, None; Jaime I.
Yankelevich, None
Program Number: 3508 Poster Board Number: D0184
Presentation Time: 11:00 AM - 12:45 PM
Variability of trabeculectomy among glaucoma surgeons: a
survey from different countries
Glauco B. Almeida1, Camila Zangalli2, Luciana M. Alencar1,
Marcelo Hatanaka1, Eduardo L. Ferreira3, George L. Spaeth2.
1
Glaucoma, Universidade de São Paulo, Campo Grande, Brazil;
2
Glaucoma, Wills Eye Institute, Philadelphia, PA; 3Glaucoma,
Hospital Santa Casa, Campo Grande, Brazil.
Purpose: To assess and report on preoperative care, postoperative
management and intraoperative techniques used for trabeculectomy
among glaucoma surgeons from several different countries.
Methods: An electronic invitation was mailed to ophthalmologists
who were active in glaucoma. Participants were invited to access the
website http://www.trabeculectomystudy.com/. This website included
information regarding the purpose, confidential nature and length of
the survey and researcher’s contact phone number. Only
ophthalmologists that reported being active in glaucoma and agreed
to complete the survey were included in the analysis. Participants
who selected more than one answer per question were excluded from
the study. The questionnaire was composed of 60 multiple-choice
questions regarding preoperative care, intraoperative technique and
postoperative management of patients undergoing primary
trabeculectomy. Data were analyzed using frequency tabulations in
SPSS (version 20.0).
Results: 101 ophthalmologists from several different countries, but
mostly from Brazil (72%) responded to this survey. Preoperatively,
54% of respondents reported using steroids while 33% preferred nonsteroidal anti-inflammatory agents. 39% used an anti-inflammatory
medication for less than 5 days; 61% used for more than 5 days.
Local block was the most popular anesthetic technique. The
variability of operative technique was marked. For example, 4,95%
used no mitomycin at all, 35% (0.2- 0.3 mg/ml) and 35% (0.31 - 0.5
mg/ml). The duration of time of application varied markedly. Some
surgeons excise a block of sclera 1 mm x 2 mm in size, others a
“snippet” so small it cannot be measured, and yet others excise no
sclera at all. One-tenth of the surgeons remove trabecular meshwork,
and 9/10ths do not. Postoperatively, 38% of surgeons used atropine.
Twenty-eight percent reported never using glaucoma medications in
the postoperative period.
Conclusions: This survey demonstrates that the surgical technique
and preoperative and postoperative care for trabeculectomy is not
standard. These significant variations in practice need to be taken into
account when considering the outcomes of trabeculectomy, which
presumably will vary depending upon the technique employed.
Commercial Relationships: Glauco B. Almeida, None; Camila
Zangalli, None; Luciana M. Alencar, None; Marcelo Hatanaka,
None; Eduardo L. Ferreira, None; George L. Spaeth, Merck (F),
U.S. Patent No. 8,042,946 (P), Pfizer (F)
Program Number: 3509 Poster Board Number: D0185
Presentation Time: 11:00 AM - 12:45 PM
The Estimated Impact of Changing Refractive Errors on the
Future Rates of Angle-closure and Open Angle Glaucoma in Asia
Naomi V. Odell, Mark A. Slabaugh, Leona Ding. Ophthalmology,
University of Washington, Seattle, WA.
Purpose: Recent research has estimated the future worldwide burden
of disease from open angle glaucoma (OAG) and angle closure
glaucoma (ACG) at year 2020 to be significantly greater than now.
Unrelated studies indicate major shifts in refractive error of certain
populations, such as those in Asia, towards higher rates of myopia
and high myopia. As myopia, and particularly long axial length, is a
known risk factor for open angle glaucoma and protective against
narrow angle glaucoma, we hypothesize that the shift in refractive
error will likely have an impact on future rates of OAG and ACG.
Methods: Review of the existing literature on changes in rates of
myopia in local, national, and worldwide populations was obtained
and the most representative data extracted. A model was then created
for converting amount of myopia to its biometric component of axial
length. This biometric surrogate was then used to estimate the change
in future rates of open-angle and angle-closure glaucoma.
Results: We estimate that rates of angle closure glaucoma in Asia
alone may be decreased by 20-40% if the current trend of increasing
myopia is sustained. This would lead to a decreased burden of disease
in approximately 6-8 million individuals by 2040. The risk of open
angle glaucoma would be significantly increased over this same time
period to affect an additional 8-10 million individuals above current
estimates.
Conclusions: Estimates of future glaucoma disease burden,
particularly in Asia, are likely to be significantly impacted by the
concomitant development of large populations with increased axial
length. There may be a higher prevalence of OAG, and a lower
prevalence of ACG, respectively, than presently appreciated.
Commercial Relationships: Naomi V. Odell, None; Mark A.
Slabaugh, None; Leona Ding, None
Support: D. Franklin Milam MD Endowment; unrestricted grant
from Research to Prevent Blindness
Program Number: 3510 Poster Board Number: D0186
Presentation Time: 11:00 AM - 12:45 PM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
The Relationship of Body Mass Index (BMI) to Glaucoma
Jessica Prince, Noah Geberer, Wen-Jeng (Melissa) Yao, Barrett
Katz. Ophthalmology, Montefiore Med Ctr/Albert Einstein, New
York, NY.
Purpose: Glaucoma is a pressure-related progressive optic
neuropathy characterized by optic disc excavation and visual field
loss. Variables found to be risk factors in addition to elevated
intraocular pressure include thin corneal thickness and advancing
age. Recently, body mass index (BMI) has been implicated - in an
inverse relationship - as an additional risk factor for open angle
glaucoma (OAG). The purpose of this study is to explore the
relationship of BMI to the prevalence of OAG in an urban
population.
Methods: Clinical Looking Glass (CLG) is an electronic medical
record data set that captures all clinical interactions for all patients
seen at our center. This data set was used to identify by ICD-9 codes
all subjects aged 18-85 years who had all types of glaucoma and had
any visit to Montefiore Medical Center between November 2002 and
November 2012. All subjects who carried the diagnosis of glaucoma
and had both a documented height and weight value within a year of
diagnosis were included in our analysis. BMI was calculated using
the standard equation (weight in kg/height in m2) and then stratified
into groups for further analysis (BMI < 25 and BMI > 25).
Demographic data - including age, race, and gender - were also
included in our analysis.
Results: We identified 21,479 unique patients with a diagnosis of
glaucoma seen over the last 10 years. Of these, 9,338 subjects
(43.5%) had both height and weight measured within a year of when
the glaucoma diagnosis was first noted. We calculated BMI values in
all our 1,673 subjects with OAG (identified by ICD-9 diagnosis
codes 365.10-11). 25.9% (n = 434) of our subjects with OAG had a
BMI < 25; 74.1% (n = 1,239) had a BMI > 25. The majority of our
OAG patients were African American (n = 957, 57.2%), with average
age of 70.2 years; 59% were female.
Conclusions: A BMI > 25 was present in 74.1% of our 1,673
subjects with OAG. This prevalence of high BMI values in our
subjects with concomitant OAG differs from recent reports where
low BMI had been associated with pressure-related optic neuropathy.
Commercial Relationships: Jessica Prince, None; Noah Geberer,
None; Wen-Jeng (Melissa) Yao, None; Barrett Katz, None
Support: Research to Prevent Blindness
Program Number: 3511 Poster Board Number: D0187
Presentation Time: 11:00 AM - 12:45 PM
EYES WITH LARGE OPTIC DISC CUPPING AND NORMAL
INTRAOCULAR PRESSURE: CLINICAL AND
EPIDEMIOLOGICAL DIFFERENCES BETWEEN THOSE
WITH AND WITHOUT GLAUCOMA
Tiago S. Prata1, 2, Marina C. Sousa1, Mauro T. Leite1, Augusto
Paranhos1. 1Ophthalmology, Federal University of Sao Paulo, Sao
Paulo, Brazil; 2Hospital Medicina dos Olhos - HMO, Osasco, Brazil.
Purpose: In eyes with large optic disc cupping and normal
intraocular pressure (IOP), we investigated potential differences in
clinical and epidemiological characteristics between those with and
without glaucoma [large physiological optic disc cups (LPC)].
Methods: We consecutively enrolled individuals with LPC and
glaucomatous patients (normal tension glaucoma). All eyes had
suspicious appearance optic disc [vertical cup-to-disc ratio
(VCDR)≥0.6) and untreated IOP<21 mmHg. For glaucomatous eyes,
a reproducible glaucomatous visual field (VF) defect was required.
Eyes with LPC required normal VF testing and at least 2 years of
follow-up with no evidence of progressive glaucomatous neuropathy
(based on stereophotographs). The following demographic and ocular
characteristics were collected and compared between groups
(glaucoma vs LPC): age, gender, race, central corneal thickness
(CCT), refractive error (spherical equivalent), and optic disc
characteristics (optic disc area and VCDR). Continuous variables
with normal distribution were compared using independent samples ttest while those non-normally distributed were analyzed using MannWhitney test. Categorical data were analyzed using chi-square test
and the alpha level (type I error) was set at 0.05.
Results: A total of 74 eyes with LPC (74 individuals) and 38
glaucomatous eyes (38 patients) were included. Glaucomatous
patients were significantly older than those with LPC (57.1±13.9 vs
46.9±15.7 years; p<0.01). There were more women and Asian
descendents in the glaucoma group (p≤0.02). Not only LPC eyes had
smaller mean VCDR compared to glaucomatous eyes (0.64 vs 0.72;
p<0.01), but also there was a trend for larger optic discs in these
cases (median of 2.36 vs 2.16 mm2; p=0.13). In fact, 90% of the
individuals with LPC presented with a maximum VCDR of 0.75. We
found no significant differences in CCT and spherical equivalent
between groups (p≥0.43).
Conclusions: In patients with large optic disc cupping and normal
IOP, those older, women, Asian descends and with vertical cup-todisc ratio>0,75 are more likely to have glaucoma, and therefore
deserve a deeper investigation and closer monitoring.
Commercial Relationships: Tiago S. Prata, Allergan (F), Merck
(F), Alcon (F), Germed (C); Marina C. Sousa, None; Mauro T.
Leite, None; Augusto Paranhos, Allergan (F), MSD (F)
Support: Postdoc scholarship from capes.
Program Number: 3512 Poster Board Number: D0188
Presentation Time: 11:00 AM - 12:45 PM
Longitudinal analysis of age related changes in intraocular
pressure in South Koreans
SungUk Baek1, Changwon Kee2, Wool Suh1. 1Ophthalmology,
Hallym University Sacred Heart Hospital, Anyang-city, Republic of
Korea; 2Ophthalmology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Republic of Korea.
Purpose: To assess the changes in intraocular pressure(IOP)with age
in South Koreans
Methods: Subjects aged 20 to 79 who had been receiving health
examinations at a university hospital for at least two years were
enrolled. They completed physical and ophthalmic examinations.
Subjects with ocular disease that could possibly affect their IOP were
excluded. The relationship between IOP and age, blood pressure,
heart rate, body mass index, blood chemistry, and electrolyte were
analyzed using a linear mixed model.
Results: A total of 31,857 subjects were enrolled in the study. The
relationship between IOP and age adjusted for sex, side of eye and
systemic parameters showed a significantly negative tendency(0.08562, P<0.001). Females had a less steep decreasing slope of IOP
with age than males. When divided depending on age(20s~80s), it
also showed a negative correlation in all age groups (respectively,
p<0.001). In particular, patients in their 60s~80s had a less steep
decreasing slope of IOP with age than patients in their 20s and 30s.
With regard to systemic parameters, systolic blood pressure and heart
rate had a significantly positive correlation with IOP(p<0.001).
Conclusions: This is the first longitudinal study on changes of IOP
with age in South Koreans. Although the amount of change was
small, IOP was significantly decreased with age(-0.08562, P<0.001).
In women and older age groups(60s~80s), IOP was less decreased
than that of men and young age groups(20s and 30s). Of all systemic
parameters, IOP was positively associated with systolic blood
pressure and heart rate.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: SungUk Baek, None; Changwon Kee,
None; Wool Suh, None
Support: None in the support
Program Number: 3513 Poster Board Number: D0189
Presentation Time: 11:00 AM - 12:45 PM
Evaluation of Ocular Surface Disease in Patients with Glaucoma
Priya M. Mathews, Pradeep Y. Ramulu, David S. Friedman, Esen K.
Akpek. Wilmer Eye Institute, Johns Hopkins University, Baltimore,
MD.
Purpose: To assess the prevalence and severity of ocular surface
disease symptoms and signs in glaucoma patients
Methods: Glaucoma subjects (n=64) and age matched controls
(n=59) underwent a full ophthalmological examination including
visual acuity and visual field examination, tear film break-up time
(TBUT, in seconds), corneal staining score (using National Eye
Institute scale), and Schirmer’s test with anesthesia. The Ocular
Surface Disease Index (OSDI) questionnaire was administered to
assess symptoms. A total OSDI score, vision-related subscore
(derived from questions about vision/task performance), and
discomfort-related subscore (derived from questions about ocular
surface discomfort) were calculated for each subject.
Results: Total corneal staining grade was greater in glaucoma
subjects than controls (6.4 vs. 4.1, p<0.001), but the groups did not
differ significantly in TBUT or Schirmer’s test (p>0.20 for both).
Multivariable linear regression showed that glaucoma therapy burden
was associated with a higher total corneal staining grade (β=+0.9 for
each additional glaucoma drop; 95% CI=0.5-1.3; p<0.001), but not
with TBUT or Schirmer’s test (p>0.20 for both). Glaucoma subjects
had significantly higher total OSDI scores than controls (16.7 vs. 7.9,
p<0.001), largely due to higher vision-related subscores compared to
controls (11.1 vs. 3.3, p<0.001). Despite greater corneal staining
scores in glaucoma patients, ocular discomfort-related subscores were
similar in both groups (5.7 vs. 4.6, p=0.30). In multivariable analyses,
each 5 decibel decrement in better-eye visual field mean deviation
was associated with a 4.7 point increase in total OSDI score (95%
CI=1.9-7.5; p=0.001) and a 3.7 point increase in the vision-related
subscore (95%CI=1.7-5.6; p<0.001), but did not predict a higher
discomfort-related subscore (β=1.1 point, p=0.07).
Conclusions: Glaucoma is associated with significant ocular surface
disease. The extent of glaucoma therapy seems to be predictive of
severity of corneal staining. Although glaucoma patients report
higher OSDI scores, this seems to be largely related to visual field
loss, producing greater vision-related symptoms or difficulty with
daily activities such as reading and driving. Therefore, total OSDI
score may not be an appropriate means of assessing ocular surface
disease in glaucoma patients. Further study is needed to establish
other reliable methods to be utilized in this susceptible population.
Commercial Relationships: Priya M. Mathews, None; Pradeep Y.
Ramulu, None; David S. Friedman, Alcon (C), Bausch & Lomb
(C), Merck (C), QLT, Inc (C), Allergan (C), Nidek (C); Esen K.
Akpek, Alcon (F), Allergan (F), Baush & Lomb (C)
Support: Research to Prevent Blindness Robert and Helen Schaub
Special Scholar Award, American Glaucoma Society/Glaucoma
Research Foundation Career Development Award, and National Eye
Institute grant EY018595
Program Number: 3514 Poster Board Number: D0190
Presentation Time: 11:00 AM - 12:45 PM
Reduced social participation among seniors with non refractive
vision problems and glaucoma
Yaping Jin1, 2, Elizabeth Badley2, 3, Monique Gignac3, 2, Yvonne M.
Buys1, Kednapa Thavorn4, Graham E. Trope1. 1Ophthalmology &
Vis Sci, University of Toronto, Toronto, ON, Canada; 2Dalla Lana
School of Public Health, University of Toronto, Toronto, ON,
Canada; 3Division of Health Care & Outcomes Research, University
Health Network, Toronto, ON, Canada; 4Applied Health Research
Centre, St. Michael's Hospital, Toronto, ON, Canada.
Purpose: Lack of social integration is associated with increased risks
of mortality and dementia. Using a population-based sample we
assessed whether vision problems or glaucoma affect senior’s
engagement in a wide range of social activities.
Methods: We compared participation in 8 community activities from
the Canadian Community Health Survey Healthy Aging 2008/09 in
people with and without non refractive vision problems (i.e. unable to
see with eyeglasses or contact lenses) and those with and without
glaucoma. Caucasian respondents aged 65 years or older (n=14,925)
were included.
Results: Participation in sports or physical activities was reduced by
nearly half in seniors with vision problems (18.2%) versus those
without vision problems (34.7%, p<0.05) and by 7% in those with
glaucoma (27.9%) compared to non-glaucoma (34.7%, p<0.05).
Participation in family or friendship activities outside the household
was also significantly reduced by 12% to 41.4% for seniors with
vision problems and by 6% to 47.4% for those with glaucoma.
Significantly reduced participation was also seen in volunteer or
charity activities (14.7% vs 26.0%), educational or cultural activities
(14.9% vs 25.8%), and service club or fraternal organizations (12.3%
vs 19.3%) for people with vision problems but not those with
glaucoma.
Participation in church or religious activities and in neighborhood or
professional association activities was very similar in people with and
without vision problems (p>0.05) and those with and without
glaucoma (p>0.05).
When the effects of age, sex, education, income and other chronic
conditions were controlled for, seniors with vision problems but
without glaucoma were three times more likely not to be involved in
any activities (odds ratio (OR) 3.0, 95% confidence interval (CI) 1.75.3), and seniors with both vision problem and glaucoma were two
times more likely not to participate (OR 2.1, 95% CI 0.7-5.8)
compared to seniors with no vision problems and no glaucoma.
Conclusions: Significant reduction in social participation was found
in 6 out of 8 community activities among seniors with vision
problems and in 2 out of 8 activities among those with glaucoma.
Future research is needed to determine if better social support (like
that provided by religious or community groups) can help seniors
with vision problems or glaucoma maintain their social participation.
Commercial Relationships: Yaping Jin, None; Elizabeth Badley,
None; Monique Gignac, None; Yvonne M. Buys, Alcon Surgical
Incorporated (R), Alcon Surgical Incorporated (F), IMED (F);
Kednapa Thavorn, None; Graham E. Trope, sensimed (F)
Support: Canadian Institutes of Health Research (CIHR SEC
117120), The Canadian National Institute for the Blind, the
Glaucoma Research Society of Canada
Program Number: 3515 Poster Board Number: D0191
Presentation Time: 11:00 AM - 12:45 PM
Using a Structural Equation Measurement Model (SEMM) for
Nested Data to Describe Agreement among Lamina Cribrosa
Pore Segmentation Methods
Richard A. Bilonick1, 2, Bo Wang1, 3, Zach Nadler1, Gadi Wollstein1,
Hiroshi Ishikawa1, 4, Yun Ling1, 2, Larry Kagemann1, 4, Joel S.
Schuman1, 4. 1UPMC Eye Center, Eye & Ear Institute,
Ophthalmology and Visual Science Research Center, Dept.
Ophthalmology, U.Pittsburgh School of Medicine, Pittsburgh, PA;
2
Dept. Biostatistics, U. Pittsburgh Graduate School of Public Health,
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Pittsburgh, PA; 3Medical Scientist Training Program, University of
Pittsburgh, Pittsburgh, PA; 4Dept. Bioengineering, Swanson School
of Engineering, U. Pittsburgh, Pittsburgh, PA.
Purpose: Lamina cribrosa (LC) consists of pores and beams. OCT
images of LC consist of 1000's of pixels. Segmentation assigns each
pixel either pore (1) or beam (0). We compared a computer algorithm
(A) and manual by 2 experts, B and Z.
Methods: 6 pixels were sampled from each image from 1 eye of each
of 29 healthy and glaucoma subjects. Pixels (1-6) were on a grid with
each cell being 100 × 100 pixels wide (see Figure). SEMM allowed
for correlation among the nested pixels based on the distance between
the pixels - see the path diagram for the case of 4 pixels (1-4). The
unknown propensity μ for a pixel to be a pore was represented by a
latent variable (LV), Normally distributed with mean 0 and standard
deviation 1 [N(0,1)]. Each measurement (X) was either 0 or 1. These
X's are assumed to come from a continuous LV (χ) that is N(0,1).
Each method has a threshold c such that if χ≦c then X=0, else 1.
Because binary Xs provide less information than continuous, grey
scale level (GSL, 0-255) was included as an indicator for μ. The
darker the GSL, the greater μ. ρ1, ρ2, ρ3 (for methods A, B, and Z)
and ρ4 (for GSL) can be interpreted as the correlation between the
indicator and μ. The 15 pairwise correlations among the 6 μ can be
represented by just 4 correlations (P1, P2, P3 and P4) that correspond
to the four distances reducing the number of parameters. The
expected covariance matrix is ΛS-1Λ'+R where for only 4 pixels, the
Λ and S matrices are shown in the figure and R is a matrix with
residual variances on the diagonal. Parameters were estimated by
maximum likelihood using the OpenMx R package.
Results: The outcomes (see Table) showed that A found 30 pores, B
found 26, and Z found 24. Unlike SEMM, the table does not account
for nested data. SEMM showed that A and B were most highly
correlated with pore propensity (ρ1=ρ2=0.99) while Z's correlation
was ρ3=0.96 and GSL was ρ4=0.76. A had the lowest threshold
(0.96), B the next highest (1.05) and Z the highest (1.09), agreeing
with the simple frequencies that Z is less likely to declare a pore. The
Ps were near 0 for the grid spacing used.
Conclusions: All methods were highly correlated with pore
propensity while GSL was substantially less correlated. The methods
differ in the probability of transitioning from beam to pore. A similar
model can be applied easily to any study of agreement based on
nested data.
Commercial Relationships: Richard A. Bilonick, None; Bo Wang,
None; Zach Nadler, None; Gadi Wollstein, Allergan (C); Hiroshi
Ishikawa, None; Yun Ling, None; Larry Kagemann, None; Joel S.
Schuman, Carl Zeiss Meditec, Inc. (P)
Support: R01-EY013178, P30-EY008098, Eye and Ear Foundation
(Pittsburgh, PA), Research to Prevent Blindness
Program Number: 3516 Poster Board Number: D0192
Presentation Time: 11:00 AM - 12:45 PM
BRIDGING THE MAJOR CLINICAL TRIALS AND
EVERYDAY CLINICAL PRACTICE: CENTRAL CORNEAL
THICKNESS AND VISUAL FIELD DAMAGE ARE
INDEPENDENT RISK FACTORS FOR PROGRESSION IN A
6-YEAR RETROSPECTIVE EVALUATION OF PATIENTS'
ELECTRONIC CHART RECORDS
Stefano A. Gandolfi1, Daniela Paoli2. 1Ophthalmology, University of
Parma, Parma, Italy; 2Ophthalmology, Community Hospital,
Monfalcone, Italy.
Purpose: to evaluate risk factors for progression in a population of
open angle glaucoma patients routinely followed up in a Hospitalbased Glaucoma Clinic
Methods: The records of 256 eyes (132 patients) routinely followed
in the years 2004-2010 in the Glaucoma Clinics of Parma and
Monfalcone were retrospectively evaluated. The data were recorded
by using the software Glaucoma Management System 3 © and were
sorted by applying a query for eyes with (a) at least one visual field
test / year HFA 24/2 SITA, (b) two IOP readings/year , (c) open
angle on gonioscopy , (d) a central corneal thickness (CCT)
evaluation before being started on therapy and (e) a minimum
follow up of six years. Visual field damage was staged by using
Brusini’s Glaucoma Staging System 2 (GSS2). Worsening by 1
stage/10 years (i.e. 0.6 of a stage in 6 years) was considered to be
significant to label an eye as “progressing”
Results: 52/256 eyes (48/132 patients) met the criteria for
progression. Mean rate of progression was 0.96 dB/year , meanwhile
those eyes, who did not meet the criteria for progression, showed a
0.08 dB/year . Baseline IOP ranged between 21 and 32 mmHg. IOP
during follow up ranged between 12 and 23. Mean IOP during follow
up was 17.8 mmHg in the non-progressing and 18.2 in the
progressing cohort (p > 0.2, unpaired two-tailed Student t test). The
eyes were further stratified according to CCT: (a) < 510
micron, (b) between 510 and 550 micron, (c) > 550 micron. The
percentage of progressing eyes among the three categories of CCT
readings were 57% in (a), 45% in (b) and 10% in (c). A multivariate
analysis (SPSS12) dissected, as independent risk factors for
progression, (a) CCT< 550 micron (OR 1.8-6.2, p < 0.0001) and (b)
baseline MD > 4 dB (2.75% risk / 0.1 dB, p < 0.001)
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Conclusions: This “everyday data set “ confirmed that CCT < 550
micron and a Mean Defect > 4 dB can be considered as independent
risk factor for progression in treated open angle glaucomas over a 6year interval.
Commercial Relationships: Stefano A. Gandolfi, SENSIMED (R),
ALLERGAN (R), ALCON (R), ALLERGAN (F), ALCON (F),
GLAUKOS (F), IVANTIS (F); Daniela Paoli, None
Program Number: 3517 Poster Board Number: D0193
Presentation Time: 11:00 AM - 12:45 PM
Impact of Educational Intervention on Compliance with Topical
Therapy for Glaucoma
Shani Reich1, Justin E. Rome1, Jack Manns1, Lilly Droll1, Joseph
Zelefsky1, 2. 1Department of Ophthalmology, Bronx Lebanon
Hospital, Bronx, NY; 2Department of Ophthalmology and Visual
Sciences, Albert Einstein College of Medicine, Bronx, NY.
Purpose: Poor compliance with medical therapy is a barrier for
effective treatment of disease. Previous studies have shown increased
compliance with medical therapy for glaucoma with educational
interventions. While these predominantly focused on Caucasian and
Black populations, data for the Hispanic community is limited. The
goal of this study was to determine if educational intervention can
increase compliance in patients on travoprost in the Hispanic
population.
Methods: Patients with glaucoma or ocular hypertension on
travoprost therapy were enrolled. Patients under 18 years of age,
unable to self-administer drops, or using any other drops were
excluded. Patients were provided with a Travatan Dosing Aid (TDA),
an electronic device that records when a drop of travoprost is
dispensed. At one-month follow-up the data was downloaded off of
the TDA and compliance was calculated. Those with <75%
compliance were randomized into either an education or control
group. Patients in the education group watched a 10 minute video
produced by the AAO, in either English or Spanish, discussing
glaucoma and eye drop usage, followed by verbal reinforcement of
drop usage. Control group patients were only given verbal
reinforcement of drop usage. Compliance was reassessed 2 months
later.
Results: A total of 70 patients will be enrolled; 44 patients are
enrolled thus far, 10 of which are mid-study. Of the 34 who have
completed the study to date (22 Hispanic, 12 Black), baseline
compliance was 45% (40% Hispanics, 54% Blacks). Nine patients (4
Hispanic, 5 Black) had >75% compliance (mean 90%, range 78100%), and 25 patients (18 Hispanic, 7 Black) had <75% compliance
(mean 29%, range 4-70%) at one-month follow-up. Thirteen patients
were randomized to the educational group, and 12 to the control
group. Compliance rates in the education group were increased from
25%→46%, p=0.006, (23%→49%, p=0.009 in Hispanics, and
28%→45%, p=0.03 in Blacks) at the three-month follow-up. There
was no statistically significant change in compliance in the control
group (34%→36% overall, p=0.7; 37%→37%, p=0.99 in Hispanics,
and 23%→32%, p=0.6, in Blacks).
Conclusions: Compliance with glaucoma therapy remains a major
problem in glaucoma management. In our Hispanic and Black patient
population, compliance increased with educational intervention. This
study underscores the importance of education in increasing
compliance with glaucoma therapy.
Commercial Relationships: Shani Reich, None; Justin E. Rome,
None; Jack Manns, None; Lilly Droll, None; Joseph Zelefsky,
Alcon (R), Allergan (R)
Program Number: 3518 Poster Board Number: D0194
Presentation Time: 11:00 AM - 12:45 PM
First-degree Consanguinity as a risk factor to developing
primary open-angle Glaucoma in Mexican families
Elia Chavez1, Jose A. Paczka1, Abraham Soto-Gomez2, Miriam A.
Ramos-Hernandez1. 1Oftalmologia, Instituto de Oftalmologia y
Ciencias Visuales. Universidad de Guadalajara, Guadalajara, Mexico;
2
Oftalmologia, CE + CECIS ISSSTE, Guadalajara, Mexico.
Purpose: To investigate the risk to developing primary open-angle
glaucoma (POAG) among Mexican individuals with first-degree
relatives affected by POAG.
Methods: Fifty-three persons (29 females, 24 males; mean age of
47.96 ± 23.04 years) belonging to eight families in which several
members are positive for POAG were prospectively assessed. All 53
individuals were comprehensively examined by the same
ophthalmologist. Glaucoma suspects derived from such assessment
underwent a battery of specialized tests (automated achromatic static
perimetry and optical coherence tomography). In addition, 44
visually healthy controls (25 females, 19 males; mean age of 49.11 ±
0.11 years) were also ophthalmologically evaluated. Relative risk to
develop POAG was estimated from a weighted family score based on
the number of affected first-degree relatives.
Results: Twenty-eight POAG patients (18 females, 10 males; mean
age of 56.28 ± 16.72 years)were younger, more commonly
represented by males, and with wider vertical c/d ratios as compared
to individuals without glaucoma as well as to the controls. Relative
risk ratio to develop POAG among members of the studied family
members is 1.86 (95% CI, 1.18-2.90; P = 0.006).
Conclusions: Our study confirmed that first-degree consanguinity in
a sample of Mexican individuals is associated with a risk of having
POAG approximately twice as much for members with a higher
family score.
Commercial Relationships: Elia Chavez, None; Jose A. Paczka,
None; Abraham Soto-Gomez, None; Miriam A. RamosHernandez, None
Program Number: 3519 Poster Board Number: D0195
Presentation Time: 11:00 AM - 12:45 PM
Associations between Systemic Factors and Longitudinal
Analyses of Intraocular Pressure: Mean, Peak and Variability
Thasarat S. Vajaranant1, Charlotte E. Joslin1, 2. 1Ophthalmology and
Visual Sciences, University of Illinois at Chicago, Chicago, IL;
2
Division of Epidemiology and Biostatistics, School of Public Health,
University of Illinois at Chicago, Chicago, IL.
Purpose: Intraocular pressure (IOP) mean, peak and variability are
risk factors for primary open-angle glaucoma development and
progression, and systemic factors may affect IOP. Here, we
characterized 12-year IOP mean, peak and variability in nonglaucomatous eyes at baseline, and determined systemic factors
associated with long-term IOP variables.
Methods: We used the dbGaP Age-Related Eye Disease Study
dataset. Glaucoma was an exclusion criterion to enrollment, and we
excluded subjects who reported glaucoma during follow-up to
minimize effects of IOP treatment. Repeated IOP measurements (OD
only), taken annually, were analyzed to assess the effect of disease
status on mean IOP using 2 methods (SAS v9.3, Cary, NC): 1) a t-test
to compare effect of disease status; and 2) mixed-effects regression
models for longitudinal data analysis with repeated measures.
Method 1: descriptive statistics for the IOP were computed; and
compared by t-test based on baseline self-reported systemic disease
status (diabetes (DM), hypertension (HTN), smoking, cancer),
obesity (BMI > 30) and age-related macular degeneration status;
antioxidant treatment; and subsequent all-cause and cardiovascular
mortality. Method 2: random-effects models were fit using PROC
MIXED to test the trend across time, and to assess the fixed effects of
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
systemic disease status. Null hypotheses were tested by comparing
model -2LogLikelihood values among nested models.
Results: Of 3,914 analyzed subjects; 55% were female and 95.7%
were White (mean age = 69.4 ± 5 yrs). Analyses totaled 31,431 IOP
measurements during a 9.6 mean yrs (max = 12.8). T-test of mortality
had no effect on mean IOP (p = 0.30), suggesting no survival effect
and validating inclusion of subjects, regardless of death. Table 1
summarizes overall long-term IOP variables. Less visit number and
baseline DM, HTN and obesity statistically significantly predicts
higher IOP mean, peak and variability in t-tests. Final multivariable
mixed-effects regression models identified a mean IOP of 15.8 at
baseline, with only visit number (estimate = -0.014, p <.0001),
baseline DM (estimate = 0.712, p <.0001) and obesity (estimate =
0.597, p <.0001) significant in predicting IOP.
Conclusions: In this older cohort with no glaucoma at baseline,
overall IOP decreases over time. During the 12-year period, baseline
DM and obesity were significantly associated with an increased IOP.
Commercial Relationships: Thasarat S. Vajaranant, None;
Charlotte E. Joslin, None
Support: The dataset used for the analyses described was obtained
from the Age-Related Eye Disease Study (AREDS) Database through
dbGaP accession number [#14756-1]. Funding support for AREDS
was provided by the National Eye Institute (N01-EY-0-2127). Other
support: The Komarek McQueen Glaucoma Research Fund in Honor
of Dr. Mark Lunde and Research to Prevent Blindness.
Program Number: 3520 Poster Board Number: D0196
Presentation Time: 11:00 AM - 12:45 PM
Comparison of the sensitivity and specificity of the Von Herick
test and ocular biometric parameters as screening tests in
prevalent and incident angle closure disease in a population
based study
Ronnie J. George, Rashima Dinesh, Manish Panday, Ramesh S Ve,
Vijaya Lingam. Glaucoma, Sankara Nethralaya Eye Hospital,
Chennai, India.
Purpose: To compare the diagnostic ability of the von Herick test
and central anterior chamber depth in the detection of angle closure
disease in a population based study in South India and in incident
angle closure disease diagnosed 6 years later.
Methods: 6815 participants in the Chennai Glaucoma Study, a
population based study in South India, who were bilaterally phakic at
the baseline evaluation were included. When they were re-examined
6 years following the baseline evaluation during the Chennai Eye
Diseases Incidence Survey 3350 of them who were bilaterally phakic
examined were included. Those with a diagnosis of angle closure
disease at baseline were excluded. All participants underwent a
comprehensive eye examination at both visits that included limbal
chamber depth assessment and gonioscopy. A random subset of
normal individuals and all those with angle closure disease
underwent ultrasound biometry at baseline, all participants in CEDIS
underwent biometry. The AUROC was calculated for the von Herick
test , axial length, lens thickness and central anterior chamber depth
at baseline and during the follow up visit.
Results: At the baseline visit the AUROC for a Von Herick grade of
2 or less was0.89(95%CI:0.876,0.904) with a sensitivity of 79.5%
and specificity of 91.9%. For axial length 0.717(95%CI:
0.692,0.741), central anterior chamber depth
0.865(95%CI:0.848,0.882) and lens thickness 0.60(95%CI:
0.571,0.629). For incident cases the AUROC for a Von Herick grade
of 2 or less was0.684(95%CI:0.642,0.727) . For axial length
0.627(95%CI: 0.581,0.673), central anterior chamber depth
0.732(95%CI:0.690,0.774) and lens thickness 0.653(95%CI:
0.607,0.700).
Conclusions: Both limbal chamber depth and central anterior
chamber depth were less effective at detecting incident as compared
to prevalent angle closure disease in a population based study.
Commercial Relationships: Ronnie J. George, None; Rashima
Dinesh, None; Manish Panday, None; Ramesh S Ve, None; Vijaya
Lingam, None
Support: Chennai Willingdon Corporate Foundation
Program Number: 3521 Poster Board Number: D0197
Presentation Time: 11:00 AM - 12:45 PM
Glaucoma Awareness in Relatives of Patients Diagnosed with
Glaucoma
aaron smith1, Jennifer Oakley2, Suzanne T. Hoadley1, Erin J. Smith1,
Omolola O. Idowu1. 1Univeristy of Mississippi Medical Center,
Jackson, MS; 2University of South Florida, Tampa, FL.
Purpose: To evaluate the knowledge of the glaucoma disease
process, risk factors, and interest in screening in first degree relatives
of glaucoma patients seen at The University of Mississippi Medical
Center glaucoma clinic.
Methods: A voluntary survey was offered to 100 persons
accompanying clinic patients with a known diagnosis of glaucoma.
Questions assessed their basic knowledge of the disease, risk factors,
and if they had a diagnosis of glaucoma or had ever been screened.
All volunteers were then provided with information regarding
glaucoma and offered free screening.
Results: Among 100 persons surveyed, with 52 being first-degree
relatives, there was a strong understanding that glaucoma led to
blindness (84.6% relatives) and that if diagnosed early and treated,
blindness could be prevented (88% relatives). 71% of first-degree
relatives knew that lowering intraocular pressure treated glaucoma.
While first-degree relatives understood that glaucoma led to
blindness, only half of first-degree relatives understood the family
link of glaucoma (53%). Out of these 53% of first-degree relatives
that knew there was a hereditary link, 60% of them had never been
screened showing a disregard for the risk of blindness. Only 30% of
first-degree relatives had been told they should be screened for
glaucoma, with most being told by an eye doctor (96%). Surprisingly,
0% of first-degree relatives were told by their family member who
had glaucoma.
Conclusions: Family and friends of patients with glaucoma have
good basic knowledge but lack an understanding of their risk for
glaucoma. The family members that do understand their risk are still
not being screened regardless of understanding that it can cause
blindness. Eye doctors are doing a good job of telling family
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
members of their patients to get screened when they have the
opportunity. Glaucoma patients are not adequately notifying their
family of their risk and are not telling them to get screened.
Glaucoma patients were not questioned in this study and therefore we
cannot comment on the reason for this deficiency, but this pitfall
deserves further investigation.
Commercial Relationships: aaron smith, None; Jennifer Oakley,
None; Suzanne T. Hoadley, None; Erin J. Smith, None; Omolola
O. Idowu, None
Program Number: 3522 Poster Board Number: D0198
Presentation Time: 11:00 AM - 12:45 PM
The Glaucoma Treatment Compliance Assessment Tool
(GTCAT) has an organizational structure consistent with the
Health Belief Model
Gordon Barker1, Paul F. Cook2, Malik Y. Kahook2, Jeffrey Kammer3,
Steven L. Mansberger1. 1Devers Eye Institute, Portland, OR;
2
University of Colorado, Aurora, CO; 3Vanderbilt University,
Nashville, TN.
Purpose: To determine the construct validity of the Glaucoma
Treatment Compliance Assessment Tool (GTCAT) towards the
organizational structure of the Health Belief Model (HBM).
Methods: We used the constructs of the HBM to create the 47-item
GTCAT with a 5-point Likert scale. We determined construct validity
using Principal Components Analysis (PCA) with an orthogonal
rotation and a > .50 cutoff for item loading into components. We
used Cronbach’s alpha (α) to evaluate the internal consistency
reliability of the components. GTCAT questions with floor and
ceiling effects (> 90% of responses 1 or 5 on the Likert Scale) were
determined using frequency analysis.
Results: We included 184 open angle glaucoma or ocular
hypertension patients on ocular hypotensive monotherapy from 3
tertiary glaucoma practices. PCA loaded 26 questions into 10
components, as determined by eigenvalues (> 1.0) and a screen plot.
Six of these components were consistent with the HBM constructs of
Severity, Benefits, Self-Efficacy (Medication), Self-Efficacy
(Control), Barriers, and Knowledge. Another component also
appeared to directly assess health behavior (Behavior). The other
components were undefined as part of the HBM organizing structure.
The internal consistency reliability was acceptable (α ≥ 0.70) for 6
components (Knowledge, Benefits, Self-Efficacy [Medication], SelfEfficacy [Control], Barriers, and Behavior). Severity showed
borderline reliability (α = 0.67) and the remaining three undefined
components showed poor reliability (α ≤ 0.30). No questions had
floor or ceiling effects.
Conclusions: The GTCAT showed good construct validity and
internal consistency, though it may be unnecessarily long. Further
evaluations will assess the performance of a shorter question, and the
predictive validity towards glaucoma medication adherence.
Commercial Relationships: Gordon Barker, None; Paul F. Cook,
Merck & Co. (F), University of Colorado Hospital (F), The
Children's Hospital Denver (F), National Hemophilia Association (F),
University of Texas San Antonio (F); Malik Y. Kahook, Alcon (C),
Allergan (C), Merck (C), B&L (C), Glaukos (C), Ivantis (C),
ClarVista Medical (P), Dose Medical (P), AMO (P), Genentech (F),
Regeneron (F); Jeffrey Kammer, Allergan (C), Merck (F); Steven
L. Mansberger, Merck (R), Alcon (C), Allergan (C), Allergan (F),
Merck (F), Santen (C), Glaukos (C)
Support: MERCK, Good Samaritan Foundation, American
Glaucoma Society
Program Number: 3523 Poster Board Number: D0199
Presentation Time: 11:00 AM - 12:45 PM
Glaucoma in Patients After Iodine-125 Brachytherapy for Uveal
Melanoma
Crystal Hung, Tara McCannel, Simon K. Law, JoAnn A. Giaconi.
Jules Stein Eye Institute/UCLA, Los Angeles, CA.
Purpose: Patients with uveal melanoma may have exacerbation of
preexisting glaucoma or develop secondary glaucoma after
brachytherapy. The characteristics of glaucoma in treated uveal
melanoma remain poorly understood. We describe the incidence,
subtype, and outcomes of glaucoma in patients with I-125 plaque
brachytherapy for uveal melanoma.
Methods: Records of all patients who underwent brachytherapy for
uveal melanoma between 2005 and 2011 by a single surgeon (TAM)
were retrospectively reviewed. Patients with glaucoma or glaucoma
suspect (GS, defined by intraocular pressure requiring treatment),
were included. The incidence, subtype, and IOP control were
described statistically.
Results: A total of 341 patients were diagnosed with uveal melanoma
and underwent I-125 brachytherapy; 44 (12.9%) had a diagnosis of
glaucoma. The melanoma involved the iris (5), ciliary body (3),
ciliochoroid (2), and choroid (34). Mean follow-up after
brachytherapy was 36.5±20.4 months (range: 5-76 months).
Of the 44 patients, 12 (3.5%) had preexisting diagnoses of glaucoma
(9) or GS (3); 33 (9.7%, including 2 preexisting GS) developed
glaucoma following brachytherapy; 1 (0.2%) became GS. Glaucoma
diagnoses were neovascular (NVG, 19), open angle (4), angle closure
(1), angle recession (1), melanomacytic (1), combined (1), phacolytic
(1), pigmentary (1), and non-specific (15).
In the 44 patients, the mean pre-brachytherapy IOP was
15.7±4.0mmHg. The mean maximum post-brachytherapy was
33.4±13.8mmHg. Eight (18.2%) patients experienced post-operative
day 1 IOP spikes (32±14.0mmHg). The time from brachytherapy to
highest IOP averaged 18.2±16.7 months. The mean final IOP was
17.2±6.7mmHg. 38 patients (86.4%) were managed medically, 5
(11.4%) underwent tube-shunt surgery, and 1 (2.3%) was enucleated.
Of note, 9 of the 19 NVG cases were treated with anti-VEGF; none
were enucleated. At last follow-up, 5 patients (11.4%) had uveal
melanoma metastasis; 3 expired as a result of metastasis. None of the
5 patients who underwent tube-shunt surgery have developed
metastasis to date.
Conclusions: We report a 12.9% incidence of glaucoma after I-125
plaque brachytherapy. The IOP in most patients can be controlled
with medical therapy. Anti-VEGF therapy may be an important
adjunctive therapy in NVG. When maximal medical therapy fails to
control IOP, glaucoma tube-shunt surgery may be an option for
optimal IOP control.
Commercial Relationships: Crystal Hung, None; Tara McCannel,
None; Simon K. Law, None; JoAnn A. Giaconi, Allergan (C)
Program Number: 3524 Poster Board Number: D0200
Presentation Time: 11:00 AM - 12:45 PM
Relationship between eye shape and the risk for glaucoma
Divakar Gupta1, Daniel B. Moore2, Karine D. Bojikian1, Mark A.
Slabaugh1. 1Ophthalmology, University of Washington, Seattle, WA;
2
Ophthalmology, Duke Eye Center, Durham, NC.
Purpose: Myopia has long been identified as a risk factor for openangle glaucoma (OAG). We aimed to determine if the primary risk
factor for OAG is due primarily to increased axial length or if other
correlated factors leading to myopia may be involved.
Methods: We collected our data using two methods: retrospective
chart review of patients who had undergone biometry (IOL Master)
prior to elective cataract surgery at University of Washington or
Harborview Medical Center from 2009-2011, and prospective
collection of data from patients in the University of Washington Eye
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Institute Glaucoma Clinic who agreed to have ocular biometry. We
excluded patients with secondary causes of glaucoma and subjects
classified as glaucoma suspects. Predicted refraction was calculated
using the biometry data and individual variation from a best fit
regression line was determined for all subjects. This was compared
between those with and without OAG.
Results: Our dataset included 901 eyes of 901 subjects, 281 with
glaucoma and 620 without glaucoma. The average age was 67.16 ±
12.38., the corneal curvature was 43.87 ±1.67 D and the axial length
was 24.38 ± 1.76 mm. Subjects with glaucoma had longer axial
lengths, (24.88 ± 1.91 mm vs. 24.16 ± 1.65, p<0.001) and flatter
corneas (43.62 ± 1.73 D vs. 43.98 ± 1.64 D, p=0.002) than those
without glaucoma. In a multivariate analysis, age and axial length
were significant independent risk factors for glaucoma in this
population. Using deviation from a best fit regression line for all
biometric data derived refractions, it was found that for any given
refractive error, subjects with glaucoma had longer axial lengths
compared to controls (0.218 ± 0.882 mm vs. -0.099 ± 0.82mm, p <
0.001).
Conclusions: Axial length and age were independent risk factors for
glaucoma in this population. Analysis of the biometric data showed
that for any refractive error, subjects with glaucoma tended to have
longer axial lengths than those without glaucoma. This data suggests
that an increased axial length rather than strictly refractive error
might be the pathophysiologic mechanism underlying the association
between myopia and OAG.
Health, Pittsburgh, PA; 3RFUMS/Chicago Medical School, Chicago,
IL; 4Dept. Bioengineering, Swanson School of Engineering, U.
PIttsburgh, Pittsburgh, PA.
Purpose: Longitudinal macular and retinal nerve fiber layer (RNFL)
measurements were obtained by two iterations of optical coherence
tomography (OCT). Latent Growth Curve Models (LGCM) were
used to calibrate the measurements obtained by the different devices
to allow the computation of the trend of the measurements changing
over time.
Methods: 904 observations from 71 eyes (36 subjects) were
available. Subjects were tested by two different iterations of OCT
over the 10-year study. In this analysis, there were 23 macula
measurement overlaps between generations, and 106 RNFL
measurement overlaps. Visit times were irregularly spaced within and
between subjects and some measurements were missing.
The R statistical language and environment with OpenMx R package
was used to fit the LGCMs. The LGCM models the true but unknown
macular or RNFL values as a function of follow-up, that is χj =I + S tj
+ξj, where χj stands for the true thickness at jth time point, I stands for
the latent intercept and S for the latent slope, tj for the time point, ξj
for the error term.
Observed device 1 and device 2 measurements are modeled as linear
functions of the unknown true thicknesses ( χ ): D i =αi + βi χj +εij,
where Di stands for the value measured by device i, α i stands for
intercept and βi for slope, εij for the error term.
After fitting the calibration model, the RNFL measurements were
“corrected” to allow the use of measurements from both iterations as
a continuum, and a linear mixed effect model was fitted to get the
individual slope for each eye.
Results: Estimates of the relevant functions of the model parameters
are shown in Table 1. For macular measurements, the average growth
curve is χj = 246.91 - 0.037 tj, the calibration curve is D3 =88.67+0.58
D2; For RNFL, the average growth curve is χ j =101.69-0.0013 tj, the
calibration curve is D3=10.31+0.744 D2. The trends and calibration
curves fit the data well.
Conclusions: SEM accounted for the correlations between eyes of
each subject, correctly estimated growth curves measured by multiple
devices by simultaneously calibrating measurements from different
devices. Using SEMs made it possible to extend the length of subject
profiles.
Relationship between axial length and predicted refractive error in
patients with open angle glaucoma (cases) and controls.
Commercial Relationships: Divakar Gupta, None; Daniel B.
Moore, None; Karine D. Bojikian, None; Mark A. Slabaugh, None
Support: D. Franklin Milam MD Fellows Support Fund, Research to
Prevent Blindness
Program Number: 3525 Poster Board Number: D0201
Presentation Time: 11:00 AM - 12:45 PM
Latent Growth Curve Model for Calibration between
Measurements Obtained by Multiple Devices
Yun Ling1, 2, Richard A. Bilonick1, 2, Igor I. Bussel1, 3, Hiroshi
Ishikawa1, 4, Gadi Wollstein1, Larry Kagemann1, 4, Ian A. Sigal1, 4,
Joel S. Schuman1, 4. 1UPMC Eye Center, Eye and Ear Institute,
Ophthalmology and Visual Science Research Center, Dept. of
Ophthalmology, U. Pittsburgh School of Medicine, Pittsburgh, PA;
2
Dept. Biostatistics, U. PIttsburgh Granduate School of Public
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Program Number: 3696
Presentation Time: 3:50 PM - 4:10 PM
Nature and Nurture and Macular Degeneration: Insights from
Twin Studies
Johanna M. Seddon. Ophthalmology, Tufts Univ School of Medicine,
Boston, MA.
Commercial Relationships: Johanna M. Seddon, Genentech (F),
Tufts Medical Center (P)
Program Number: 3697
Presentation Time: 4:10 PM - 4:30 PM
Aging and Epigenetics: How Do They Relate to AMD?
Leonard M. Hjelmeland. Ophthalmology, Univ of California-Davis,
Davis, CA.
Commercial Relationships: Leonard M. Hjelmeland, NeuroTech
Inc. (C)
421 Eye Care
Wednesday, May 08, 2013 8:30 AM-10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 4383-4428/D0021-D0066
Organizing Section: Clinical/Epidemiologic Research
Commercial Relationships: Yun Ling, None; Richard A. Bilonick,
None; Igor I. Bussel, None; Hiroshi Ishikawa, None; Gadi
Wollstein, Allergan (C); Larry Kagemann, None; Ian A. Sigal,
None; Joel S. Schuman, Carl Zeiss Meditec, Inc. (P)
Support: R01-EY013178EY013178, P30-EY008098, Eye and Ear
Foundation (Pittsburgh, PA), Research to Prevent Blindness
368 Epigenetics: Genes and Environment - Minisymposium
Tuesday, May 07, 2013 2:45 PM-4:30 PM
615-617 Minisymposium
Program #/Board # Range: 3693-3697
Organizing Section: Clinical/Epidemiologic Research
Contributing Section(s): Genetics
Program Number: 3693
Presentation Time: 2:50 PM - 3:10 PM
Opening Our Eyes to Epigenetics
Alex W. Hewitt. Department of Ophthalmology, Centre for Eye
Research Australia, Surrey Hills, VIC, Australia.
Commercial Relationships: Alex W. Hewitt, None
Program Number: 3694
Presentation Time: 3:10 PM - 3:30 PM
Epigenetic Changes Associated with Neuronal Cell Death
Robert W. Nickells. Ophthalmology & Visual Science, Univ of
Wisconsin-Madison, Madison, WI.
Commercial Relationships: Robert W. Nickells, None
Program Number: 3695
Presentation Time: 3:30 PM - 3:50 PM
Genes and Nutrition, How Do They (Counter) Interact in the
Development of AMD?
Caroline C. Klaver. Ophthalmology and Epidemiology, Erasmus
Medical Center, Rotterdam, Netherlands.
Commercial Relationships: Caroline C. Klaver, Bayer (F),
Novartis (F), Topcon (F)
Program Number: 4383 Poster Board Number: D0021
Presentation Time: 8:30 AM - 10:15 AM
Screening of Potentially Blinding Eye Diseases by Vision
Technicians at Rural Vision Centres in Southern India and their
Referral Agreement with an Ophthalmologist
Uday Addepalli1, Suram Vasantha2, Rohit C. Khanna3, Krishnaiah
Sannapaneni3, Vilas Kovai3. 1VST Center for Glaucoma Services, L
V Prasad Eye Insititute, Hyderabad, India; 2Glaucoma, Sarojini Devi
Eye Hospital, Hyderabad, India; 3Allen Foster Research Centre for
Community Eye Health, International Centre for Advancement of
Rural Eye care, L V Prasad Eye Insititute, Hyderabad, India.
Purpose: To validate the ability of vision technicians (VTs) in
screening potentially blinding eye diseases and to find the
interobserver agreement (with reference to ophthalmologist) for
referral to higher level centers in a vision centre (VC) based model in
rural South India.
Methods: A random sample of subjects at the 7 VCs between July to
August 2010 were simultaneously examined in masked manner by
the 7 VTs and an ophthalmologist. The screening protocol included
vision testing, refraction, slit-lamp biomicroscopy, applanation
tonometry and undilated direct ophthalmoscopy examination. Interobserver agreement and diagnostic accuracy parameters for referral
pattern and screening of eye diseases were assessed using weighted
kappa statistics. The diagnosis by the ophthalmologist was
considered as the reference standard.
Results: The subjects (n=279) with a mean age of 32.9+21.8 years
were enrolled and examined at the 7 VCs. Agreement for diagnosis of
ocular pathology was 0.82 (95% CI; 0.8-0.83). There was good
agreement for the diagnosis of cataract (0.97; 95% CI, 0.93-1),
refractive error (0.98; 95% CI, 0.96-1), corneal pathology (1.0; 95%
CI, 1.0-1.0) and other anterior segment disorders (0.95; 95% CI, 0.91). The agreement was moderate to fair for the diagnosis of glaucoma
and glaucoma suspects (0.43; 95% CI, 0.28-6) and retinal pathologies
(0.39; 95% CI, 0.14-0.63).
The sensitivity for diagnosis of anterior segment pathologies was
good (94.6 to 100%); glaucoma and glaucoma suspects (35.6%; 95%
CI, 21.9-51.2%) and retinal pathologies (26.3%; 95% CI, 9.2-51.2%)
ranged from fair to moderate, while specificity for ocular pathologies
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
(including refractive error) was between 98.2 to 100%. The overall
kappa (κ) agreement for referral between the VTs and
ophthalmologist was 0.79 (95% CI; 0.74-0.84).
Conclusions: While there was good agreement between the VTs and
ophthalmologist for referral and detection of anterior segment
disorders, it was only was moderate to fair for glaucoma, glaucoma
suspect and retinal pathologies.
Commercial Relationships: Uday Addepalli, None; Suram
Vasantha, None; Rohit C. Khanna, None; Krishnaiah
Sannapaneni, None; Vilas Kovai, None
Program Number: 4384 Poster Board Number: D0022
Presentation Time: 8:30 AM - 10:15 AM
Geographic Variability In The Age Of First Cataract Surgery
And Rate Of Cataract Surgery Among Persons Living In
Communities Throughout The U.S
Courtney Y. Kauh, Taylor S. Blachley, Paul R. Lichter, Paul P. Lee,
Joshua D. Stein. Ophthalmology and Visual Sciences, The University
of Michigan, Ann Arbor, MI.
Purpose: To determine whether there is geographic variability in the
age of first cataract surgery and the age-adjusted rate of cataract
surgery among a large group of patients living in different
communities throughout the United States.
Methods: Health care claims data from a large nationwide managedcare network were reviewed to identify all enrollees age >40 who
underwent ≥1 cataract surgery between 2001-2011. The age of first
cataract surgery was obtained for each enrollee and comparisons of
the median age of first cataract surgery were made for enrollees
residing in each of the 306 different communities throughout the U.S.
Results: Of the 1052277 enrollees diagnosed with cataracts, 243467
(23.1%) underwent ≥1 cataract surgery. Large differences were noted
in the median age of first cataract surgery among the different
communities: those with the lowest median age of first cataract
surgery (Lansing, MI- 59.9 years and Aurora, IL- 60.1 years) differed
considerably from those with the highest median age (Marquette, MI77.0 years, Rochester, NY-78.4 years and Binghamton, NY-79.6
years). Differences in the age-standardized rates of cataract surgery
varied 5 fold across communities ranging from 7.5% in Honolulu, HI
to 37.3% in Lake Charles, LA. Some communities exhibited
variability in age of first cataract surgery of as little as 6-7 years
(Lawton, OK- 6.4 years and Yakima, WA- 7.2 years) while others
had large variability in the age of first cataract surgery (Bloomington,
IL- 12.7 years and Santa Cruz, CA- 12.7 years).
Conclusions: Dramatic variability exists in the age of first cataract
surgery and the age-standardized rate of cataract surgery for enrollees
residing in different communities throughout the U.S. Efforts should
be directed at understanding the extent by which these differences are
due to patient-related factors, supply of ophthalmologists or
optometrists in a given community, and the impact of the timing of
cataract surgery on patient outcomes.
Commercial Relationships: Courtney Y. Kauh, None; Taylor S.
Blachley, None; Paul R. Lichter, None; Paul P. Lee, Genentech
(C), University of Michigan (E), Duke University (E), Pfizer (C),
Pfizer (I), Glaxo (I), Merck (I), Allergan (C), Duke University (P);
Joshua D. Stein, University of Michigan - time to next glaucoma test
algorithm patent (P)
Support: National Eye Institute K23 Mentored Clinician Scientist
Award (1K23EY019511-01), Research to Prevent Blindness
“Physician Scientist Award” and unrestricted grant from Research to
Prevent Blindness
Program Number: 4385 Poster Board Number: D0023
Presentation Time: 8:30 AM - 10:15 AM
Power & type II errors in recently published ophthalmology
research
Zainab Khan, C. Jordan Milko, Ayaz K. Kurji, Munir Iqbal, David
Almeida. Ophthalmology, Queen's University, Kingston, ON,
Canada.
Purpose: Prospective clinical trials are used to make important
clinical decisions that impact patient care. Results from literature are
said to be not statistically significant when they yield a p value>0.05.
This conclusion may be inaccurate if studies are powered
inadequately, resulting in the occurrences of type II errors. The
purpose of this study was to examine the power of unpaired t-tests
when these tests failed to detect a statistically significant difference
and to determine the frequency of type II errors in recently published
prospective randomized trials from 4 major ophthalmology journals.
Methods: We examined all prospective randomized trials published
between 2010 and 2012 in four major ophthalmology journals
(Archives of Ophthalmology, British Journal of Ophthalmology,
Ophthalmology and American Journal of Ophthalmology). Studies
that used unpaired t-tests were included. Power was calculated using
the number of subjects in each group, standard deviations and α =
0.05. The difference between control and experimental means was set
to be (1) 20% and (2) 50% of the absolute value of the control’s
initial conditions. Power and Precision version 4.0 software was used
to carry out calculations. Finally, the proportion of articles with type
II errors was calculated. β=0.3 was set as the largest acceptable value
for the probably of type II errors.
Results: 280 articles were screened. Final analysis included 50
randomized control trials using unpaired t-tests. The median power of
tests to detect a 50% difference between means was 0.9 and was the
same for all 4 journals. The median power of tests to detect a 20%
difference between means ranged from 0.26 to 0.9 for the four
journals. The median power of these tests to detect a 50% and 20%
difference between means was 0.9 and 0.5 for tests that did not
achieve statistical significance. A total of 14% and 57% of articles
with negative unpaired t-tests contained results with β>0.3 when
power was calculated for differences between means of 50% and
20%, respectively.
Conclusions: A large portion of studies demonstrate high
probabilities of type II errors when detecting small differences
between means. The power to detect small difference between means
varies across journals. It is, therefore, worthwhile for authors to
mention the minimum clinically important difference for individual
studies. Journals can consider publishing statistical guidelines for
authors to use.
Commercial Relationships: Zainab Khan, None; C. Jordan
Milko, None; Ayaz K. Kurji, None; Munir Iqbal, None; David
Almeida, None
Program Number: 4386 Poster Board Number: D0024
Presentation Time: 8:30 AM - 10:15 AM
A Longitudinal Analysis of 1,660 Recipients of Bilateral Laser
Peripheral Iridotomies to Determine Subsequent Need for
Cataract Surgery and Additional Interventions for Glaucoma
Sharmini Balakrishnan, Taylor S. Blachley, Jennifer Weizer, Paul P.
Lee, Joshua D. Stein. Ophthalmology, University of Michigan
Kellogg Eye Center, Ann Arbor, MI.
Purpose: To determine the need for medical or surgical interventions
for glaucoma and/or cataract surgery among a large cohort of patients
who underwent bilateral laser peripheral iridotomies (LPIs).
Methods: We identified all enrollees age ≥ 21 in a large nationwide
managed care network claims database who underwent bilateral LPIs
between 2001-2011. We compared the proportion of enrollees who
had been prescribed IOP-lowering medications in the 6, 12, and 24
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
months prior to versus 6, 12, and 24 months after the LPIs. We
assessed the proportion of enrollees who then required subsequent
laser or incisional glaucoma surgery or cataract surgery, and the
timing of these surgical procedures relative to the LPIs.
Results: Over a mean follow-up of 8.07 ± 2.07 years, of the 1,660
enrollees who underwent bilateral LPI, 1,280 enrollees (77.1%) had
no record of IOP-lowering medication use before or after the LPIs, 30
enrollees (1.8%) were on IOP-lowering medications before the LPIs
but took no medications afterwards, 205 enrollees (12.3%) had no
record of medication use prior to the LPIs but were prescribed
medications afterwards, and 145 enrollees (8.7%) were taking IOPlowering medications before and after the LPIs. Among the 380
enrollees taking IOP-lowering medications before or after the LPIs,
251 individuals (66.1%) required more medications after as
compared with before the LPIs. The mean (SD) number of IOPlowering medications increased from before to after the LPIs (1.48 ±
0.76 versus 1.80 ± 0.97; p<0.0001). A total of 193 enrollees (11.6%)
who underwent bilateral LPIs underwent subsequent cataract surgery,
including 103 enrollees (53.4%) who underwent cataract surgery
within 1 year of the LPIs. There were 75 enrollees (4.5%) who
underwent laser or incisional glaucoma surgery within two years after
the LPIs.
Conclusions: Nearly three quarters of patients treated with LPIs
(77.5%) were not prescribed any IOP-lowering medical or surgical
intervention after the LPIs, suggesting that the LPIs were curative
and many of these patients did not develop chronic angle closure.
However, a sizable number of patients (11.6%) required cataract
surgery after LPIs. These findings have important implications for
angle closure management.
Commercial Relationships: Sharmini Balakrishnan, None;
Taylor S. Blachley, None; Jennifer Weizer, None; Paul P. Lee,
Genentech (C), University of Michigan (E), Duke University (E),
Pfizer (C), Pfizer (I), Glaxo (I), Merck (I), Allergan (C), Duke
University (P); Joshua D. Stein, University of Michigan - time to
next glaucoma test algorithm patent (P)
Support: National Eye Institute K23 Mentored Clinician Scientist
Award (1K23EY019511-01), Research to Prevent Blindness
“Physician Scientist Award”, American Glaucoma Society Clinician
Scientist Grant, and unrestricted grant from Research to Prevent
Blindness
Program Number: 4387 Poster Board Number: D0025
Presentation Time: 8:30 AM - 10:15 AM
Are Chronic Users of Chloroquine or Hydroxychloroquine
Undergoing Regular Visits to Eye Providers and Diagnostic
Testing to Check for Maculopathy?
Melisa Nika1, Taylor S. Blachley1, Paul A. Edwards2, Paul P. Lee1,
Joshua D. Stein1. 1Ophthalmology and Visual sciences, Kellogg Eye
Center, Ann Arbor, MI; 2Ophthalmology and Visual sciences, Henry
Ford, Detroit, MI.
Purpose: To determine whether patients with rheumatoid arthritis
(RA) and systemic lupus erythematosus (SLE) who are receiving
chronic treatment with chloroquine (CQ) or hydroxychloroquine
(HCQ) are regularly visiting eye care providers and undergoing
screening tests to check for toxic maculopathy.
Methods: Claims data of all persons with RA or SLE who were
chronic users of CG or HCG and were continuously enrolled for ≥5
years in a large U.S. managed-care network were reviewed to
determine the proportion of enrollees with these conditions who
visited an eye care provider and underwent diagnostic testing (visual
field (VF) testing , optical coherence tomography (OCT)) to check
for toxic maculopathy during the period of Jan. 1, 2001 through Dec.
31, 2011 and the frequency of these examinations. Logistic
regression was performed to identify factors associated with use of
eye care services among chronic CQ or HCQ users.
Results: Among 52285 persons with RA or SLE who met the
inclusion criteria, 27091 (51.8%) enrollees had ≥1 record of CQ or
HCQ use and 1262 enrollees (2.4%) were taking these medications
for ≥ 4 of the 5 years. Among the 1262 highest users of CQ or HCQ,
63.4-69.8% had eye provider visits in a given year and 91.6% had ≥1
eye visit over the 5 year period. Among this highest users of CQ or
HCQ, 33.1%-37.1% underwent VF testing in a given year, 2.8-5.5%
underwent OCT testing in a given year, 33.8-38.9% underwent ≥1 of
any diagnostic test in a given year, and 64.7% underwent ≥1 of any
of these diagnostic tests over the 5 year period. Among the highest
users of CQ and HCQ, for every additional year of age, the odds of
undergoing an eye visit increased 4% (adjusted OR =1.04,95% CI
1.02-1.05) and those under the care of rheumatologists for their
RA/SLE had a 142% increased odds of visiting an eye provider
(OR=2.42, CI 1.63-3.47) compared to those managed by other
providers. Among users of CQ and HCQ, a total of 875 enrollees
(3.2%) were diagnosed with ICD-9 codes for “toxic maculopathy”
and/or “Plaquenil toxicity”.
Conclusions: In a given year, only two thirds of the highest users of
CQ or HCQ for RA or SLE visit an eye care provider and only a third
undergo testing to look for signs of medication toxicity. These data
suggest a need for better education of clinicians prescribing CQ and
HCQ as to the need for monitoring for ocular side effects.
Commercial Relationships: Melisa Nika, None; Taylor S.
Blachley, None; Paul A. Edwards, None; Paul P. Lee, Genentech
(C), University of Michigan (E), Duke University (E), Pfizer (C),
Pfizer (I), Glaxo (I), Merck (I), Allergan (C), Duke University (P);
Joshua D. Stein, University of Michigan - time to next glaucoma test
algorithm patent (P)
Support: NEI 1K23EY019511-01 (JDS), Research to Prevent
Blindness Physician Scientist Award (JDS), unrestricted grant from
Research to Prevent Blindness
Program Number: 4388 Poster Board Number: D0026
Presentation Time: 8:30 AM - 10:15 AM
Optimizing cost-effectiveness analyses of treatments for
neovascular age-related macular degeneration using real-life data
Robert P. Finger1, 2, Arthur Hsueh1, Jill E. Keeffe1, Robyn H.
Guymer1. 1Ophthalmology, Centre for Eye Research Australia,
Melbourne, VIC, Australia; 2Ophthalmology, University of Bonn,
Bonn, Germany.
Purpose: To assess cost-effectiveness (CE) of anti-VEGF treatment
for neovascular age-related macular degeneration (nv AMD) from a
healthcare payer’s perspective, using long-term data from routine
medical practice in Australia.
Methods: 200 patients undergoing long-term (>1 year) anti-VEGF
treatment for nvAMD were included and costs for services assigned
based on Medicare Australia rebates. Three Markov models (MM)
were created to reflect impact of anti-VEGF treatment on 1. better
eye and 2. treated eye VA and 3. vision states combining both eye
VA using TreeAge software, based on our real life data. Visionrelated utilities were based on a large (n>1300) reference sample
interviewed using the Vision and Quality of Life multi-attribute
utility instrument. Costs and rewards were discounted at 3.5%/year
and final results tested in probabilistic sensitivity analyses.
Results: Mean treatment duration was 37 (±13) months and mean
injections were 21(±11;7 in year 1-3, 6 in year 4, 5 in year 5). VA in
the treated eye improved from baseline to last follow-up (+7 ltrs; 49
to 56 ltrs, p<0.001) and remained stable in the better eye (-3 ltrs; 66
to 63 ltrs, p=0.001). 40% of patients were treated in both eyes during
year 1, and 50% by year 5. Treatment costs were highest in the first
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
year (A$18,296 ± 7,991), and lower for uniocular (A$16,123±6,757)
than for binocular treatment ($21,487±8,610). Based on these data
MMs ran for 5 years, with all treatment assumed to be with
ranibizumab (A$ 1976.36). Cost-effectiveness was A$17,155/QALY
for better eye, 17,812/QALY for treated eye and 17,243/QALY for
both eye vision state models, with the both eye vision state MM
generating most QALYs (1.80 compared to 1.74 in MM1 and 1.70 in
MM2).
Conclusions: All modeling approaches arrived at CE estimates well
below the cut-off of $50,000/QALY commonly accepted to be costeffective. Using treated eye VA led to a low estimate of treatment
effects and high costs, whereas using better eye VA led to a medium
estimate of treatment effect and the lowest cost. Using both eyes’ VA
(in vision states) most accurately reflects clinical reality with a
necessity to treat both eyes in a considerable proportion of patients
and led to the highest estimate of treatment impact with a medium
cost estimate. Economic evaluations of bilateral ocular disease and its
treatments should take both eyes’ VA into account.
Commercial Relationships: Robert P. Finger, None; Arthur
Hsueh, None; Jill E. Keeffe, Novartis (F); Robyn H. Guymer,
Novartis Advisory board (C), Bayer Advisory Board (C), Novartis
(R)
Support: German Research Council grant to RPF (DFG FI-1540/51). CERA receives Operational Infrastructure Support from the
Victorian Government.
Program Number: 4389 Poster Board Number: D0027
Presentation Time: 8:30 AM - 10:15 AM
Comparison of Resource Consumption in Penetrating versus
Endothelial Keratoplasty from 2009-2010
Duna Raoof-Daneshvar, Roni M. Shtein, Taylor S. Blachley, Maria
A. Woodward, Shahzad I. Mian, Alan Sugar, Joshua D. Stein.
Ophthalmology, University of Michigan, Ann Arbor, MI.
Purpose: To evaluate differences in resource consumption associated
with postoperative management of patients in a large nationwide U.S.
managed care network who underwent penetrating keratoplasty (PK)
or endothelial keratoplasty (EK) for corneal endothelial disease
(CED).
Methods: All individuals age ≥ 50 years with CED who underwent ≥
1 keratoplasty surgery between January 2009 and December 2010
and had at least 1 year of follow-up were identified from a large
managed care network database. Numbers of billed post-operative
visits to eye-care providers, diagnostic procedures (e.g., topography,
specular microscopy), and need for concomitant or subsequent
intraocular surgery were obtained from the billing data. Statistical
comparisons of resource utilization between PK and EK were
performed.
Results: A total of 115 PK and 194 EK surgeries were performed for
CED during 2009-2010. The mean number of billed post-operative
visits to eye-care providers in the year after surgery was higher for
PK compared with EK (5.9 ± 4.5 for PK versus 3.4 ± 2.8 for EK) (p<
0.0001). The mean number of anterior segment diagnostic tests
performed in the year after surgery was also higher for PK compared
with EK (1.4 ± 2.0 for PK vs. and 0.7 ± 1.2 for EK) (p= 0.0007).
Among the 115 enrollees who underwent PK, cataract surgery was
performed concurrently in 12.1% and in the year following surgery in
4.3%. By comparison, among the 194 enrollees who underwent EK,
cataract surgery was performed concurrently in 38.7% and in the year
following surgery in an additional 22.2%. The rate of serious
complications for both of these surgeries was low and not
significantly different between EK and PK (p=0.29).
Conclusions: Numbers of post-operative visits and diagnostic testing
in the year after surgery were much less for enrollees undergoing EK
as compared with PK. However, there were considerably more
cataract surgeries performed both concurrently and in the year
following surgery with EK as compared with PK (60.9% v. 16.4%).
Improved understanding of resource consumption associated with PK
and EK can help inform future analyses of costs as well as patient
and caregiver burden associated with these procedures.
Commercial Relationships: Duna Raoof-Daneshvar, None; Roni
M. Shtein, None; Taylor S. Blachley, None; Maria A. Woodward,
None; Shahzad I. Mian, None; Alan Sugar, None; Joshua D. Stein,
University of Michigan - time to next glaucoma test algorithm patent
(P)
Support: National Eye Institute K23 Mentored Clinician Scientist
Award (1K23EY019511-01), Research to Prevent Blindness
“Physician Scientist Award”, American Glaucoma Society Clinician
Scientist Grant, unrestricted grant from Research to Prevent
Blindness, and Alliance for Vision Research
Program Number: 4390 Poster Board Number: D0028
Presentation Time: 8:30 AM - 10:15 AM
The Sight Loss and Vision Priority Setting Partnership (SLVPSP) - initial survey methods, respondents’ demographics and
preliminary categorisation framework
Michael Bowen1, 2, Michele Acton5, Dolores M. Conroy5, Richard P.
Wormald10, 3, Anita Lightstone8, 9, Katherine Cowan7, Catey Bunce10,
4
, Mark Fenton6, Karen Bonstein10. 1Research, College of
Optometrists, London, United Kingdom; 2Psychology, City
University London, London, United Kingdom; 3Cochrane Eyes and
Vision Group, London School of Hygiene and Tropical Medicine,
London, United Kingdom; 4Institute of Ophthalmology, University
College London, London, United Kingdom; 5Fight for Sight, London,
United Kingdom; 6UK Database of Uncertainties about the Effects of
Treatments (UK DUETs), National Institute for Clinical Excellence
(NICE), London, United Kingdom; 7The James Lind Alliance,
National Institute for Health Research (NIHR), London, United
Kingdom; 8VISION 2020 UK, London, United Kingdom; 9Royal
National Institute for Blind People (RNIB), London, United
Kingdom; 10Biomedical Research Institute at Moorfields Eye
Hospital NHS Foundation Trust and UCL Institute of
Ophthalmology, National Institute for Health Research, London,
United Kingdom.
Purpose: The SLV-PSP was established to identify unanswered
questions about the prevention, diagnosis and treatment of sight loss
and eye conditions that are most important to patients,
partners/carers/relatives and eye health professionals in the UK. The
exercise aims to identify research priorities which can then be used to
inform the decisions of funding bodies and researchers and to
enhance the case for additional research funding.
Methods: The process commenced with a survey open to patients,
partners / carers / relatives and eye health professionals. People were
asked to submit questions about the prevention, diagnosis and
treatment of sight loss and eye conditions that they would like to see
answered by research. The survey was widely disseminated by
patient groups, professional bodies and through the media (radio and
press) and was available to be completed on-line, by phone, by post
and by alternative formats including Braille and audio. The survey
also gathered demographic data about respondees.
Results: 2,200 people responded to the survey generating 4,606
questions. Of these respondents, 65% were persons with sight loss or
an eye condition. 17% identified themselves as healthcare
professionals including primarily: ophthalmologists, optometrists,
orthoptists, ophthalmic nurses, opticians and people working in social
care and rehabilitation. The basic demographics of the respondents
were as follows: Male 38.4%, Female 61.6%; mean age 63. Ethnicity:
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
White (92.9%), Black (2.1%), Asian (2.8%), Mixed race (1.0%),
Chinese (0.4%), Other (0.8%). The questions were categorised in 13
eye disease categories prior to further analysis.
Conclusions: The initial analysis of demographic data for
respondents indicates that the sample is generally representative of
the UK population. The number and diversity of conditions
represented in responses was encouraging and initial review suggests
that the distribution across the major conditions fits projected
population incidence. Further analysis is underway.
Commercial Relationships: Michael Bowen, The College of
Optometrists (F); Michele Acton, None; Dolores M. Conroy, None;
Richard P. Wormald, None; Anita Lightstone, RNIB (E);
Katherine Cowan, None; Catey Bunce, None; Mark Fenton,
None; Karen Bonstein, None
Program Number: 4391 Poster Board Number: D0029
Presentation Time: 8:30 AM - 10:15 AM
Applying Lean Principles to Clinical and Translational Research
in Ophthalmology
Vesper Williams1, Phyllis Summerfelt1, Tracy Kaczanowski1, Krissa
Packard1, Diane M. Bishop1, Mara Goldberg1, Alfredo Dubra1, 2,
Joseph Carroll1, 3, Aneesh Suneja4. 1Ophthalmology, Medical College
of Wisconsin, Milwaukee, WI; 2Biophysics, Medical College of
Wisconsin, Milwaukee, WI; 3Cell Biology, Neurobiology, and
Anatomy, Medical College of Wisconsin, Milwaukee, WI; 4FlowOne
Lean Consulting, LLC, Milwaukee, WI.
Purpose: Lean is a philosophy that considers the expenditure of
resources for any goal other than the creation of value to be wasteful.
Originally applied in the manufacturing sector, lean methodologies
have more recently been applied to a wide range of clinical
operations, often focusing on decreasing patient wait times and
improving and standardizing process flow. With an increased focus
on translational research at academic medical centers, there is
increased demand on exceedingly finite clinical resources to serve
both clinical and research needs. Here we applied lean to identify,
evaluate, and improve our research infrastructure on both strategic
and operational levels.
Methods: We established a core team consisting of research
coordinators, administrative personnel, research faculty, a research
photographer, and a lean consultant. We undertook a quantitative
evaluation of the existing research infrastructure within our clinical
trials unit and Advanced Ocular Imaging Program. We mapped the
flow of 35 research subjects, tracking movement as well as valueadded and wasted (non-value added) times. We also examined the
current overlap of resources, including equipment, space, and
personnel. Finally, we presented preliminary findings to other
stakeholders within the organization, in order to raise awareness and
work towards achieving strategic alignment.
Results: Total wasted time ranged 8-103 minutes per visit. On
average, this comprised 25% of total visit time, with wait times
comprising up to 59% of total visit time. Sources of waste included
decentralized resources resulting in unnecessary movement, the need
to wait for clinical equipment to become available, and utilization of
clinical personnel as study staff - posing an inherent conflict.
Competition for resources negatively impacts research subjects but
also places significant strain on clinical personnel, resulting in
predominantly negative attitudes towards research as a priority.
Conclusions: Our analysis identified numerous opportunities to
improve the overall efficiency of research within our department.
This has led to focused efforts to create parallel resources dedicated
to research, including new staff, imaging equipment, and space.
These modifications are expected to generate increased capacity for
subject throughput. To our knowledge, this is the first report of lean
application to an ophthalmic research environment.
Commercial Relationships: Vesper Williams, None; Phyllis
Summerfelt, None; Tracy Kaczanowski, None; Krissa Packard,
None; Diane M. Bishop, None; Mara Goldberg, None; Alfredo
Dubra, US Patent No: 8,226,236 (P); Joseph Carroll, Imagine Eyes,
Inc. (S); Aneesh Suneja, FlowOne Lean Consulting, LLC (I),
FlowOne Lean Consulting, LLC (C)
Support: Research to Prevent Blindness
Program Number: 4392 Poster Board Number: D0030
Presentation Time: 8:30 AM - 10:15 AM
Evaluation of Fundamental Ophthalmology Knowledge among
Internal Medicine and Emergency Department Residents
Priya Janardhana, Manishi A. Desai. Boston Medical Center,
Chestnut Hill, MA.
Purpose: Evaluate the Ophthalmology knowledge of Internal
Medicine (IM) and Emergency Department(ED) Residents. Our
hypothesis is that residents that have had a prior rotation in
Ophthalmology, during medical school or residency, will score
higher compared to residents not having a prior ophthalmolgoy
rotation.
Methods: Ten question survey of basic ophthalmology given to
Boston University Medical students was given to IM and ED
residents at Boston Medical Center. Analysis of scoring was done
based on PGY level, previous ophthalmology rotation (medical
school, residency, or both), and length of rotation: <1 week, 1-2
weeks, > 2 weeks.
Results: Among IM residents, 41% were PGY-1, 38% were PGY-2,
21% were PGY-3, and their average (avg) survey scores were 68%,
51%, 49% respectively. Half (47%) of the residents had prior
ophthalmology exposure, in medical school or residency, averaging a
62%score. Residents without an ophthalmology rotation avg a score
of 54%. Among residents with prior rotations, the majority completed
the rotation during medical school (81%), whereas the remainder
completed the rotation in residency (6%), and/or both residency and
medical school (13%). Rotation length varied: 12.5% <1 week,
15.6% 1-2 weeks, and 18.8% 2-4 weeks. Average survey scores
increased with length of rotation (53%, 66%, and 65% respectively).
Among ED residents, 23% were PGY-1, 12% were PGY-2, 24%
were PGY-3, 41% were PGY-4 with avg scores of 55%, 55%, 80%,
and 63% respectively. More than three-fourths (82%) of residents had
prior ophthalmology exposure and averaged 68%; those without a
rotation averaged 47%. Among ED residents having prior
ophthalmology exposure, half completed this during residency and
half in both residency and medical school. No ED resident had an
ophthalmology rotation solely in medical school. Residents having a
rotation in residency averaged 74%, whereas those with a rotation in
both residency and medical school averaged 64%. The
ophthalmology rotation length varied: 24% had 1-2 weeks and 59%
had 2-4 weeks and resident scores averaged 53% and 74%,
respectively.
Conclusions: Among IM residents, the avg survey score decreased as
PGY level increased. The avg survey score was approximately the
same regardless of length of ophthalmology elective. Among ED
residents, the avg survey score increased as PGY level increased.
Those having a longer ophthalmology rotation scored higher.
Commercial Relationships: Priya Janardhana, None; Manishi A.
Desai, None
Program Number: 4393 Poster Board Number: D0031
Presentation Time: 8:30 AM - 10:15 AM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
The Ophthalmology Job Market In the Aftermath of the Great
Recession
Chukwuemeka C. Nwanze1, Ron A. Adelman3, 1, Janine Barth2, 1. 1Lab
of Computer Science, MGH, Lab of Computer Science, Chestnut
Hill, MA; 2Ophthalmology Job Center, American Academy of
Ophthalmology, SanFrancisco, CA; 3Department of Ophthalmology
and Visual Sciences, Yale School of Medicine, New Haven, CT.
Purpose: Previous work has indicated that economic recessions can
depress the ophthalmology job market for up to three years after the
end of the recession. This project attempts to evaluate the state of the
ophthalmology job market two years after the end of the Great
Recession (December 2007 June 2009).
Methods: Three data sources were used to evaluate the state of the
ophthalmology job market. A print-based help-wanted index (HWI)
of physician recruitment advertisements appearing in the following
journals:Ophthalmology, American Journal of Ophthalmology and
Archives of Ophthalmology/ from January 1986 through June 2012;
an internet-based HWI of physician recruitment advertisements based
on the American Academy of Ophthalmology’s (AAO) online
recruitment advertisements (April 1999 through January 2012) and
data abstracted from the job fairs during the annual American
Academy of Ophthalmology meetings (2003 through 2010).
Results: Compared to the pre-recession period, the print-based HWI
demonstrated a decline in the demand for ophthalmologist (68.94%, p
= 1.70 x 10^-14). The online-based HWI similarly showed a decrease
in demand (27.79%, p=0.001). The ratio of advertised jobs to jobseekers worsened from 0.492 to 0.408 (p= 0.003)
Specific economic factors associated with demand for academic
ophthalmologists include national research expenditure and stock
market gains (p = 0.00135), while demand for private practice
ophthalmologists was associated with Gross Domestic Product
(GDP), and discretionary healthcare expenditure (p = 4.06 x 10^-4).
Conclusions: Despite increases in the elderly and the prevalence of
eye diseases, demand for ophthalmologists has declined following the
Great Recession. A similar pattern of decline in demand for
ophthalmologists was noted after the previous two economic
recessions that the United States went through (3/01-11//01 and 7/903/91). Our data suggests that the current recession appears to have
had a larger short-term impact on the ophthalmology job market than
the previous recessions. The reduced marketplace demand for
ophthalmologists may continue for a period of time. Given the
increase in eye diseases, such as diabetic retinopathy, with timedependent treatment windows, this economics-mediated decline in
demand for ophthalmologists may pose a significant public health
threat.
Commercial Relationships: Chukwuemeka C. Nwanze, None;
Ron A. Adelman, None; Janine Barth, None
Support: grant T15LM007092 from the Natonal Library of
Medicine, National Institutes of Health
Program Number: 4394 Poster Board Number: D0032
Presentation Time: 8:30 AM - 10:15 AM
PROSE treatment for moderate to severe ocular graft-versushost disease: Analysis of utilization rates versus projected
demand across four centers
Ryan Ridges, Beth Beard, Deborah S. Jacobs. Boston Foundation for
Sight, Needham, MA.
Purpose: Ocular graft-versus-host disease (oGVHD) is a debilitating
complication in 30-40% of allogeneic hematopoetic stem cell
transplants (allo-HSCT). While many oGVHD treatment modalities
are available, oGVHD can remain undertreated because the
diagnosing physicians, typically oncologists, may be unfamiliar with
the range of treatments available while the treating physicians, often
ophthalmologists, may be unfamiliar with the natural history and
pathophysiology of the disease. This study investigates utilization
rates vs. projected demand for prosthetic replacement of the ocular
surface ecosystem (PROSE) treatment at four geographically distinct
centers with various models for delivery of eye care.
Methods: PROSE is an effective treatment for moderate to severe
oGVHD. Because BostonSight™ PROSE is available at a limited
number of affiliated referral centers, its utilization rate can be
conveniently tracked as an indicator of regional oGVHD detection
and treatment patterns. Based on published estimates of oGVHD
incidence and severity, we developed a formula to estimate the
expected prevalence of moderate to severe oGVHD in allo-HSCT
recipients as a function of annual transplant volume. This metric
forecasts the annual incidence of moderate to severe oGVHD cases
for which PROSE treatment is appropriate. For each of four PROSE
centers, we compare the number of new PROSE patients treated in
2011 to the predicted number of new adult moderate/severe oGVHD
cases generated by allo-HSCT done at all major transplant centers
within 100 miles of the PROSE site. Factors contributing to the
variation in utilization rate are considered.
Results: Candidate oGVHD cases receiving PROSE treatment versus
predicted demand, expressed as a percentage, were as follows: Site 1:
29.8%, Site 2: 13.1%, Site 3: 22.0%, Site 4: 64.7%. Site 4 is unique
in that all allogeneic transplant recipients undergo ophthalmic
evaluation prior to and at scheduled intervals after transplantation,
whereas at other centers, ophthalmic consultation occurs on an asneeded basis.
Conclusions: There is wide variation in utilization of PROSE
treatment in regions where it is available to allo-HSCT patients.
Ophthalmic evaluation as part of allo-HSCT protocol is associated
with higher utilization of a treatment proven to have high impact on
visual function in patients with oGVHD.
Commercial Relationships: Ryan Ridges, Boston Foundation for
Sight (501(c)(3) nonprofit) (E); Beth Beard, Boston Foundation for
Sight, 501(c)3 (E); Deborah S. Jacobs, Boston Foundation for Sight,
501(c)3 (E)
Program Number: 4395 Poster Board Number: D0033
Presentation Time: 8:30 AM - 10:15 AM
Ophthalmology Consultation on Asymptomatic Patients
Ryan K. Wong, John Huang. Ophthalmology and Visual Science,
Yale University School of Medicine, New Haven, CT.
Purpose: A recent study showed that a lack of ocular symptoms in
the setting of fungemia correlated with a lack of fungal eye
involvement in all cases, which could be a potentially useful
prognostic factor in eliminating low yield ocular evaluations.
Anecdotal evidence at our hospital suggests a similar trend not only
in asymptomatic patients with fungemia, but also for other
asymptomatic patients for which ophthalmology consultation is
requested. The purpose of this study was to characterize the rate,
utility, and cost of these ophthalmic consultations of asymptomatic
patients.
Methods: A retrospective chart review was conducted on
consecutive new patients from September 2010 to August 2011.
Ophthalmology consultations on alert and orientated patients who
had no ocular evidence or complaints were specifically collected.
Results: 80/1,399 (6%) alert and orientated patients underwent
ophthalmology consultation despite having no signs or symptoms
suggestive of ocular disease. The most common reasons for these
consultations were to rule out ocular involvement with fungemia
[17/80 (21%)] and to rule out papilledema [16/80 (18%)] (Table 1).
Inpatient services demonstrated a significantly higher rate of
consultation request of asymptomatic patients when compared to
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
emergency services (Table 2; 12.4% vs. 1.2%, p<0.0001).
Of all asymptomatic patients evaluated, one had findings (retinal
flame hemorrhages) related to the reason for consultation, which was
to assess for end-organ damage in a patient admitted for hypertensive
crisis. Eighteen patients had incidental findings unrelated to reason
for consultation. None of these patients had a change in management
due to findings on ophthalmology consultation. The estimated total
cost of these consultations, based on 2011 Medicare fees, was
$16,685.
Conclusions: Our results suggest that ophthalmology consultations
on alert, asymptomatic patients seem to have low diagnostic and
therapeutic utility for hospital-based management. However, it
should be noted that many incidental ophthalmic findings did occur
that required routine, outpatient ophthalmologic follow-up, such as
choroidal nevi and familial drusen. Additionally, an estimated cost of
these consultations was relatively high.
Commercial Relationships: Ryan K. Wong, None; John Huang,
None
Support: Research to Prevent Blindness
Program Number: 4396 Poster Board Number: D0034
Presentation Time: 8:30 AM - 10:15 AM
The economic impact of cataract surgery in a remote Ghanaian
village three years after surgical intervention
John D. Welling1, Emily R. Newick2, Geoffrey C. Tabin2, 3.
1
Ophthalmology, The Ohio State University Havener Eye Institute,
Columbus, OH; 2Himalayan Cataract Project, Waterbury, VT;
3
Ophthalmology and Visual Sciences, University of Utah John A.
Moran Eye Center, Salt Lake City, UT.
Purpose: To study the economic impact of cataract surgery three
years after cataract surgical intervention in Bonsaaso, Ghana.
Methods: In 2010, nineteen patients who had undergone cataract
surgery in 2007 as part of a Himalayan Cataract Project - Millennium
Villages Project intervention in Bonsaaso, Ghana were interviewed
regarding how cataract surgery had impacted their economic wellbeing. The survey was designed to compare pre- versus postoperative economic well-being, utilizing six indicators relevant to
this rural African setting. The survey was administered in the
patients’ native language by an interpreter from the United Nations
Millennium Villages Project, after obtaining informed consent.
Results: One hundred percent (19/19) of patients reported that their
eyesight prior to cataract surgery interfered with their ability to
provide income for themselves and their families; of those who
reported moderate to severe impairment, 94% (15/16) reported
improved ability to provide income, with 69% (11/16) improving by
at least two steps. Seventy-eight percent (15/19) of patients said their
vision prior to cataract surgery interfered with their ability to
participate in all forms of work. Of those with moderate to severe
impairment, 82% (9/11) reported that their ability to work was
improved, with 55% (6/11) improving by at least 2 steps. Most
patients who reported relying on caregivers for help with their
activities of daily living (ADLs) reported that post-operatively they
were able to perform their ADLs independently. Overall, the average
number of caregiver hours decreased by 62%. On average, the
number of hours worked by patients increased by 121% after cataract
surgery. Two patients who had been completely unable to work due
to bilateral cataracts reported that post-operatively they were farming
more than 40 hours per week.
Conclusions: Cataract surgery appeared to positively impact
economic well-being for nearly all patients in this rural African
setting. Cataract surgery not only improved most patients’ ability to
work more hours and provide more income for themselves and their
families, it also decreased their dependence on caregivers who may
have been taken out of the workforce to assist patients with ADLs.
Prospective, controlled studies with larger samples are needed to
better establish the economic impact of sight-restoring cataract
surgery in the developing world.
Commercial Relationships: John D. Welling, None; Emily R.
Newick, None; Geoffrey C. Tabin, None
Program Number: 4397 Poster Board Number: D0035
Presentation Time: 8:30 AM - 10:15 AM
Immediately Sequential Bilateral Cataract Surgery-A Costeffective Procedure
Monali Malvankar1, William G. Hodge1, Richard Filek1, Munir
Iqbal2, Muhammad A. Shakir1, Madhukar Malvankar1, Swati
Chavda1, Francie F. Si1. 1Ophthalmology, The University of Western
Ontario, London, ON, Canada; 2Queens University, Kingston, ON,
Canada.
Purpose: More than 2.5 million Canadians are currently suffering
from cataract and this value is likely to double by 2031. According to
Statistics Canada, there has been a constant increase in the percentage
of population that entails seniors; it has been estimated that by 2031,
seniors will make up 23% of the population of Canada. Increase in
senior population will result in larger number of cataract surgeries
performed per year. Moreover, one in three Canadian
ophthalmologists are over the age of 55 and are due to retire in the
next decade; it is expected that the ratio of ophthalmologists to
people over 65 will drop about 43% over the next 15 years. Therefore
it is necessary to choose a cost-effective cataract surgery that can
compensate for negative correlation between number of
ophthalmologists and cataract surgeries. There are two types of
cataract surgeries: immediately sequential bilateral cataract surgery
(ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).
ISBCS requires ophthalmologists to perform cataract surgery on both
eyes on the same day. For DSBCS, cataract extractions for both eyes
are done on different days. The purpose of the study was to perform
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
cost-effectiveness analysis (CEA) of ISBCS by using current
literature on cataract outcomes and complications.
Methods: We constructed a decision analytic model from the public
third-party (Ministry of Health) payer’s perspective to conduct a
CEA of both the surgeries, ISBCS and DSBCS. A study population
consisted of adults with bilateral cataract surgery. Cost data consisted
of the cost of the surgery, intravitreal injections, medications, and
drops. The effectiveness was measured by the utility values
associated with visual acuity in better seeing eye.
Results: The mean discounted cost of the treatment of ISBCS was
CAD$ 1335.85 and of DSBCS was CAD$ 1783.61. The difference
between the two cataract surgeries, ISBCS and DSBCS - equaled a
0.08 net utility gain. The cost-effectiveness of ISBCS was calculated
to be CAD$ 1391.51 per QALY gained per patient treated. A 3%
annual discount rate was used resulting in 0.96 discounted QALYs
gained over 12 year life expectancy.
Conclusions: Our research is the first step in performing such health
economics assessment of ISBCS and the results of this economic
evaluation will be useful for policy makers, clinicians, hospital
administrators, and payers in order to put forward a protocol for
performing ISBCS.
Commercial Relationships: Monali Malvankar, None; William G.
Hodge, None; Richard Filek, None; Munir Iqbal, None;
Muhammad A. Shakir, None; Madhukar Malvankar, None;
Swati Chavda, None; Francie F. Si, None
relevance to the modern ophthalmologist with tremendous versatility
in daily clinical practice. However, despite the rapid emergence of
apps in ophthalmology, there remains a low level of medical
involvement in app development and a lack of peer review after
publishing. This article shows there is a clear need for evidencebased principles and standards of app development to be adapted to
this emerging area of mobile health.
Program Number: 4398 Poster Board Number: D0036
Presentation Time: 8:30 AM - 10:15 AM
iPhone applications in ophthalmology: Current capabilities,
limitations and future directions
Nicholas M. Cheng1, Rahul Chakrabarti2, 3, Jonathan K. Kam3. 1The
Royal Melbourne Hospital, Melbourne, VIC, Australia; 2Centre for
Eye Research Australia, Melbourne, VIC, Australia; 3The Royal
Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.
Purpose: Smartphone applications (‘apps’) continue to revolutionize
modern medical practice, with a growing trend of app use in nearly
all branches of medicine. Ophthalmology is no exception and
although previous studies have attempted to document the
capabilities of many ophthalmology-related smartphone apps, the
majority of these utilize arbitrary search methods with a
comprehensive review yet to be published in this area. Additionally,
while ophthalmologists have been enthusiastic in their uptake of
smartphone apps, concerns regarding the reliability and validity of
these apps have not been addressed. This quantitative review
categorizes the ophthalmology apps currently available, evaluates
medical involvement, identifies current limitations and suggests
future directions in this area.
Methods: The United States Apple iTunes store was searched for
iPhone ophthalmology themed apps using terms based on the Centers
for Disease Control and Prevention’s (CDC) common eye conditions.
Data collected included publisher, publication date, category/primary
purpose, cost, number of downloads, average user rating and
documented involvement of medical professionals.
Results: A total of 90 ophthalmology-related apps were identified.
The number of ophthalmology apps published increased each year
from 2009, with 25 apps published in 2012. The majority of apps
lacked consumer ratings and had fewer than 1000 downloads (71%
and 76% respectively). Consistent with other medical specialties,
only 32% of apps had documented medical professional involvement
in their development. 41% of apps designed for ophthalmologists had
documented medical involvement, compared to 28% for nonophthalmic medical professionals, and 10% for the general public.
Conclusions: Smartphone apps are likely to only become of greater
Program Number: 4399 Poster Board Number: D0037
Presentation Time: 8:30 AM - 10:15 AM
Activity and epidemiology of a recently opened ophthalmic
emergency center in a University Hospital
Francois Ameloot1, 3, Nelly Agrinier2, Fanny Tréchot1, Toufic
Maalouf1, Karine Angioi1. 1Ophthalmology, University Hospital of
Nancy, Nancy, France; 2Epidémiologie et Evaluation Cliniques,
University Hospital of Nancy, Nancy, France; 3Ophthalmology, CHR
Metz, Metz, France.
Purpose: To investigate activity, and characteristics of ophthalmic
emergencies, in a recently opened unit of ophthalmic emergencies
care in a University hospital, in order to evaluate and improve the
management of patients and the running of the department.
Methods: Prospective monocentric cross-sectional study of
ophthalmic emergencies over a 2-months period. All patients,
presenting themselves, or referred, for ophthalmic emergencies have
been included. Patient’s characteristics, waiting-time, pathology and
the reality of the emergency were analysed.
Results: 1496 patients were examined. Mean age was 45 years and
55% were male. The median of waiting time was 30 minutes and
28% of patients were registered during the on-call time. 28% of
patients had to drive more than 32 miles to get ophthalmic emergency
cares. The main reasons for consultation were red eye (32%), pain
(29%), and visual loss (23%). The main diagnoses were ocular
trauma (28%), ocular inflammation and infection (24%), normal
examination and refractive error (13%).In cases where eye protection
would have been required only 16% of the patients were in fact
wearing a protection. We have estimated that 38% of our patients did
not need an ophthalmic specialized emergency examination or
treatment.
Numerus and various daily ophtalmic emergencies often require
relevant diagnosis and treatment. This unit allowed taking care of
patients in a satisfactory manner and within reasonable waiting time.
It has also improved the care of patients with a scheduled
consultation. Better information of the population and prevention of
trauma and infection could help decreasing the number and the
severity of ophtalmic emergencies. An improvement of the general
Figure 1: Number of apps with medical involvement stratified by
intended audience.
Commercial Relationships: Nicholas M. Cheng, None; Rahul
Chakrabarti, None; Jonathan K. Kam, None
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
and emergency practitioners knowledges in regards to ophthalmic
pathologies could allow them to diagnose and treat benign cases.
Conclusions: There is a real need for a permanent ophthalmic
emergency department. The creation of a specialized emergencies
unit within our department allowed us to offer better care for patients
and a better working environment for practitioners.
Commercial Relationships: Francois Ameloot, None; Nelly
Agrinier, None; Fanny Tréchot, None; Toufic Maalouf, None;
Karine Angioi, None
Program Number: 4400 Poster Board Number: D0038
Presentation Time: 8:30 AM - 10:15 AM
Stability of the Relationship Between Self-Reported Vision
Impairment and Blindness and Medical Care Expenditures Over
Time
Kevin D. Frick, Elizabeth Wehler. Health Policy and Management,
Johns Hopkins Bloomberg Sch of Public Hlth, Baltimore, MD.
Purpose: The excess medical care associated with vision impairment
and blindness in the United States for individuals aged 40 and over
was shown to be $2157 for individuals self-reported as blind and
$1037 self reported as visually impaired in 2007. This study’s
objective is to use additional data on self-reported vision status and
medical care expenditures to compare the original estimates from
1996-2002 with estimates from 2003-2009 to determine whether the
impact of blindness and vision impairment at the individual level has
changed.
Methods: Medical Expenditure Panel Survey (MEPS) data from
1996-2009 were used. A logistic regression was used to assess the
relationship between not having self-reported normal vision and
having any medical care expenditures. A separate generalized linear
model with a log link-function and an assumption of a gamma family
error term distribution was used to assess the relationship between
not having self-reported normal vision and the level of positive
medical care expenditures.. Survey regression techniques were used
to make the estimates as applicable as possible to the population of
the United States. Demographic variables including income, health
status, age, and insurance, were included in the regressions. Total
expenditures were compared as well as 26 other categories of
expenditures and total out-of-pocket expenditures that lead to a
higher burden on the blind and visually impaired individuals.
Results: Of the 112 differences examined, only 9 were statistically
significant. When comparing the chance of any expenditure,
significant changes implied a smaller odds ratio in the more recent
time period. When comparing levels of expenditures among those
with non-zero expenditures, the significant changes implied less
spending for blind or visually impaired individuals relative to those
with self-reported normal vision in the more recent time period in all
cases but one.
Conclusions: Blindness and vision impairment continued to be
associated with a total expenditures and various categories of
expenditures overall. However, to the degree the differences are not
stable, evidence suggests the impact has decreased between 19962002 and 2003-2009. This may be more associated with poorer health
indicators for the general population rather than any relative
advantage gained by visually impaired individuals.
Commercial Relationships: Kevin D. Frick, Center for Applied
Value Analysis (C), National Association for Eye and Vision
Research (C); Elizabeth Wehler, None
Sumir Pandit1, Teresa C. Chen2. 1Harvard Medical School, Boston,
MA; 2Ophthalmology/Glaucoma Service, Mass Eye and Ear
Infirmary, Boston, MA.
Purpose: The health and economic impacts of non-adherence to
glaucoma treatment are significant. If adherence were increased, even
marginally, the occurrence of severe complications such as blindness
may be reduced. This study aimed to understand which factors
contribute to glaucoma patients’ failure to properly take their
medication and elicit how these reasons can be remedied.
Methods: Patients from a single physician’s clinic, who had both a
diagnosis of glaucoma and a prescription for one or more pressurelowering eye drops, comprised the eligible population. These patients
were recruited in the clinic waiting room where they took a 17
question written paper survey, which asked patients questions about
their medication taking habits, their technology usage, and their
preferred medication-reminder methods. Patients were recruited and
surveyed one at a time, with the researcher available to answer any
questions. Of those patients asked to participate, 81% completed the
survey. In total, 99 patients completed surveys. Independent sample T
tests were performed to find correlations between medication habits
and adherence.
Results: For the survey question, “Do you take your medicated eye
drops at approximately the same time (within an hour) every day?”
there was a statistically significant correlation (p= .04611), indicating
that older patients tend to take their medication closer to the same
time every day than do younger patients. Interestingly, a similar
correlation between reported number of missed doses and age was
NOT seen. According to the survey, those who take their medication
within the same hour every day tend to use many medicationreminder methods - friends, family, and written notes - in addition to
themselves to remember their medication (Figure 1). Meanwhile,
those who take their medication less consistently during the day used
fewer medication-reminder methods - mainly their spouses (Figure
2). At this time, there appears to be no statistically significant
correlation between a patient’s “tech-savviness” and his/her selfreported level of adherence.
Conclusions: Patients who take their medications at consistently the
same time every day used many medication-reminder methods
compared to patients who take their medications less consistently.
Better knowledge of the role of technology, reminders, and timing
habits as they are related to adherence is integral to improving patient
adherence - and thus health - overall.
Figure 1
Program Number: 4401 Poster Board Number: D0039
Presentation Time: 8:30 AM - 10:15 AM
Glaucoma Treatment: A Closer Look at Non-adherence
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Figure 2
Commercial Relationships: Sumir Pandit, None; Teresa C. Chen,
None
Program Number: 4402 Poster Board Number: D0040
Presentation Time: 8:30 AM - 10:15 AM
Predictive Factors for Incomplete Adherence to Glaucoma
Management amongst Singaporean Chinese
Reuben C. Foo1, Hiok Hong Chan2, Ecosse L. Lamoureux3, 4, Ryan
Wong2, Sue Wei Ho4, Gwyneth Rees3, Tin Aung1, 4, Shamira Perera1,
4
, Tina Wong1, 4. 1Singapore National Eye Centre, Singapore,
Singapore; 2Yong Loo Lin School of Medicine, Singapore,
Singapore; 3Centre for Eye Research Australia, University of
Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, VIC,
Australia; 4Singapore Eye Research Institute, Singapore, Singapore.
Purpose: To investigate the rate and factors (objective and
subjective) associated with adherence to treatment in glaucoma
patients.
Methods: Singaporean Chinese patients with primary open angle or
angle closure glaucoma currently on topical anti-glaucoma
medication were recruited from specialist glaucoma clinics. Sociodemographic data and information about patients’ general and ocular
health were collected. Objective adherence was assessed via clinic
attendance records (from 1 January 2006 through 30 November
2012) and subjective adherence using the interviewer-administered
Modified 8-item Medication Adherence Scale (MMAS). Beliefs
towards medicines, glaucoma and eye drops were assessed using
validated questionnaires. Patients with full attendance on clinic visits
and the maximum possible score of 8 on the MMAS were deemed
completely adherent.
Results: A total of 594 patients were enrolled. Mean (SD) age was
65.3 (10.3) years and 362 (60.9%) were male. 465 (78.3%) patients
were diagnosed with primary open angle glaucoma, with a mean
deviation (SD) of -13.49 (9.51) on the Humpfrey visual field test.
Average duration (SD) since diagnosis was 4.32 (4.47) years. The
mean (SD) objective adherence rate was 93.48% (7.76%) over an
average (SD) follow-up duration of 4.80 (1.85) years. 223 (37.5%)
patients had full attendance for scheduled clinic visits. The mean
(SD) subjective adherence using the MMAS was 6.12 (1.72). 281
(47.3%) patients had a MMAS maximum possible score of 8.
Overall, 165 (27.8%) patients fulfilled the criteria for complete
adherence. Objective and subjective non-adherence were found to be
strongly associated (OR [odds ratio] 6.25, 95% CI [confidence
intervals] 4.32-9.06, p<0.001). Predictive factors for incomplete
adherence included older age (p=0.005), a diagnosis of primary angle
closure glaucoma (p=0.002) and a longer duration of disease since
diagnosis, [≥4 years] (p=0.023). Beliefs towards medicines,
glaucoma and eye drops, and other socio-demographic, ocular and
general health factors were not independently associated with nonadherence.
Conclusions: Elderly patients living with primary angle closure
glaucoma for at least 4 years are more likely to default on clinic
visits. Targeting this group with disease specific education and
reminder strategies for clinic visits and eye drop administration may
help to improve glaucoma management.
Commercial Relationships: Reuben C. Foo, None; Hiok Hong
Chan, None; Ecosse L. Lamoureux, None; Ryan Wong, None; Sue
Wei Ho, None; Gwyneth Rees, None; Tin Aung, Alcon (R), Alcon
(C), Alcon (F), Allergan (R), Allergan (C), Carl Zeiss Meditec (F),
Carl Zeiss Meditec (R), Ellex (F), Ellex (R), Santen (R); Shamira
Perera, Carl Zeiss Meditec (R), Allergan (R), Pfizer (R); Tina
Wong, 61, 250,006 (P)
Support: This research is supported by the Singapore National
Research Foundation under its Translational Clinical Research
Programme and administered by the Singapore Ministry of Health’s
National Medical Research Council Translational Clinical Research,
Grant Number 002-Singapore Eye Research Institute, 2008.
Program Number: 4403 Poster Board Number: D0041
Presentation Time: 8:30 AM - 10:15 AM
Patient Adherence and Persistence with Topical Ocular
Hypotensive Therapy: a Claims-Based Comparison of
Bimatoprost 0.01% and Travoprost with sofZia
Joanna Campbell1, Gail F. Schwartz2, 3, Britni LaBounty4, Jonathan
W. Kowalski1, Vaishali D. Patel1. 1GHOSR, Allergan, Irvine, CA;
2
Greater Baltimore Medical Center, Baltimore, MD; 3Wilmer Eye
Institute, Johns Hopkins University, Baltimore, MD; 4Principled
Strategies, Inc., Encinitas, CA.
Purpose: To compare patients’ adherence and persistence with
bimatoprost 0.01% and travoprost 0.004% with sofZia ocular
hypotensive therapy in real-world settings.
Methods: Pharmaceutical claims from a major, longitudinal database
of prescription and medical claims for >115 million patients were
analyzed. Patients with an initial prescription for bimatoprost 0.01%
or travoprost 0.004% with sofZia between April and June 2011, and
with no medication claim for a topical prostaglandin analog or
prostamide during the previous 18 months, were identified.
Persistence over 12 months was assessed using Kaplan-Meier
survival analyses, assuming a 30-day grace period for prescription
refill. Adherence was measured as the mean and median proportion
of days covered (PDC) with drug supply (calculated using the
number of drops/bottle and dose), and the proportions of patients
with PDC ≤0.2 and >0.8.
Results: In total, 10,470 patients were included in the adherence
analysis (4,131 on bimatoprost 0.01%; 6,339 on travoprost 0.004%
with sofZia) and 12,985 patients in the persistence analysis (5,099 on
bimatoprost 0.01%; 7,886 on travoprost with sofZia). Overall
adherence was greater with bimatoprost 0.01% than with travoprost
0.004% with sofZia (mean PDC 54.0% vs 48.6%, p<0.001; median
PDC 51.2% vs 46.0%, p<0.001), and more patients showed high
adherence (PDC > 0.8) with bimatoprost than with travoprost (29.1%
vs 22.3%, p<0.001). Similar proportions of patients had low
adherence (PDC ≤0.2) with bimatoprost 0.01% and travoprost with
sofZia (20.7% vs 22.2%; p>0.05). Significantly more patients
remained on continuous treatment with bimatoprost than with
travoprost over the 12-month follow-up period (29.5% [95% CI 28.330.8%] vs 24.2% [95% CI 23.2-25.2%], p<0.001). Sensitivity
analyses performed in subcohorts of elderly (≥65 years) patients and
ocular hypotensive treatment-naïve patients produced qualitatively
similar findings.
Conclusions: In clinical practice, patients demonstrated superior
adherence and persistence with bimatoprost 0.01% than with
travoprost 0.004% with sofZia ophthalmic solution.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Joanna Campbell, Allergan Inc (E);
Gail F. Schwartz, Allergan (C), Tissue Banks International (R),
Allergan (R); Britni LaBounty, Allergan (C); Jonathan W.
Kowalski, Allergan Inc (E); Vaishali D. Patel, Allergan, Inc. (E)
Support: Allergan, Inc.
Program Number: 4404 Poster Board Number: D0042
Presentation Time: 8:30 AM - 10:15 AM
Identifying requirements for effective glaucoma electronic health
records: a consensus study
John E. Somner1, Rupert R. Bourne1, Peter Shah2, Rob Froud3.
1
Anglia Ruskin University, Vision & Eye Research Unit, Cambridge,
United Kingdom; 2National Institute for Health Research (NIHR)
Biomedical Research Centre (BRC), Moorfields Eye Hospital NHS
Foundation Trust, London, United Kingdom; 3Centre for Primary
Care and Public Health, Barts and The London School of Medicine
and Dentistry, London, United Kingdom.
Purpose: Specific requirements for electronic health records (EHRs)
in ophthalmology are recognised but there is no consensus on EHR
requirements for managing glaucoma. This study aimed to establish
whether the Rand/UCLA appropriateness method could establish
consensus on aspects of importance to implementing EHRs in the
current healthcare landscape.
Methods: 57 attendees at the 2011 UK & Eire Glaucoma Society
meeting agreed to be contacted to participate in an online study using
a Delphi process, 66% of these participated. Two Delphi rounds were
conducted with 75% completing both rounds. The sample included
staff at University and district general hospitals with a normally
distributed range of attitudes to the ease of use and usefulness of
EHRs, different levels of experience of EHR use and self-rated IT
proficiency.
Results: Participants agreed that several strategies for migrating to an
EHR from paper records exist, all of which may be appropriate but
could not agree on training requirements to summarise clinical
records. Twenty one core data fields to be extracted from paper
records were defined; six fields were disputed even after round two.
Thirty- four clinical decision support tools were prioritised, with drug
alerts, documentation aids and risk assessment tools regarded as top
priorities. Patient Reported Outcome Measures (PROMs) were
agreed to have a role in assessing the outcomes of all glaucoma
procedures and all glaucoma patients in routine glaucoma care.
Patient Reported Experience Measures (PREMS) were considered an
important measure of service quality. Collecting this type of data was
felt to be appropriate in the clinic but there was debate about
collecting such data at patients' homes. There was no strong
preference for any questionnaire format. Measurement should ideally
be conducted on a random sample of patients on an annual basis. The
role of personal health records for glaucoma was disputed but email
communication was felt to be unlikely to be useful for most patients
although there was disagreement about its role in patients with
complex glaucoma.
Conclusions: This method successfully established consensus on a
range of issues. The need to develop a working PROM for routine
care was established in addition to priorities for the development of
clinical decision support tools and minimum data fields required from
historic paper records for effective on-going care with an EHR.
Commercial Relationships: John E. Somner, None; Rupert R.
Bourne, Allergan Ltd (F); Peter Shah, None; Rob Froud, None
Support: Knowledge Transfer Partnership
Program Number: 4405 Poster Board Number: D0043
Presentation Time: 8:30 AM - 10:15 AM
Quality of Referral Letters to a Tertiary Glaucoma Unit and
adherence to Glaucoma Guidelines
Jason Cheng, Laura Beltran-Agullo, Graham E. Trope, Yvonne M.
Buys. Ophthalmology & Vision Sciences, Toronto Western Hospital,
Toronto, ON, Canada.
Purpose: To assess the quality of glaucoma referral letters in relation
to current guidelines and discuss the impact of inter physician
communication quality in glaucoma management
Methods: Prospective review of 200 consecutive referral letters to a
tertiary glaucoma unit. Letters were assessed for content in relation to
the Canadian Ophthalmological Society glaucoma guidelines and
also other information that a specialist would require to make a
glaucoma management decision.
Results: Out of 200 referrals, 92(46%) came from ophthalmologists,
84(42%) from optometrists, 20(10%) from family physicians & 4
from other. The most common reason for referral was for suspected
diagnosis of glaucoma (37%) followed by assessment for
progression/further treatment (25%), angle closure assessment (17%),
transfer of care (10%), second opinion (6%) and secondary glaucoma
(4%).
Of the 73 referrals for suspected diagnosis of glaucoma, 34 were
from optometrists, 28 from ophthalmologists & 11 from others. The
34 optometry referrals provided visual acuity (VA)(97%), intraocular
pressure (IOP)(100%), disc assessment(88%) and visual fields
(VF)(13%) much more frequently than the 28 referrals from
ophthalmologists, whom 46% (p<0.001) provided VA, 64%
(p<0.001) provided IOP, 75% (p=0.2) disc assessment and only 7%
(p=0.006) enclosed visual fields.
Of the 50 referrals for progression assessment or for consideration of
surgery, 45 (90%) included the current IOP, 34 (68%) disc
assessment, 42 (84%) current glaucoma therapy, 16 (32%) included a
current VF and 8 (16%) provided previous VFs. Only 12 (24%) of
these referrals included more than 10 of the 14 suggested information
points in the Canadian Ophthalmological Society glaucoma
guidelines, and 34% included less than 8 of the 14 points. Overall,
74% of the referral letters were deemed legible.
Conclusions: Our study shows that glaucoma referral letters rarely
contain all the relevant information and ophthalmologists are
particularly at fault. Previous visual fields and pre-treatment IOP can
be invaluable in management planning and progression analysis. 34%
of glaucoma referrals from optometrists and ophthalmologists contain
half or less of the suggest information recommended by the Canadian
Ophthalmological Society. Over a quarter of the referrals were at
least partially illegible. Further education and perhaps
implementation of a proforma may improve referral letter quality
Commercial Relationships: Jason Cheng, None; Laura BeltranAgullo, None; Graham E. Trope, sensimed (F); Yvonne M. Buys,
Alcon Surgical Incorporated (R), Alcon Surgical Incorporated (F),
IMED (F)
Program Number: 4406 Poster Board Number: D0044
Presentation Time: 8:30 AM - 10:15 AM
The Utility of a Medical Student Run Glaucoma Screening
Program
Mona A. Kaleem, Valerie C. Lerebours, John W. Logan, Juliana
Llano, Leslie S. Jones. Department of Ophthalmology, Howard
University Hospital, Washington, DC.
Purpose: To describe the characteristics of those who participate in a
medical student run glaucoma screening program in the Washington
D. C. metropolitan area.
Methods: The Student Sight Savers Program (SSSP) is a volunteer
organization that provides free glaucoma screenings throughout the
Washington D. C. metropolitan area. Screenings were performed at
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
local health fairs at community centers. Screenings were staffed by
trained medical students, ophthalmology residents, and attending
physicians. Participants filled out a questionnaire which asked about
demographics, date of last exam, medical history, family history, and
understanding of glaucoma and cataract. Visual acuity was measured
with a portable titmus vision tester. The Humphrey Portable
Frequency Doubling Technology (FDT) was used to test peripheral
visual fields. Intraocular pressure (IOP) was measured with a
tonopen, and a direct ophthalmoscope was used to assess the optic
nerve. Records of those participating in screenings between
September and November 2012 were reviewed.
Results: Complete data was available for 41 of the 83 screened
participants. The average age of participants was 47 years. 83% were
black or Hispanic. Amongst those screened, 93% reported having
medical insurance. One third had routine eye care; 43% were unable
to remember the date of their last exam. A family history of
glaucoma was present in 22% of participants; 83% had heard of
glaucoma, and 80% knew that it was a blinding disease. Average IOP
was 16 mm Hg. A glaucoma consultation was recommended for 12%
of participants and an ophthalmic consultation based on another
finding was recommended for 51%. The leading diagnostic finding
was cataract which was present in 15% of those screened. Forty
participants indicated that their SSSP screening exam would prompt
them to seek routine eye care.
Conclusions: Participants in SSSP glaucoma screenings tend to have
medical insurance but most are not receiving eye care. The majority
of those attending screenings are identified as having a finding which
requires follow up ophthalmic care. This suggests a need for
continued efforts to provide community based ophthalmic screenings
and education.
Commercial Relationships: Mona A. Kaleem, None; Valerie C.
Lerebours, None; John W. Logan, None; Juliana Llano, None;
Leslie S. Jones, None
Program Number: 4407 Poster Board Number: D0045
Presentation Time: 8:30 AM - 10:15 AM
Opportunistic Glaucoma Screening in Rural India: Role of
Vision Centers
Mona Khurana, MOHIDEEN A. KADER, Rengappa Ramakrishnan.
Glaucoma, Aravind Eye Hospital, Tirunelveli, India.
Purpose: To study the role of Vision Center in opportunistic
screening for glaucoma in rural India.
Methods: We reviewed the charts of all patients attending 5 vision
centers (under Aravind Eye Hospital, Tirunelveli) from a period of
May 2007 to August 2010. All patients had undergone a
comprehensive eye examination by mid level ophthalmic
practitioners (MLOPs) and those with any of the following: a family
history of glaucoma, intraocular pressure =/> 21mmHg, shallow
anterior chamber, optic disc changes suggestive of glaucoma were
referred to the base hospital. Data were analyzed with respect to the
diagnosis and response rate at the hospital.
Results: Of the total 82,349 patients examined, 852 (1.04%) had a
provisional diagnosis of glaucoma. Of these, 20.4% had Primary
open angle glaucoma (POAG), 26.04% were POAG suspects, 18.7%
had angle closure disease and 19.94 % had secondary glaucoma. 75%
of referred patients visited the base hospital. Diagnosis of glaucoma/
glaucoma suspects was confirmed in 90% of patients who visited the
base hospital.
Conclusions: Glaucoma being a silent disease, the importance of
screening cannot be undermined. However, population based
screening is not cost-effective. Both POAG and angle closure disease
are prevalent in India, where most of the population resides in the
rural areas. Vision centers, established under the Vision 2020
program to improve utilization of services in rural areas provide
permanent primary eye care, are affordable and easily accessible. By
screening for glaucoma during a patients’ regular visit to a Vision
Center, a large section of the rural population at risk of glaucoma can
be accessed. In our study, a provisional diagnosis of glaucoma was
made in 1.04% patients visiting the vision center and confirmed in
90% of patients who visited the base hospital. In the presence of
limited economic resources, Vision centers can be used for
opportunistic glaucoma screening in rural population which would
otherwise be difficult to access and help reduce the burden of disease.
Further studies are needed to evaluate and explore their full potential
in detection of disease.
Commercial Relationships: Mona Khurana, None; MOHIDEEN
A. KADER, None; Rengappa Ramakrishnan, None
Support: : Lavelle Fund for the blind, Inc 307 West 38th Street,
Suite 2010 • New York, NY 10018
Program Number: 4408 Poster Board Number: D0046
Presentation Time: 8:30 AM - 10:15 AM
Qualitative Analysis of Web-Based LASIK Information Sessions
Roni M. Shtein, Paul P. Lee. Ophthalmology, Univ of MichiganKellogg Eye Ctr, Ann Arbor, MI.
Purpose: To assess the feasibility and the nature of web-based group
discussions to obtain qualitative insights into health care issues and to
enhance avenues of communications with patients and the public,
particularly the types of information sought and received in this mode
of communication.
Methods: Transcripts of five web-based information sessions
provided by the Refractive Surgery Service at the Kellogg Eye Center
from 2008-2012 were analyzed. The information sessions comprised
of a corneal refractive surgeon and an ophthalmic technician
available for an hour-long session of answering questions and
interactive discussion in a web-based “chat” setting. Qualitative
analysis methods, similar to those used for analysis of in-person
focus groups, were used to evaluate the transcripts to assess for
common themes.
Results: The one-hour chat sessions had a range of 9 to 39 questions
raised by the participants. The surgeon answered from 67-89% of the
questions, and a refractive surgery technician answered the remaining
11-33%. Common themes that were raised in each of the web-based
information sessions were: (1) the cost of surgery, (2) logistics of
scheduling a screening evaluation and/or surgery, and (3) the
characteristics of eligibility for surgery. Specific questions about
eligibility included: age, presence of astigmatism, stability of
refraction, and issues surrounding presbyopia. In almost all of the
sessions, participants asked about details of surgical techniques and
potential risks of surgery. In three of the five sessions, many of the
questions were phrased in the first person and included personal
experiences - in all of these cases, one of the 1st three questions of
the session were phrased in this manner. In the remaining two
sessions, almost all of the questions were phrased in the third person
or as hypothetical situations.
Conclusions: Web-based discussion allows for dissemination of
information to interested members of the public, in this instance
about refractive surgery. Our qualitative analysis reveals several
common themes that are consistently of interest to participants in this
particular area. Further research is needed to understand the utility of
this mode of communication in providing information to patients in
other areas.
Commercial Relationships: Roni M. Shtein, None; Paul P. Lee,
Genentech (C), University of Michigan (E), Duke University (E),
Pfizer (C), Pfizer (I), Glaxo (I), Merck (I), Allergan (C), Duke
University (P)
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Program Number: 4409 Poster Board Number: D0047
Presentation Time: 8:30 AM - 10:15 AM
Results of the Appalachian Vision Outreach Program: Year 2
J V. Odom, Rebecca Coakley, Judie Charlton, Serena Morrison.
Ophthalmology, West Virginia Univ Eye Inst, Morgantown, WV.
Purpose: To present second year results of the Appalachian Vision
Outreach Program (AVOP), created through the West Virginia
University Eye Institute (WVU EI) to improve vision care for the
underserved and socio-economically isolated populations of West
Virginia.
Methods: The Department of Health and Human Services includes in
its Healthy People 2020 plan the goal that patients with a broad range
of vision-threatening diseases receive yearly dilated eye exams.
Because West Virginia has a high proportion of low income,
underinsured, rural and older citizens with poor access to health care,
medical and vision health in the state is poor. WVU EI as a part of a
land grant university seeks to reduce these health disparities. WVU
EI collaborated with the free clinics in WV and with the WV Lions
Sight Conservation Foundation, supported by the Benedum
Foundation. Screening sessions and clinical sessions were held at
each free clinic in WV, a catchment area of roughly 1.5 million
people. Screenings performed by AVOP personnel included an
assessment of monocular distance visual acuity (VA), binocular near
VA, intraocular pressure (IOP), and obtaining a history of diabetes. A
general ophthalmologist staffed clinics to provide complete eye
examinations on people who failed the AVOP screening or who
requested a full examination. Patients needing glasses received them
through the WV Lions with a $10 co-pay; those needing surgery were
referred to the WV Lions for possible financial assistance. Those
needing more specialized care and/or follow up were referred to a
local ophthalmic professional.
Results: We have conducted screenings and clinics at 7 locations.
441 of 642 persons failed the screening. 395 patients were referred
for additional care. 248 patients had cataract, 21 of which were
referred for surgery. 22 of 202 diabetic patients had retinopathy. 83
of 145 systemic hypertensive patients had vascular changes. 37
patients had high C:D ratios. 200 patients had uncorrected refractive
errors. 191 pairs of glasses were provided.
Conclusions: High levels of undiagnosed and untreated eye disease
exist in people who inhabit rural, medically underserved regions of
West Virginia. Data from our initial period aided AVOP in
developing a model of screenings and clinics in partnership with local
and state-wide organizations which has the potential to improve eye
care delivery in rural environments.
Commercial Relationships: J V. Odom, None; Rebecca Coakley,
None; Judie Charlton, None; Serena Morrison, None
Support: Charles W. Benedum Foundation; Research to Prevent
Blindness Challenge Grant
Program Number: 4410 Poster Board Number: D0048
Presentation Time: 8:30 AM - 10:15 AM
Are outcomes in primary retinal detachment repair related to
distance away from an academic medical center?
Kristen Harris Nwanyanwu, Leslie M. Niziol, David C. Musch, David
N. Zacks. Department of Ophthalmology and Visual Sciences,
University of Michigan, Ann Arbor, MI.
Purpose: To determine if distance from an academic medical center
influences outcomes in patients who undergo primary
rhegmatogenous retinal detachment repair.
Methods: We performed a retrospective chart review on patients >18
yo, who underwent primary repair of a rhegmatogenous retinal
detachment over the course of 1 year. Sociodemographics; distance
and time to Kellogg Eye Center (KEC) in Ann Arbor, Michigan;
extent of retinal detachment at presentation; whether the detachment
was macula-off or macula-on; pre-operative and post-operative visual
acuity; pre-operative and post-operative intraocular pressure; and
whether or not the retina was attached at baseline, 3 months, and 12
months were recorded. SAS 9.3 was used for all data analysis.
Sociodemographic information was summarized with means,
standard deviations, frequencies, and percentages. Distance and time
were calculated using the Google maps. ANOVA, Kruskal-Wallis,
Tukey adjusted pairwise comparison, and t-test were applied.
Results: 85 patients met inclusion criteria and 1 patient contributed
both eyes to the study. The mean(SD) age of symptom onset in eyes
was 57.5(11.1) years. The majority of patients were identified as
white (93.4%) and the mean distance travelled was 37.4 miles and
45.0 minutes from KEC. The mean presenting visual acuity measured
0.65 in logMAR units; the median presenting IOP measured 14.0
mmHg; 42.3% of eyes presented with 1 quadrant detached, while
38.5% presented with 2 quadrants detached, with the median being 2
quadrants. When the distance values were divided into tertiles, the
mean number of quadrants detached at presentation increased with
distance, but was not found to be statistically significant (p=0.09).
There was no correlation between distance and logMAR visual acuity
or the number of quadrants detached at baseline. Baseline and 3
month logMAR worsened with increase in number of quadrants
detached at baseline (p<0.0023 for both values). By three months, a
significant difference between the visual acuity of the phakic and
pseudophakic eyes developed (p=<0.0001), with phakic eyes having
worse logMAR.
Conclusions: While there is a trend towards an increase in number of
quadrants detached at presentation in those at increased distances
from KEC, distance does not appear to negatively impact outcomes
in surgically repaired primary retinal detachment.
Commercial Relationships: Kristen Harris Nwanyanwu, None;
Leslie M. Niziol, Pfizer (F); David C. Musch, Glaukos (C),
AqueSys (C), InnFocus (C), Pfizer (F), DigiSight Technologies (C);
David N. Zacks, ONL Therapeutics, LLC (I), University of
Michgian (P)
Program Number: 4411 Poster Board Number: D0049
Presentation Time: 8:30 AM - 10:15 AM
Consent For Future Corneal Transplantation And Eye Research
From AMD Patients In An Ophthalmic Clinic
Meidong Zhu1, 2, Jamie Chew1, 3, Pierre Georges2, Con Petsoglou1, 2,
Andrew A. Chang1, 3. 1SSI, Ophthalmology & Eye Health, Sydney
Eye Hospital Campus, University of Sydney, Sydney, NSW,
Australia; 2Lions New South Wales Eye Bank, NSW Organ and
Tissue Donation Service, Sydney, NSW, Australia; 3Sydney Retina
Clinic & Day Surgery, Sydney, NSW, Australia.
Purpose: The demand for human tissue for corneal transplantation
and for advancing research is increasing. In Australia, more than 95%
of consent for eye donation is obtained from the next of kin (NOK)
through Eye Bank by telephone interview at the time of donor death.
The overall consent rate for eye donation was 57% in 2011. There is
frequently a lack of clinical information on donor eyes provided for
research. Patients with eye diseases often express that their eyes don’t
see well therefore are not suitable for donation to help others. This
study aims to evaluate the effectiveness of patient and NOK
education by a direct approach at seeking consent for future eye
donation for both corneal transplantation and research in eye clinic
patients.
Methods: We established a novel approach in recruiting patients for
future eye donation at a tertiary referral retinal clinic. Patients with
age-related macular degeneration were approached and consent was
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
sought for eye donation. A 15 minute face to face education of the
benefits of donation was provided to all patients and their NOK.
Qualitative and quantitative data were collected on the effectiveness
of the intervention and consent rate.
Results: 228 patients were approached and registered between
August and November 2012. At initial interview, 126 patients agreed
to donation immediately after the education, 8 refused and 94 patients
were undecided. 13/94 undecided patients (14%) then consented for
donation at a later date. The final consent rate for donation was 61%
(139/228). 81 patients (35%) remained undecided and may still
consent in the future. The final refusal rate for donation was 3.5%.
Donor files with all clinical information for all consented patients
were established.
Conclusions: A direct approach with effective education in an
ophthalmic diseased population resulted in high consent rate of eye
donation. Initiating a pre-death eye donation allows donor eye tissue
to be collected with minimal time delay thereby improving the tissue
quality for both corneal transplantation and eye research. It also
provides eye tissue for researchers with valuable documented
longitudinal ophthalmic findings vital for clinicopathological
correlation. A direct approach should be considered in all eye clinics
by trained health professionals to educate the patients and their NOK
for eye donation and to increase eye donor rates.
Commercial Relationships: Meidong Zhu, None; Jamie Chew,
None; Pierre Georges, None; Con Petsoglou, None; Andrew A.
Chang, Alcon (C), Bayer (C), Novartis (C), Alcon (R), Bayer (R),
Novartis (R), Bayer (F)
Program Number: 4412 Poster Board Number: D0050
Presentation Time: 8:30 AM - 10:15 AM
Objective and subjective severity of affections observed at
emergency room in ophthalmology
Aurelie Pison1, Chadi Mehanna1, 4, Georges Sawiress2, Reda Mikou1,
Astrid Queant3, 1, Antoine P. Brezin3, 1, Jean-Louis Bourges3, 1.
1
Department of Ophthalmology, Hotel Dieu/Cochin Hospital, APHP,
Paris, Paris, France; 2Department of informatics, Hotel Dieu/Cochin
Hospital, APHP, Paris, Paris, France; 3Paris Descartes school of
medicine, Sorbonne Paris Cité university, Paris, France; 4Team 17,
INSERM, CIC des Cordeliers, Paris, France.
Purpose: The severity of ocular affections is critical to the triage
process at ophthalmological emergencies (OER). However, the
concept of severity is broad and vague concept, and might be
differently approached by physicians and patients. We investigated
ocular affection presenting at emergencies. We compared the
subjective severity perceived by patients and the objective evaluation
of physicians.
Methods: Both patients and physicians were enrolled to quantify the
severity of the ocular affection justifying the visit at
ophthalmological emergencies. We deliberately did not define
severity. From the 1st January to the 31st of November 2012, a nurse
collected from patients the subjective severity on a scale graded from
0 (no severity) to 5 (maximal) and graded patient’s behavior from 0
(normal) to 5 (violent or highly incoherent). After ophthalmological
examination, the physician had to quantify objective severity from 0
to 5. Data were analyzed prospectively and anonymously.
Results: A total of 3003 forms were collected. Two third of the
patients displayed a normal behavior (score 0; score 2000). The mean
behavior score was 0.375, while only one patient scored 5. No
severity score could be obtained from 241 patients (8%). Severity
was considered by patients as none, minor, moderate, serious, severe
or maximal in 1011, 827, 491, 363, 59 and 11 cases, and by
ophthalmologists in 687, 575, 894, 498, 218 and 131 cases,
respectively. Severity was identically scored both by the
ophthalmologist and the patient in a fifth of the cases (230, 151, 128,
55, 7 and 0 respectively). The score for severity was underestimated
(score 0 to 3 vs 4 to 5) by 280 patients and overestimated (4 to 5 vs 0
to 3) by 52 patients. No statistical correlation was found between
patient’s behavior and subjective severity although a third of the
patients displayed abnormal behaviors.
Conclusions: The severity of an ocular affection seem at OER is
scored differently by patients and by ophthalmologists. It seems to be
more often underestimated by patients. A third of the patients seen at
OER considered their behavior to be modified by the affection.
Commercial Relationships: Aurelie Pison, None; Chadi Mehanna,
Sisène (E); Georges Sawiress, None; Reda Mikou, None; Astrid
Queant, None; Antoine P. Brezin, None; Jean-Louis Bourges,
None
Program Number: 4413 Poster Board Number: D0051
Presentation Time: 8:30 AM - 10:15 AM
Acceptance, Attitudes and Beliefs Of Singaporean Chinese
Towards Subconjunctival, Intracameral and Punctal Plug
Methods of Sustained Glaucoma Drug Delivery Systems
Hiok Hong Chan1, 2, Tina Wong1, 3, Ecosse L. Lamoureux3, 4, Shamira
Perera1. 1Glaucoma, Singapore National Eye Centre, Singapore,
Singapore; 2Yong Loo Lin School of Medicine, National of
University of Singapore, Singapore, Singapore; 3Singapore Eye
Research Institute, Singapore, Singapore; 4Centre for Eye Research
Australia, Melbourne, VIC, Australia.
Purpose: To investigate the acceptance, attitudes and beliefs towards
the subconjunctival, intracameral and punctal plug methods of
sustained drug delivery systems in glaucoma patients. These
sustained drug delivery systems may improve adherence and provide
better outcomes compared to glaucoma eye drops.
Methods: A cross-sectional study involving 250 patients recruited
from outpatient glaucoma clinics for an interviewer-administered
survey. Beliefs towards medicines, eye drops, illness perception,
medication adherence and health literacy were assessed via validated
questionnaires. After receiving standard education of the 3 sustained
drug delivery systems, acceptance and attitudes towards them were
determined via a newly designed questionnaire.
Results: The 250 patients enrolled had a mean (SD) age of 64.4
(10.2) and 139 (55.6%) were males. 174 (69.6%) of the patients
received healthcare subsidies. 194 (77.6%) had Primary Open Angle
Glaucoma with a mean duration since diagnosis of 4.64 years (5.39).
204 (81.6%) patients had bilaterally affected glaucomatous eyes and
174 (69.6%) had their worse eye with at least stage 2 glaucoma
(Glaucoma Severity Staging). Majority accepted the 3 sustained drug
delivery systems - via subconjunctival (61.6%), intracameral (57.2%)
and punctal plug (63.2%) methods. Amongst those who accepted,
78.6%, 79.1% and 78.5% were willing to pay at least an equal cost as
their current eye drops for the subconjunctival, intracameral and
punctal plug methods, respectively. Predictive factors of acceptance
include: male gender (p= 0.009, 0.014, 0.046, respectively), patients
not on healthcare subsidies (p= 0.032, 0.002, 0.016, respectively) and
bilaterally affected glaucomatous eyes (p= 0.006, 0.013, 0.004,
respectively). 120 (48.0%) patients ranked punctal plug placement as
the top choice for sustained drug delivery compared to
subconjunctival (76, 30.4%) and intracameral (54, 21.6%) methods.
Conclusions: Although the subconjunctival, intracameral and punctal
plug methods of sustained drug delivery are acceptable alternatives to
glaucoma eye drops, the punctal plug placement was the preferred
method for sustained drug delivery. The male gender, patients not on
healthcare subsidies and with bilaterally affected glaucomatous eyes
were the subgroups most receptive to these alternatives.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Commercial Relationships: Hiok Hong Chan, None; Tina Wong,
61, 250,006 (P); Ecosse L. Lamoureux, None; Shamira Perera,
Carl Zeiss Meditec (R), Allergan (R), Pfizer (R)
Support: Singapore National Research Foundation-Funded
Translational & Clinical Research (TCR) Programme Grant 002
[Protocol number: R619]
Program Number: 4414 Poster Board Number: D0052
Presentation Time: 8:30 AM - 10:15 AM
Electronic Health Record Systems in Ophthalmology: Impact on
Operating Room Time Requirements for Cataract Surgery
Daniel C. Tu1, 2, David S. Sanders2, Sarah Read-Brown2, Anna S.
Brown2, Dongseok Choi3, Thomas R. Yackel4, 5, Michael F. Chiang2,
4 1
. Ophthalmology, Portland Veterans Administration Medical
Center, Portland, OR; 2Casey Eye Institute, Ophthalmology, Oregon
Health & Science University, Portland, OR; 3Public Health and
Preventive Medicine, Oregon Health & Science University, Portland,
OR; 4Medical Informatics, Oregon Health & Science University,
Portland, OR; 5Clinical Epidemiology, Oregon Health & Science
University, Portland, OR.
Purpose: Electronic health record (EHR) systems are currently
promoted through federal incentives to improve the quality,
efficiency and cost of ophthalmic care. However, only a minority of
ophthalmologists and surgical centers have adopted EHRs. One
concern is that EHRs may disrupt operating room workflow and
increase documentation time. We aim to compare cataract surgery
operating room time requirements using paper versus EHR systems at
an academic ambulatory surgery center.
Methods: An EHR system for operative care (OpTime by Epic
Systems, Madison, WI) was implemented in January 2012 by the
ophthalmic ambulatory surgery center at Oregon Health & Science
University. For 1 month prior to and 10 months following EHR
implementation, a trained observer recorded cataract surgery
duration, intraoperative documentation time, operating room turnover
time and number of nursing staff. Descriptive statistics and twosample t-tests with unequal variance were performed (StataCorp LP,
College Station, TX).
Results: Mean cataract surgery duration was 16.7 minutes (SD
=11.4). Mean paper-based intraoperative documentation time was 6.8
(SD =1.2) minutes per surgery. During the initial 2 weeks after EHR
implementation, intraoperative documentation time increased to 17.1
(SD =4.3) minutes (p<.0001), then decreased to 7.9 (SD =2.3)
minutes by 6 to 10 months after EHR implementation, although this
remained greater than paper documentation time (p<.05). There was
no statistically significant difference between mean operating room
turnover time with paper records (14.4 minutes) and mean turnover
time 2 weeks or 6 to 10 months after EHR implementation (12.9 and
12.8 minutes, respectively). Only 1 nurse was needed per cataract
surgery to complete both clinical care and documentation while using
paper records, compared to a mean of 1.8 nurses while using EHRs.
Conclusions: EHR implementation for cataract surgery operative
care was associated with increased intraoperative documentation
time, but no significant change in operating room turnover time.
Initially after EHR implementation, mean intraoperative
documentation time more than doubled and was greater than mean
surgery duration. Although EHR documentation time decreased over
subsequent months, this was in the setting of increased nursing staff
requirements. These findings have implications for the efficiency and
cost of ophthalmic surgical care delivery.
Commercial Relationships: Daniel C. Tu, Research to Prevent
Blindness (F); David S. Sanders, Supported by unrestricted
departmental funding by Research to Prevent Blindness (New York,
NY) (F); Sarah Read-Brown, None; Anna S. Brown, None;
Dongseok Choi, None; Thomas R. Yackel, None; Michael F.
Chiang, Clarity Medical Systems (unpaid member of Scientific
Advisory Board) (S)
Support: Unrestricted departmental funding from Research to
Prevent Blindness (New York, NY)
Program Number: 4415 Poster Board Number: D0053
Presentation Time: 8:30 AM - 10:15 AM
Efficiency improvements using an ophthalmological Picture
Archiving and Communication System (PACS) in the diagnostic
workflow of an eye hospital
Karsten U. Kortuem, Wolfgang J. Mayer, Simon F. Leicht, Lukas
Reznicek, Anselm Kampik, Marcus Kernt. Ophthalmology, LudwigMaximilians-University, Munich, Germany.
Purpose: To evaluate improvements in imaging workflow by the
implementation of a Digital Imaging and Communications in
Medicine (DICOM) standard based specific ophthalmological PACS
in an university eye hospital setting, using various imaging modalities
Methods: In 2011 a specific ophthalmological PACS (Forum
Version 3.0, Carl Zeiss Meditec, Jena, Germany (DE)) was
implemented at the Department of Ophthalmology at the LudwigMaximilians-University of Munich, Germany. It linked various
imaging modalities - Optical Coherence Tomography (OCT),
Angiography, Wide field fundus photography, fundus photography,
keratometry, biometry, Heidelberg Retina Tomograph (HRT) and
ultrasound - to one PACS using DICOM standard. To assess the level
of efficiency improvement, we analyzed the OCT imaging process of
our age related macular degeneration (AMD) clinic and identified 5
process steps. In 64 patients time demand for each step of the process
was evaluated. Potential time and resource savings were analyzed.
Results: In average OCT examination process took 3min 25sec (see
figure 1 for detailed timing). Major savings of process time and
resources were identified: patient data acquisition (data are sent from
the Electronic Health Record (EHR) System through PACS to the
OCT), printing resources (no need to print paper report, as exams are
stored and archived digitally and available online for reviewing). In
summary, a potential process time saving of 92sec (10s for data
entry, 58s for printing and 24s for record keeping) and resources for
four color printing pages per patient was calculated.
Conclusions: In our study, the implemented ophthalmological PACS
has proven to efficiently integrate equipment from a variety of
different manufacturers in a larger university eye hospital setting. It
resulted in time-saving for clinical and technical staff, cost-saving
regarding printing costs and labor and shorter average waiting time
for patients. Calculated on an average of 30 patients per day, 26
working days and more than 30.000 color printing pages can be saved
per annum. An even deeper integration of imaging modalities could
provide even more increased efficiency.
Commercial Relationships: Karsten U. Kortuem, None;
Wolfgang J. Mayer, None; Simon F. Leicht, None; Lukas
Reznicek, None; Anselm Kampik, None; Marcus Kernt, Allergan
(R), Novartis (R), OD-OS (C), Optos (C)
Program Number: 4416 Poster Board Number: D0054
Presentation Time: 8:30 AM - 10:15 AM
Ambulatory Surgery Center (ASC) Utilization by three
Ophthalmic Sub-specialists: 1999-2011
Kamyar Vaziri1, Andrew A. Moshfeghi1, Tina Hernandez-Boussard2,
Natalia Fijalkowski3, Darius M. Moshfeghi3. 1Ophthalmology,
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Bascom Palmer Eye Institute, University of Miami Miller School of
Medicine, Miami, FL; 2Surgery, Stanford University School of
Medicine, Palo Alto, CA; 3Ophthalmology, Byers Eye Institute,
Horngren Family Vitreoretinal Center, Stanford University School of
Medicine, Palo Alto, CA.
Purpose: To evaluate the utilization of ambulatory surgery centers
(ASCs) in Florida for vitreoretinal, cataract, and glaucoma
procedures over the years 1999-2008 and to also calculate these
trends specifically for the years 2008 to 2011 for glaucoma and
cataract surgeries with the purpose of assessing any potential
consequences of the new ASC reimbursement system implemented in
2008 by Centers for Medicare & Medicaid Services (CMS) on ASC
utilization.
Methods: The Healthcare Cost and Utilization Project (HCUP) State
Ambulatory Surgery Databases (SASD) for Florida from 1999-2008
were obtained and evaluated. ICD-9 codes for vitreoretinal, Cataract
and Glaucoma procedures were queried in this database for each
year. For the years 2009-2011, preliminary publicly available data
from the same databases (available from: http://www.hcupus.ahrq.gov/cdstats/cdstats_search.jsp) were used. Joinpoint
regression analysis was utilized to assess the trends in ASC
utilization by studied sub-specialties by calculating annual percent
changes over time.
Results: Over this time period of 1999-2008, average annual percent
change (APC) in ambulatory surgery center utilization was +33.6%
(95% CI, 4.5% to 70.8%; P = 0.028) for vitreoretinal surgery,
+28.6% (95% CI, 1.3% to 63.2%; P= 0.044) for cataract surgery and
+35.23% (95% CI, 12.7% to 62.4%; P= 0.0055) for glaucoma
surgery. By utilizing the preliminary publicly available data (web
address provided above) from the ambulatory surgery center database
of Healthcare Cost and Utilization Project (HCUP) for the years of
2009-2011, over the period of 2008-2011, annual percent change in
ASC utilization was -14.70% (95% CI, -23.5% to -5.1%; P = 0.0236)
for cataract surgery and -20.09% (95% CI, -36.2% to 0.0%; P =
0.050029) for glaucoma surgery. Preliminary public data were not
available with regards to vitreoretinal surgery for the years 20092011.
Conclusions: There was a significant increase in ASC utilization by
vitreoretinal, cataract and glaucoma surgeons in the years 1999-2008,
likely due to increased ASC reimbursements and advances in surgical
techniques and equipment. However the implementation of the new
ASC reimbursement system in 2008, which has led to the widening
of the gap between ambulatory surgery center and hospital outpatient
department reimbursement rates, appears to have reversed some of
these encouraging trends.
Commercial Relationships: Kamyar Vaziri, None; Andrew A.
Moshfeghi, Thrombogenics, Inc. (C), Allergan, Inc. (C), Alcon, Inc.
(C), Bausch & Lomb, Inc. (C), Valeant, Inc. (C), Regeneron, Inc. (C),
Genentech/Roche, Inc. (C), OptiSTENT, Inc. (I); Tina HernandezBoussard, None; Natalia Fijalkowski, None; Darius M.
Moshfeghi, None
Program Number: 4417 Poster Board Number: D0055
Presentation Time: 8:30 AM - 10:15 AM
Comparison of theoretical demand for glaucoma eye care by the
African-American population of cook county to the supply of
ophthalmologic manpower as a pilot study of access to care
Stephen Watson, Dmitry Pyatetsky. Ophthalmology, Northwestern
University Feinberg School of Medicine, Chicago, IL.
Purpose: To determine the methodology to calculate the demand for
ophthalmic care of common ophthalmic conditions among various
racial groups and amount of care provided by the ophthalmology
workforce. To determine whether there is a mismatch between the
geographical distribution of African-American theoretical demand
and the ophthalmology workforce in Cook County, Illinois.
Methods: Geographic distribution by zip code of African-Americans
above 40 years of age was determined by plotting the 2010 US
Census Data on a population density map of Cook County using
geographic information systems (GIS) software. "African-American”
was defined as selecting African-American alone and no other race
on the 2010 US Census questionnaire. The density of licensed
ophthalmologist per zip code in Cook county was calculated using
Illinois Department of Financial and Professional Regulations
website. To compare demand for eye care with supply of
ophthalmologists a single unit was defined: a full-time equivalent
(FTE). 1 FTE for an ophthalmologist is defined as the amount of time
an average ophthalmologist works per year, approximately 2016
hours. An average glaucoma patient’s demand per year (71
minutes/year of the ophthalmologist’s available 2016 work
hours/year) can be expressed as 0.0000546 FTE.
Results: The calculated theoretical demand for primary open angle
glaucoma (POAG) related eye care for African-Americans 40 years
of age or older has a non-uniform distribution. The difference
between ophthalmologists manpower and the theoretical demand for
POAG demand eye care for African-Americans 40 years of age or
older shows many zip-codes with a lack of manpower to meet the
need of theoretical demand. The areas with the largest deficit are
located in areas with a dense African-American population.
Conclusions: In Cook County of Illinois, there exists a geographic
mismatch between demand for eye care by the African-American
population and the supply of ophthalmologists. As a pilot study, this
provides a precise methodology for calculating the theoretical
demand geographic distribution, and comparing that theoretical
demand to ophthalmic manpower. Future studies looking at more
common ophthalmic diseases amongst various racial groups may
provide further insight in the limitation of access to eye care.
Commercial Relationships: Stephen Watson, None; Dmitry
Pyatetsky, None
Program Number: 4418 Poster Board Number: D0056
Presentation Time: 8:30 AM - 10:15 AM
Trends in Utilization of Ancillary Testing for Patients with
Exudative Macular Degeneration and Macular Edema from 2001
to 2009
Eric W. Schneider1, 2, Prithvi Mruthyunjaya1, Nidhi Talwar2, Kristen
Harris Nwanyanwu2, Bin Nan3, Joshua D. Stein2. 1Ophthalmology,
Duke University, Durham, NC; 2Ophthalmology and Visual Sciences,
University of Michigan, Ann Arbor, MI; 3Biostatistics, University of
Michigan, Ann Arbor, MI.
Purpose: To assess trends in the use of ancillary diagnostic imaging
in patients with exudative age-related macular degeneration (AMD)
and macular edema (ME) over the past decade.
Methods: Claims data from a large nationwide managed-care
network were analyzed to assess trends in the use of fluorescein
angiography (FA), fundus photography (FP), and other ocular
imaging (OOI) for beneficiaries with a diagnosis of exudative AMD
(n= 22,954) or ME (n= 31,810) in 2001-2009. Repeated measures
multivariable logistic regression was performed to compare the odds
of undergoing each of these procedures in 2001, 2005, and 2009.
Next, enrollees with an incident diagnosis of exudative AMD or ME
in 2003 (n= 1,023 for AMD; n= 1,090 for ME) and 2008 (n=1,258
for AMD; n= 2,616 for ME) were compared to determine changes in
the proportion who received FA, FP, and OOI.
Results: The proportion of enrollees undergoing OOI—for which
optical coherence tomography represents >90% of all claims—within
1 year following initial diagnosis of exudative AMD and ME
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
increased 53.9% and 44.2%, respectively, from 2003 to 2008. By
comparison, significant decreases were noted (7.9-11.5%) in the
usage of FA and FP in the 2008 cohort relative to the 2003 cohort.
The use of OOI without FA within 1 year following initial diagnosis
of exudative AMD and ME increased 19.0% and 27.9%, respectively,
from 2003 to the 2008. For beneficiaries with exudative AMD, the
odds of undergoing OOI increased 24-fold from 2001 to 2009. In
contrast, the odds of undergoing FA and FP testing for exudative
AMD decreased 68% and 79%, respectively, during this time period.
Trends for ME were similar to those for exudative AMD.
Conclusions: Utilization of OOI for AMD and ME increased
dramatically over the study period. This corresponded with a smaller,
but significant, decrease in FA and FP use, suggesting that OOI is
replacing more traditional diagnostic testing. As current treatment
paradigms are based on historic treatment trials that have utilized FA
with or without OCT to define treatable disease, further studies are
needed to assess if increased reliance by eye care providers on OOI in
lieu of FA and FP impacts patient outcomes.
Commercial Relationships: Eric W. Schneider, None; Prithvi
Mruthyunjaya, None; Nidhi Talwar, None; Kristen Harris
Nwanyanwu, None; Bin Nan, None; Joshua D. Stein, University of
Michigan - time to next glaucoma test algorithm patent (P)
Support: National Eye Institute K23 Mentored Clinician Scientist
Award (1K23EY019511-01) (JDS); Blue Cross Blue Shield of
Michigan Foundation (JDS), Research to Prevent Blindness
Physician Scientist Award (JDS)
Program Number: 4419 Poster Board Number: D0057
Presentation Time: 8:30 AM - 10:15 AM
Comparing Patient and Public Preferences for Health States
Associated with Age-Related Macular Degeneration
Thomas Butt1, Hannah M. Dunbar1, Steve Morris2, Shepley Orr3,
Gary S. Rubin1, 4. 1Institute of Ophthalmology, University College
London, London, United Kingdom; 2Department of Applied Health
Research, University College London, London, United Kingdom;
3
Department of Civil and Environmental Engineering, University
College London, London, United Kingdom; 4NIHR Moorfields
Biomedical Research Centre, London, United Kingdom.
Purpose: Health utility values suitable for calculating qualityadjusted life years (QALYs) are increasingly used to assess the cost
effectiveness of treatments for age-related macular degeneration
(AMD). Health care decision makers disagree whether to use
members of the public or patients to provide utilities. The public offer
an unbiased view of health states, unaffected by the condition they
are valuing, whereas patients are likely to have a greater
understanding of the condition and its effects on quality of life. Our
aim was to test if utility values for health states associated with AMD
elicited directly from patients were different from those calculated
from public tariffs for health-related quality of life (HRQoL)
questionnaires.
Methods: Generic preference-based HRQoL questionnaires (EQ-5D
and SF-6D) and the time trade-off (TTO) and visual analogue scale
(VAS) valuation techniques were administered to a sample of UK
patients with AMD (N=60, visual acuities: 0.3 to 1.3 logMAR).
Health utilities were calculated using standard general population
tariffs for the patient EQ-5D and SF-6D health states and directly
from patient TTO and VAS scores.
Results: Mean utilities derived from the public tariffs were 0.613
(SD=0.275) for the EQ-5D and 0.628 (SD=0.114) for the SF-6D.
Mean utilities elicited from patients were 0.481 (SD=0.411) for the
TTO and 0.567 (SD=0.218) for the VAS. Repeated measures analysis
of variance (ANOVA) identified a significant difference between the
four utility measures (p<0.01). Paired t-tests found no significant
difference between the two public-derived utilities (EQ-5D and
SF6D). Differences between the EQ-5D and patient-derived utilities
(TTO and VAS) were both significant (p<0.05). Visual acuity (VA)
in the better-seeing eye was not associated with any utility measure.
The VAS was the measure best predicted by VA: R-squared=0.06,
p>0.2.
Conclusions: Patient and public preferences for health states
associated with AMD are different, with patients valuing their health
state more severely than the public tariffs of commonly used HRQoL
questionnaires. VA did not predict health utility using any measure
and therefore care should be taken when using VA as a surrogate
measure for utility in health economic analyses.
Commercial Relationships: Thomas Butt, None; Hannah M.
Dunbar, None; Steve Morris, None; Shepley Orr, None; Gary S.
Rubin, None
Support: Crucible Centre for Lifelong Health and Wellbeing
Program Number: 4420 Poster Board Number: D0058
Presentation Time: 8:30 AM - 10:15 AM
Provision of Mass Drug Administration for Trachoma Control:
Cost per gain in coverage
Sheila K. West1, Harran A. Mkocha2, Beatriz E. Munoz1, Kevin D.
Frick3. 1Ophthalmology, Johns Hopkins Wilmer Eye Inst, Baltimore,
MD; 2Kongwa Trachoma Project, Kongwa, United Republic of
Tanzania; 3Health Services Research Division, Johns Hopkins
University, Baltimore, MD.
Purpose: The World Health Organization recommends Mass Drug
Administration (MDA) when the prevalence of follicular trachoma in
children is ≥ 10%. The recommendation is coverage with antibiotic at
least at 80%. The costs to achieve this level of coverage is unknown.
Methods: MDA was provided to 48 communities as part of the
PRET trial in Kongwa, Tanzania. In the first four communities
detailed records were kept of all costs associated with the provision
of azithromycin, hiring and training of Community Drug Distributors,
drug distribution, and supervision. Data were collected on persons
treated over the days of the MDA. Azithromycin is donated so the
cost of the drug was not included. Topical tetracycline costs were
included. We calculated the cost per person treated, and additional
cost per days of MDA.
Results: Coverage of children in these communities was above 80%.
The cost per person treated was estimated as $0.22. The largest cost
drivers were supervision and transportation. Cost per unit of coverage
increases markedly after three days, from $3/1% increase to $35/1%
increase. Adding days beyond three days of MDA increases costs for
limited gains in coverage.
Conclusions: Costs per person treated, under a program where
Community Drug Distributors provide drug and are paid, are
reasonable and similar to other MDA programs.
Commercial Relationships: Sheila K. West, None; Harran A.
Mkocha, None; Beatriz E. Munoz, None; Kevin D. Frick, Center
for Applied Value Analysis (C), National Association for Eye and
Vision Research (C)
Support: Bill and Melinda Gates Foundation
Program Number: 4421 Poster Board Number: D0059
Presentation Time: 8:30 AM - 10:15 AM
Trachoma Control: A Potential Field Test for Ocular C.
Trachomatis Infection
Alexander Jenson1, 2, Laura Dize3, Harran A. Mkocha2, 1, Beatriz E.
Munoz1, 2, Jennifer S. Lee1, 2, Sheila K. West1, 2. 1Dana Center for
Preventative Opthamology, The Johns Hopkins University,
Baltimore, MD; 2Kongwa Trachoma Project, The Johns Hopkins
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
University, Kongwa, United Republic of Tanzania; 3Infectious
Disease, The Johns Hopkins University, Baltimore, MD.
Purpose: There has been an increasing demand for an inexpensive
field test for ocular C. trachomatis
(CT) detection in resource-limited settings. The purpose of our study
was to determine the sensitivity, specificity, and field utility of the
Cephied GeneXpert (CGX) CT/NG RUO test done in rural Tanzania
compared to the Roche Amplicor test done in a standard laboratory in
the US.
Methods: 144 children ages 0 to 9 in a trachoma-endemic
community in Kongwa Tanzania were surveyed to assess clinical
trachoma and have two ocular swabs taken from the same eye. Both
swabs were stored dry, one shipped to JHU and stored frozen, the
other stored frozen in Kongwa, Tanzania. With one freeze-thaw cycle
at both sites, the specimens at Johns Hopkins were reconstituted and
tested using Amplicor PCR test, where positivity was defined >0.8;
the specimens at Kongwa were reconstituted and tested using CGX,
where positivity was defined as a field value of 1. The sensitivity and
specificity of the new test against the commercial standard was
compared, as well as the field utility of CGX.
Results: Of the samples tested in the field, 127/144 (88%) yielded
results. Of the 12% of samples that could not be processed, half were
due to insufficient volume (likely the result of drying out during
reconstitution in the field) and the other half were electricity issues
and clogged machine. The prevalence of follicular trachoma was 44%
and of infection according to the Amplicor PCR was 29%. The
sensitivity of CGX was 100% and the specificity was 95% when
compared to Amplicor PCR as the “gold-standard”. CGX identified 5
more positives than Amplicor, and in four of those, the children had
either trachoma or another test for infection that was positive.
Conclusions: The sensitivity and specificity of the GeneXpert
CT/NG RUO assay, as done in the field in rural Tanzania, was
extremely good compared to Amplicor testing done at a reference
laboratory in the US. This is among the first PCR based test to show
these results in a field setting. Pending a cost analysis and evaluation
of pooling methods, it is a promising new testing method for
evaluating trachoma control in the field in resource limited
environment.
Commercial Relationships: Alexander Jenson, None; Laura Dize,
None; Harran A. Mkocha, None; Beatriz E. Munoz, None;
Jennifer S. Lee, None; Sheila K. West, None
Support: Bill and Melinda Gates Foundation, Research to Prevent
Blindness
Program Number: 4422 Poster Board Number: D0060
Presentation Time: 8:30 AM - 10:15 AM
Compliance with Eye Screening Guidelines among NewlyDiagnosed Diabetic Patients without Diabetic Retinopathy
David J. Lee1, Potyra Rosa2, William J. Feuer2, Byron L. Lam2, Joyce
C. Schiffman2, Naresh Kumar1, Alexis Morante2. 1Epidemiology &
Public Health, University of Miami, Miami, FL; 2Bascom Palmer Eye
Institute, University of Miami, Miami, FL.
Purpose: 1) To estimate compliance with annual eye screening
guidelines among patients with diabetes mellitus (DM), and 2) to
evaluate system-and individual-level factors associated compliance.
Methods: Utilizing computerized billing records we selected Bascom
Palmer Eye Institute patients who were initially seen with ICD-9
diagnoses of DM without complications and without diabetic
retinopathy (DR) or other eye disease. Medical records of patients
first seen in 2007-08 (n=248) were reviewed for demographic and
ocular variables, including all clinic visits through 2010. Compliance
was defined by follow-up exam frequency and permitted follow-up
intervals as large as 15 months to accommodate exam scheduling
challenges: (1) Never returned (2) non-compliant but seen within the
last 15 months (3) non-compliant and not seen within the last 15
months (4) fully compliant. We geocoded addresses of participants
using the Google API. Local Kriging, an optimal interpolation
method, assessed participants’ neighborhood socio-economic status
(SES) using 8 indicators from the 2000 US Census data. An effort
was made to survey by telephone patients who never returned.
Results: 203 (82%) medical records were available for review with
only three patients excluded given evidence of a DR diagnosis. The N
(%) of patients in the four compliance groups were: 108 (54%), 30
(15%), 37 (19%), and 25 (12%), respectively. Compliance was not
significantly associated with gender, type of insurance, or years since
DM diagnosis (p>0.1). Fully compliant patients were more likely to
be younger (p=0.036) and African American patients were more
likely to return for follow-up exams than Hispanic or non-Hispanic
White patients (p=0.038). None of the neighborhood SES variables
studied differentiated patients by compliance group (all p>0.1). 69
(66%) of patients not returning for follow-up were telephoned but
only 8 could be contacted for the survey, a sample size too small
from which to draw inferences.
Conclusions: Less than 15% of patients in our study were fully
compliant with exam guidelines and >50% never returned for a
follow-up exam. Compliance was associated with both age and
ethnicity; however, these relationships were not explained by SES
variables.
Commercial Relationships: David J. Lee, None; Potyra Rosa,
None; William J. Feuer, Abbott Medical optics (F), New World
Medical (F); Byron L. Lam, None; Joyce C. Schiffman, None;
Naresh Kumar, None; Alexis Morante, None
Support: CDC Grant 1U58DP002652-01
Program Number: 4423 Poster Board Number: D0061
Presentation Time: 8:30 AM - 10:15 AM
Methods of Assessing Provider Performance for Quality
Improvement
Paul P. Lee1, Gerald McGwin2, Sanjay Asrani1, William Rafferty1,
David Lobach1, Kathy Kimrey1. 1Ophthalmology and Visual
Sciences, University of Michigan, Ann Arbor, MI; 2University of
Alabama - Birmingham, Birmingham, AL.
Purpose: To compare the results of alternative methods of measuring
provider performance in the care of patients with open-angle
glaucoma (OAG). While chart abstraction is the current gold
standard, the expense and need for training limit its utility. We
investigated the ability of case vignettes to provide similar
information about performance of key examination steps by
optometrists enrolled in an ongoing clinical trial.
Methods: Community-based optometrists who agreed to participate
in a trial assessing the effectiveness of electronic methods to improve
the quality of glaucoma care completed a baseline survey that
included case vignettes. Self-report of examination steps captured in
an open-ended response format in the survey was compared to the
results of chart abstractions for patients cared for by these providers
prior to the initiation of any interventions. We report a comparison of
the results for gonioscopy, a critical step in the care of patients with
OAG and one that is known to be underperformed by all eye care
providers..
Results: Depending on the criteria used to determine if gonioscopy
would be performed, 83 to 93% of respondents reported that they
would typically include gonioscopy in their new patient evaluation of
open-angle glaucoma. Chart abstractions from the patients of
participating providers indicated that gonioscopy could be found on
average in less than 2% of charts (SD of 4%) among those who did
not indicate they performed routine gonioscopy, compared to 11%
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
(SD of 14%) among those that indicated they would do routinely
perform gonioscopy.
Conclusions: Open-ended clinical vignette responses have been
found to be reliable relative to chart abstractions in general medicine.
For the performance of gonioscopy by optometrists, self-reported
performance is associated with a greater likelihood of actual
documentation in patient charts but not with the absolute level of
performance. However, while potentially usable as a relative
indicator, self-reported responses on vignettes may not be helpful for
quantitative assessment. Additional analyses are under way for
additional elements of the history and exam elements for OAG
patients.
Commercial Relationships: Paul P. Lee, Genentech (C), University
of Michigan (E), Duke University (E), Pfizer (C), Pfizer (I), Glaxo
(I), Merck (I), Allergan (C), Duke University (P); Gerald McGwin,
None; Sanjay Asrani, None; William Rafferty, None; David
Lobach, None; Kathy Kimrey, None
Support: NEI EY 018405
Clinical Trial: NCT00672048
Program Number: 4424 Poster Board Number: D0062
Presentation Time: 8:30 AM - 10:15 AM
Electronic health record (EHR) systems in ophthalmology:
Impact on clinical documentation
David S. Sanders1, Daniel Lattin1, Daniel C. Tu1, 2, Sarah ReadBrown1, David J. Wilson1, Thomas S. Hwang1, John C. Morrison1,
Thomas R. Yackel3, Michael F. Chiang1, 3. 1Ophthalmology, Oregon
Health & Science University, Portland, OR; 2Ophthalmology
Operative Care Division, Portland VA Medical Center, Portland, OR;
3
Medical Informatics and Clinical Epidemiology, Oregon Health &
Science University, Portland, OR.
Purpose: To evaluate quantitative and qualitative differences in
ophthalmology documentation between paper and electronic health
record (EHR) systems.
Methods: An academic ophthalmology department implemented an
EHR (EpiCare; Epic, Madison, WI) in 2006. Database queries were
performed to identify cases in which the same provider documented
the same problems on different dates, using paper vs. EHR methods.
A total of 150 consecutive pairs of matched paper and EHR notes
were documented by 3 attending ophthalmologist providers. 50
consecutive pairs of exams were examined in 3 different diseases:
age-related macular degeneration (AMD), glaucoma, and pigmented
choroidal lesions (PCL). Quantitative measures were used to compare
completeness of documenting the complete ophthalmological exam,
as well as disease-specific critical findings using paper vs. EHR.
“Documentation score,” was defined as the number of exam elements
recorded for the slit lamp exam, fundus exam, complete
ophthalmological exam, and critical clinical findings for each disease.
Qualitative differences in paper vs. EHR documentation were
illustrated by selecting representative paired examples.
Results: For all 3 diseases (AMD, glaucoma, PCL), the number of
complete examination findings recorded was significantly lower with
paper as opposed to EHR (p≤0.004). Among the 3 individual
examination sections (general, slit lamp, fundus) for the 3 diseases, 7
of the 9 possible combinations had lower mean documentation scores
with paper than EHR notes. For 2 of the 3 diseases, the number of
critical clinical findings recorded was significantly lower using paper
than EHR notes (p≤0.022). All (150/150) paper notes relied on
graphical representations using annotated hand-drawn sketches,
whereas no (0/150) EHR notes contained drawings. Instead, EHRs
documented clinical findings using textual descriptions and
interpretations.
Conclusions: There are fundamental quantitative and qualitative
differences in the nature of paper vs. EHR documentation of
ophthalmic findings. Additional studies examining the impact of
EHRs on improving efficiency, safety, and quality of ophthalmic care
will be required.
Commercial Relationships: David S. Sanders, Supported by
unrestricted departmental funding by Research to Prevent Blindness
(New York, NY) (F); Daniel Lattin, None; Daniel C. Tu, Research
to Prevent Blindness (F); Sarah Read-Brown, None; David J.
Wilson, None; Thomas S. Hwang, None; John C. Morrison, None;
Thomas R. Yackel, None; Michael F. Chiang, Clarity Medical
Systems (unpaid member of Scientific Advisory Board) (S)
Support: Supported by unrestricted departmental funding from
Research to Prevent Blindness (New York, NY).
Program Number: 4425 Poster Board Number: D0063
Presentation Time: 8:30 AM - 10:15 AM
Ophthalmologists’ Attitudes on Implementing an Electronic
Health Record System
Monica M. Michelotti1, Jennifer Weizer1, Taylor S. Blachley1, Kai
Zheng2, Mick Couper3, Grant Greenberg4, Sharon Kileny5, Greta
Branford6, David A. Hanauer5. 1Ophthalmology, University of
Michigan, Ann Arbor, MI; 2School of Public Health, University of
Michigan, Ann Arbor, MI; 3Institute for Social Research, University
of Michigan, Ann Arbor, MI; 4Family Medicine, University of
Michigan, Ann Arbor, MI; 5Pediatrics, University of Michigan, Ann
Arbor, MI; 6Internal Medicine, University of Michigan, Ann Arbor,
MI.
Purpose: The practice of ophthalmology has documentation
requirements that differ from other medical fields. Many health
systems are adopting electronic health records (EHR) systems
designed for general or subspecialty medicine or surgery that are not
highly tailored for ophthalmology. As most practices will soon be
required to use EHRs in the United States to meet meaningful use
objectives, thousands of ophthalmologists will need to change their
documentation process. The goal of this initiative was to determine
the attitudes of ophthalmologists at a large academic institution
before and after the implementation of a popular commercial EHR
system.
Methods: A prospective survey was sent to 59 faculty
ophthalmologists one month prior to implementing a new EHR
system at the University of Michigan. The ophthalmologists were
transitioning from primarily paper charting. The survey asked 29
questions focused on satisfaction with the prior system, training
experience, practice style, and expectations about the new EHR.
Three months after implementation, a follow-up survey was sent to
all participants. The findings from both surveys were compared using
Fisher exact tests.
Results: 32 of 59 ophthalmologists (54%) completed the preimplementation survey compared to 28 of 59 (47%) postimplementation. Job satisfaction scores (p=0.0022) and time spent
completing charts in the evening (p=0.0072) were significantly
different, with fewer physicians satisfied and more physicians
charting in the evening post-implementation. Comparing prior paper
charting with EHRs, ophthalmologists as a group reported no
significant differences in: their ability to create high quality
documentation, interact with patients in a meaningful way, or
document information in a timely fashion. EHR implementation did
not significantly affect ophthalmologists’ perception of efficiency
and workflow. Fifty percent of respondents expressed at least some
degree of concern about the EHR system both prior to and after
implementation. Overall more ophthalmologists preferred to keep the
EHR instead of returning to paper charting.
Conclusions: As ophthalmology practices rapidly transition to EHRs,
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
tailoring the EHR programs to best fit their needs, and measuring the
impact these systems have on quality of care and user satisfaction,
will become even more crucial.
Commercial Relationships: Monica M. Michelotti, None; Jennifer
Weizer, None; Taylor S. Blachley, None; Kai Zheng, None; Mick
Couper, None; Grant Greenberg, None; Sharon Kileny, None;
Greta Branford, None; David A. Hanauer, None
Program Number: 4426 Poster Board Number: D0064
Presentation Time: 8:30 AM - 10:15 AM
Implementation of electronic health record systems in
ophthalmology: impact on clinical volume compared to other
medical fields
Travis Redd1, Sarah Read-Brown1, Anne Kitzmiller1, Thomas R.
Yackel2, Dongseok Choi3, Michael F. Chiang2. 1Ophthalmology,
Casey Eye Institute, Oregon Health & Science University, Portland,
OR; 2Ophthalmology & Medical Informatics, Casey Eye Institute,
Oregon Health & Science University, Portland, OR; 3Public Health &
Preventive Medicine, Oregon Health & Science University, Portland,
OR.
Purpose: Electronic health records (EHRs) have the potential to
improve efficiency and quality of ophthalmic care. However,
concerns have been raised about a possible negative impact on patient
volume in ophthalmology due to unique documentation requirements,
high clinical volume, and relatively limited attention from vendors.
This study aims to compare the impact of EHR implementation on
patient volume in ophthalmology to 7 other specialty and primary
care fields (orthopedics, dermatology, hematologic malignancies,
hematology/oncology, cardiology, family medicine, and pediatrics).
Methods: An institution-wide EHR system (Epic; Madison, WI) was
implemented at Oregon Health & Science University from 20062008. Stable clinical providers were identified from among the 8
departments listed above, and quarterly patient volume recorded for
each via query of the EHR system. Data for each department was
collected from 9 months before to 36 months after EHR
implementation. Provider characteristics were recorded, including
gender, age, department, and patient volume. Descriptive statistics
and paired t-tests were used to evaluate the data.
Results: 86 stable providers were identified, including 23 from
ophthalmology and 4-12 from each of the other departments.
Ophthalmology showed a small non-significant decrease in volume
(Table 1) following implementation (range: 93-97% of baseline, p
0.52-0.81). The 5 other specialties combined experienced an increase
in volume (surgical group range: 107-124%; medical group range:
110-121%). This change was significant only for dermatology (p
0.03), hematology/oncology (p 0.04-0.27), and cardiology (p 0.010.02). Primary care departments trended toward decreased volume
(range: 88-90%, p 0.18-0.28). Provider characteristics associated with
increased volume included low pre-implementation clinical volume
(p 0.04-0.12), female gender (p 0.21-0.57), and younger age (p 0.120.60, Table 1).
Conclusions: At this medical center, EHR implementation did not
have a significant negative impact on clinical volume in
ophthalmology. In comparison, other specialty fields had
significantly increased volume, while primary care fields trended
toward decreased volume. This suggests that EHR may not have a
negative impact on volume in ophthalmology or other specialty
fields, but further research is needed to determine the generalizability
of these findings.
Commercial Relationships: Travis Redd, None; Sarah ReadBrown, None; Anne Kitzmiller, None; Thomas R. Yackel, None;
Dongseok Choi, None; Michael F. Chiang, Clarity Medical Systems
(unpaid member of Scientific Advisory Board) (S)
Support: Supported by unrestricted departmental funding from
Research to Prevent Blindness (New York, NY). Also supported by
NIH grant EY010572.
Program Number: 4427 Poster Board Number: D0065
Presentation Time: 8:30 AM - 10:15 AM
Physician and patient perceptions of electronic health record
(EHR) use in a tertiary care ophthalmologic clinic
Patrick Chan, Rishi Singh, Suzanne Charvat. Cole Eye Institute,
Cleveland Clinic, Cleveland, OH.
Purpose: To evaluate physician and patient perception of electronic
health record use in a tertiary care ophthalmology clinic.
Methods: A custom development of a commercial EHR was
implemented at a tertiary care ophthalmology clinic. All physicians
included in this study had trained originally using paper
documentation. Both physicians and patients were exposed to this
system for at least 6 months. Surveys relating to clinic efficiency and
patient satisfaction were distributed to physicians and patients.
Survey items were scored using a 5-point Likert scale (1=strongly
disagree, 3=neutral, 5=strongly agree).
Results: A total of 25 physician surveys were completed. All
physicians reported that they used computers outside of the
workplace, and the majority felt that the EHR improved their ability
to document and review exam findings and order ancillary tests. They
did not feel strongly whether their ability to communicate with
patients was affected by the EHR (Score=3). Physicians overall felt
that they spent less time talking to patients with EHR use and would
rather use paper charting. Eleven physicians (44%) reported being
able to complete charts consistently by the end of clinic. Six
physicians (24%) reported spending less than 1 hour, while 8 (32%)
reported spending more than 1 hour after clinic completing charts.
Of the 49 patient surveys obtained, 38 (78%) strongly felt that they
were still able to communicate well with their physicians after EHR
implementation, and 46 (94%) were comfortable (Score >=4) with
having their records stored electronically. The majority of patients
reported that they their physicians were able to maintain eye contact
while using the EHR, also overall preferred EHR use over paper
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
charting.
Conclusions: Physician satisfaction with EHR use is mixed, although
patient perception of EHR use has been mostly positive.
Commercial Relationships: Patrick Chan, None; Rishi Singh,
Genentech (C), Alcon (C), Bausch and Lomb (R), Zeiss (R), Quark
Pharmaceuticals, Inc. (F); Suzanne Charvat, None
Program Number: 4428 Poster Board Number: D0066
Presentation Time: 8:30 AM - 10:15 AM
Critical Review of High Quality Ophthalmology Educational
Web Resources Targeting Trainees
Milad Modabber1, Sourabh Arora2, Karim F. Damji3, Feisal Adatia4.
1
Medicine, McMaster University, Hamilton, ON, Canada;
2
Ophthalmology, University of Alberta, Edmonton, AB, Canada;
3
Ophthalmology, University of Alberta, Edmonton, AB, Canada;
4
Ophthalmology, University of Calgary, Edmonton, AB, Canada.
Purpose: To identify, quantitatively evaluate, and to rank web-based
educational resources in ophthalmology to facilitate improved
selection by trainees.
Methods: A systemic search of scientific databases (PubMed,
EMBASE) was conducted to identify academic and non-academic
educational ophthalmology websites intended for medical students
and trainees. Quantitative evaluation was performed using the
validated Quality Component Scoring system (QCS), assessing for:
ownership, purpose, authorship qualification, attribution, interactivity
and currency. The Technical Component Score System (TCS),
assessing for clinical content parameters was also utilized. T-test and
ANOVA were conducted to compare scores on the basis of the
various teaching modalities, general vs. subspecialty focus, and the
level of expertise.
Results: A total of 33 websites were included for analysis. The mean
score from was 9.6 ± 1.7 (maximum possible score (MPS): 13); while
for TCS it was 10.6 ± 6.6 (MPS: 20), with a mean combined score of
20.2 ± 6.7 (MPS: 33). The dominant teaching styles used were
text/lecture-based (39%), video/multimedia (24%), case-based (21%),
research articles (12%), and quiz-based (3%). However, 42% of the
websites utilized multiple teaching modalities. The website formats
that yielded the highest combined scores were: text-based (22 ± 7)
and case-based (22 ± 6), while quiz-based was the lowest (9 ± 0.1).
The mean TCS for resources targeting residents/fellows (9.2 ± 6.7,
n=25) was significantly lower than websites intended for medical
students/allied health professionals (15.0 ± 3.5, n=8; p= 0.004). The
same trend was observed with total combined scores (19.1 ± 7.0,
n=25 vs. 23.6 ± 4.7, n=8) respectively (p=0.05). The mean combined
score for general ophthalmology (20.5 ± 7.2, n=24) versus
subspecialty websites (19.6 ± 5.5, n=9) was not significantly different
(p=0.71).
Conclusions: This study has provided a quality-ranked listing of
online learning resources, stratified by the learning modality, general
ophthalmology vs. subspecialty, and the audience’s assumed level of
training. This will allow trainees to access websites most suited to
their specific needs and learning styles. Hence, the quality of current
and future ophthalmological resources can be enhanced through
consideration of the QCS and TCS parameters.
Figure 1. Assessment of (A) QCS and (B) TCS for ophthalmology
website content targeting trainees
Commercial Relationships: Milad Modabber, None; Sourabh
Arora, None; Karim F. Damji, None; Feisal Adatia, None
422 Ocular Trauma
Wednesday, May 08, 2013 8:30 AM-10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 4429-4441/D0114-D0126
Organizing Section: Clinical/Epidemiologic Research
Program Number: 4429 Poster Board Number: D0114
Presentation Time: 8:30 AM - 10:15 AM
Characteristics of eyelid laceration due to dog bite in children
MOHAMMAD ALI SADIQ1, 2, Iason Mantagos1, 2. 1Department of
Ophthalmology, Boston Children's Hospital, Boston, MA;
2
Ophthalmology, Harvard Medical School, Boston, MA.
Purpose: Studies have shown that eyelid lacerations due to dog bites
are often associated with trauma to the lacrimal apparatus. This is the
largest retrospective review of eyelid lacerations from dog bites in
children.
Methods: This is a retrospective chart review from 1992 until 2012
of patients treated at our institution for eyelid lacerations secondary
to dog bites. 73 patients that had sustained eyelid lacerations due to
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
dog bites were identified. As a control group we randomly selected
365 patients that had sustained eyelid lacerations from other causes
during the same period.
Results: 28 of the 73 (39%) patients that had sustained an eyelid
laceration due to a dog bite also had damage to the lacrimal
apparatus. Statistically this was significantly higher than patients who
sustained an eyelid laceration due to other causes. Of the 28 patients
with lacrimal apparatus trauma due to a dog bite 21 had involvement
of the lower canaliculus, 5 of the upper canaliculus, 1 of both the
upper and the lower canaliculi, and 1 had only trauma to the
nasolacrimal sac.
Conclusions: Eyelid lacerations secondary to dog bites in children
are associated with damage to the lacrimal apparatus, with the lower
canaliculus more often involved than the upper. This is thought to be
from canine teeth tearing and avulsing the canaliculus as the eyelid is
stretched. Clinicians should have a high index of suspicion for
canalicular involvement in eyelid lacerations due to dog bites.
Commercial Relationships: MOHAMMAD ALI SADIQ, None;
Iason Mantagos, None
Program Number: 4430 Poster Board Number: D0115
Presentation Time: 8:30 AM - 10:15 AM
Demographic and Clinical Profile of Ocular Chemical Injuries in
Children
Pooja Bandivadekar, Himanshu Shekhar, Namrata Sharma, Rasik B.
Vajpayee. Dr.rajendra prasad Centre, AIIMS, New Delhi, India.
Purpose: To review the pattern, risk factors, and visual outcomes of
pediatric chemical eye injuries.
Methods: Retrospective study of pediatric patients with ocular burns
over a 5-year period at a tertiary eye center.
Results: Of the 134 children, the majority were male (63.3%). The
mean age at time of injury was 8.95 ± 4.89 years. Severe ocular burns
(grade 4 to 6) were seen in 70% of children, with bilateral
involvement seen in 18% of the cases. The majority of these were
caused by lime kept at home for use as an additive by an adult
tobacco chewer. Surgical intervention was required in 85% of eyes.
Overall visual outcome was poor, and median visual acuity at final
follow-up (mean: 537 ± 354 days) was 3/60.
Conclusions: Conclusion: Tobacco chewing in adults poses a major
ocular health hazard for children resulting in significant ocular
morbidity.
Commercial Relationships: Pooja Bandivadekar, None;
Himanshu Shekhar, None; Namrata Sharma, None; Rasik B.
Vajpayee, None
Program Number: 4431 Poster Board Number: D0116
Presentation Time: 8:30 AM - 10:15 AM
Motor Vehicle Crash-Associated Eye Injuries Presenting to
United States Emergency Departments
Grayson W. Armstrong1, 2, Allison J. Chen1, 3, James G. Linakis4, 5,
Michael J. Mello2, 5, Paul B. Greenberg1, 6. 1Division of
Ophthalmology, Warren Alpert Med Sch of Brown Univ, Providence,
RI; 2Department of Community Health, Warren Alpert Medical
School of Brown University, Providence, RI; 3Program in Liberal
Medical Education, Brown University, Providence, RI; 4Department
of Pediatrics, Warren Alpert Medical School of Brown University,
Providence, RI; 5Department of Emergency Medicine, Warren Alpert
Medical School of Brown University, Providence, RI; 6Section of
Ophthalmology, Providence VA Medical Center, Providence, RI.
Purpose: To evaluate occupant characteristics and risk factors
associated with motor vehicle crash (MVC)-related eye injuries
presenting to United States (US) emergency departments (EDs).
Methods: Retrospective cross-sectional study utilizing the National
Electronic Injury Surveillance System All Injury Program (NEISSAIP) from 2001 to 2008 to assess the risk of presenting to an ED with
a MVC-associated eye injury in relation to specific occupant
characteristics, including age, gender, race/ethnicity, disposition, and
occupant (driver/passenger) status.
Results: From 2001 to 2008, an estimated 75,028 MVC-associated
eye injuries presented to US EDs. The annual rate of ED-treated eye
injuries resulting from MVCs declined during this study period.
Males accounted for 59.6% of eye injuries (95% confidence interval
[CI] 56.2%-63.0%). Rates of eye injury were highest among 15-19
year olds (5.8/10,000 people; CI 4.3-6.0/10,000) and among African
Americans (4.5/10,000 people; CI 2.0-7.1/10,000), while the lowest
rates occurred among 0-4 year olds (0.8/10,000 people; CI 0.41.2/10,000) and >65 years olds (1.0/10,000 people; CI 0.71.3/10,000). Drivers of motor vehicles accounted for 62.2% (CI
58.3%-66.1%) of ED-treated MVC eye injuries when occupant status
was known. Contusion/Abrasion was the most common diagnosis
(61.5%; CI 56.5%-66.4%). Among licensed US drivers, 16-24 year
olds had the highest risk (3.7/10,000 licensed drivers; CI 2.64.8/10,000).
Conclusions: This study reports a recent decline in the annual
incidence of ED-treated MVC-associated eye injuries. The risk of
MVC eye injury is greatest among males, 15 to 19 year olds, and
African Americans, and is lowest among the elderly and 0 to 4 year
olds.
Commercial Relationships: Grayson W. Armstrong, None;
Allison J. Chen, None; James G. Linakis, None; Michael J. Mello,
None; Paul B. Greenberg, None
Program Number: 4432 Poster Board Number: D0117
Presentation Time: 8:30 AM - 10:15 AM
A Ten Year Review of Open Globe Trauma in Elderly Patients at
an Urban Hospital
Iris Y. Sheng, Alain M. Bauza, Paul D. Langer, Marco A. Zarbin,
Neelakshi Bhagat. IOVS, New Jersey Medical School, Newark, NJ.
Purpose: To evaluate the demographics, characteristics, and
outcomes of open globe injuries (OGI) in elderly patients.
Methods: Retrospective chart review
Results: Of the 90 cases, 36 (40 %) were male. The average age was
80.0 years (SD 8.23; range of 65-96 years). The types of OGIs
included rupture (83.3%) and penetrating (16.7%) injuries. The
causes of trauma were falls (64.4 %), accidental trauma (20%), motor
vehicle accidents (5.5%) and assault (3.33%). Of these 90 eyes, 35
(38.9%) were in OTS category of 1, 15 (16.7%) in OTS category of 2
and 2 (2.22%) in OTS category of 3. The majority of lacerations were
corneal (44.4%), followed by corneoscleral (26.7%), and then scleral
(28.9%). Forty- one (45.6%) cases presented with pseudophakia, 26
(28.9%) with aphakia and 21 (23.3%) with phakic lens. Forty cases
were OGIs with dehiscence of previous ocular surgical wounds. Ten
eyes had concurrent orbital fractures. All cases underwent primary
OGI repair within 24 hours of admission. Sixty-five (72.2%) patients
spent 1-5 days in the hospital and 15 (16.7%) patients spent 6-10
days. The average visual acuity, in logMAR, at presentation was 2.37
(SD .638); at 3 months was 2.07 (SD .760), at 6 months was 2.04 (SD
.890), and at 1 year was 1.66 (SD .997). While 22 patients presented
with no light perception (NLP), only 10 remained NLP after OGI
repair. Complications at presentation included: uveal prolapse (70%),
hyphema (66.7%), chemosis (20%), hemorrhagic choroidals (37.8%),
vitreous hemorrhage (VH) (51.1%), and retinal detatchment (RD)
(20%) and afferent pupillary defect (42.2%). Four patients (4.44%)
underwent primary pars plana vitrectomy (PPV) for RD and VH and
1 (1.11%) patient underwent primary PPV for endophthalmitis.
Overall, retinal attachment was achieved in 3 of 5 eyes (60%) that
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
underwent primary PPV. Secondary PPV was performed in 16 eyes:
14 for RD, 1 for suspicious RD and 1 for dislocated IOL. Retinal
attachment was achieved in 13 of 16 eyes that underwent secondary
PPV (81.3%). Primary enucleations were performed in 4 (4.44%)
cases for non- salvageable, NLP eyes. Thirty-one patients underwent
reoperations, which included 9 secondary enucleations.
Conclusions: The visual prognosis in open globe injury in elderly
population is poor; only 14.4 % achieved 20/200 or better VA.
Precautionary measures should be taken to prevent falls in the elderly
population.
Commercial Relationships: Iris Y. Sheng, None; Alain M. Bauza,
None; Paul D. Langer, None; Marco A. Zarbin, Iridex (C),
Novartis (C), Pfizer (C), Calhoun Vision (C), Imagen Biotech (C),
UMDNJ (P); Neelakshi Bhagat, None
Support: in part by Research to Prevent Blindness, Inc., and The
Lions Eye Research Foundation of New Jersey
Program Number: 4433 Poster Board Number: D0118
Presentation Time: 8:30 AM - 10:15 AM
Clinical outcomes of surgically-treated trapdoor fractures in the
pediatric population
Kathleen C. Oktavec, Shannath L. Merbs, Michael Grant. Division of
Oculoplastics, The Wilmer Eye Institute, Baltimore, MD.
Purpose: A trap-door orbital floor fracture, in which an extraocular
muscle is incarcerated in a small defect in the orbital floor, is an often
cited indication for acute repair. Previous studies have indicated that
rapid identification and early repair of this type of fracture is
associated with a better outcome. In order to learn more about the
prevalence and outcomes associated with inferior rectus entrapment,
we have reviewed our experience with pediatric trapdoor fractures.
Methods: Retrospective chart review of 205 pediatric patients with
an orbital fracture surgically treated in the Division of Oculoplastics,
Wilmer Eye Institute from January 1991 through December 2011.
Forty-eight of the 205 patients treated during this period were found
to have trapdoor floor fracture with incarceration of the inferior
rectus muscle utilizing the following inclusion criteria: 1) Attending
note stating the patient had a history and exam consistent with a
trapdoor fracture 2) a CT scan demonstrating a trapdoor fracture 3)
an operative note stating forced ductions were positive and the
muscle was seen to be incarcerated. Clinical outcomes were
compared between groups using contingency tables and Fisher’s
exact tests.
Results: The median age at time of injury was 13.7 years. 79% of
patients were male; 58% were Caucasian. The most common
mechanism of injury was sports-related (42%), and 10 patients had
associated anterior (microhyphema) and/or posterior (commotio
retinae) ocular injuries. The median duration of injury to surgical
repair was less than one day (0 to 27 days). The most common
presenting symptom was double vision (87%), followed by pain with
attempted eye movement (71%) and nausea/vomiting (69%). Over a
median follow up of 4 months (0.8 to 139.6), no patient needed
additional surgical treatment. 7 of the 48 patients had residual
strabismus at last follow up, all of whom had surgery > 4 days
following injury.
Conclusions: Our data suggest that early surgical intervention of
pediatric trapdoor floor fractures leads to a better clinical outcome,
and that injury to the muscle continues until the inferior rectus
muscle is released.
Commercial Relationships: Kathleen C. Oktavec, None;
Shannath L. Merbs, None; Michael Grant, Stryker CMF (C),
Synthes CMF (C)
Program Number: 4434 Poster Board Number: D0119
Presentation Time: 8:30 AM - 10:15 AM
Severe Ocular Trauma In The Emergency Room
Albert Lin, Cassie Confait, Suzanne T. Hoadley, Madiha Ahmad,
Ching J. Chen. Ophthalmology, Univ of Mississippi Med Center,
Jackson, MS.
Purpose: To assess the nature, severity, and mechanisms of severe
ocular trauma in the emergency room at an academic teaching
hospital.
Methods: Individual patient records involving ocular trauma in the
emergency room were reviewed as a retrospective case review series.
Severe intraocular trauma in this study was defined as any injury that
required intraocular surgery immediately or in the future, any
traumatic optic neuropathy, or total destruction of the eye. Injuries
were classified per the Birmingham Eye Trauma Terminology.
Results: Of 519 patients in 2010 seen in the emergency room for
ocular trauma, 52 patients (10%) had severe intraocular trauma as
defined previously. Of these 52 patients, contusions (n=17) were the
most common traumatic injury, followed closely by penetrating
lacerations (n=16) and ruptures (n=16). Other injuries included
perforating lacerations (n=1), traumatic optic neuropathy (n=1), and
complete destruction of the eye (n=1). In addition, 33 of these 52
patients (63.5%) were considered to have a full-thickness open
eyewall globe injury. Of these full-thickness open eyelid wall
injuries, 11 patients had confirmed physical assault, 4 fell, 2 suffered
firearm injury (either accidental or intentional), 3 were involved in a
motor vehicle crash, and the rest (13) suffered some type of
workplace or outdoor environmental injury that did not fall into the
etiologies above.
Conclusions: The most common types of severe intraocular traumas
seen in the emergency room were contusions, penetrating lacerations,
and ruptures, making up 94.2% of severe ocular traumas. Penetrating
lacerations (48.5%) and ruptures (48.5%) were the most common
types of full-thickness open eyewall injuries with a variety of
etiologies, with physical assault and workplace or outdoor
environmental injury being the most common. Characterizing the
most common types and etiologies of these injuries will not only help
with medical education and treatment regarding these injuries, but
also help assist in ways to address these injuries from a public health
viewpoint.
Commercial Relationships: Albert Lin, None; Cassie Confait,
None; Suzanne T. Hoadley, None; Madiha Ahmad, None; Ching
J. Chen, None
Program Number: 4435 Poster Board Number: D0120
Presentation Time: 8:30 AM - 10:15 AM
Outcomes and characteristics of open-globe injuries with delayed
presentation
Danielle Trief1, 2, Michael T. Andreoli3, Ankoor S. Shah1, 2, Yoshihiro
Yonekawa1, 2, Christopher M. Andreoli1, 4. 1Ophthalmology, Mass
Eye and Ear Infirmary, Boston, MA; 2Ophthalmology, Boston
Children's Hospital, Boston, MA; 3Ophthalmology, University of
Illinois College of Medicine at Chicago, Chicago, IL;
4
Ophthalmology, Harvard Vanguard Medical Associates, Boston,
MA.
Purpose: Open-globe injury (OGI) is a devastating trauma to the eye.
Unfortunately, patients with OGI are sometimes unaware of the
damage to their eye or these injuries are missed on initial ophthalmic
assessment. This study describes outcomes and characteristics of
patients with delayed presentation of OGI and compares them to
patients who presented early.
Methods: Consecutive patients treated for OGI at Massachusetts Eye
and Ear Infirmary (MEEI) between January 1, 2000 and April 6,
2009 were reviewed. Cases where the date of injury was unknown
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
were excluded. Patients were divided into an “early group,“ defined
as patients who presented within one calendar day of injury, and a
“late group,” defined as patients who presented two or more calendar
days after injury. These groups were subsequently analyzed for
baseline characteristics such as age, gender, visual acuity, zone of
injury, and extent of anterior and posterior injury, and for final visual
outcomes.
Results: 823 OGIs were treated at MEEI, and 3 patients were
excluded for unknown date of injury. Of the 820 OGIs reviewed, 58
were late presenters. The mean age was similar between the two
groups (42.0 and 42.8 years in the early and late presenters,
respectively). Both early and late presenters had a higher proportion
of men compared to women (78.9% men in the early and 77.6% men
in the late group). Late presenters were more likely to have better
acuity on presentation (Median 20/250) compared to early presenters
(Median Hand Motions) (P = 0.0028). Late presenters were less
likely to have a zone 3 injury (9.3% compared to 31.3%, P < 0.0001)
or hyphema (P = 0.0308) than early presenters. However, the late
presentation patients were no less likely to be complicated by
vitreous hemorrhage (P = 0.0550), choroidal detachment (P = 1.000),
retinal detachment (P = 0.1863), or retinal hemorrhage (P = 1.000).
The late presenters were more likely to have better post-operative
best visual acuities (median of 20/30 compared to 20/50 for the early
presenters, P = 0.0328). There were no cases of endophthalmitis
among the late presenters.
Conclusions: Patients with late presentation of OGI had better visual
acuity and were less likely to have a posterior location of injury. In
the setting of trauma, one must always consider the possibility of an
OGI, even when the visual acuity is good, and the exam findings are
subtle.
Commercial Relationships: Danielle Trief, None; Michael T.
Andreoli, None; Ankoor S. Shah, None; Yoshihiro Yonekawa,
None; Christopher M. Andreoli, None
Program Number: 4436 Poster Board Number: D0121
Presentation Time: 8:30 AM - 10:15 AM
Correlation of Ocular Trauma Score and visual acuity outcomes
in combat-related traumatic cataracts
Michael P. Smith, Marcus Colyer, David L. Greenburg.
Ophthalmology, Walter Reed Nt'l Military Med Ctr, Bethesda, MD.
Purpose: To determine if ocular trauma scores are predictive of
visual outcomes in eyes sustaining traumatic cataracts as a result of
combat-associated ocular trauma.
Methods: A retrospective comparative case series of United States
military personnel treated at Walter Reed Army Medical Center who
sustained traumatic cataracts from combat ocular trauma from March
2003 to December 2010. Ocular trauma scores (OTS) were calculated
and eyes were grouped according to OTS classifications. Eye injuries
were described according to the Birmingham Eye Trauma
Terminology System (BETTS). The primary outcome is visual acuity
at final follow-up. Visual outcomes were predicted using the OTS
and the predictions were compared with actual outcomes.
Results: Records of 200 eyes of 178 patients with traumatic cataracts
were reviewed. 22 eyes were excluded for lack of calculable ocular
trauma score or final visual acuity. The average patient age was 27.2
+/-7.7 years. 33 cataracts (19%) were caused by closed globe injuries.
143 cataracts (80%) were associated with open globe injuries. 15
eyes (8%) were ruptured globes. 102 cataracts (57%) were associated
with intraocular foreign bodies. 21 (12%) eyes had penetrating
injuries and 22 (12%) sustained perforating injuries.
Visual outcomes were compared to OTS predictions. In OTS
category 1 (n=32), 69% of eyes were no light perception (vs. 73%
predicted), 22% were light perception to hands motion (versus 17%
predicted), 3% were 20/400-20/200 (vs. 7% predicted) and 6.3%
were 20/40 or better (vs. 1%). In OTS category 2 (n=69), 30% were
NLP (28% predicted), 30% were LP-HM (26% predicted), 9% were
20/400-20/200 (18% predicted), 17% were 20/200-20/50 (13%
predicted) and 13% were ≥20/40 (15% predicted). In OTS category 3
(n=67), 15% were LP-HM (11% predicted), 8% were 20/400-20/200
(15% predicted), 24% were 20/200-20/50 (28% predicted) and 54%
were ≥20/40 (44% predicted). In OTS category 4 (n=7), 14% of eyes
were NLP and LP-HM respectively (1% & 2% predicted) and 71%
were ≥20/40 (74% predicted). In OTS category 5 (n=3), 100% were
≥20/40 (92% predicted). Spearman rank correlation of OTS score
with visual category was coefficient = 0.64, p<0.001.
Conclusions: Despite origins in the civilian setting, the Ocular
Trauma Score is a reliable predictor of final visual outcome in
traumatic cataracts associated with combat ocular trauma.
Commercial Relationships: Michael P. Smith, None; Marcus
Colyer, None; David L. Greenburg, None
Program Number: 4437 Poster Board Number: D0122
Presentation Time: 8:30 AM - 10:15 AM
Ocular and adnexal injuries in patients with all-terrain vehicle
accidents in West Virginia
Evan Newbolt, Charles B. Chen, John Nguyen, Jennifer SivakCallcott, Brian D. Ellis, Chad M. Bingham. West Virginia
University, Morgantown, WV.
Purpose: To evaluate the demographics of patients in ATV
accidents, determine the type and extent of the ocular and adnexal
injuries sustained, identify risk factors associated with ATV
accidents, and compare initial and final visual acuities of these
patients.
Methods: A retrospective chart review was performed on 3,012
patient charts in the West Virginia University ophthalmic trauma
database and electronic medical record to identify patients with
ophthalmic injuries related to ATV accidents from July 2002 - June
2012. Patients were included in the study if sufficient documentation
was available.
Results: One hundred fifty-five patients were identified. The patients'
age ranged from 3-80 years (mean, 33.4 years). Only eleven patients
(7.5%) were wearing a helmet. One hundred twenty-five patients
(81.7%) were admitted to the hospital. The average length of stay
was 6.4 days. Two patients died from severe intracranial injuries.
53% of patients tested positive for alcohol, while 49% were found to
be under the influence of other illicit drugs. The most common
ophthalmic injury was orbital fracture (130 patients). Forty-eight
patients (37%) required fracture repair. Eleven patients (7%) were
noted to have a visual deficit prior to the accident. Not including
enucleation (4 patients, 4 eyes), the final visual acuities were found to
be similar to the initial visual acuities.
Conclusions: Ocular and adnexal injuries due to ATV accidents are
relatively common in West Virginia. These injuries vary widely in
severity, ranging from minor abrasions to complex fractures and open
globe injuries. Orbital fractures are the most frequent complication of
these accidents. Fortunately, only a small minority of patients have
severe visual loss. Failure to wear a helmet and the use of alcohol
and/or illicit drugs are repeatedly identified as risk factors for injury.
The presence of a visual deficit prior to the accident may be a risk
factor not previously described.
Commercial Relationships: Evan Newbolt, None; Charles B.
Chen, None; John Nguyen, None; Jennifer Sivak-Callcott, None;
Brian D. Ellis, None; Chad M. Bingham, None
Program Number: 4438 Poster Board Number: D0123
Presentation Time: 8:30 AM - 10:15 AM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Characteristics and Management of Traumatic Eyes with Full
Thickness Corneal Lacerations
Yi C. Lai, Alain M. Bauza, Paul D. Langer, Suqin Guo, David S. Chu,
Albert S. Khouri, Robert D. Fechtner, Roger E. Turbin, Neelakshi
Bhagat. Institute of Ophthalmology and Visual Science, New Jersey
Medical School, Newark, NJ.
Purpose: To describe the characteristics, management, posterior
segment complications, and outcomes of traumatic eyes with full
thickness corneal lacerations.
Methods: Retrospective chart review. Medical records of all eyes
that presented to the University Hospital, Newark, NJ with corneal
lacerations between 2001 and 2010 were analyzed. Data on age,
gender distribution, type of injury, zone of injury, pre-operative
visual acuity (VA), post-operative VA, lens status, vitreous
hemorrhage (VH), retinal detachment (RD), hemorrhagic choroidals
(HC), intraocular foreign body (IOFB), dislocated lens, retained lens
fragments, endophthalmitis, proliferative vitreoretinopathy,
enucleation, penetrating keratoplasty (PKP) and pars plana
vitrectomy (PPV) were recorded.
Results: 270 patients with corneal lacerations were identified. The
demographics and characteristics of these eyes are recorded below in
a table. Posterior segment (PS) complications were seen in 105
(38.9%) of 270 eyes: 70 (66.7%) eyes were noted to have PS
complications at presentation (within one week of presentation), 19
(18.1%) developed early PS complications (between one and six
weeks), and 16 (15.2%) developed late complications (after six
weeks). Comparison of parameters are outlined below:
Among eyes with PS complications, 24 (22.9%) developed VH only,
23 (21.9%) developed HC along with other complications (VH, RD,
IOFB, macular hole, dislocated lens, or proliferative
vitreoretinopathy), 52 (49.5%) developed RD along with other
complications (VH, HC, IOFB, macular hole, dislocated lens,
subluxated lens, epiretinal membrane, or proliferative
vitreoretinopathy). Five (4.8%) eyes developed endophthalmitis. Of
24 eyes with VH only, 9 (37.5%) underwent PPV, while 15 (62.5%)
spontaneously resolved. Of 23 eyes with HC, 9 (39.1%) underwent
choroidal drainage, 7 (30.4%) spontaneously resolved, 5 (21.7%)
underwent PPV (for concurrent complications), and 2 (8.7%) were
enucleated. Of 52 eyes with RD, 17 (32.7%) had anatomic success
with one PPV, and 12 (23.1%) had anatomic success with two or
more PPV, with overall anatomic success of 29/32 (90.6%).
Conclusions: A large number of eyes (~40%) with full-thickness
corneal lacerations had PS complications; half of these eyes had
retinal detachment. Overall, 8.5% of eyes underwent PKP. Eyes with
PS complications were less likely to achieve a more favorable postoperative VA than eyes without PS complications.
Commercial Relationships: Yi C. Lai, None; Alain M. Bauza,
None; Paul D. Langer, None; Suqin Guo, None; David S. Chu,
Abbott (F), Novartis (F), Santen (F), Eyegate (F), Lux Biosciences
(F), Bausch & Lomb (R); Albert S. Khouri, None; Robert D.
Fechtner, None; Roger E. Turbin, None; Neelakshi Bhagat, None
Support: Supported in part by Research to Prevent Blindness, Inc.,
and The Lions Eye Research Foundation of New Jersey.
Program Number: 4439 Poster Board Number: D0124
Presentation Time: 8:30 AM - 10:15 AM
Nail Gun-Induced Open Globe Injuries: A Ten-Year
Retrospective Review
Avni Shah, Alain M. Bauza, Anton M. Kolomeyer, Paul D. Langer,
Marco A. Zarbin, Neelakshi Bhagat. Institute of Ophthalmology and
Visual Science, UMDNJ New Jersey Medical School, Newark, NJ.
Purpose: To describe the epidemiology, clinical presentation,
management, and complications of open globe injuries (OGI)
resulting from nail gun accidents.
Methods: A retrospective review of all patients who presented to
University Hospital at Newark, NJ, between 2000 and 2010 with
open globes secondary to nail gun injury was conducted. Data were
collected on demographics, setting of accident, presenting clinical
exam findings, inpatient management, surgical procedures needed,
and long-term outcomes. Final visual acuity (VA) of patients with at
least three months of follow-up was compared to presenting VA.
Results: Forty-three eyes of 42 patients (7.1% of all open globes,
n=604) suffered OGI from nail gun accidents. All patients were male;
mean presenting age was 31.6 years. Most patients (88%) were
Hispanic. 86% of accidents were work-related. Mechanism of injury
included ricochet, gun jamming, and backfiring. All injuries were
classified as penetrating or intraocular foreign body (IOFB). Entrance
wounds were classified into zone I (n=24 [56%]), zone II (n=12
[28%]), and zone III (n=7 [16%]). Mean presenting VA was 1.64
logMAR (Snellen VA 20/873). 40% of eyes developed traumatic
cataracts and 28% developed retinal detachments (RD). Posterior
segment complications were present in 77% of cases. Six eyes (14%)
had retained IOFBs. All eyes underwent primary closure without
primary enucleation. 23 eyes (53%) required a mean of 1.5
reoperations. Of these, 14 (61%) underwent pars plana vitrectomy for
non-resolving vitreous hemorrhage and/or RD. Average duration of
follow up was 14 months. At last visit, mean VA was 1.02 logMAR
(Snellen VA 20/211). 84% of eyes had improved or stable vision
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
compared to presentation. Only 47% of eyes had a final VA of 20/40
or better (n=32). No eyes developed endophthalmitis. Three (7%)
eyes were phthisical or pre-phthisical, with one secondarily
enucleated due to phthisis and no light perception VA.
Conclusions: To our knowledge, this is the largest compilation of
nail gun-related OGI reported thus far. Posterior segment
complications were noted in over three-fourths of cases, likely
contributing to the overall guarded visual outcomes. Preventative
measures for eye protection should be strictly followed while using
nail guns.
Commercial Relationships: Avni Shah, None; Alain M. Bauza,
None; Anton M. Kolomeyer, None; Paul D. Langer, None; Marco
A. Zarbin, Iridex (C), Novartis (C), Pfizer (C), Calhoun Vision (C),
Imagen Biotech (C), UMDNJ (P); Neelakshi Bhagat, None
Support: Unrestricted grant from Research to Prevent Blindness, the
New Jersey Lions Eye Research Foundation
Program Number: 4440 Poster Board Number: D0125
Presentation Time: 8:30 AM - 10:15 AM
Utilizing HIWA, a Scoring System of Pediatric Ocular Trauma
Retrospective Reports, Analyzing Existing Literature and
Informing Future Standards
Andrea Honda1, Paul Latkany1, Monica Lorenzo1, Emily Su2. 1New
York Eye and Ear Infirmary, New York, NY; 2St. Luke's Roosevelt
Hospital, New York, NY.
Purpose: Less than 0.3% of surgical interventions in general
pediatric surgery are supported by randomized controlled trials.
Scoring systems have been published to rank the significance of
retrospective pediatric surgical trials outside of the ophthalmic
literature. Up to 43% of open-globe injuries occur in individuals less
than 18 years old. We investigate standards for reporting
retrospective studies on pediatric ocular trauma and determine the
inter-rater agreement of a new retrospective pediatric ocular trauma
literature scoring system.
Methods: We identified pediatric trauma articles using Pubmed from
January 1, 2000 through August 1, 2011 in four comprehensive
ophthalmology journals. We then selected all of the articles that had
follow-up with exclusively a pediatric patient population. We created
a novel scoring system, HIWA, for assessing the quality of
retrospective clinical studies in pediatric eye trauma. We built on
generic retrospective pediatric surgical scoring system by dividing
the scoring into three categories 1) potential clinical relevance 2)
quality of study methodology 3) quality of discussion and stated
conclusion. A global qualifying score was derived by combining the
score from each subscale. Three independent reviewers were utilized
to determine the inter-rater agreement of HIWA.
Results: We identified 11 articles in pediatrics with 3290 patients.
Six articles exclusively followed patients with pediatric eye trauma.
Four articles reported a follow-up at 6 months, only three used a
scoring system of any type. In the six articles, the mean age was 8.3
years old with a range of 1 day old to 18 years old. 164 (40.4%) were
females. 359 were unilateral injuries and 29 were bilateral. The range
of follow-up was from 3 days to 4,320 days and a mean of 244 days.
The HIWA inter-rater reliability was excellent with > 95%
concordance for 20 items. The HIWA global quality rating is good.
The ranking of papers by individual reviewers was highly predictive
of overall ranking by mean quality scores (n=18 rank pairs, r=0.90, p
< 0.05).
Conclusions: There is woefully non-standardized reporting in the
pediatric ocular trauma articles that did not facilitate data aggregation
and meta-analysis. HIWA will help standardize reporting of pediatric
ocular trauma and categorize existing reports.
Commercial Relationships: Andrea Honda, None; Paul Latkany,
None; Monica Lorenzo, None; Emily Su, None
Program Number: 4441 Poster Board Number: D0126
Presentation Time: 8:30 AM - 10:15 AM
Enucleation following Open Globe Injury
Ananya Anne, Alain M. Bauza, Paul D. Langer, Roger E. Turbin,
Marco A. Zarbin, Neelakshi Bhagat. University of Medicine and
Dentistry of New Jersey, Newark, NJ.
Purpose: To describe the demographics, characteristics and
outcomes of eyes with traumatic open globe injuries that underwent
enucleations at University Hospital (UH), Newark, New Jersey over a
ten-year period.
Methods: The medical records of all traumatic OGIs that underwent
enucleations from 2001- 2010 were reviewed.
Results: 94 eyes of 93 patients with open globe injury underwent
enucleations at UH in the defined 10- year time period. Seventy-six
percent of patients were male and the mean age was 40.8 years. The
most common cause of open globe injury was assault for 36 patients
(38.7%), followed by blunt trauma due to an accidental fall for 16
patients (66.7%).The most common type of injury noted was rupture
for 62 patients (66.7%), followed by penetrating injury for 21 patients
(22.6%). The predominant anatomic site of the open globe wound
was zone 3 in 55 patients (59.1%). Primary enucleations were
performed in 21 (22.6%) of 94 enucleations for severely injured, nonsalvageable eyes. All eyes that underwent primary enucleations were
NLP at presentation. Mean length of time between primary globe
repair and secondary enucleation was 41.3 days. Three patients
(.03%) were enucleated for blind, endophthalmic eyes. Medpore
implants were used in 86 enucleated eyes (92.5%); 62 eyes (72%)
were fitted with 20 mm medpore balls. Complete post-operative
records were available only for 44 of the 93 patients who underwent
enucleations; 16(36%) of 44 eyes eyes noted to post-enucleation
complications. The most common complaint after enucleation was
periorbital pain within the first month (5 patients). Five patients
(11.4%) complained of a mucoid discharge between 1 and 7 years
post surgery. Only 2 eyes (4.5%) had extrusions of their implants, at
1 week and 1 year post-enucleation, respectively; only one of these
underwent replacement of the implant.
Conclusions: Out of the 604 patients admitted to the UH with open
globe injuries, 15.4% underwent enucleations. Those with zone 3
injuries are more likely to undergo primary enucleations (90.4%) than
secondary enucleations (61.2%). Post-enucleation complications
were low with only a 4.5% rate of implant extrusion.
Commercial Relationships: Ananya Anne, None; Alain M. Bauza,
None; Paul D. Langer, None; Roger E. Turbin, None; Marco A.
Zarbin, Iridex (C), Novartis (C), Pfizer (C), Calhoun Vision (C),
Imagen Biotech (C), UMDNJ (P); Neelakshi Bhagat, None
Support: Research to Prevent Blindness Inc; Lions Eye Research
Foundation of NJ
431 Eye Care: Who’s Not Getting It and Why It Matters
Wednesday, May 08, 2013 11:00 AM-12:45 PM
615-617 Paper Session
Program #/Board # Range: 4542-4548
Organizing Section: Clinical/Epidemiologic Research
Program Number: 4542
Presentation Time: 11:00 AM - 11:15 AM
Does government assistance improve access for low-income
individuals to eye care providers?
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Chris J. Hong1, Graham E. Trope2, Yvonne M. Buys2, Barbara E.
Robinson4, Yaping Jin2, 3. 1Department of Medicine, University of
Ottawa, Ottawa, ON, Canada; 2Department of Ophthalmology and
Vision Sciences, University of Toronto, Toronto, ON, Canada; 3Dalla
Lana School of Public Health, University of Toronto, Toronto, ON,
Canada; 4School of Optometry, University of Waterloo, Waterloo,
ON, Canada.
Purpose: To evaluate if low-income support programs facilitate
access to eye care providers in Canada.
Methods: We systematically reviewed government-funded lowincome vision care support programs and compared them with the
average fee charged for routine eye exams in 10 Canadian provinces.
We then compared utilization of eye care providers between those
likely eligible for vision care assistance versus those likely not
eligible using data from the Canadian Community Health Survey
(CCHS) Healthy Aging 2008/09.
Results: The CCHS data reveals that 12.5% of Canadians aged 45-64
and 13.2% of those aged 65+ have difficulty meeting basic expenses
such as food, shelter and clothing. Individuals are eligible for vision
care assistance only if they are receiving government financial
assistance. The Canadian Financial Capability Survey revealed that
7.9% of Canadians aged 45-64 and 5.5% aged 65+ received social
assistance and provincial supplements in 2009.
The cost of routine eye exams in Canada is not covered by
government for those aged 20-64. In 4 provinces (NFLD, PEI, NB,
SK) seniors are also not covered. For those receiving financial
assistance the government covers maximum 70% of the eye exam
cost in one province (NB). In two provinces the government coverage
is less than the average fee charged by optometrists ($55 by
government vs $65 by optometrists in NFLD; $52 by government vs
$84-$90 by optometrists in PEI). Waiving the fee difference however
is at optometrist’s discretion.
Among middle-aged Caucasians who did not report having
glaucoma, cataracts, diabetes and vision problems, utilization of eye
care providers was lower among those reporting difficulty meeting
basic expenses when compared to those without difficulty (28.2%
versus 42.0%, p<0.05). Utilization was 25.0% for those in the lowest
10% income decile (p<0.05) and 22.5% for those in the 11%-20%
income decile (p<0.05) compared to 42.1% in the 21%-100% income
distribution.
When effects of age, sex and education were adjusted for, Caucasians
having difficulty meeting basic needs used an eye care provider
significantly less often than those without difficulty: about 30% less
often for those aged 45-64 (prevalence ratio (PR) 0.68, 95% CI 0.570.80) and about 10% less often for seniors (PR 0.88, 95% CI 0.780.99).
Conclusions: Despite government assistance, the poor have
significantly reduced utilization of vision care.
Commercial Relationships: Chris J. Hong, None; Graham E.
Trope, sensimed (F); Yvonne M. Buys, Alcon Surgical Incorporated
(R), Alcon Surgical Incorporated (F), IMED (F); Barbara E.
Robinson, None; Yaping Jin, None
Support: Canadian Institutes of Health Research (CIHR SEC
117120)
Program Number: 4543
Presentation Time: 11:15 AM - 11:30 AM
The Association of Vision Loss with Work Status in the United
States
Cheryl Sherrod2, 1, Kevin D. Frick3, 5, Pradeep Y. Ramulu4, 1. 1Dana
Center for Preventive Ophthalmology, Wilmer Eye Institute at Johns
Hopkins, Baltimore, MD; 2Preventive Medicine, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD; 3Health Policy
& Management, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD; 4Glaucoma Division, Wilmer Eye Institute at Johns
Hopkins, Baltimore, MD; 5International Health, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD.
Purpose: To examine the association between visual acuity and selfreported work status in a nationally representative cross-sectional
sample of American adults.
Methods: A total of 23,805 adults between 18 and 74 years of age
participated in both the interview and the examination component of
the 1999-2008 National Health and Nutritional Examination Survey.
Visual acuity (VA) testing was performed in both eyes. Upon
presentation, participants were asked to wear their usual distance
correction if any. Subjects were categorized as having normal vision
(presenting VA of 20/40 or better), uncorrected refractive error
(URE; presenting VA of 20/50 or worse improving to 20/40 or better
with autorefraction), vision impairment (VI; post-refraction VA of
20/40 to 20/200), or severe VI (post-refraction acuity of 20/200 or
worse). Participants were categorized as working if they described
being employed within the past week, and not working if they had
not worked in the last week and/or if they were looking for work.
Associations between work and vision status were determined in
multivariable models adjusting for age, gender, race/ethnicity, and
presence of chronic disease.
Results: A total of 19,710 participants (82.8%) had complete vision,
employment, and demographic data. Among those with normal
vision, the percent who were working was 71.5% (95% CI= 70.3 to
72.8) compared to 64.7% (95% CI= 60.8 to 68.6) among those with
URE, 40.0% (95% CI= 30.5 to 49.6) among those with VI, and
25.8% (95% CI= 8.7 to 43.0) among those with severe VI. In a
multivariable logistic regression adjusted for age, gender,
race/ethnicity, and chronic disease status, URE (Odds Ratio [OR] =
0.67, 95% CI= 0.56 to 0.80), VI (OR = 0.27, 95% CI= 0.17 to 0.43),
and severe VI (OR = 0.18, 95% CI= 0.07 to 0.42) were all associated
with a lower likelihood of working. Increasing age, female gender,
being Mexican American or non-Hispanic Black, and the presence of
a chronic disease were all associated with a lower odds of working
(p-values <0.01).
Conclusions: Decreased vision, particularly from non-refractive
causes is associated with a significantly lower likelihood of working.
Further investigation is warranted to understand the barriers for
employment in those individuals with VI and URE.
Commercial Relationships: Cheryl Sherrod, None; Kevin D.
Frick, Center for Applied Value Analysis (C), National Association
for Eye and Vision Research (C); Pradeep Y. Ramulu, Tissue Banks
International (C)
Program Number: 4544
Presentation Time: 11:30 AM - 11:45 AM
Despite Possessing Health Insurance, Large Disparities Exist in
Likelihood of Visits to Eye Care Providers Across U.S.
Sociodemographic Groups
Patricia A. Ple-plakon1, Chris A. Andrews1, David C. Musch1, 2, Paul
P. Lee1, Joshua D. Stein1. 1Ophthalmology and Visual Sciences,
University of Michigan, Ann Arbor, MI; 2Epidemiology, University
of Michigan, Ann Arbor, MI.
Purpose: To determine whether race, education, and income impact
the likelihood of visiting an eye care provider among a nationwide
sample of enrollees in a U.S. managed care plan.
Methods: Reviewed claims data of all enrollees ≥21 years old in a
U.S. managed care network who had eye care from 2001-2011 to
determine the proportion visiting eye care providers yearly.
Performed logistic regression to determine the impact of
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
sociodemographic factors on the likelihood of visits to various eye
care providers.
Results: Among 9.8 million enrollees, those with racial data included
80.6% white, 6.1% black, 8.7% Latino, 3.5% Asian American and
1.1% other; 30.4% had ≤ high school(HS) diploma and 20.3% had
≥college degree; 5.5% had income <$30K and 6.6% had income
>$125K. Adjusting for other factors, the odds of visiting an
ophthalmologist were 3% lower among blacks (OR=0.97) and 9%
higher among Asian Americans (OR=1.09) relative to whites. Racial
minorities were less likely to visit an optometrist relative to whites
(ORblack=0.80,ORlatino=0.71,ORasian=0.80). Compared to those
with HS diploma, enrollees with college degrees had 35% higher
odds of visiting an ophthalmologist (OR=1.35) and equal odds of
visiting an optometrist (OR=1.01). Compared to those earning
<$30K, those earning >$125K had 19% higher odds of visiting an
ophthalmologist (OR=1.19) and 23% lower odds of visiting an
optometrist (OR=0.77). Controlling for major ocular comorbidities,
the most affluent and well-educated whites, relative to the least
affluent and less-educated blacks, had 120% higher odds of visiting
an ophthalmologist (OR=2.2) and 24% lower odds of visiting an
optometrist (OR=0.76). All SEs of ORs ≤0.02. Further analyses
compared probabilities of visits to eye care providers among the most
affluent and educated whites versus the least affluent and educated
blacks with glaucoma, cataract, ARMD, and diabetic retinopathy.
Conclusions: Race, education, and wealth dramatically impact the
probability of seeking eye care by ophthalmologists and optometrists,
despite all enrollees having health insurance. Income and education
had a greater effect than race. This pattern of eye care utilization puts
racial minorities and people of lower socioeconomic status at higher
risk for many sight-threatening ocular diseases, thus creating
important implications for policy-making and future resource
allocation.
Commercial Relationships: Patricia A. Ple-plakon, None; Chris
A. Andrews, None; David C. Musch, Glaukos (C), AqueSys (C),
InnFocus (C), Pfizer (F), DigiSight Technologies (C); Paul P. Lee,
Genentech (C), University of Michigan (E), Duke University (E),
Pfizer (C), Pfizer (I), Glaxo (I), Merck (I), Allergan (C), Duke
University (P); Joshua D. Stein, University of Michigan - time to
next glaucoma test algorithm patent (P)
Program Number: 4545
Presentation Time: 11:45 AM - 12:00 PM
The global burden of potential productivity loss from presbyopia
Susan M. Joy1, Kevin D. Frick1, Kovin S. Naidoo2, David A. Wilson2,
Brien A. Holden2, 3. 1Department of Health Policy and Management,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
2
Brien Holden Vision Institute, Sydney, NSW, Australia; 3University
of New South Wales, Sydney, NSW, Australia.
Purpose: The onset of presbyopia in middle adulthood results in
potential losses in productivity among otherwise healthy adults. This
economic burden may be particularly noticeable in lower income
countries where up to 94% of cases may be under-corrected or
uncorrected. This study estimates the global burden of potential
productivity lost due to presbyopia.
Methods: Population data from the US Census Bureau were
combined with the estimated prevalence of presbyopia, age of onset,
labor force participation rate, employment rate, per capita gross
domestic product (GDP) in purchasing power parity units, and
presbyopia disability weights to estimate the global loss of
productivity due to presbyopia in each country in 2007. We
conservatively assumed that only employed people under the age of
50 contribute to the economy. Disability weights ranged from the
same as low vision in other studies to approximately 6% of the
original disability weight as motivated by the literature and data from
the United States.
Results: An estimated 376 million cases of presbyopia worldwide
were associated with a potential productivity loss of between 0.06%
and 0.99% of global GDP. With different disability weights assigned
for corrected and uncorrected cases, an estimated 0.43% of global
GDP was lost to presbyopia. Correcting global presbyopia to the
level achieved in rich countries could reduce the burden to 0.22% of
global GDP.
Conclusions: Even with conservative assumptions around the
productive population, presbyopia is likely to be a significant burden
on productivity and correction could have a significant impact on
productivity in lower income countries.
Commercial Relationships: Susan M. Joy, None; Kevin D. Frick,
Center for Applied Value Analysis (C), National Association for Eye
and Vision Research (C); Kovin S. Naidoo, None; David A. Wilson,
None; Brien A. Holden, Allergan (F), AMO (I)
Support: A grant from the Brien Holden Vision Institute to the Johns
Hopkins Bloomberg School of Public Health for the support of health
economics work
Program Number: 4546
Presentation Time: 12:00 PM - 12:15 PM
An Evaluation of Non-Physician Educators' Role In Enhancing
Cataract Patient’s Surgical Knowledge and Satisfaction
Paula Anne Newman-Casey1, Sathya Ravilla2, Haripriya Aravind2,
Vinoth Palanichamy2, Manju Pillai2, Vijayakumar Balakrishnan2,
Alan L. Robin3. 1Ophthalmology & Visual Sciences, Kellogg Eye Ctr,
Univ of Michigan, Ann Arbor, MI; 2Ophthalmology and Visual
Sciences, Aravind Eye Care System, Madurai, India; 3Ophthalmology
and Visual Sciences, Johns Hopkins University, Baltimore, MD.
Purpose: To evaluate the effectiveness of the pre-surgical patient
counseling system at the Aravind Eye Hospital in Madurai, India.
Counselors are non-physician educators trained in counseling
strategies and ophthalmology.
Methods: We administered a questionnaire to 60 patients with newly
diagnosed visually significant cataracts and no other ocular pathology
both before and after they underwent cataract counseling. The
questionnaire measured their knowledge of cataract and cataract
surgery and decisional conflict over whether to undergo surgery. The
questionnaire assessed socio-demographic characteristics including
age, sex, occupation, literacy status, education, insurance status, and
whether the patient was the primary decision maker. After
counseling, we measured patients’ overall satisfaction with the
counseling services. We evaluated the counselors’ knowledge.
Results: Both the patient knowledge scores and decisional conflict
scores significantly improved following counseling (mean difference
+2.0, p=0.004 and +8.4, p<0.0001, respectively). Multiple regression
identified female gender, being illiterate, and being the primary
decision maker as important factors in how much the counseling
increased patient knowledge (β=2.5, p<0.001 for sex, β=1.7, p=0.04
for literacy and β=-1.5, p=0.06). 99% of patients reported that they
were satisfied with the counseling system, and counselor knowledge
score was significantly correlated to the patient satisfaction score
(Pearson correlation coefficient 0.49, p<0.001). There was also a
significant correlation between the patient satisfaction score and the
change in patient knowledge score (Pearson correlation coefficient
0.28, p=0.03).
Conclusions: Training non-physician educators to counsel patients
about cataract surgery is effective in improving patients’ knowledge
about their condition, and in reducing their anxiety about making the
decision to go through with the surgery. Counseling can be
performed by a non-physician extender and is very important in
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
reaching out to patients who have traditionally had more limited
access to healthcare such as women, illiterate patients and patients
who are not their own primary decision maker. Increased use of
counseling might help to further reduce the global burden of cataract
blindness.
Commercial Relationships: Paula Anne Newman-Casey, None;
Sathya Ravilla, None; Haripriya Aravind, None; Vinoth
Palanichamy, None; Manju Pillai, None; Vijayakumar
Balakrishnan, None; Alan L. Robin, merck (C), merck (R), Aerie
(C), Aerie (I), Sucampo (E), Glaukos (C), Glaukos (I), Allergan (R)
Support: Heed Ophthalmic Foundation; Blue Cross Blue Shield of
Michigan
Program Number: 4547
Presentation Time: 12:15 PM - 12:30 PM
Cohort- and age-specific effects of annual mass drug
administration on prevalence of trachoma: a longitudinal study
in rural Tanzania
Nakul Shekhawat1, 2, Beatriz E. Munoz1, Harran A. Mkocha3, Sheila
K. West1, 2. 1Dana Center for Preventative Ophthalmology, Wilmer
Eye Institute, Johns Hopkins, Baltimore, MD; 2Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD; 3Kongwa
Trachoma Project, Kongwa, United Republic of Tanzania.
Purpose: Mass drug administration (MDA) in trachoma-endemic
areas is part of the World Health Organization (WHO) SAFE strategy
for elimination. The aim of this study was to determine the effect of
three rounds of annual MDA on prevalence of active trachoma
among thirteen longitudinal birth cohorts of Tanzanian children.
Methods: Complete census of four villages collected information on
known trachoma risk factors (hygiene status, number of children in
household, educational level of head of household, distance to
primary water source, presence/absence of household latrine). All
children ages nine years & under were followed for 36 months, with
trachoma status re-assessed every 6 months. Annual MDA consisted
of topical tetracycline for children <6 months old and oral
azithromycin for those >6 months old. Thirteen birth cohorts were
created, with newborns assigned to new cohorts over time. The
prevalence of trachoma was compared across age groups & birth
cohorts at each survey. Differences were assessed using tests of trend.
Results: MDA coverage was consistently >80% for all groups. All
age groups showed decreased prevalence of active trachoma after the
first MDA, with further decreases after each additional MDA for
most age groups (see figure). Children <1 year old showed sequential
reductions in prevalence after each MDA (7.14% baseline, 3.35%,
2.99% and 0% after repeat MDA; p <0.001), suggesting a protective
herd effect from previous rounds of MDA. Birth cohorts aged 1 year
or older at baseline had persistent reductions in prevalence after each
MDA, while younger cohorts had increased prevalence every year in
spite of MDA. Other than starting prevalence of trachoma, there were
no differences in trachoma risk factors corresponding to differences
in younger versus older cohorts. The birth cohort that was 5 years old
at baseline exhibited a cohort effect persisting across two annual
surveys, with higher rates of trachoma than would have been
predicted by older or younger cohorts. Excluding recently migrated
children from the cohort analysis yielded similar results.
Conclusions: This study shows the benefits of multiple rounds of
MDA, with lower prevalence of trachoma after each round and a
protective herd effect for children born into communities that have
previously undergone MDA. It also highlights the possibility of
persistent cohort effects that should be explored.
Commercial Relationships: Nakul Shekhawat, None; Beatriz E.
Munoz, None; Harran A. Mkocha, None; Sheila K. West, None
Support: Bill and Melinda Gates Foundation, Research to Prevent
Blindness
Program Number: 4548
Presentation Time: 12:30 PM - 12:45 PM
Time-Motion Analysis of Clinical Nursing Documentation during
Implementation of an Electronic Operating Room Management
System for Ophthalmic Surgery
Sarah Read-Brown1, Anna S. Brown1, Thomas R. Yackel2, Dongseok
Choi3, Daniel C. Tu1, 4, David S. Sanders1, Michael F. Chiang1, 2.
1
Ophthalmology, Oregon Health & Science University, Portland, OR;
2
Medical Informatics & Clinical Epidemiology, Oregon Health &
Science University, Portland, OR; 3Public Health & Preventative
Medicine, Oregon Health & Science University, Portland, OR;
4
Portland Veterans Administration Medical Center, Portland, OR.
Purpose: The efficiency and quality of clinical documentation are
critical in surgical settings because operating rooms are a major
source of hospital revenue, and because adverse events may have
enormous consequences. Electronic health records (EHR) have the
potential to impact surgical quality, workflow, and documentation
time. We aim to examine the speed of intra-operative nursing
documentation during the implementation of an EHR operating room
management system for ambulatory ophthalmology surgery.
Methods: In January 2012, Oregon Health & Sciences University
(OHSU) implemented an EHR operating room management system
throughout the institution (OpTime; Epic Systems, Madison, WI),
replacing paper-based documentation. Using a paper log sheet and
time stamping software, time-motion data was collected by a single
observer who shadowed the nurse responsible for documentation in
the surgical suite of the ophthalmology department at OHSU. Data
was collected for 3 weeks pre-implementation (paper), and 10 months
post-implementation (EHR). Descriptive statistics and a mixedeffects model were used to analyze data.
Results: During the 11-month study period, 238 cases were observed
(58 pre-implementation, 151 post-implementation) representing 13
nurses, 22 ophthalmic surgeons, and 5 ophthalmic sub-specialties.
Baseline mean ± SD paper documentation time/case was 7.5 ± 2.7
minutes. In the first 2 weeks post-EHR implementation, this
increased to 19.9 ± 10.3 minutes (p<.001). In the months following
implementation the documentation time/case decreased reaching a
steady level after 17 weeks at 9.4 ± 2.8 minutes per case, but was
slower than with paper documentation (p<.001). Postimplementation, there was significant variation in documentation
time among nurses 11.4 ± 4.0 minutes (p<.001), although the
variation among nurses decreased over time.
Conclusions: Ophthalmic nursing documentation time requirements
increased significantly with EHR compared to paper, but this
improved to a steady level after several months that remained slower
than the paper baseline. EHR implementation seemed to affect some
ophthalmic nurses more than others, though the variation among
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
nurses decreased with time. These finding have implications for
implementation and delivery of ophthalmic surgical care using EHRs.
Figure 1. Mean ophthalmic nurse documentation time per case.
Commercial Relationships: Sarah Read-Brown, None; Anna S.
Brown, None; Thomas R. Yackel, None; Dongseok Choi, None;
Daniel C. Tu, Research to Prevent Blindness (F); David S. Sanders,
Supported by unrestricted departmental funding by Research to
Prevent Blindness (New York, NY) (F); Michael F. Chiang, Clarity
Medical Systems (unpaid member of Scientific Advisory Board) (S)
Support: Supported by unrestricted departmental funding from
Research to Prevent Blindness (New York, NY). NIH grants
EY010572
478 Vision Function and Quality of Life
Wednesday, May 08, 2013 2:45 PM-4:30 PM
Exhibit Hall Poster Session
Program #/Board # Range: 5306-5339/D0067-D0100
Organizing Section: Clinical/Epidemiologic Research
Program Number: 5306 Poster Board Number: D0067
Presentation Time: 2:45 PM - 4:30 PM
What are people rating when they rate their vision status?
Associations with Vision Tests and Self-Reported Visual Function
in the Salisbury Eye Evaluation Study
Mahmood El-Gasim1, Beatriz E. Munoz2, Sheila K. West2, Adrienne
W. Scott3. 1School of Medicine, Johns Hopkins University,
Baltimore, MD; 2Dana Center for Preventive Ophthalmology, Johns
Hopkins University, Baltimore, MD; 3Wilmer Eye Institute, Johns
Hopkins University, Baltimore, MD.
Purpose: To understand the most important determinants of selfrated vision status by examining associations with vision tests, selfreported visual function, demographic, and health-status
characteristics.
Methods: Participants included 2467 individuals, aged 65-84 in a
longitudinal, population-based cohort study. Participants rated their
vision status from 0-10. Visual acuity, contrast sensitivity, stereoacuity and visual fields were assessed. The Activities of Daily Vision
Scale (ADVS) questionnaire was administered. Multivariate ordinal
and multinomial logistic-regression models examined the association
of demographic, health-status characteristics, vision tests, and ADVS
subscales with self-rated vision status score. Odds ratios described
the association of these characteristics with reporting better vision
status.
Results: Better visual acuity, contrast sensitivity, stereo-acuity, and
visual fields were associated with increased odds of reporting better
vision status. Among the vision tests, a 2-line increase in visual
acuity was most likely to result in an individual reporting better
vision status (odds ratio, 1.49; 95% CI, 1.30-1.70). A 5-point increase
in the near vision, far vision, and glare ADVS subscale scores were
associated with increased odds of reporting good vision status versus
poor vision status. A 5-point increase in the near vision subscale was
most likely to result in an individual reporting good vision status
versus poor vision status (odds ratio, 1.38; 95% CI, 1.28-1.50).
Conclusions: Self-rated vision status is a multidimensional measure.
Near-vision visual function and visual acuity are important
determinants of self-rated vision status in an elderly population.
Commercial Relationships: Mahmood El-Gasim, None; Beatriz
E. Munoz, None; Sheila K. West, None; Adrienne W. Scott, None
Support: National Institute on Aging Grant AG02513
Program Number: 5307 Poster Board Number: D0068
Presentation Time: 2:45 PM - 4:30 PM
Controlling Photophobia and Light-Induced Headache: the Use
of Artificial Pupil Contact Lenses
Mary M. Jackowski1, 2, Brad Motter1, 3. 1VA Medical Center,
Syracuse, NY; 2Ophthalmology, SUNY Upstate Medical University,
Syracuse, NY; 3Neuroscience and Physiology, SUNY Upstate
Medical University, Syracuse, NY.
Purpose: We report here our clinical finding that wearing artificial
pupil contact lenses (APCLs) substantially reduces the severe light
sensitivity (LS) of photophobia (PP) and light-induced headache
(LHA), possibly related to head trauma, as reported by young
veterans referred to our VA Visual Rehabilitation Clinic. These
otherwise ocular normal patients are very light sensitive, even to
normal room lighting conditions, and typically wear dark (1 log
neutral density), wrap-around sunglasses during their waking hours
both indoors and outdoors. APCLs have been previously used to
control light sensitivity from anterior segment defects, typically holes
in the iris.
Methods: We have used a 4.5 mm APCL that produces a visual field
cut beyond 70 degrees eccentricity and reduces light entering the eye
by at most 30%, compared to the 90% reduction of the dark
sunglasses. Patients received a complete ocular health workup,
including optical correction, near triad examination, dilated retina and
anterior segment exams, and visual field testing. A multi-part
questionnaire with 0-10 rating scales for subjective assessments of
LS & LHA discomfort and interference with daily living activities is
administered. Patients are followed and after one month return for reexamination including the questionnaires.
Results: We have examined the response in 18 patients who have
been fitted with binocular APCLs. Every patient reported substantial
benefits with chronic use of APCLs. LS scores dropped 50% (Signed
Rank p<.001) with major reductions in LHA. Patients are able to
avoid wearing sunglasses in all but direct sunlight conditions, have
re-engaged in normal activities, and indicate increased positive
interactions with family members and co-workers resulting from not
‘hiding’ behind sunglasses. Removing the APCLs returns the patient
to apparent pre-treatment sensitivity levels.
Conclusions: These observations suggest that peripheral light exerts
an unexpectedly strong control over PP symptoms. Restoring the
central visual field to normal light levels by wearing APCLs, breaks
the chronic dark adaptation problems associated with wearing dark
sunglasses. The dynamic interaction between the pupil and the APCL
that controls actual light levels needs further study. The use of
APCLs to treat PP improves upon currently available treatment and
suggests avenues for research into the origins of PP and its sequelae.
Commercial Relationships: Mary M. Jackowski, None; Brad
Motter, None
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Program Number: 5308 Poster Board Number: D0069
Presentation Time: 2:45 PM - 4:30 PM
Quantifying the Impact of Vision Training using Short Duration
Transient Visual Evoked Potential (SD-tVEP)
Robert Orsillo1, Peter H. Derr2. 1Orsillo Vision Care, Tallahasse, FL;
2
Diopsys Inc, Pine Brook, NJ.
Purpose: To objectively quantify changes in the SD-tVEP’s latency
resulting from the completion of a vision training program.
Methods: Forty-seven subjects with a mean age of 21.18±3.38 (SD)
were tested. All subjects had a BCVA of 20/30 or better. Vision
training drills were designed with the goal of improving the span and
speed of visual recognition. The subject’s score is determined by the
number of the subject’s correct responses to a set of rotating
peripheral presentations. There is a time limit for the subject to
respond to each presentation and has a finite number of trys of each
presentation. Baseline SD-tVEPs measurements were recorded prior
to initiating the visual training protocol. The drill protocols were
conducted for eight weeks, three times per week for a period of 15
minutes each session. After eight weeks SD-tVEPs were recorded
using the Diopsys NOVA System (Diopsys, Inc. Pine Brook, NJ).
Each eye was stimulated with low and high Michelson contrast
checkerboard patterns. High contrast checks were presented at 6, 12
and 24 minutes of arc while low contrast checks were presented at 24
minutes of arc. Test duration was 15 seconds/eye. Each subject’s SDtVEP latency response was compared to the baseline recording.
Results: 83% of the subjects completed the program. 48% of the
subjects showed a unilateral reduction in the P100 latency at the low
contrast SD-tVEP while 52% had a bilateral P100 latency reduction.
At high contrast, 22% had a unilateral P100 latency reduction while
66% had a bilateral P100 latency reduction. 12% of the subjects
showed no latency reduction at high contrast.
Conclusions: SD-tVEP objectively measured the reduction in the
P100 latency as a result of the vision training program. The low
contrast SD-tVEP P100 latency demonstrated the largest sensitivity
to the training.
Commercial Relationships: Robert Orsillo, None; Peter H. Derr,
Diopsys Inc (E)
Program Number: 5309 Poster Board Number: D0070
Presentation Time: 2:45 PM - 4:30 PM
Quality of life of Keratoconus Patients in an Asian Population
Hon Kiat Wong, Jimmy Lim, Wee-Jin Heng. Ophthalmology,
National Healthcare Group Eye Institute, Tan Tock Seng Hospital,
Singapore, Singapore.
Purpose: To study the quality of life of Asian keratoconus patients.
Methods: Telephone interview of keratoconus patients seen at Tan
Tock Seng Hospital from July 2003 to June 2011 were performed
using the VFQ-25 questionnaire. Demographic data and quality of
life such as near and distance activities, social functioning, role
difficulties, dependency and driving were assessed.
Results: Twenty patients were surveyed, of which 40% were male
(8/20) and 60% female (12/20). The mean age was 20.7 ± 7.5 years
(range 17-47). There were 40% Chinese (8/20), 25% Malays (5/20)
and 35% Indians (7/20). Patients who had best spectacle corrected
visual acuity (BSCVA) 6/21 or better scored better in role difficulties
(76.7 vs 50.0, P=0.05). They also performed better in near and
distance activities (95.6 vs 79.2, P=0.30; 97.8 vs 72.9, P=0.30).
Patients with maximal keratometry readings (Kmax) less than 49
dioptres fared better in terms of social function (100 vs 90.63,
P=0.05) and role difficulties (83.0 vs 54.7, P=0.03). Patients who
underwent cornea transplant were more independent (100 vs 87.8,
P=0.04) in their activities of daily living. Keratoconus patients
wearing rigid gas permeable lenses were more confident in their
driving (97.2 vs 75.0, P=0.20).
Conclusions: Patients with BSCVA better than 6/24 and Kmax less
than 49 dioptres had less role difficulties and better social
functioning. Those who underwent cornea transplant were
functionally more independent.
Commercial Relationships: Hon Kiat Wong, None; Jimmy Lim,
None; Wee-Jin Heng, None
Program Number: 5310 Poster Board Number: D0071
Presentation Time: 2:45 PM - 4:30 PM
Dry eye and Changes in Driving Habits: The Salisbury Eye
Evaluation
Jamie Brown1, Esen K. Akpek1, Suzanne W. van Landingham1, Sheila
K. West1, 2, Beatriz E. Munoz1, 2, Pradeep Y. Ramulu1, 2. 1Johns
Hopkins Wilmer Eye Institute, Baltimore, MD; 2Dana Center for
Preventive Ophthalmology, Baltimore, MD.
Purpose: To evaluate the association between dry eye symptoms
(DES) and clinically significant dry eye (CSDE) with self-reported
driving limitations.
Methods: A population-based sample of 1,896 current or previous
drivers (ages 65 to 84), with visual acuity better than 20/40 and no
significant visual field loss, were asked if they had driven: (1) at all in
the last year, (2) at least 3000 miles in the last year, (3) at night in the
last 3 months, or (4) in unfamiliar areas over the last 3 months. DES
were defined as one or more self-reported dry eye symptom occurring
often or always, while CSDE was defined as the presence of DES
plus clinical evidence of dry eye based on Schirmer’s or rose bengal
staining. Associations between DES and CSDE with driving
cessation and driving restrictions were assessed in multivariable
models adjusting for demographic, visual, and health-related factors.
Results: From the eligible subjects, 275 (11%) had DES and 92 (4%)
had CSDE.
Univariate analysis showed that subjects with DES, compared to
subjects without DES, were more likely to cease driving (14.3% vs.
8.0%, p=0.001), to drive <3000 miles/year (36.5% vs. 26.8%,
p=0.002), to not drive at night (26.2% vs. 20.1, p=0.03), but were not
more likely to avoid driving in unfamiliar areas (51.7% vs. 50.4%,
p=0.7). Subjects with CSDE, compared to subjects without CSDE,
trended toward higher likelihood of driving cessation (14.5% vs.
8.6%, p=0.09), but not driving limitations (p>0.19 for all).
Multivariable analysis demonstrated that the presence of DES was
associated with a 1.8-fold greater odds of driving cessation (95%
CI=1.2-2.9; p=0.008) and a greater likelihood of driving less than
3000 miles per year (Odds Ratio [OR]=1.6; 95% CI=1.1-2.2;
p=0.007). Subjects with CSDE had a 2.4-fold greater odds of driving
cessation when compared with subjects without any signs or
symptoms (95% CI=1.1-5.1; p=0.02). Neither DES nor CSDE was
significantly associated with the other driving limitations (p>0.13 for
all).
Conclusions: Assessment and treatment of dry eye may prevent
significant changes in driving habits or driving cessation, ultimately
with improvement of independence and quality of life.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Conclusions: IVF MD rarely differs from, and does not predict
measures of disability better than, better-eye MD. Unlike better-eye
MD, IVF measurements require extra software or calculation.
Furthermore, information from studies using better-eye VF MD can
be more easily integrated into clinical decision-making and therefore
provide a robust and meaningful method for reporting VF loss
severity. Evidence supporting the use of IVF preferentially to bettereye VF is lacking.
Commercial Relationships: Karun S. Arora, None; Michael V.
Boland, None; David S. Friedman, Alcon (C), Bausch & Lomb (C),
Merck (C), QLT, Inc (C), Allergan (C), Nidek (C); Joan L. Jefferys,
None; Sheila K. West, None; Pradeep Y. Ramulu, None
Percent of subjects who ceased driving, stratified by the number of
dry eye symptoms(DES)
Commercial Relationships: Jamie Brown, None; Esen K. Akpek,
Alcon (F), Allergan (F), Baush & Lomb (C); Suzanne W. van
Landingham, None; Sheila K. West, None; Beatriz E. Munoz,
None; Pradeep Y. Ramulu, None
Support: NIH grants EY01765, AG10184, EY015025, the Research
to Prevent Blindness Special Scholar Award, Jerome L. Greene
Sjogrne’s Syndrome Foundation Discovery Fund and the Doris Duke
Charitable Foundation
Program Number: 5311 Poster Board Number: D0072
Presentation Time: 2:45 PM - 4:30 PM
Comparing Better-eye and Integrated Visual Field Mean
Deviation as Metrics for Capturing Visual Disability
Karun S. Arora, Michael V. Boland, David S. Friedman, Joan L.
Jefferys, Sheila K. West, Pradeep Y. Ramulu. Ophthalmology, Johns
Hopkins University School of Medicine, BALTIMORE, MD.
Purpose: To determine 1) extent of difference between better-eye
visual field (VF) mean deviation (MD) and integrated VF (IVF) MD
and 2) whether better-eye or IVF MD better relates to disability
measures obtained in the Salisbury Eye Evaluation (SEE)
Methods: VF testing was performed in each eye and used to
calculate the amount of integrated VF loss (IVF MD) using binocular
summation in both 1,098 SEE subjects and 13,955 Wilmer Eye
Institute glaucoma patients. Differences between better-eye and IVF
MD were calculated for the 490 SEE patients and the 7053 Wilmer
glaucoma patients with VF MD ≤ -3 in at least one eye. In SEE
subjects with VF loss, models were constructed to compare the
relative impact of better-eye and IVF MD on driving habits, mobility,
self-reported vision-related function and reading speed.
Results: The median difference between the better-eye and the IVF
MD (defined as better-eye MD minus IVF MD) was 0.41 dB
(Interquartile range [IQR] = -0.21 to 1.04 dB) and 0.72 dB (IQR =
0.04 to 1.45 dB) for the SEE and Wilmer glaucoma subjects with VF
loss, respectively, with differences of ≥ 2 dB between the two MDs
observed in 9% and 18% of the groups. Amongst SEE subjects with
VF loss, better-eye and IVF MD had similar associations with
multiple disability metrics as judged by the presence/absence of
statistically significant association between MD and the metric, the
magnitude of observed associations (i.e. odds ratios, rate ratios or
regression coefficients associated with 5 dB decrements in MD) and
the extent of variability in the metric explained by the model (R^2
values). For example, a 5 dB decrement in better-eye and IVF MD
slowed subjects' reading speed by -19.7 and -19.1 words per minute
(p<0.0001 for both), respectively, with associated R^2 values of 0.12
and 0.10. Similar findings were noted in the subgroup of glaucoma
subjects and the subgroup of persons in whom better-eye and IVF
MD differed by ≥ 2 dB.
Program Number: 5312 Poster Board Number: D0073
Presentation Time: 2:45 PM - 4:30 PM
Comparing the Impact of Refractive and Non-Refractive Vision
Loss on Disability
Nazlee Zebardast, Sheila K. West, Beatriz E. Munoz, Pradeep Y.
Ramulu. Johns Hopkins Wilmer Eye Institute, Baltimore, MD.
Purpose: To compare the effects of uncorrected refractive error
(URE) and non-refractive visual impairment (VI) on disability
measures.
Methods: Cross-sectional study using data from first round of the
Salisbury Eye Evaluation. 2469 individuals with binocular presenting
visual acuity (PVA) of 20/80 or better were included. URE was
defined as binocular PVA of 20/30 or worse, improving to better than
20/30 with subjective refraction. VI was defined as post-refraction
best corrected visual acuity (BCVA) of 20/30 or worse. Visual acuity
(VA) decrement due to VI was calculated as the difference between
BCVA and 20/30 while that due to URE was taken as the difference
between PVA and BCVA. Multivariable regression analyses were
used to assess the disability impact of: 1) vision status using the
group with normal vision as reference and 2) one-line decrement in
acuity due to VI and URE. The main outcome measures were
objective measures of visual function obtained from timed
performance of mobility and near vision tasks, self-reported driving
cessation, and self-reported visual disability measured by the
Activities of Daily Vision (ADV) scale.
Results: Compared to individuals with normal vision, subjects with
VI (n=191) demonstrated a significant decline in all objective and
subjective metrics of visual function (p<0.05) while subjects with
URE (n=142) demonstrated slower walking speeds, slower near task
performance, more frequent driving cessation, and lower ADV
scores, but did not demonstrate slower stair climbing or descent
speed. For all disability metrics evaluated, the magnitude of the
performance decrement was consistently greater in subjects with VI
than in individuals with URE (Fig 1). A one-line decrement in VA
due to VI was associated with slower completion of stair climb and
descent tasks, greater odds of driving cessation, and greater difficulty
in self-reported visual function when compared to a one-line VA
decrement due to URE (Fig 2).
Conclusions: VI is associated with greater disability than URE
across a wide variety of functional measures, even in analyses
adjusting for the severity of vision loss. Refractive and non-refractive
vision loss should be distinguished in studies evaluating visual
disability and should be understood to have differing consequences.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
1.Comparison of measures of visual disability by vision status
2.Comparison of measures of visual disability associated with a oneline decrement in VI vs URE
Commercial Relationships: Nazlee Zebardast, None; Sheila K.
West, None; Beatriz E. Munoz, None; Pradeep Y. Ramulu, None
Support: This work was supported by NIH grants EY01765,
AG10184, EY015025, and the Research to Prevent Blindness Special
Scholar Award.
Program Number: 5313 Poster Board Number: D0074
Presentation Time: 2:45 PM - 4:30 PM
Rasch analysis of the glaucoma-specific module of the Eye-tem
Bank project
Konrad Pesudovs1, Jyoti Khadka1, Eva K. Fenwick2, Ecosse L.
Lamoureux2, 3. 1NHMRC Ctr Clin Eye Res/Optometry, Flinders
University SA, Adelaide, SA, Australia; 2Centre for Eye Research
Australia, University of Melbourne, Melbourne, VIC, Australia;
3
Singapore Eye Research Institute, Singapore National Eye Centre,
Singapore, Singapore.
Purpose: To assess the psychometric properties of a glaucomaspecific quality of life (QOL) item bank module of the Eye-tem Bank
project.
Methods: The glaucoma-specific QOL item bank has 342 items
distributed across 10 QOL domains: Visual symptoms, SY; Ocular
surface symptoms, OS ; General Symptoms, GS ; Activity limitation,
AL ; Mobility, MB ; Emotional, EM ; Health Concerns, HC ; Social,
SC ; Convenience, CV ; and Economic, EC. The item bank was
interviewer-administered to patients with glaucoma. Each QOL
domain of the item bank was individually evaluated using Rasch
analysis to assess its psychometric properties, namely precision
(adequate if the person separation index (PSI) >2.0); dimensionality
(principal component analysis of residuals, PCA: unidimensionality
is considered if the (1) raw variance explained by the measure >50%,
(2) unexplained variance of the 1st contrast <3.0 eigenvalues or
≤5%); item fit to the model (infit mean square ≤ 1.5); and differential
item functioning (DIF) by age and gender (no DIF if the DIF contrast
is <1.0).
Results: The glaucoma item bank was administered to 293 patients
(male, 55%; median age, 70 yrs; range 20-91 yrs). The majority
(between 80% and 93%) of the participants endorsed the two lower
end categories of all questions, indicating that most participants had
low levels of QOL impact across the domains. Among the 10 QOL
domains, five domains (AL, MB, EM, HC and CV) demonstrated
excellent measurement precision, whereas, five domains (SC, EC,
VS, OS and GS) had borderline precision (PSI ranging from 1.50 to
2.50). The PCA of residuals confirmed that eight domains (MB, EM,
HC, CV, SC, OS, VS and GS) were unidimensional. Two domains
(AL and CV) demonstrated some degree of multidimensionality (1st
contrast >3.0 eigenvalues), which could be repaired by rearranging
the items into subdomains. Of the 342 items, only 27 (7.9%)
displayed misfit, and 7 (2.0%) showed DIF for age or gender.
Conclusions: The 10 QOL domains of the glaucoma-specific item
bank demonstrated good psychometric properties against most
metrics. Despite using a large sample, the preponderance of
participants with low QOL impact of glaucoma impairs the
establishment of precise measurement. Ongoing data collection in
patients across the spectrum of glaucoma will strengthen the
assessment of the psychometric properties and validity of these
glaucoma-specific QOL domains.
Commercial Relationships: Konrad Pesudovs, None; Jyoti
Khadka, None; Eva K. Fenwick, None; Ecosse L. Lamoureux,
None
Support: NHMRC Grant (1031838)
Program Number: 5314 Poster Board Number: D0075
Presentation Time: 2:45 PM - 4:30 PM
Cognitive dysfunction reduces vision-specific quality of life in
older Asian adults
Peggy P. Chiang1, 3, Charumathi Sabanayagam1, 3, Yingfeng Zheng5,
Tien Y. Wong1, 4, Ecosse L. Lamoureux2, 1. 1Epidemiol, Hlth Services
Rsrch, Singapore Eye Research Inst, Singapore, Singapore;
2
Ophthalmology, Centre for Eye Research Australia, University of
Melbourne, Melbourne, VIC, Australia; 3Duke-NUS Graduate
Medical School, Singapore, Singapore; 4Ophthalmology, Department
of Ophthalmology, National University of Singapore, Singapore,
Singapore; 5Ophthalmology, Zhongshan Ophthalmic Center, Sun
Yat-Sen University, Guangzhou, China.
Purpose: Older persons with vision impairment (VI) are more likely
to have cognitive dysfunction (CD). VI impacts on vision-specific
quality of life (QoL). However whether CD also impacts negatively
on vision-specific QoL remains unclear. We examined the
association between CD and vision-specific QoL (vision-specific
functioning (VF)).
Methods: We examined data from Chinese (n=1523), Malay
(n=1429), and Indian (n=1350) adults aged 60 years and older who
participated in three independent population based studies conducted
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
from 2004-2012 in Singapore. Participants underwent standardized
ophthalmic assessments for VI and blindness, defined using
presenting visual acuity (PVA) (United States (U.S) definition).
Sociodemographic data were recorded using a standardized
questionnaire. CD was defined categorically i.e. absence/presence
using the locally validated Abbreviated Mental Test and educationbased cutoff scores. VF was measured via the psychometrically
validated VF-11 questionnaire using Rasch analysis. Multivariate
linear regression analysis was performed to assess the association
between VF and CD, adjusting for presenting vision, major eye
diseases, and other covariates.
Results: Of the 4310 participants (mean±SD age was 68.9±6.0yr;
47.7% were female) examined, 15.5% (666/4310) had CD - Chinese10.0%, Indians-15.5%, and Malays-21.2%; p<0.001. The overall
mean±SD VF score was 4.34±1.59 logits (Chinese 4.69±1.32,
Indians 4.21±1.62; Malays 4.09±1.76; p<0.001), indicating a high
mean level of functioning for this cohort. In multivariate linear
regression models, after adjusting for age, gender, education and
literacy levels, income, cardiovascular disease, total cholesterol,
hypertension, and diabetes, the presence of CD was independently
associated with reduced VF (β [beta coefficient] -0.61, 95%CI
[confidence interval] -0.76,-0.47; p<0.05) and remained statistically
significant after adjusting for unilateral VI (β -0.49, 95%CI-0.63,0.35; p<0.05); bilateral VI (β -0.43, 95%CI -0.56,-0.29; p<0.05); and
eye diseases (β -0.56, 95%CI-0.70,-0.42; p<0.05) in three separate
statistical models. In models stratified by ethnicity, the association
between CD and VF remained statistically significant among the
three ethnic groups.
Conclusions: Older persons with CD, irrespective of their ethnicity,
have reduced VF compared to people who do not have the condition.
Preventing CD may contribute to better vision-related QoL.
Commercial Relationships: Peggy P. Chiang, None; Charumathi
Sabanayagam, None; Yingfeng Zheng, None; Tien Y. Wong,
Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche
(F); Ecosse L. Lamoureux, None
Support: THIS STUDY WAS FUNDED BY BIOMEDICAL
RESEARCH COUNCIL (BMRC), 08/1/35/19/550 & NATIONAL
MEDICAL RESEARCH COUNCIL (NMRC), STAR/0003/2008,
SINGAPORE.
Program Number: 5315 Poster Board Number: D0076
Presentation Time: 2:45 PM - 4:30 PM
Assessment of Disability Weights Associated with Visual Acuity
Impairment in Patients from a University Hospital in Brazil
Solange R. Salomao1, Nívea N. Cavascan1, Adriana Berezovsky1,
Marcia R. Mitsuhiro1, Paula Y. Sacai1, Arnaud Araujo-Filho1, Paulo
Henrique A. Morales1, Sung E. Watanabe1, Rubens Belfort1, Leon B.
Ellwein2. 1Departamento de Oftalmologia, Universidade Federal de
Sao Paulo, Sao Paulo, Brazil; 2NEI, Bethesda, MD.
Purpose: To quantify the self-reported degree of vision difficulty
perceived by patients presenting with reduced visual acuity.
Methods: The study population consisted of adult patients (age ≥
25years) from the Ophthalmology Clinic of UNIFESP University
Hospital with a wide range of ophthalmological diagnosis stratified
by presenting binocular distance visual acuity (VA) measured with an
ETDRS retro-illuminated chart, age, gender, and education level.
Patients were first asked to assess the degree of difficulty seeing
(none, mild, moderate, severe or extreme/cannot do) for five vision
vignettes representing the visual acuity spectrum from normal vision
to no light perception. Patients then ranked these five vignettes, along
with their own vision, from the most desirable to the least desirable.
Rank ordering was followed by a 0 to 100 analog scale rating of each
of the six vision states, where a valuation of 0 (corresponding to a
disability weight [DW] = 100) was to be considered as undesirable as
death and a valuation of 100 (DW=0) as perfect vision. The
correlation between the patient’s VA and the DW valuation of their
own vision was assessed by Spearman coefficients. The association
of DW valuations with VA, age, gender, and education level was
assessed by multivariate regression.
Results: A total of 606 patients (54.45% females) were included in
the study. Mean valuations ranged from 90.55±12.7 for the normal
vision vignette to 5.47±10.2 for the no light perception vignette.
Overall, the mean valuation for the patient’s own vision state was
48.46 ±28.0. Mean valuations were 73.9 ±18.6 for those with
VA≥20/32, 57.7 ±21.8 for those with VA 20/40 to 20/63, 47.8 ±20.1
for those with VA 20/80 to 20/160, 34.6 ±18.6 for those with VA
20/200 to 20/400, and 19.0 ±18.8 for those with VA ≤20/500. DW
valuations were closely correlated with VA, with a Spearman
correlation coefficient of .728, P<0.001. In multivariate regression,
lower valuations were associated with decreased VA (P<0.001),
younger age (P<0.001), and increased education level (P<0.05).
Gender was not significant.
Conclusions: The increasing impact on DW valuations was
consistent with severity of visual acuity impairment, and also
associated with age and education level. DW valuations provide a
promising tool to quantify the patient-perceived burden of visual
impairment due to ocular abnormalities.
Commercial Relationships: Solange R. Salomao, None; Nívea N.
Cavascan, None; Adriana Berezovsky, None; Marcia R.
Mitsuhiro, None; Paula Y. Sacai, None; Arnaud Araujo-Filho,
None; Paulo Henrique A. Morales, None; Sung E. Watanabe,
None; Rubens Belfort, CNPQ (F), FAPESP (F), ALCON (C),
ALLERGAN (R), BAYER (R), NOVABAY (R), ALCON (R); Leon
B. Ellwein, None
Support: FAPESP, Brazil #2004/06670-9; CNPq, Brasilia, Brasil
#303285/2004-4; WHO, Geneva, Switzerland
Program Number: 5316 Poster Board Number: D0077
Presentation Time: 2:45 PM - 4:30 PM
New Method for the Classification of Vitreous Floaters and Study
of their Correlations with Ocular Biometry
Irene Ruiz1, 2, Jos J. Rozema1, 2, Marie-José B. Tassignon1, 2.
1
Ophthalmology, Antwerp University Hospital, Edegem, Belgium;
2
Medicine and Health Science, University of Antwerp, Wilrijk,
Belgium.
Purpose: To introduce a new classification system for vitreous
floaters and to study their prevalence and correlation with ocular
biometry.
Methods: This prospective cross-sectional study conducted at the
Antwerp University Hospital involves 191 subjects aged between
17.7 and 78.6 years. For each eye the type and grade of floaters were
determined by looking into a light box and pointing at a table with
the shapes of the most common types of floaters, which is repeated
using a modified blue light entoscope (vitreoscope). Subjects were
also asked to answer a short survey to determine how their floaters
affect their daily lives. Finally subjects underwent measurements of
autorefraction, ocular biometry (Zeiss IOL Master), keratometry
(Oculus Pentacam), logMAR visual acuity, intraocular pressure
(Reichert ORA), contrast sensitivity (Sine Wave Contrast Test) and
aberrometry (Tracey iTtrace). Data were analyzed using multivariate
and partial correlation analyses.
Results: Based on their floater scores and answers to the
questionnaire subjects could be divided into three groups: 164
subjects with floaters (85.86%), 23 symptomatic subjects with
floaters (12.04 %), and 4 subjects with significant floaters but few
complaints (2.09%). Only 2 subjects (0.99%) did not have any
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
floaters at all. Weak but significant partial correlations were found
between floater score and age (Pearson r = 0.326), axial length (r =
0.144) and the spherical refraction (r = -0.15). No differences were
found in the quantity and type of floaters present in symptomatic or
non-symptomatic subjects, suggesting that other parameters might
play a role (e.g. location of the floater along the optical axis).
Conclusions: The proposed classification method permits objective
grading of the type and amount of vitreous floaters, which may be a
useful tool to select the most suitable treatment for each case. The
presence of vitreous floaters does not automatically lead to floater
related complaints. The floater score was found to increase slowly
with age and axial length.
Commercial Relationships: Irene Ruiz, None; Jos J. Rozema,
None; Marie-José B. Tassignon, None
Support: Research Grant of ESCRS (€ 25000)
Program Number: 5317 Poster Board Number: D0078
Presentation Time: 2:45 PM - 4:30 PM
Participants’ experiences in a clinical trial for vision restoration:
Motivation to participate, visual perception and functional use,
and experience of loss following termination
Frank J. Lane1, Philip R. Troyk2, Kristian P. Nitsch1. 1Pyschology,
Illinois Insitute of Technology, Chicago, IL; 2Biomedical
Engineering, Illinois Insitute of Technology, Chicago, IL.
Purpose: At the 2012 World Congress on Artificial Vision, more
than 12 investigators reported on the status of their vision implant
designed to restore visual percepts for people who are blind. Many of
the investigations have moved to human clinical trials, yet, to date
little exists in the literature on the experiences of participants in
visual prosthesis trials. This presentation is the first report on the
experiences of 12 of the 16 recipients implanted with a surface-cortex
implant by William Dobelle.
Methods: In-depth qualitative interviews of individuals who received
a Dobelle cortical visual prosthesis were conducted. Eleven
recipients, and the parents of one deceased recipient, were contacted
and invited to an interview, so that they could describe their
experiences of participation in the Dobelle study. Informed consent
was obtained from all participants. All interviews were audio or
video recorded, professionally transcribed, and qualitatively analyzed
using MAXQDA software.
Results: Analyses of participant interviews revealed motivation that
has not been previously documented. While restoration of vision
emerged as the strongest motivator, altruism, excitement associated
with participating in “ground breaking” research, and the importance
of hope were notable; these have not been reported in the literature
and are not well understood. While some of the recipients reported no
functional benefit from the implant, others described perceiving a
range of phosphenes with as few as two and as many as 119.
Participants describe functional benefits across this range of
phosphenes. Individuals who experienced restored visual perception
also experienced feelings of loss upon project termination.
Conclusions: The experiences of former implantable device users
should be a critical component of every implantable device project,
especially when considering the risk/benefit ratio. The Dobelle
recipients interviewed in this study have provided valuable
information on the importance of including self-reported feedback
from participants in clinical trials. These interview results are being
used to develop a framework to prepare for the screening and
informed consent of future visual prosthesis human implantation
trials.
Commercial Relationships: Frank J. Lane, None; Philip R.
Troyk, Sigenics, Inc (I), Sigenics, Inc (E); Kristian P. Nitsch, None
Program Number: 5318 Poster Board Number: D0079
Presentation Time: 2:45 PM - 4:30 PM
Developing a questionnaire to measure the quality of life of
Blepharitis patients
Linda Bourque1, 2, Melissa M. Kelley1, 2, Kamran Hosseini2. 1Fielding
School of Public Hlth, University of California, Los Angeles, Los
Angeles, CA; 2InSite Vision, Inc., Alameda, CA.
Purpose: Blepharitis is a common, chronic eye condition that
manifests as an inflammation of the eyelids. Usual treatments include
lid hygiene, topical steroids, and antibiotics either alone or in
combination. While patients “learn to live” with blepharitis, it does
have an impact on quality of life (QOL). Currently, no validated
QOL questionnaire is available to measure this impact. As part of a
double-blinded, clinical trial of alternative treatment protocols, we
designed a questionnaire to assess the impact of treatment on the
QOL of blepharitis patients.
Methods: Thirteen questions about clinical signs and symptoms were
administered to 900 blepharitis patients throughout a phase III
clinical trial. Upon enrollment into the trial, all patients underwent a
lid hygiene regimen for at least one week. If blepharitis signs and
symptoms persisted after the hygiene treatment, patients were
randomized into one of four groups that received treatment for two
weeks with either: placebo (N = 150), azithromycin alone (N = 150),
dexamethasone alone (N = 300), or a combination of azithromycine
and dexamethasone (N = 300).
To examine trends in responses and while still blinded to treatment
assignments, preliminary analyses of 875 patients compared answers
to the 13 questions at the beginning and end of treatment. Exploratory
cluster analyses examined whether the QOL questionnaire might
effectively differentiate between the four experimental groups at the
end of the treatment period.
Results: Sixty-seven percent of patients received a treatment
containing a corticosteroid, which should result in a measurable
regression in clinical signs and symptoms at the end of treatment.
Across the 13 signs and symptoms measured, on average, 40-55% of
patients reported a reduction in symptoms, 40-50% of patients
reported no change in symptoms, and 8-10% of patients reported an
increase in symptoms. Reports of “lid irritation” showed the greatest
improvement, with 54.9% of patients reporting that symptoms were
reduced at the end of treatment; reports of “eye lids stuck together”
exhibited the least improvement with 28.4% reporting that symptoms
were reduced.
Conclusions: Preliminary findings suggest QOL can be measured in
blepharitis patients.
Next steps include analyzing how patient reported outcomes compare
with clinical data from the same patients.
Commercial Relationships: Linda Bourque, InSite Vision, Inc.
(C); Melissa M. Kelley, InSite Vision, Inc. (C); Kamran Hosseini,
InSite Vision Inc. (E)
Clinical Trial: NCT01408082
Program Number: 5319 Poster Board Number: D0080
Presentation Time: 2:45 PM - 4:30 PM
Evaluation of Methods Handling Missing Diary Data for
Statistical Analysis in Dry Eye Studies
Hui-Chun T. Hsu, Dale W. Usner, Richard Abelson. Biostatistics,
Statistics and Data Corporation, Tempe, AZ.
Purpose: Patient symptom diaries are a commonly used method to
collect efficacy data in clinical trials such as those for dry eye
treatments. Typically, patients are asked to report the severity of
several ocular symptoms multiple times per day over the course of a
study that may last weeks or even months. Missing data can rarely be
avoided when the patients are asked to complete many items in the
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
patient diaries. There are several possible ways to handle the missing
diary data each of which will result in an different statistical outcome.
The goal of imputing missing diary data is to represent as close as
possible the statistical outcome that would have been achieved with
no missing data.
Methods: 5000 sets of diary data were randomly created from a
multivariate normal distribution for two treatment groups (active and
placebo). For each simulation, a complete two weeks of diary data
was generated for 50 subjects per treatment, assuming a 0.6 treatment
mean difference on a scale of 0-5 with a standard deviation of 1 and a
correlation of 0.85 between diary days. Two percent of the data were
randomly set as missing and ten percent of the subjects were
randomly selected as early withdrawals. Several imputation methods
were used to handle the missing data: (1) last observation carried
forward (LOCF); (2) baseline observation carried forward (BOCF);
(3) worst observation carried forward (WOCF); (4) subject mean; (5)
treatment group mean. A mixed model accounted for repeated
measures within each subject was used for statistical analysis. The
percentages of times where the results indicated significant treatment
differences based on the different imputation methods were compared
to the complete simulated data as well as observed data only (ODO).
Results: Compared to the analysis based on the complete simulated
data, treatment group mean imputation (5) yielded artificially higher
percentage of significance, whereas BOCF (2) yielded artificially
lower percentage of significance. All other methods had similar
percentages of significance as the analysis based on the complete
simulated data.
Conclusions: All of the above imputation methods are valid for
missing data handling. More than one imputation method is
recommended to apply to the clinical research for sensitivity analysis.
The methods yielding similar percentages of significance as based on
the complete simulated data are recommended.
Commercial Relationships: Hui-Chun T. Hsu, Statistics & Data
Corporation (E); Dale W. Usner, SDC (E); Richard Abelson,
Statistics & Data Corporation (E)
Program Number: 5320 Poster Board Number: D0081
Presentation Time: 2:45 PM - 4:30 PM
Visual Function Affects Reported Depressive Symptoms and
Suicidal Ideation in Older Adults
Priyanka Jain1, Merideth Smith2, J V. Odom1, G. Jamie Miller1,
Charles Moore1, Monique J. Leys1. 1WVU Eye Institute,
Morgantown, WV; 2Psychology, West Virginia University,
Morgantown, WV.
Purpose: To evaluate the relationship of visual function to quality of
life as measured on scales of depression, suicidal ideation and life
satisfaction in older patients.
Methods: We report data on 100 persons who participated in a
telephone interview to determine the relationship of prosocial
behaviors, e.g., volunteering or giving help, and help received on
depression and suicidal ideation in the elderly. The specific
depression measures which we employed were the Satisfaction with
Life Scale (SLS), the Center for Epidemiological Studies Depression
Scale Revised (CESDSR), the Reasons for Living Scale (RLS) and
the Modified Scale for Suicidal Ideation (MSSI). Patients were aged
60 years or more (mean: 73.48 years; range 60-94) and passed
standard cognitive tests to rule out dementia. 55 were female and 45
were male. All participants were recruited from the WVU Eye
Institute for the study. Exclusion criteria for the study did not include
visual function. Patients ranged from normal vision to severe visual
impairment. A chart review determined the monocular visual acuities,
ocular disease, duration of disease, and visual fields present within
one month of the telephone interview. Visual acuities were converted
to LogMAR value. The visual field information in the charts was
converted to a 4-point rating scale of field loss severity. Disease
duration was expressed to the nearest year. Using correlation analyses
and stepwise regression, we determined which of the visual variables
predicted depression and/or suicidal ideation in our sample.
Results: Stepwise regression indicated a significant relationship of
visual variables to SLS (p < .0001; Multiple R-squared = 0.17 with
acuity in the better eye (VA-B) and visual fields (VF) as the relevant
independent variables [IV]), to CESDSR (p<.00185; Multiple Rsquared = 0.09 with VA-B as the IV), and to MSSI (p < 0.005;
Multiple R-squared = 0.10 with VA-B and VF as the IVs) but not to
RFL (p<0.22904; Multiple R-squared = 0. .0147). Although 6 of 100
patients reported suicidal thoughts on the MSSI, none were judged to
be clinically suicidal.
Conclusions: Our data provide additional support for the importance
of visual function in mental health. The visual acuity in the better
seeing eye and visual fields have significant impact on quality of life
as reflected on scales of life satisfaction, depression, and suicidal
ideation.
Commercial Relationships: Priyanka Jain, None; Merideth
Smith, None; J V. Odom, None; G. Jamie Miller, None; Charles
Moore, None; Monique J. Leys, None
Support: Research to Prevent Blindness Challenge Grant
Program Number: 5321 Poster Board Number: D0082
Presentation Time: 2:45 PM - 4:30 PM
Subjective Influences on Visual Acuity Testing Performance: A
Prospective Study with Non-accommodating Intra-ocular Lenses
Arvind V. Iyer1, Edward R. Chu2, Billy X. Pan2, Bosco S. Tjan3,
Alfredo A. Sadun2, Kenneth L. Lu2, Firdaus E. Udwadia4.
1
Biomedical Engineering, University of Southern California, Los
Angeles, CA; 2Ophthalmology, University of Southern California,
Los Angeles, CA; 3Psychology, University of Southern California,
Los Angeles, CA; 4Aerospace and Mechanical Engineering,
University of Southern California, Los Angeles, CA.
Purpose: Multifocal and accommodating intraocular lenses (IOLs)
have been purported to provide much better near vision than what is
optically predicted. In this study, we perform multiple measurements
of visual acuity (VA) in IOL users to investigate if different verbal
interactions induce improvement in visual performance.
Methods: Distance and near VA measurements were obtained from
each of 19 patients with non-accommodating IOLs, in four sessions
during the same visit interspersed with two reading conditions : (i)
before and after reading a page of typed text on an extraneous topic,
handed by a non-expert, and (ii) before and after reading a page of
text that emphasized the favorable aspects of these IOLs, handed by
the attending physician who also briefly presented the advantages of
IOL to patients. There was a break (without any reading) between
these two pairs of sessions.
All patients had distance vision of 20/40 or better. In each session,
near VA measurements retained for analysis were from the betterperforming eye. All near VA measurements were converted to
logMAR (log minimum angle of resolution).
Results: The accompanying figure shows the mean near VA across
subjects for each of the four sessions.
Near VA varied significantly across sessions [F(3,54)=6.66, p=0.007]
and better acuity was observed in Session 4 than in Session 1
[t(18)=3.72, one-tail p<0.001]. No interaction between reading
(measuring VA before vs. after reading) and reading type (extraneous
vs. IOL-related) was observed [F(1,18)=0.29, p=0.6]. Furthermore,
there was also no significant difference between VA changes due to
reading versus that due to the non-reading break [F(1,18)=1.24,
p=0.28].
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Conclusions: Our preliminary results show short-term improvement
in near-VA testing performance over sessions. There is no evidence
that prior reading contributes to this improvement, which suggests
that test-retest practice effects contribute to the apparent
improvement in measured acuity.
Apps most suited to their needs, and physicians to make
recommendations.
Commercial Relationships: Arvind V. Iyer, None; Edward R.
Chu, Edison Pharmaceuticals (F); Billy X. Pan, None; Bosco S.
Tjan, None; Alfredo A. Sadun, None; Kenneth L. Lu, None;
Firdaus E. Udwadia, None
Program Number: 5322 Poster Board Number: D0083
Presentation Time: 2:45 PM - 4:30 PM
Educational and vision-assistive smartphone Apps for patients: a
quantitative evaluation
Stephanie Kletke1, Sourabh Arora2, Feisal Adatia3. 1Medicine,
McMaster University, Hamilton, ON, Canada; 2Ophthalmology,
University of Alberta, Edmonton, AB, Canada; 3Ophthalmology,
University of Calgary, Calgary, AB, Canada.
Purpose: To identify and quantitatively evaluate high quality patient
educational and vision assistive Apps.
Methods: Webstores of major smartphone platforms, including
iPhone (App Store) and Android (Market) were searched to identify
vision assistive and educational Apps targeting patients. Quantitative
evaluation was performed using the Quality Component Scoring
system (QCS), which assessed for: ownership, purpose, authorship,
author qualification, attribution, interactivity, and currency
(maximum score of 13). For vision assistive Apps, usability
parameter assessment included: interface design, ease of use/user
feedback, navigation, terminology, and low vision accessibility
(maximum score of 10). The Technical Component Score System
(TCS) was used for educational Apps only (maximum score of 16).
Average user ratings, App cost, and links to other resources were also
considered.
Results: Thirty-four (23 vision assistive, 11 educational) smartphone
Apps were included for analysis. Amongst all Apps’ QCS, the mean
attribution score (indicating use of references) was the lowest
(0.15+/-0.4), while the currency score (indicating dates of latest
updates are listed) was the highest (1.7+/-0.5, p<0.001). For assistive
Apps, the mean usability total was 6.4+/- 1.7, and the combined QCS
and usability total was 17.6+/- 2.9 (maximum possible score = 23).
Patient-appropriate terminology scored the highest (2.0) and lowvision accessibility scored the lowest (0.78+/-0.52, p<0.001).
Number of ratings for an App was significantly correlated with its
usability score (Spearman’s rho=0.513, p=0.012) and combined total
score (Spearman’s rho=0.422, p=0.045). Amongst educational Apps,
the mean TCS total was 8.1+/- 5.3 and the combined QCS and TCS
total was 18.6+/- 7.4 (maximum possible score = 29). The most
common learning methods were text-based (82%) and video/audiobased (18%). The TCS scores were significantly higher for text-based
Apps (9.3+/-5.1) compared to video/audio-based (2.5+/-0.7,
p=0.004).
Conclusions: This study has provided a list of patient educational
and vision assistive Apps, ranked by order of quality and categorized
by their purpose/learning method. This will allow patients to access
Figure 1. Assessment of quality component parameters
Figure 2: Usability parameters for ophthalmology smartphone Apps
targeting patients
Commercial Relationships: Stephanie Kletke, None; Sourabh
Arora, None; Feisal Adatia, None
Program Number: 5323 Poster Board Number: D0084
Presentation Time: 2:45 PM - 4:30 PM
Patient Experience During the Fitting Process for the Prosthetic
Replacement of the Ocular Surface Ecosystem (PROSE) Device
Eda Dou, Yvonne Wang, Ryan M. St Clair, Michelle N. Lee, Mark
Rosenblatt, Priyanka Sood, Ana G. Alzaga Fernandez, Christopher
E. Starr, Jessica Ciralsky, Kimberly C. Sippel. Ophthalmology, Weill
Cornell Medical College, New York, NY.
Purpose: To determine time to full-time wear, and also the time and
difficulty of device insertion and removal in patients newly fitted
with the PROSE device.
Methods: Patients referred to the Weill Cornell Department of
Ophthalmology for PROSE fitting from July through November 2012
were enrolled in the study. Patient diagnosis was categorized into 1)
ectasia/irregular astigmatism, e.g. keratoconus, pellucid marginal
degeneration, post-laser vision correction ectasia, and 2) severe
ocular surface disease, e.g. Sjogren’s syndrome, graft-versus-host
disease, Stevens-Johnson syndrome. Patients were given a diary to
record daily wear time, amount of time needed for insertion and
removal, and difficulty of insertion and removal throughout the
fitting process. Patients were also asked if they required an assistant
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
for the insertion/ removal process. Patients were instructed to identify
the amount of time needed for insertion and removal by circling ≤5
minutes, 5-15 minutes, or >15-30 minutes. Difficulty of insertion and
removal was rated by patients on a scale of 1-5 (1=no difficulty;
5=very difficult).
Results: 20 patients (36 eyes) were included in the study. Patient age
ranged from 26-76 years, with a mean of 56. Fourteen patients were
referred for ectasia/irregular astigmatism and six for severe ocular
surface disease. On average, patients achieved all day (12 hours)
PROSE wear seven weeks after initial fitting. 56% of patients
required ≤5 minutes to insert the device, 33% required 5-15 minutes,
and 4% required >15-30 minutes by the 2-week mark. 70% of
patients required ≤5 minutes to remove the device, 30% required 515 minutes, and no patients required >15-30 minutes. Mean rating for
difficulty of insertion was 1.5, while removal was rated 1.4, by week
two. Assistants were not required at any time.
Conclusions: Apprehension towards learning to insert and remove
the PROSE device constitutes a barrier for many patients, as well as
referring ophthalmologists. Our study shows that all patients,
including the elderly, were able to learn to insert and remove the
device by themselves quickly and with relative ease.
Commercial Relationships: Eda Dou, None; Yvonne Wang, None;
Ryan M. St Clair, None; Michelle N. Lee, None; Mark Rosenblatt,
None; Priyanka Sood, None; Ana G. Alzaga Fernandez, None;
Christopher E. Starr, None; Jessica Ciralsky, None; Kimberly C.
Sippel, None
Support: Research to Prevent Blindness
Program Number: 5324 Poster Board Number: D0085
Presentation Time: 2:45 PM - 4:30 PM
Importance of Physical Activity and Low Vision: Preliminary
Findings from an Adaptive Sport and Recreation Program for
Military Service Members with Low Vision
Laura E. Dreer1, 2, Cady Block1, Andy Wood1, Susan Robinson2,
Mandy Goff2, Laurie Malone2. 1Ophthalmology/Callahan Eye Fndtn
Hosp, Univ of Alabama at Birmingham, Birmingham, AL;
2
Lakeshore Foundation, Birmingham, AL.
Purpose: To examine changes in health outcomes and quality of life
among injured military service members with low vision following
participation in an organized sport and recreation camp.
Methods: Design: Interventional pre-post evaluation. Injured service
members participating in a weekend camp through the Lakeshore
Foundation's Lima Foxtrot Programs (Operation Night Vision) for
Injured Military Families, were given assessments over the telephone
at one month prior to camp, two months following camp, and seven
months following camp. Participants: As part of this ongoing study,
thirteen individuals, 10 male and 3 female, agreed to participate. All
participants had a vision impairment. Main Outcomes Measures:
Health behaviors and quality of life were measured with the General
Health Questionnaire (GHQ), Current Level of Physical Activity, the
Physical Activity Disability Survey-Revised (PADS-R), the SF-12,
and the Lifestyle Profile-II. All measures were administered at all
three time points. T-tests were conducted on scores from the baseline
and two month follow-up assessments.
Results: Participants showed significant improvement on both the
Physical and Mental Health composite scores of the SF-12. Results
showed a significant decrease in scores on the Score C (therapy)
subscale of the PADS-R, indicating less time spent in any kind of
physical therapy. Finally, participants also reported significantly
higher scores on the Health Promoting Lifestyle subscale of the
Lifestyle Profile-II. Trends were found for increases in days per week
of moderate exercise as measured by the Current Level of Physical
Activity, the Score B (general) subscale of the PADS-R, and the
Health Responsibility Subscale of the Lifestyle Profile-II.
Conclusions: Participating in a sports and recreation camp resulted
in improvement of health behaviors and quality of life for injured
military with low vision. Utilizing camps such as this could help
military men and women with vision difficulties better recover from
their injuries in areas that standard treatments do not always address
as part of low vision rehabilitation. The importance of physical
activity and such programs also have implications for civilian
populations living with low vision as well.
Commercial Relationships: Laura E. Dreer, None; Cady Block,
None; Andy Wood, None; Susan Robinson, None; Mandy Goff,
None; Laurie Malone, Lakeshore Foundation (E)
Support: Lakeshore Foundation
Program Number: 5325 Poster Board Number: D0086
Presentation Time: 2:45 PM - 4:30 PM
Fear of falling, activity restriction and self-reported physical
function among older adults with glaucoma
Alex A. Black, Joanne M. Wood. School of Optometry and Vision
Science, Queensland University of Technology, Brisbane, QLD,
Australia.
Purpose: To describe the associations between fear of falling,
activity restriction, self-reported physical function and visual
impairment among older adults with glaucoma.
Methods: This cross-sectional study included 98 communitydwelling older adults (mean age 74 ± 6 years; 60% male) with a
range of visual impairment from glaucoma. Vision assessment
included tests of binocular high-contrast visual acuity, binocular
contrast sensitivity (Pelli-Robson) and integrated visual field (IVF)
sensitivity (merged monocular HFA SITA-Standard 24-2).
Participants completed questionnaires which assessed fear of falling
(Have you been worried or afraid that you might fall in the past 12
months?), activity restriction due to fear of falling (Do you ever limit
your activities because you are afraid of falling?) and the 10-item
physical function subscale from the Medical Outcomes Study SF-36.
Multivariate regression procedures were used to examine associations
between the outcome and visual function measures, after controlling
for potential covariates (age, gender, previous falls and
comorbidities).
Results: In this cohort, 19% expressed fear of falling and 10%
reported associated activity restriction. In the multivariate logistic
regression models, IVF sensitivity was the strongest visual factor
associated with these outcomes. Each 1 dB reduction in IVF
sensitivity was associated with higher odds of fear of falling (OR
1.11; 95% CI 1.02-1.20; p=0.021) and activity restriction (OR 1.20;
95% CI 1.06-1.36; p=0.004). In the multivariate linear regression
models, greater IVF loss was associated with declines in self-reported
physical function (β = -0.09 logits per dB reduction, p=0.012).
Moreover, including activity restriction in the model eliminated the
significant association between IVF sensitivity and self-reported
physical function.
Conclusions: Greater visual field loss among older adults with
glaucoma is associated with higher likelihood of fear of falling and
associated activity restriction, and declines in self-reported physical
function. Activity restriction is a potential mediating factor on the
effect of visual field loss on physical function. This highlights the
need to prevent excessive activity restriction among older adults with
visual impairment from glaucoma to minimise subsequent physical
deconditioning, which can increase the risk of future falls and
fractures.
Commercial Relationships: Alex A. Black, None; Joanne M.
Wood, None
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Program Number: 5326 Poster Board Number: D0087
Presentation Time: 2:45 PM - 4:30 PM
Can chronic visual symptoms measures accurately predict acute
visual discomfort symptoms?
Stefanie A. Drew1, Amy Escobar2, Chunming Liu3, Efrain
Castellanos3, Lawrence R. Stark4, Eric Borsting4, Chris Chase3.
1
Psychology, California State University, Northridge, Northridge,
CA; 22U, Inc., Landover, MD; 3College of Optometry, Western
University of Health Sciences, Pomona, CA; 4Southern California
College of Optometry, Fullerton, CA.
Purpose: Most surveys of discomfort symptoms are retrospective
and assess the frequency and severity of chronic conditions. To our
knowledge, there are no studies that have shown chronic symptom
surveys can predict acute symptoms. We investigated the relationship
between chronic visual discomfort and ratings of acute discomfort
symptoms after tests of accommodation and vergence.
Methods: Prior to testing accommodation and vergence function, the
Conlon visual discomfort survey (Conlon et al., Vis Cogn
1999;6:637-666) assessed chronic visual discomfort symptoms in 38
graduate students. This survey consists of 23 items that address one
of five symptom categories (text movement, headache and soreness,
blur, reading problems and glare). Acute symptoms were measured
with four questions using a five-point rating scale i) discomfort
experienced, ii) amount of distortions or movement, iii) discomfort
from overhead lights and iv) amount of headache experienced.
Binocular function was tested using standard clinical procedures.
After a control accommodation facility test using ± 0.12D lens,
baseline acute visual discomfort was 5.05 (1.11). A second acute
symptom test was made after the binocular exam, producing an
average score of 7.63 (3.35). Individuals were classified into High
(N=16) or Low (N=22) acute symptom groups with a post-exam cutoff score ≥ 7. A logistic regression analysis was performed with the
symptom group as a dependent variable and scores from the Conlon
question categories as the independent variables to determine how
well the chronic symptom survey predicts acute symptom grouping.
Results: A full model significantly predicted post-exam classification
(High or Low) (omnibus chi square = 13.039, df = 5, p = 0.023). This
model accounts for between 29.7% and 40.1% of the variance in
post-exam performance, with 81.8% of the Low post-exam symptoms
correctly predicted and 66.7% of High post-exam symptoms
predicted. Overall, 75.7% of predictions were accurate. Examination
of the predictor variables revealed that only headache questions
reliably predict post-exam symptom group (B = .381, df = 1, p =
0.018).
Conclusions: These data suggest that a chronic symptom survey can
make reasonably good predictions about acute symptoms associated
with tests of accommodation and vergence and that questions
assessing headache and soreness symptoms are the best correlate.
Commercial Relationships: Stefanie A. Drew, None; Amy
Escobar, None; Chunming Liu, None; Efrain Castellanos, None;
Lawrence R. Stark, None; Eric Borsting, None; Chris Chase,
None
Support: EY021021
Clinical Trial: NCT01329848
Program Number: 5327 Poster Board Number: D0088
Presentation Time: 2:45 PM - 4:30 PM
Contrast Sensitivity, Electroretinography and Optical Coherence
Tomography Changes in Young Subjects After an Acute
Unacclimatized Short Exposure to High Altitude
Mehmet S. Karakucuk, Burcu Polat, Ertugrul Mirza, Hatice Arda,
Koray Gumus, Ayse Oner. Dept. of Ophthalmology, Erciyes
University Faculty of Medicine, Kayseri, Turkey.
Purpose: Changes in visual integrity during prolonged
unacclimatized ascent to high altitudes (over 8000ft/2438m) maybe
of concern in mountaineering, outdoor sports, military operations or
aviation related duties such as those involving unpressurized flights.
However, it is not known whether these changes can occur after
relatively short exposures to high altitudes and continue a few days
after the exposure. Here we present the first evaluation of retinal
changes after an acute unacclimatized and short (approximately 3
hours) exposure to high altitude at the 2630m/8628ft-2650m/8694ft
range.
Methods: Contrast sensitivity testing, electroretinography (ERG) and
optical coherence tomography (OCT) were performed on twentythree healthy subjects aged between 17-29 years (mean age ±S.E.M =
20.88±0.64 years) at the Eye clinic of Erciyes University Faculty of
Medicine which is located at an altitude of 1080m/3543ft. On the
following week, during a one-day-activity, the subjects were
transported from 1080m/3543ft to a station at 2630m/8628ft on Mt.
Erciyes by buses and cable-cars within one hour. After resting for one
hour at 2630m/8628ft, the group started to climb by a moderate pace,
reached 2650m/8694ft altitude, completed a route within 2 hr. and
returned back to 2630m/8628ft. The group overall spent 3 hours at
high altitude (2630m/8628ft-2650m/8694ft range) and were
transported back to the city. The same set of tests were repeated
within the 3 days following the altitude exposure. The test results
before and after the altitude exposure were compared with each other.
Results: Average pre-exposure contrast sensitivity on the 20/25 scale
was 0.12 logMar units on the right and 0.13 logMar units on the left
eyes. After the altitude exposure, these values decreased to 0.14
logMar units (p=0.02) and 0.14 log mar units (p=0.01), on the right
and left eyes, respectively.
Average pre-exposure ERG flicker amplitude on the left eyes was
58.64mV and decreased to 52.05mV after the altitude exposure
(p=0.05). No significant differences were observed in the OCT values
between the pre- and post exposure values.
Conclusions: Acute unacclimatized short exposure to high altitude
can negatively affect some of the photopic photoreceptor functions in
young subjects and this effect can last a few days following the
exposure.
Commercial Relationships: Mehmet S. Karakucuk, None; Burcu
Polat, None; Ertugrul Mirza, None; Hatice Arda, None; Koray
Gumus, None; Ayse Oner, None
Program Number: 5328 Poster Board Number: D0089
Presentation Time: 2:45 PM - 4:30 PM
Age-related eye disease and cognitive status
Solmaz Moghadaszadeh1, Hélène Boisjoly1, 2, Marie-Jeanne
Kergoat3, Jacqueline Rousseau3, Fawzia Djafari1, 2, Ellen E.
Freeman1, 2. 1Ophtalmology, Maisonneuve-Rosemont's Hospital,
Montreal, QC, Canada; 2Ophthalmology, Université de Montréal,
Montreal, QC, Canada; 3Centre de Recherche, Institut universitaire
de gériatrie de Montréal, Montreal, QC, Canada.
Purpose: To examine whether patients with age-related macular
degeneration (AMD), glaucoma, or Fuchs corneal dystrophy have
lower cognitive scores compared to a control group of older adults
with good vision.
Methods: We recruited 345 patients (93 with bilateral AMD, 57 with
bilateral Fuchs, 98 with bilateral glaucoma, and 97 controls) from the
ophthalmology clinics of Maisonneuve-Rosemont Hospital
(Montreal, Canada) to participate in a cross-sectional study from
September, 2009 until July, 2012. Control patients who had normal
visual acuity and visual field were recruited from the same clinics.
Participants completed the Mini-Mental State Exam-blind version
which excludes 8 items that rely on vision. People who scored ≤18
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
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ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
out of 22 were defined as having worse cognition. Logistic regression
was used.
Results: 5% of the controls had worse cognition compared to 35% of
AMD, 21% of Fuchs, and 29% of glaucoma patients (P<0.05). After
adjusting for age, gender, education, race, and living alone, all 3
groups with eye disease still had worse cognition (P<0.05). Other
variables associated with worse cognition included older age and
lower levels of education.
Conclusions: Despite using a measurement instrument appropriate
for people with impaired vision, patients with three age-related eye
diseases had worse cognitive scores. Whether this is due to common
biological mechanisms between eye disease and brain disease or
whether this is due to decreased cognitive stimulation after loss of
sight is unknown and should be further explored.
Commercial Relationships: Solmaz Moghadaszadeh, None;
Hélène Boisjoly, None; Marie-Jeanne Kergoat, None; Jacqueline
Rousseau, None; Fawzia Djafari, None; Ellen E. Freeman, None
Support: CIHR MOP 114971
Program Number: 5329 Poster Board Number: D0090
Presentation Time: 2:45 PM - 4:30 PM
DIGS and ADAGES: Relationship Between Rates of Binocular
Visual Field Loss and Vision-Related Quality of Life in
Glaucoma
Renato Lisboa1, 2, Yeoun Sook Chun1, 3, Linda M. Zangwill1, Robert
N. Weinreb1, Peter Rosen1, Jeffrey M. Liebmann4, Christopher A.
Girkin5, Felipe A. Medeiros1. 1Ophthalmology, Hamilton Glaucoma
Center, La Jolla, CA; 2Ophthalmology, Federal University of São
Paulo, São Paulo, Brazil; 3Ophthalmology, Chung-Ang University,
Seoul, Republic of Korea; 4Opthtalmology, New York Eye and Ear
Infirmary, Ney York, NY; 5Ophthalmology, University of Alabama,
Birmingham, AL.
Purpose: To evaluate the relationship between binocular rates of
visual field change and vision-related quality of life (VRQOL) in
glaucoma.
Methods: The study included 796 eyes of 398 participants that had
diagnosed or suspected glaucoma followed for an average of 7.3 ±
2.0 years. Subjects were recruited from the Diagnostic Innovations in
Glaucoma Study (DIGS) and the African Descent and Glaucoma
Evaluation Study (ADAGES). VRQOL was evaluated using the
National Eye Institute Visual Function Questionnaire (NEI VFQ-25)
at the last follow-up visit. Integrated binocular visual fields (BVF)
were calculated from the monocular fields of each patient. Linear
regression of mean deviation (MD) values was used to evaluate rates
of visual field change during the follow-up period. Logistic
regression models were used to investigate the relationship between
abnormal VRQOL and rates of visual field change, while adjusting
for potentially confounding socio-economic and demographic
variables.
Results: Thirty-two patients (8.0%) had abnormal VRQOL as
determined by the results of the NEI VFQ-25 questionnaire. Subjects
with abnormal VRQOL had significantly faster rates of BVF change
than those with normal VRQOL (-0.18 db/year vs. -0.06 dB/year,
respectively; P < 0.001). Rates of BVF change were significantly
associated with abnormality in VRQOL (OR = 1.31 per 0.1dB/year
faster; P = 0.038), after adjustment for confounding variables.
Conclusions: Patients with faster rates of BVF change were at higher
risk of reporting abnormal VRQOL. Assessment of rates of BVF
change may provide useful information in determining risk of
functional impairment in glaucoma.
Commercial Relationships: Renato Lisboa, None; Yeoun Sook
Chun, None; Linda M. Zangwill, Carl Zeiss Meditec Inc (F),
Heidelberg Engineering GmbH (F), Optovue Inc (F), Topcon
Medical Systems Inc (F), Nidek Inc (F); Robert N. Weinreb, Aerie
(F), Alcon (C), Allergan (C), Altheos (C), Amakem (C),
Bausch&Lomb (C), Carl Zeiss-Meditec (C), Genentech (F), HaagStreit (F), Heidelberg Engineering (F), Konan (F), Lumenis (F),
National Eye Institute (F), Nidek (F), Optovue (C), Quark (C), Solx
(C), Topcon (C); Peter Rosen, None; Jeffrey M. Liebmann, Alcon
Laboratories, Inc. (C), Allergan, Inc. (C), Allergan, Inc. (F), Carl
Zeiss Meditech, Inc (F), Heidelberg Engineering, GmbH (F), Topcon
Medical Systems, Inc. (F), National Eye Institute (F), New York
Glaucoma Research Institute (F), SOLX, Inc. (C), Bausch & Lomb,
Inc (C), Diopsys, Inc. (C), Diopsys, Inc. (F), Merz, Inc. (C), Glaukos,
Inc. (C), Quark, Inc. (C); Christopher A. Girkin, SOLX (F),
Heidelberg Engineering (F); Felipe A. Medeiros, Carl-Zeiss (F),
Heidelberg Engineering (F), Topcon (F), Alcon (F), Allergan (F),
Sensimed (F), Reichert (F)
Support: NEI EY11008, NEI EY08208,EY021818, EY022039 and
participant retention incentive grants in the form of glaucoma
medication at no cost from Alcon Laboratories Inc, Allergan, Pfizer
Inc, and Santen Inc.
Clinical Trial: NCT00221897
Program Number: 5330 Poster Board Number: D0091
Presentation Time: 2:45 PM - 4:30 PM
Utility and Uncorrected Refractive Error
Nina Tahhan1, 2, Eric B. Papas1, 3, Timothy R. Fricke1, Kevin D.
Frick4, Brien A. Holden1, 3. 1Brien Holden Vision Institute, Sydney,
NSW, Australia; 2School of Optometry & Vision Science, UNSW,
Sydney, NSW, Australia; 3Vision Cooperative Research Centre,
Sydney, NSW, Australia; 4Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD.
Purpose: Utilities are preference based quality of life (QoL)
measures used in health economic evaluations such as costeffectiveness studies. Utilities have been derived for a variety of
ocular conditions but not previously reported for uncorrected
refractive error (URE). This study evaluates utility associated with
URE.
Methods: This was a cross-sectional study involving participants
presenting for an eye exam at a university based clinic. Participants
met study criteria if aged 40-65 years, wore refractive error
correction and had no ocular disease impairing vision worse than 0.1
LogMAR units in the better eye. All participants underwent a
comprehensive eye examination including refraction, aided and
unaided VA measures at 6m and 40cm using a Bailey-Lovie
LogMAR chart. Utilities were elicited using the Time Trade-Off
(TTO) method for a number of scenarios including the participants
own corrected and uncorrected vision state. Utilities ranged from 0-1
where 0=death and 1=perfect vision and were scaled to account for
co-morbidities so that 1= perfect health (adjusted utility).
Results: Data analysis was based on a cohort of 341 participants (out
of 361 screened).
Unaided, 30 participants had no vision impairment, 65 had only
distance vision impairment (DVI), 97 had only near vision
impairment (NVI), 112 had moderate amounts of both distance and
near vision impairment (DNVI) and 37 had severe impairment
(distance or near impairment >1.0 LogMAR units) in the better eye.
Unaided VA was DVI group 0.50±0.24 LogMAR at distance, NVI
group 0.43±0.17 LogMAR at near, and DNI group 0.72±0.36 at
distance and 0.56±0.29 at near. Adjusted utilities for the three groups
were DVI 0.82±0.16, NVI 0.81±0.17 and DNVI 0.68±0.25. The
(adjusted and unadjusted) DVI and NVI utilities did not significantly
differ (p=0.73 and p=0.77 respectively). DNVI utility was
significantly worse than DVI and NVI (adjusted and unadjusted
p<0.01).
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Conclusions: URE is associated with measurable reductions in utility
(and therefore QoL). Reductions are similar irrespective of whether
near or distance vision is impaired but worse when both are impaired.
The results underscore the significance of URE on QoL, particularly
with respect to uncorrected presbyopia which has been a relatively
neglected area in research and policy. The utility figures in this study
can be used as inputs for cost-effectiveness evaluations for programs
relating to URE to assist governments with resource allocation
decisions.
Commercial Relationships: Nina Tahhan, None; Eric B. Papas,
None; Timothy R. Fricke, None; Kevin D. Frick, Center for
Applied Value Analysis (C), National Association for Eye and Vision
Research (C); Brien A. Holden, Allergan (F), AMO (I)
Program Number: 5331 Poster Board Number: D0092
Presentation Time: 2:45 PM - 4:30 PM
An iPad Test of Letter Contrast Sensitivity
Mark A. Bullimore1, Meredith E. Jansen2, Elli J. Kollbaum2, Pete S.
Kollbaum2. 1College of Optometry, University of Houston, Boulder,
CO; 2School of Optometry, Indiana University, Bloomington, IN.
Purpose: An iPad-based letter contrast sensitivity test was developed
by Ridgevue Vision (ridgevue.com) consisting of two letters on each
page of an iBook. The contrast decreased from 80% (logCS = 0.1) to
0.5% (logCS = 2.3) by 0.1 log units per page. Agreement and
repeatability of this iPad test was compared to the Pelli-Robson Chart
and the computer-based Freiburg Visual Acuity and Contrast Test
(FrACT, version 3.7).
Methods: Twenty normally sighted subjects were recruited (age 2138 years). Subjects were tested monocularly (OD) at 1 meter using
the three tests following a subjective sphero-cylindrical refraction.
After a 5 minute break, subjects were retested with each test in
reverse order. Two different letter charts were used for both the PelliRobson and iPad tests, and the order of testing was varied
systematically. Nominally, on all charts letters were 49 mm and
background luminance was 120 cd/m2. Letter-by-letter scoring (each
letter 0.05 logCS) was used for both letter tests. For the Freiburg, the
target was a variable contrast Landolt C presented at eight possible
orientations. The Best PEST procedure was used with 30 trials (every
sixth trial at 3x threshold). Repeatability and agreement were
assessed by determining the 95% limits of agreement (LoA): ±1.96
SD of the differences between administrations or tests.
Results: All values are in log Weber contrast sensitivity. All tests
showed good repeatability in terms of the 95% LoA: iPad = ±0.19,
Pelli-Robson = ±0.19, Freiburg = ±0.15. The iPad test showed good
agreement with the Freiburg test: iPad mean = 1.94 ± 0.15, Freiburg
mean = 1.94 ± 0.07, 95% LoA = ±0.24, but the Pelli-Robson test
gave significantly lower values: mean = 1.66 ± 0.04.
Conclusions: The iPad Letter Contrast Sensitivity Test showed
similar repeatability to the other tests and may be a rapid and
convenient alternative to traditional measures. The Pelli-Robson test
gave lower values than the both the iPad and Freiburg tests
Commercial Relationships: Mark A. Bullimore, Alcon (C), Carl
Zeiss Meditec (C), DigitalVision Systems (C), Ridgevue (I);
Meredith E. Jansen, Bausch + Lomb (C), Alcon (C); Elli J.
Kollbaum, None; Pete S. Kollbaum, None
Program Number: 5332 Poster Board Number: D0093
Presentation Time: 2:45 PM - 4:30 PM
Fear of falling in age-related macular degeneration
Sabyasachi Sengupta, Suzanne W. van Landingham, Robert W.
Massof, Emilie Chan, David S. Friedman, Pradeep Y. Ramulu.
Wilmer Eye Institute, Baltimore, MD.
Purpose: To determine if age-related macular degeneration (AMD)
and AMD-related vision loss are associated with fear of falling.
Methods: Sixty-five AMD subjects and 60 controls completed a
validated fear of falling questionnaire. Responses were Rasch
analyzed. Scores were expressed in logit units, with lower scores
demonstrating lesser ability, and greater fear of falling.
Results: In multivariable models controlling for gender, body
habitus, strength, and comorbid illness, AMD subjects reported
greater fear of falling as compared to controls (β=-0.77 logits, 95%
CI=-1.5 to -0.002, p=0.045). Greater fear of falling was observed in
subjects with worse visual acuity (VA) (β=-0.15 logits/1 line
decrement, 95% CI=-0.28 to -0.03, p=0.02) and contrast sensitivity
(CS) (β=-0.20 logits/0.1 log unit decrement, 95% CI=-0.31 to -0.09,
p=0.001). Greater fear of falling was also associated with higher
BMI, weaker grip, and more comorbid illnesses (p<0.05 for all.)
Conclusions: AMD and AMD-related vision loss are associated with
greater fear of falling in the elderly. Development, validation, and
implementation of methods to address falls and fear of falling for
individuals with vision loss from AMD is an important goal for
future work.
Commercial Relationships: Sabyasachi Sengupta, None; Suzanne
W. van Landingham, None; Robert W. Massof, None; Emilie
Chan, None; David S. Friedman, Alcon (C), Bausch & Lomb (C),
Merck (C), QLT, Inc (C), Allergan (C), Nidek (C); Pradeep Y.
Ramulu, Tissue Banks International (C)
Support: The National Institutes of Health, Bethesda, Maryland
(grant no.: EY018595)
Program Number: 5333 Poster Board Number: D0094
Presentation Time: 2:45 PM - 4:30 PM
Photophobia and Light-Induced Headache: Novel Long-Term
Effects of Pilocarpine
Brad Motter1, 3, Mary M. Jackowski1, 2. 1VA Medical Center,
Syracuse, NY; 2Ophthalmology, SUNY Upstate Medical University,
Syracuse, NY; 3Neuroscience and Physiology, SUNY Upstate
Medical University, Syracuse, NY.
Purpose: Many young veteran patients are presenting with chronic
aversive light sensitivity (LS), associated with photophobia (PP), and
light-induced headache (LHA) despite the absence of any correlated
ocular health abnormality or positive neuro-imaging findings, but
have a history of potential head trauma. In these patients, LS and
LHA are not significantly relieved by headache medications, optical
correction or spectral filters. In the course of clinical management
attempts we have found, and report here, an unexpectedly long-term
relief of symptoms from a single application of pilocarpine, a
parasympathetic drug which is a strong stimulus for pupillary and
ciliary body constriction.
Methods: Patients referred to our VA Visual Rehabilitation Clinic
for light sensitivity receive a full ocular health workup including
optical correction, anterior and posterior segment examinations, and
visual fields. They are also administered a multi-part questionnaire
that uses 0-10 rating scales for assessing LS & LHA discomfort and
interference with daily activities. We have examined the response to
a single treatment of pilocarpine (1%, 1-2 drops, O.U.) in 14 patients.
Patients were followed for one hour post treatment, by phone the next
day, and upon return to the clinic at one week.
Results: In the immediate post treatment hour, constriction of the
pupils was observed in each case, as well as subjective reports of
decreased light sensitivity. Also, as expected, a small number of
patients developed brow headaches, a known side effect. Within 24
hours pupils returned to normal as self-reported and confirmed by
companions. At the one week follow-up, the rating questionnaire was
administered again; 70% of subjects reported continuous, substantial
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
relief, with median LS scores dropping from 8.0 to 3.8, LHA scores
dropping from 6.5 to 4.0 (Sign Ranked p<.003, n=14). For three
subjects relief was gone after the constrictive phase; for one other,
relief lasted only a few days post-treatment. The symptoms of the
remaining 10 were still reduced by 50% below pre-treatment scores
one month later, although symptoms returned in most patients by 6
months.
Conclusions: Successful treatment with pilocarpine is the first
demonstration of a simple, effective drug treatment of PP and LHA.
The well established pharmacology is a short term, local effect,
suggesting an unknown mechanism triggered by pilocarpine action.
Commercial Relationships: Brad Motter, None; Mary M.
Jackowski, None
Program Number: 5334 Poster Board Number: D0095
Presentation Time: 2:45 PM - 4:30 PM
Is visual impairment just another comorbid condition?
Bonnielin K. Swenor, Beatriz E. Munoz, Sheila K. West.
Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore,
MD.
Purpose: Determine if the association between visual impairment
status and mobility disability is due to visual impairment or is a result
of the total number of comorbid conditions
Methods: We used baseline data from the Salisbury Eye Evaluation
study, a population-based sample of 2,520 adults 65 years or older.
Visual impairment (yes/no) was defined by visual and visual fields.
Walking speed on three mobility tasks was measured: walking up 7
steps (steps/second), walking down 7 steps (steps/second), and
walking 4 meters (meters/second). Mobility disability was classified
as 1 standard deviation below the population mean for each task.
Data on 16 conditions thought to impact mobility, including visual
impairment, was categorized (1, 2, 3, or 4+ comorbid conditions).
Non-visually impaired individuals without any other comorbid
conditions were excluded. Logistic regression models using mobility
disability as the outcome and visual impairment status as a predictor
were built for each strata. We then compared, for example,
individuals with visual impairment and 1 other comorbid condition (a
total of 2 comorbid conditions), to individuals without visual
impairment and 2 other comorbid conditions. Odds ratios (OR) and
95% confidence intervals (CI) were determined after adjusting for
age, sex, and race.
Results: Visually impaired who did not have any other comorbid
conditions were significantly more likely to be disabled on all three
mobility tasks than the non-visually impaired who had 1 other
comorbid condition (OR disability walking up 7 steps = 4.2; 95% CI:
1.3-16.1; OR disability walking down 7 steps = 6.4, 95% CI: 1.823.2; OR disability walking 4 meters =6.7, 95% CI: 1.8-24.8). For
strata indicating 2, 3 or 4+ comorbid conditions, the associations
between visual impairment status and mobility disability declined and
were not statistically significant for any of the mobility tasks.
Conclusions: Among older adults with 1 comorbid condition,
mobility disability is more likely if that condition is visual
impairment than if that condition is any of the other 15 conditions
examined. However, as the number of comorbid conditions increases,
the unique association between visual impairment and mobility
disability was attenuated. This may indicate that while visual
impairment is an important factor contributing to mobility disability,
as comorbid conditions accumulate this association is diluted by the
combined impact on mobility of all conditions.
Commercial Relationships: Bonnielin K. Swenor, None; Beatriz
E. Munoz, None; Sheila K. West, None
Support: NIA T32AG000247
Program Number: 5335 Poster Board Number: D0096
Presentation Time: 2:45 PM - 4:30 PM
Development of an Arabic version of the National Eye Institute
Visual Function Questionnaire as a tool to study eye diseases
patients in Egypt
Nizar F. Saleh1, 2, Ahmed A. Salama3, Mohamed A. Abdel-Baqy4,
Marina E. Israel5, Ghada A. Elhawary5, Ahmed E. Radwan3, Tamer
M. EL Nakhal2, Islam T. Elkhateb6, Ahmed M. Kassem2, Mohamed
Amgad6. 1Cortoba Eye Femtolaser Centers, Cairo, Egypt;
2
Ophthalmology, Faculty of Medicine University of Alexandria,
Alexandria, Egypt; 3Ophthalmology, Faculty of Medicine Menofeyya University, Shebin El-Kom, Egypt; 4Alexandria Regional
Center for Women’s Health & Development, Alexandria, Egypt;
5
Faculty of Medicine - Ain Shams University, Cairo, Egypt; 6Faculty
of Medicine - Cairo University, Cairo, Egypt.
Purpose: Assessment of therapeutic modalities for eye diseases has
traditionally been judged by visual acuity. Disparity often occurs
between patients' self-perceived evaluation of treatments and
standard ophthalmic tests. National Eye Institute Visual Function
Questionnaire-25 (NEI-VFQ-25) was developed in 1999 to address
this disparity. This study aims to develop and test an Arabic version
of the NEI-VFQ-25
Methods: NEI-VFQ-25 was translated into Arabic according to
WHO translation guidelines. We enrolled adult consenting patients
with bilateral chronic eye diseases who presented to 14 hospitals
across Egypt from October to December 2012, and documented their
clinical findings. Psychometric properties were then tested using
Stata.
Results: We recruited 379 patients, whose mean age was (54.53 +/15.03). 46.2% were males. 227 had cataract, 31 had glaucoma, 23
had retinal detachment, 37 had diabetic retinopathy, and 61 had
miscellaneous visual defects. Non-response rate and the floor and
ceiling numbers of the Arabic version (ARB-VFQ-25) in relation to
visual acuities were calculated. Internal consistency was high in all
sub-scales (except general health), with Cronbach-alpha ranging from
0.702-0.911. Test-retest reliability was high (intraclass correlation
coefficient 0.79)
Conclusions: ARB-VFQ-25 is a reliable and valid tool for assessing
visual functions of Arabic speaking patients. However, some
questions had high non-response rates and should be substituted by
available alternatives. Our results support the importance of including
self-reported visual functions as part of routine ophthalmic
examination
Commercial Relationships: Nizar F. Saleh, None; Ahmed A.
Salama, None; Mohamed A. Abdel-Baqy, None; Marina E. Israel,
None; Ghada A. Elhawary, None; Ahmed E. Radwan, None;
Tamer M. EL Nakhal, None; Islam T. Elkhateb, None; Ahmed M.
Kassem, None; Mohamed Amgad, None
Program Number: 5336 Poster Board Number: D0097
Presentation Time: 2:45 PM - 4:30 PM
The Impact of Visual Field Loss and Hearing Loss on Social
Function
Bei Bei Chen, Nazlee Zebardast, Frank R. Lin, Pradeep Y. Ramulu,
David S. Friedman. Johns Hopkins, Baltimore, MD.
Purpose: To evaluate the independent and combined impact of visual
field loss from glaucoma and hearing loss on measures of social
function and well-being.
Methods: 137 subjects (60-80 years old) with binocular presenting
visual acuity (VA) of 20/40 or better were recruited from patients
followed for glaucoma or suspect glaucoma at the Wilmer Eye
Institute. Visual field (VF) impairment was defined as a better-eye
VF mean deviation (MD) of -5 decibels (dB) or worse. Hearing
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
impairment was defined as better-ear pure-tone average hearing
threshold of 25 dB or worse across 4 frequencies (0.5, 1, 2 and 4
kHz). Subjects were divided into 4 groups: no impairment (N=53),
visual impairment (VI; N=20), hearing impairment (HI; N=39) and
combined vision and hearing impairment (CVHI; N=25). Selfreported hearing-related social handicap and communication
difficulty were assessed using the Hearing Handicap Inventory for
the Elderly (HHIE) and the Quantified Denver Scale of
Communication Function (QDS) respectively. Patients’ sense of
social isolation and loneliness were assessed using the Social
Network Index (SNI) and the UCLA Loneliness Scale respectively.
Multivariable regression analyses, adjusted for demographic factors,
were used to assess the impact of sensory impairment on metrics of
social function using the group with no impairment as reference.
Results: Group differences were identified in age (p<0.05) but not in
gender, race, education, cognitive ability or comorbid illness.
Moderate hearing-related social handicap (higher HHIE score) was
more common amongst subjects with HI (odds ratio [OR]=8.0,
p<0.01) and CVHI (OR=8.2, p<0.01) as compared to individuals with
no impairment. Subjects with HI (OR=6.5, p=0.01) and CVHI
(OR=5.6, p=0.03) were also more likely to report communication
difficulty (higher QDS score). Sensory impairment was not
associated with an increase in sense of loneliness as judged by the
UCLA loneliness scale. Subjects with VI (OR=3.2, p=0.05), but not
subjects with HI or CVHI, were more likely to have significantly
lower network diversity (lower SNI score) when compared to
subjects with no impairment.
Conclusions: VI, HI and CVHI all demonstrated a negative impact
on at least one measure of social function. Detection of vision and
hearing impairment may be of particular importance in improving
social well-being in the elderly.
Commercial Relationships: Bei Bei Chen, None; Nazlee
Zebardast, None; Frank R. Lin, None; Pradeep Y. Ramulu, Tissue
Banks International (C); David S. Friedman, Alcon (C), Bausch &
Lomb (C), Merck (C), QLT, Inc (C), Allergan (C), Nidek (C)
Program Number: 5337 Poster Board Number: D0098
Presentation Time: 2:45 PM - 4:30 PM
The Effect of Comprehensive Vision Rehabilitation on SelfAdministration of Medication in Patients with Central Vision
Loss
Catherine J. Choi, Jennifer Wallis, Mary Lou Jackson.
Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA.
Purpose: Central vision loss can have significant implications in a
patient’s ability to perform activities of daily living, including healthrelated tasks, such as self-administration of medication. Vision
Rehabilitation programs offer strategies to aid patients in coping with
such tasks. The purpose of this study was to analyze the effect of
comprehensive vision rehabilitation on medication selfadministration in a cohort of low vision patients.
Methods: 37 patients with central vision loss with acuity ranging
from 20/400 to 20/40 in the better eye and normal cognitive abilities
by Mini-Mental State Exam were enrolled as part of a larger study.
Participants read the instructions on a standardized prescription label.
In addition, patients reported their ability to perform health-related
tasks. All measurements were taken at the start of vision
rehabilitation (T1), one month later at the beginning of occupational
therapy (T2), and at the termination of vision rehabilitation (T3).
Results: Complete data sets were available from 23 patients and
included in the analysis. When patients first presented to vision
rehabilitation, most participants (57%) were either not able to read
the medication label at all or could only partially read it. At T2, 78%
and at T3, 90% were able to read the label. These improvements with
rehabilitation were statistically significant, as shown by a main effect
of time, F(2,44)=18.4, MSE=.86, p< .001.
Patients’ reports on their ability to manage health-related tasks agreed
with the observed improvement in reading with vision rehabilitation.
Patients reported less interference from their vision loss on (A)
opening medications and (B) reading medication labels and
instructions; F(2,44)=4.67, MSE=.59, p=.018; F(2,44)=13.29,
MSE=1.01, p<.001. Reported difficulty and importance of generally
‘taking care of one’s health’ did not change over time.
Conclusions: While patients perceive less interference with
managing medications, they are also observed to read medications
more accurately and efficiently post-rehabilitation compared to prerehabilitation. Comprehensive vision rehabilitation, including
occupational therapy, can assist significantly with medication
management.
Commercial Relationships: Catherine J. Choi, None; Jennifer
Wallis, None; Mary Lou Jackson, None
Clinical Trial: NCT01670643
Program Number: 5338 Poster Board Number: D0099
Presentation Time: 2:45 PM - 4:30 PM
Blue streetlights effect on visual acuity in glaucoma
Kozo Masuda1, Hiroshi Uozato2. 1Health and Social Services, Osaka
University of Human Sciences, Settsu, Japan; 2Ophthalmology and
Visual Science, Kitasato University, Sagamihara, Japan.
Purpose: Blue streetlights are believed to be helpful in preventing
suicides and street crime.In Japan, many blue streetlights have been
installed. In conditions of rain or fog, blue light when compared to
white light, has been shown to decrease visibility and increase the
possibility of traffic accidents. Blue cone cells are influenced by
intraocular pressure in glaucoma and this influence will appear earlier
than visual field loss. We evaluated the effect on visual acuity in
moderate defect glaucoma (MDG) by blue light.
Methods: We used two healthy volunteers groups (HVG) and MDG
group. One HVG 16 volunteers mean aged 30.1 years old (range: 20 40) and the other 17 volunteers mean aged 47.9 years old (range: 40 60). Nine eyes of 7 MDG patient mean aged 45.0 years old. We
decided on two requirements one to have a good corrected visual
acuity over 20/20, the other for MDG patients not to have other eye
diseases. We tested visual acuity in three different conditions;
photopic vision, scotopic vision in white light and scotopic vision in
blue light. The luminance of scotopic vision was 1.0±0.5 lx. We
considered dark adaptation in this test.
Results: The scotopic visual acuity under both white light and blue
light was lower than photopic visual acuity in each three groups. In
each groups, there was no significant difference in the scotopic visual
acuity under white light, but in glaucoma there was a significant
decrease in the scotopic visual acuity under blue light (p<0.01). The
scotopic visual acuity under blue light decreased significantly in
MDG group compared with the scotopic visual acuity under white
light (p<0.01).
Conclusions: Low illumination decreases visual acuity, the decrease
on scotopic visual acuity in MSG patients is especially enhanced
under blue light. This study suggests that the use of blue light for
streetlights should consider the safety of MDG patients and the
necessity to increase road illumination.
Commercial Relationships: Kozo Masuda, None; Hiroshi Uozato,
None
Support: Grant-in-Aid for Encouragement of Scientists JSPS
23933014
Program Number: 5339 Poster Board Number: D0100
Presentation Time: 2:45 PM - 4:30 PM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
How Maryland Eye Care Practitioners Complete the Motor
Vehicle Administration (MVA)Vision Screening Form
Ruidi Wang, Rhonda Miller, Henry D. Jampel. Ophthalmology,
Johns Hopkins Wilmer Eye Institute, Baltimore, MD.
Purpose: The state of Maryland requires a vision evaluation either in
person at the MVA, or performed by an eye care practitioner, for
driver’s license renewal. Qualifications for an unrestricted driver’s
license include binocular vision, Snellen visual acuity (VA) of at
least 20/40 in each eye, and a continuous visual field (VF) of at least
140 degrees. We assessed how Maryland eye care practitioners
approach completion of the vision screening form.
Methods: We obtained contact information for eye care practitioners
in Maryland through the American Academy of Ophthalmology and
the Maryland Board of Optometry. Eye practitioners who did not
practice primarily in Maryland or who did not fill out at least one
MVA vision screening form per month were excluded. The
anonymous online survey comprised 25 questions covering
demographics, VA, VF testing, and binocular vision screening.
Results: 128 (23%) practitioners responded to 586 invitations. The
majority of respondents were Caucasian (73%), male (66%),
comprehensive (65%), and practiced in a suburban (69%), private
practice (60%) setting. 62% of respondents completed between two
and ten forms per month.
Most respondents were able to identify the requirements of a VA
>20/40 in each eye (86%) and a continuous visual field of 140
degrees (68%) for an unrestricted license. However, only 38% were
aware of the binocular vision requirement.
74 % of respondents reported measuring the patient’s Snellen
uncorrected VA to determine the need for corrective lenses. 73%
assessed VF by confrontation with no difference between
ophthalmologists and optometrists (p=0.37). Although 109
respondents perform automated perimetry, only 13 of them used
automated perimetry results in filling out the form. 54% of
participants assessed binocular vision; half using the stereo fly test.
Conclusions: A majority of a self-selected group of eye care
practitioners in one state measure VA using a Snellen eye chart to
determine whether acuity standards for a license renewal are met and
whether refractive correction is necessary. VF is usually determined
by confrontation. Binocular vision is only assessed half the time, and
often with a test better suited to near vision. Regardless of
practitioner adherence to the state-mandated criteria, there is a need
to understand better the relationship between office measures of
visual function and safe driving.
Commercial Relationships: Ruidi Wang, None; Rhonda Miller,
None; Henry D. Jampel, Endo Optics (C), Sinexus (C), Allergan
(C), Allergan (I), Aerie Pharmaceutical (C), Transcend (C), Ivantis
(C)
Support: Odd Fellows
512 Pediatric Epidemiology
Thursday, May 09, 2013 8:30 AM-10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 5664-5692/C0135-C0163
Organizing Section: Clinical/Epidemiologic Research
Program Number: 5664 Poster Board Number: C0135
Presentation Time: 8:30 AM - 10:15 AM
The Prevalence of Infantile Esotropia in Children of Chinese
Descent
Maria del Pilar Gonzalez Diaz, Agnes M. Wong. Ophthalmology and
Visual Sciences, University of Toronto - The Hospital for Sick
Children, Toronto, ON, ON, Canada.
Purpose: The prevalence of strabismus varies according to the
population studied, ethnicity, and geographic area. Previous studies
in Asian population have found that, unlike those in western
countries, esotropia is much less common (2.5x) than exotropia.
Because of the homogeneous nature of the population studied,
however, it is difficult to ascertain whether there is a real difference
in the epidemiology among ethnic groups. The aim of the study is to
determine the prevalence of infantile esotropia (IET), in otherwise
healthy cohort of Chinese and non-Chinese children referred to a
tertiary eye center in a large center in North America that serves a
ethnically-diverse population of over 8 million. We hypothesize that
the prevalence of IET is significantly lower in patients of nonChinese descent than those of Chinese descent.
Methods: A retrospective chart review was conducted on patients
referred for possible IET between January 2004 and June 2012.
Demographic data including gender, age at referral, family history of
strabismus, medical history, refractive error, final diagnosis, and
strabismus surgery history were recorded. Patients were classified as
Chinese and non-Chinese based on their last names. Analysis of last
names has been used in epidemiology and population-based studies
to identify people of Chinese origin. Patients who were referred after
age 2 or those with comorbidities (e.g., low birth weight, prematurity,
neurological disorders, Down syndrome, developmental delay) were
excluded. Patients were divided into two groups based on the final
diagnosis: IET and no IET.
Results: 256 patients were included in the analysis. There were 20
(7.8%) patients of Chinese descent and 236 (92.2%) of non-Chinese
decent. Of these 20 children, only one was diagnosed with IET,
giving a prevalence of IET of 5.0% (1/20) in patients of Chinese
descent. IET was diagnosed in 129 patients of non-Chinese descent,
giving a prevalence of IET of 54.6% (129/236), which is significantly
higher than that in Chinese patients (Fisher’s exact, p<0.001).
Conclusions: The prevalence of IET is significantly higher in healthy
patients of non-Chinese descent (54.6%) than those of Chinese
descent (5.0%).
With growing global immigration, the ethnic composition of
developed countries will continue to change. Improved understanding
of racial variations in epidemiology and disease features will allow us
to better serve our increasingly diverse population.
Commercial Relationships: Maria del Pilar Gonzalez Diaz, None;
Agnes M. Wong, None
Program Number: 5665 Poster Board Number: C0136
Presentation Time: 8:30 AM - 10:15 AM
Chronic anterior uveitis in paediatric patients
Cristobal A. Couto, Maria de las Mercedes Frick, Bernardo A.
Schlaen, Erika Miolet Hurtado Jallaza, Matilde Lopez.
Ophthalmology, University of Buenos Aires, Buenos Aires,
Argentina.
Purpose: To describe clinical features and visual prognosis of
chronic anterior uveitis in paediatric patients.
Methods: The medical records of 35 paediatric patients who met
criteria for chronic anterior uveitis (SUN) were reviewed to identify
clinical features, complications, visual outcome and treatment
between 1996 and 2012 at the University of Buenos Aires
Results: There were 35 patients, 21 (60%) girls, mean age 7,4 years (
r: 2-15 ) and mean follow up 79,2 months ( r: 12-192). Out of 35, 26
(74,2%) presented bilateral uveitis. ANA was positive in 19 (54,2%)
patients while arthritis was found in 18 (51,4%). Metotrexate was
given in 25 (71,4%) patients. Fourteen patients (40%) were treated
with biologics agents: 11 with Adalimumab, 3 with Etanercept, 1
with Infliximab and 1 with Rituximab. Final visual acuity better than
20/40 was found in 49 out of 61 (80%) eyes. Most common
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
complications were band keratopathy in 20 eyes, cataract in 16 eyes
and posterior sinechiaes in 13 eyes. Facoemulsification with IOL was
performed in 10 eyes. Regresion of uveitis after a mean time of
treatment of 8 years was achieved in 6 patients.
Conclusions: In our series, chronic anterior uveitis was related to
Juvenile Idiopathic Arthritis only in half of patients. Therefore, not
all chronic anterior uveitis in children are associated with JIA.
Regarding treatment 40% of our patients had to receive biologic
agents to improve the inflammation.
Commercial Relationships: Cristobal A. Couto, None; Maria de
las Mercedes Frick, None; Bernardo A. Schlaen, None; Erika
Miolet Hurtado Jallaza, None; Matilde Lopez, None
Program Number: 5666 Poster Board Number: C0137
Presentation Time: 8:30 AM - 10:15 AM
Pediatric Idiopathic Orbital Inflammation
Jordan Spindle1, Marco Pellegrini2, Todd R. Shepler3, Bita Esmaeli4,
Edward Wladis5, Elena Piozzi6, Carol L. Shields2, Roman Shinder1, 4.
1
Ophthalmology, SUNY Downstate Ophthalmology, Brooklyn, NY;
2
Ocular Oncology, Wills Eye Institute, Philadelphia, PA; 3Texas
Oculoplastic Consultants, Austin, TX; 4University of Texas MD
Anderson Cancer Center, Houston, TX; 5Opthalmology, Albany
Medical College, Albany, NY; 6A. O. Ospedale Niguarda Ca'
Granda, Milan, Italy.
Purpose: Idiopathic orbital inflammation (IOI) typically presents in
adults with acute orbital signs such as pain, proptosis, ocular
injection, diplopia, periorbital edema, and chemosis. IOI in the
pediatric population is rare with approximately 70 reported cases, and
differs from IOI in adults in that affected children more often have
bilateral disease, as well as constitutional symptoms. We report the
clinical presentation, serology, radiography, histopathology, and
treatment outcome of 24 children with IOI.
Methods: Records of 24 patients 18 years and younger with IOI were
reviewed.
Results: 6 males and 18 females had a median age of 11 years (range
2-18, Table 1). 19 patients were found to have primary IOI, while 5
had recurrent disease with median age of diagnosis of 9.5 (range 516). 21 patients were found to have unilateral IOI (87%), while 3
patients had bilateral disease (13%). 13 (54%) had constitutional
signs on presentation. Ocular findings included periorbital edema
(75%), limited ductions with diplopia (32%), proptosis (29%), ptosis
(29%), tenderness (21%), conjunctival injection (17%), dystopia
(13%), decreased visual acuity (13%), and chemosis (8%).
Radiographic findings included an orbital mass (54%), myositis
(29%), dacryoadenitis (29%), extraorbital extension (13%) , optic
nerve sheath enhancement (4%), and posterior scleritis (4%).
Correctly diagnosed IOI by first health care provider occurred in 8 of
the children (33%), with 16 (67%) misdiagnoses including orbital
cellulitis (63%), preseptal cellulitis (13%), conjunctivitis (13%),
chalazion (6%), allergic reaction (6%), malignancy (6%), and retinal
detachment (6%).
Conclusions: IOI is a rare but important cause of acute orbital
syndrome in the pediatric age range. We found 13% of children to
have bilateral disease, and 54% to have associated constitutional
signs and symptoms. The percentage of children presenting with
bilateral disease in our series was less than the traditional quoted
33%. The percentage of patients presenting with constitutional
symptoms in our series (54%) was consistent with past reports (53%).
Clinicians should consider IOI in any child presenting with acute
orbital signs, and confirm the diagnosis with serology, orbital
radiography, and biopsy when warranted. A multidisciplinary team to
include an ophthalmologist, pediatrician, radiologist, and
rheumatologist should be recruited for prompt diagnosis and a
tailored treatment plan for all children with IOI.
Commercial Relationships: Jordan Spindle, None; Marco
Pellegrini, None; Todd R. Shepler, None; Bita Esmaeli, None;
Edward Wladis, None; Elena Piozzi, None; Carol L. Shields,
None; Roman Shinder, None
Support: Research to Prevent Blindness
Program Number: 5667 Poster Board Number: C0138
Presentation Time: 8:30 AM - 10:15 AM
Risk Factors for Amblyopia in the Vision in Preschoolers (VIP)
Study
Maisie R. Pascual1, Jiayan Huang2, Maureen G. Maguire2, Marjean
T. Kulp3, Graham E. Quinn4, Elise Ciner5, Lynn A. Cyert6, Deborah
A. Orel-Bixler7, Bruce Moore8, Gui-Shuang Ying2. 1Drexel University
College of Medicine, Philadelphia, PA; 2University of Pennsylvania,
Philadelphia, PA; 3Ohio State University, Columbus, OH; 4Children's
Hospital of Philadelphia, Philadelphia, PA; 5Salus University, Elkins
Park, PA; 6Northeastern State University, Tahlequah, OK;
7
University of California, Berkeley, Berkeley, CA; 8New England
College of Optometry, Boston, MA.
Purpose: To evaluate risk factors for unilateral and bilateral
amblyopia in the Vision in Preschoolers (VIP) Study.
Methods: 3- to 5-year Head Start preschoolers, over-representing
children with vision problems, were enrolled in the cross-sectional
VIP Study from 5 clinical centers (Berkeley, Boston, Columbus,
Philadelphia, Tahlequah). All children had full eye exams done by
VIP-certified pediatric optometrists and ophthalmologists. Visual
acuity (VA) was tested without correction and retested with full
cycloplegic correction when retest criteria were met. Unilateral
amblyopia was defined as an inter-ocular difference in best-corrected
VA≥2 lines. Bilateral amblyopia was defined as best-corrected VA in
each eye <20/50 for 3-year-olds and <20/40 for 4- to 5-year-olds. The
odds ratios (ORs) and their 95% confidence intervals (95% CIs)
associated with demographic and ocular risk factors were estimated
using logistic regression models.
Results: Among 3869 children, 257(6.6%) had unilateral amblyopia
and 225(5.8%) had bilateral amblyopia. Hispanic ethnicity and the
presence of strabismus were independently associated with increased
risk of unilateral amblyopia. Presence and greater magnitude of
significant refractive errors (myopia, hyperopia, astigmatism, and
anisometropia) were independently associated with increased risk of
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
unilateral amblyopia (Table 1). Using myopia ≥0.5D, hyperopia
≥2.0D, astigmatism ≥1.0D, anisometropia ≥0.5D, or presence of
strabismus, almost all (92%) unilateral amblyopia cases were found.
Presence and greater magnitude of both astigmatism and bilateral
hyperopia were independently associated with increased risk of
bilateral amblyopia (Table 2). Age was independently associated, but
gender and ethnicity were not associated with bilateral amblyopia.
Using bilateral hyperopia ≥2.0D, or astigmatism ≥1.0D, 82% of
bilateral amblyopia cases were found.
Conclusions: Significant refractive error and strabismus were
associated with unilateral amblyopia. Astigmatism and bilateral
hyperopia were associated with bilateral amblyopia. These results are
consistent with findings from the population-based Multi-ethnic
Pediatric Eye Disease and Baltimore Pediatric Eye Disease studies.
Screening for refractive error can identify the majority of children at
high risk of amblyopia.
Refractive error and amblyopia in a school-children population
of Central Italy
Paolo Trabucco1, Mariella Salomone1, Ilia Domanico1, emanuele
gerace2, Carmela Carnevale2, Enzo M. Vingolo1. 1Ophthalmology,
Univ of Rome La Sapienza Osp "S M Goretti" LT, Latina, Italy;
2
Ophthalmology, Univ of Rome La Sapienza, Rome, Italy.
Purpose: to investigate the prevalence of refractive errors and
amblyopia in a school-age population in the city of Latina, located in
central Italy near Rome.
Methods: we examined a total of 500 children, 264 males and 236
females between 3 and 10 years old. The examination included:
visual acuity and ocular motility evaluation. We performed also a
measurement of refraction with autorefractometer under cycloplegia.
Results: Myopia was found in 6,6% of children (n=33, 20 males and
13 females), hyperopia in 10,2% (n=51, 23 males and 28 females)
and astigmatism 0.75 D or greater was found in 12,6% of children
(n=63, 29 males and 34 females). We found association between
myopia, older age, and male gender; hyperopia was inversely
associated with age and associated with female gender. Astigmatism
was present most in female gender. In total, children with refractive
errors which needed spectacles were 29,4% (n=147). Spectacles were
effectively weared by 36,7% of these children (n=54). Amblyopia
was found in 1% of all children (n=5). The most common causes of
amblyopia were anisometropia (4 of 5 children) and strabismus (1 of
5 children)
Conclusions: refractive errors which cause a reduced vision are
common in school-aged children, in particular hyperopia which has a
high prevalence among females and younger children. Most of these
children are unaware of their spectacle needs. Eye health education
and screening programs are necessary to early detect and treat these
causes of visual impairment.
Commercial Relationships: Paolo Trabucco, None; Mariella
Salomone, None; Ilia Domanico, None; emanuele gerace, None;
Carmela Carnevale, None; Enzo M. Vingolo, None
Table 1 Multivariate analysis for risk factors of unilateral amblyopia
Program Number: 5669 Poster Board Number: C0140
Presentation Time: 8:30 AM - 10:15 AM
Efficacy and Safety of Ahmed Glaucoma Valve Implantation for
Pediatric Glaucoma
Maria E. Lim, Daniel E. Neely, Kathryn M. Haider, David Plager.
Indiana University School of Medicine, Indianapolis, IN.
Purpose: To review the efficacy and safety profile of Ahmed
Glaucoma Valve (AGV) implantation in pediatric patients.
Methods: Retrospective chart review of 36 eyes in 36 patients who
had undergone AGV implantation for refractory glaucoma. All
patients were less than 18 years of age and had at least 6 months of
follow up. Primary outcome measure was decrease in intraocular
pressure (IOP) from baseline. Need for subsequent glaucoma surgery
or occurrence of vision threatening complications were deemed
failures.
Results: Mean age at time of AGV implantation was 6.8 years
(range, 0.3-17.7) with average follow up of 4.8 years (range 0.510.5). Number of prior glaucoma procedures was 2.9 (range, 0-8).
Mean IOP reduction was 19.7 mmHg from a baseline of 35.3 mmHg
to 15.6 mmHg at time of last visit. Nine eyes (25%) had postoperative complications including postoperative flat anterior
chambers (2), tube migration (2), prolonged hypotony (1), hypotony
with vitreous hemorrhage (1), retinal detachment (1), implant
exposure (1), and choroidal effusion (1).
Conclusions: The AGV is very successful at both short and long
term lowering of IOP but secondary complications requiring
additional surgical intervention are common. Nine eyes were surgical
failures with mean time to failure of 4.43 years. Overall success rate
Table 2 Multivariate analysis for risk factors of bilateral amblyopia
(N=3869)
Commercial Relationships: Maisie R. Pascual, None; Jiayan
Huang, None; Maureen G. Maguire, Inspire Pharmaceuticals (F),
Amakem (F), IDx LLC (F), Merck (C); Marjean T. Kulp, None;
Graham E. Quinn, None; Elise Ciner, None; Lynn A. Cyert,
None; Deborah A. Orel-Bixler, None; Bruce Moore, EyeNetra Inc.
(I); Gui-Shuang Ying, None
Support: Supported by NEI/NIH, DHHS grants: U10EY12644;
U10EY12547; U10EY12545; U10EY12550; U10EY12534;
U10EY12647; U10EY12648 and R21EY018908.
Program Number: 5668 Poster Board Number: C0139
Presentation Time: 8:30 AM - 10:15 AM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
of AGV implantation for pressure control without complications was
75%. While the AGV is a useful and frequently successful therapy, it
is also accompanied by a significant rate of postoperative
complications in pediatric patients and should be reserved for
refractory cases of glaucoma.
Commercial Relationships: Maria E. Lim, None; Daniel E. Neely,
None; Kathryn M. Haider, None; David Plager, None
Program Number: 5670 Poster Board Number: C0141
Presentation Time: 8:30 AM - 10:15 AM
Inter-ocular Difference of Axial Lengths in Children with
Unilateral Congenital and Developmental Cataracts
Kathryn M. Haider, Jingyun Wang, Drew C. Mitchell, Heather A.
Smith, Heather A. Smith, Gavin Roberts, Derek Sprunger, Daniel E.
Neely, David Plager. Ophthalmology, Indiana University,
Indianapolis, IN.
Purpose: Preoperative axial length is a critical parameter for
estimating eye growth and selecting intraocular lens power for
surgery in children with unilateral cataracts. However, without
classifying diagnosed subtypes of cataract, previous studies have
failed to reach a consensus on the inter-ocular difference (IOD) of
axial length between cataract eye (CE) and the fellow eye (FE). In the
current study in children with unilateral congenital and
developmental cataracts, IOD is compared according to previously
diagnosed subtypes.
Methods: Charts of otherwise healthy patients born in 1979 through
2011 with primary unilateral cataract surgery were reviewed. All
axial lengths (AL) were measured with either contact or immersion
A-scan prior to ocular surgery. IOD was calculated. Surgeons
classified cataracts during surgery into one of four subtypes posterior lenticonus (PL, N=36), persistent fetal vasculature (PFV,
N=22), posterior subcapsular (PSC, N=7) and nuclear (NUC, N=3).
Results: Among subtypes of diagnosis, axial lengths are significantly
different for both CE (p<0.001) and FE (p<0.001); however, there is
no significantly different IOD (p=0.71). NUC and PFV patients have
shorter CE (IOD= -0.85 ± 0.51 (100% shorter); -0.40±1.46mm (59%
shorter)); PL on average has similar CE and FE (IOD=-0.26±1.03
(71% shorter CE)); PSC patients has longer CE on average
(IOD=0.11±0.53mm (43% shorter CE).
Conclusions: IOD between eyes is variable even for subtypes of
diagnosis. Subtypes of cataract may explain the variety of IOD in
unilateral cataract.
Commercial Relationships: Kathryn M. Haider, None; Jingyun
Wang, Fight for Sight (F), IUPUI EMPOWER (F); Drew C.
Mitchell, None; Heather A. Smith, None; Heather A. Smith, None;
Gavin Roberts, None; Derek Sprunger, Alcon (C); Daniel E.
Neely, None; David Plager, None
Program Number: 5671 Poster Board Number: C0142
Presentation Time: 8:30 AM - 10:15 AM
Ophthalmic abnormalities in children with Developmental
Coordination Disorder: Data from the Avon Longitudinal Study
of Parents and Children
Alex Creavin1, 2, Raghu Lingam1, Kate Northstone1, Cathy Williams1.
1
School of social and community medicine, Bristol University,
Bristol, United Kingdom; 2Ophthalmology, Cheltenham general
hospital, Cheltenham, United Kingdom.
Purpose: To explore associations between developmental
coordination disorder (DCD) and common ophthalmic abnormalities
in children aged 7 to 8 years.
Methods: Data were analysed from the Avon Longitudinal Study of
Parents and Children (ALSPAC), a UK birth cohort. DCD was
defined according to DSM-IV-TR criteria. Children with neurological
difficulties such as cerebral palsy or muscular dystrophy or an IQ less
than 70 were excluded. Complete data were available for 7154
children.
Ophthalmic abnormalities including visual acuity, refraction and
binocular function were assessed using standard tests. After
descriptive analyses, logistic regression models were used to assess
the association between DCD and each visual difficulty.
Results: Results: 120 children (1.8%) met the criteria for severe
DCD and had available data from vision testing. Children with severe
DCD were more likely to have ocular alignment or binocular vision
abnormalities including clinically significant strabismus (OR 2.31
(95% CI 1.26-4.24) and stereoacuity worse than 60 seconds of arc
(OR 2.75(1.78-4.23)). These children also had higher rates of
estimated hypermetropia (OR 2.29(1.1-4.57). These associations
persisted when adjustment was made for gender, birth-weight and
socioeconomic factors.
When children with strabismus were removed from the analysis,
refractive error (linear x2 8.01 p=0.0182), abnormal motor fusion
(linear x2 14.49 p=0.0007) and abnormal stereopsis (linear x2 14.49
p=0.0007) were over-represented in those with DCD.
Conclusions: Children with severe DCD had abnormalities in ocular
alignment, binocular vision and refractive error. We recommend that
children with diagnosed DCD are screened for visual abnormalities
as early intervention may improve long-term visual outcome.
Commercial Relationships: Alex Creavin, None; Raghu Lingam,
None; Kate Northstone, None; Cathy Williams, None
Support: UK Medical Research Council and the Wellcome Trust:
Grant ref: 092731
Program Number: 5672 Poster Board Number: C0143
Presentation Time: 8:30 AM - 10:15 AM
IOLunder2 study: outcomes following surgery with and without
primary intraocular lens implantation in children <2years old
Lola A. Solebo1, 2, Isabelle Russell-Eggitt2, 3, Jugnoo S. Rahi2, 4.
1
MRC Centre Epidemiology (Child Health), Institute Child Health,
UCL, London, United Kingdom; 2Ulverscroft Vision Research
Group, London, United Kingdom; 3Clinical and Academic
Department of Ophthalmology, Great Ormond Street Hospital,
London, United Kingdom; 4Institute of Ophthalmology, UCL,
London, United Kingdom.
Purpose: Investigate clinical and functional outcomes of surgery in
children <2 with congenital/infantile cataract.
Methods: A national prospective observational cohort study
undertaken through the BCCIG, a collaborative research network.
Standardized data collection on children undergoing surgery between
January 2009 - December 2010. Multivariable multilevel regression
analysis to identify predictors of outcome.
Results: 1 year post-operative outcomes data are available on 221
children (131 bilateral cataract:BC, 90 unilateral cataract:UC). Ocular
comorbidity was common: persistent fetal vasculature in 47% UC,
8% BC; axial length <16mm in 23% BC, 8% UC; horizontal corneal
diameter<9.5mm 10% BC, 3% UC. 56/131 BC and 48/90 UC
children had primary IOL implantation. Implantation was more
common in more socioeconomic deprived children (49% v 31%,
p=0.01). Outcome at 1 year after surgery: - Vision in normal range
for age in 31% of all children with BC and 22% all operated UC
eyes, and also in normal range in 49% BC children and 31% UC eyes
without ocular co-morbidity or cerebral visual impairment
- Additional surgery for visual axis opacity (VAO) in 24% all BC &
50% all UC eyes
- Postoperative glaucoma in 10% all BC, 9% all UC eyes,
additionally ocular hypertension in 6% BC, 16% UC - 47% of
pseudophakic BC eyes and 47% of UC eyes achieved early refraction
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
within 1D of planned outcome. Primary IOL was not independently
associated with either visual outcome or postoperative glaucoma, but
was associated with VAO (OR:6.7, 95%CI 1.7-26, p=0.006 in BC,
OR:6.2, 95%CI 1.1-35, p<0.05 in UC ), where VAO was more likely
with single piece IOLs (OR 43.7, 95%CI 1.4-9.7, p<0.01).
Conclusions: Primary IOL implantation in children under 2 does not
appear to confer any visual benefit in the first post-operative year, nor
alter the high risk of aphakic/pseudophakic glaucoma but often
commits children to early re-operation requiring repeat general
anaesthetic during the crucial neurological developmental period.
Planned follow-up of the IOLunder2 cohort will provide currently
unavailable data on predictors of favourable and adverse long term
outcomes.
Commercial Relationships: Lola A. Solebo, None; Isabelle
Russell-Eggitt, None; Jugnoo S. Rahi, None
Support: Ulverscroft Foundation; NIHR Institute of Child Health /
Great Ormond Street Hospital Biomedical Research Centre; NIHR
Moorfields Biomedical Research Centre
Program Number: 5673 Poster Board Number: C0144
Presentation Time: 8:30 AM - 10:15 AM
Clinical testing of a new objective binocular refraction device
Lei Shi1, Ying-Ling Chen1, James W. Lewis2, Ming X. Wang3. 1Center
for Laser Applications, University of Tennessee Space Inst,
Tullahoma, TN; 2E-Vision Technologies, Tullahoma, TN; 3Wang
Vision Institute, Nashville, TN.
Purpose: Objective, non-cycloplegic, and binocular refraction
measurements are the most important part of pediatric vision
screening. Accuracies of current methods are strongly compromised
by variations of pupil size, and intraocular scattering. This study
evaluates a new device, the Dynamic Ocular Evaluation System
(DOES) [US patents: 7,427,135 7,878,652] and the dependence of its
accuracy on pupil size and age.
Methods: The DOES optical design uses infrared video
photorefraction (PR) with multi-eccentricities and meridians. Subj:
71 patients of age 4 to 81 years were recruited. Hyperopic or mild
myopic (SE>-1) subjects younger than 50 years old were excluded
for possible error due to accommodation. DOES testing: In 2 roomlighting conditions, 8 measurements were acquired as the patient
viewed a cartoon figure projected by a 3D screen at 4 distances (0.75,
1.5, 2.7, and >6 m); a 6-cm IPD was assumed. All patients received
standard clinical refraction examinations. Accuracy evaluation: After
eliminating images with technical faults (eye lids and saturation), 69
eyes of 35 patients of ages 8- 81 yielded 453 refraction data (n=453)
for analysis. We used the Bland-Altman statistical method to evaluate
agreement between DOES and the clinical gold standard
measurements. The standard errors (σ) of the spherical equivalent
(SE) and crossed cylinders (J0 and J45) were obtained. To examine
the influence of intraocular scattering, σ were compared in three age
groups; kids (8-13yrs, 18 eyes, SE=0.9±2.7D, n=142), adults (1738yrs, 13 eyes, SE=1.5±3D, n=93), and older adults (41-81yrs, 38
eyes, SE=2.2±0.2D, n= 218). Pupil size influence was examined in 2
groups with pupil=6.37±0.83mm (age=17-22, n=49) and
pupil=3.73±0.51mm (22-38yrs, n=44).
Results: The standard errors for DOES refraction measurements of
SE, J0, and J45 are 0.47, 0.3 and 0.17 D, respectively. σ_SE in the 3
age groups are 0.49, 0.44, and 0.47 D. In the 2 pupil groups σ_SE
=0.55 and 0.28D.
Conclusions: Between -3 and +2D, the region of concern for
referrals, the device shows outstanding binocular refractive error
performance with σ_SE =0.42D (n=297), while across the full-range
of age 8-81 and pupil of 2.5-8.3mm, σ_SE =0.47D (n=453). Large
pupils appear to correlate with larger error. No discrimination among
age groups was found, which indicates the effectiveness of DOES in
calibrating individual intraocular scattering.
Commercial Relationships: Lei Shi, None; Ying-Ling Chen,
University of Tennessee Research Foundation (P), E-Vision
Technologies (I); James W. Lewis, University of Tennessee
Research Foundation (P), E-Vision Technologies (P); Ming X.
Wang, None
Support: NIH Grant EY018385; UTRF Maturation funding project
Program Number: 5674 Poster Board Number: C0145
Presentation Time: 8:30 AM - 10:15 AM
Ophthalmological long-term follow-up in children and young
adults with Kearns-Sayre Syndrome
Marita A. Gronlund1, Antovan K. Seyedi Honarvar1, Niklas Darin2,
Mar Tulinius2, Susann Andersson1. 1Pediatric Ophthalmology, Inst
Neurosci & Phys/Ophthal, Goteborg, Sweden; 2Dept of Peadiatrics,
The Queen Silvia Children's Hospital, The Sahlgrenska Academy at
the University of Gothenburg, Gothenburg, Sweden.
Purpose: Kearns-Sayre Syndrome (KSS), which is most commonly a
sporadic mitochondrial disorder associated with large scale deletions
in mtDNA, is a multisystem disease with onset before the age of 20.
It’s defined clinically by the triad of chronic progressive external
ophthalmoplegia (CPEO), retinal pigmentary degeneration in
addition to at least one of the following: heart block, cerebellar
dysfunction, and/or cerebrospinal fluid protein concentration of more
than 1g/l. The aim of this study was to describe and longitudinally
follow-up ophthalmological findings in KSS.
Methods: 15 individuals with KSS (3 males, 12 females) with a
mean age of 12.4 years (1.3-35.0 yrs) were diagnosed, eye examined,
and followed-up at The Queen Silvia Children’s Hospital,
Gothenburg, Sweden, emphasizing on eye motility, ptosis, visual
acuity (VA), refraction, corneal thickness (CCT), retinal function,
and optic disc status. All were genetically diagnosed with single large
scale mtDNA deletions.
Results: The follow-up mean time was 4 years (0-14 yrs) with a
mean of 5 (1-19) examinations performed. Seven patients deceased
during the follow-up period at a mean age of 19 years (1.8-43.7 yrs).
All but one with KSS developed reduced eye motility over time and
in 10/15 it was found at the first examination. In 11 children ptosis
was registered initially, and in two other girls during follow-up; four
patients had been operated on. In more than half of the cases, VA was
relatively stable over time. Myopia (≥-0.5 D SE) was found in five
individuals and hyperopia (≥+2.0 D SE) in three and astigmatism
(≥1.0 D) was measured in eight children. 6/10 eyes had increased
CCT (≥615 microm) and in two girls edematous corneas were
developed. Photograph taken by noncontact specular microscope in
one of these girls showed abnormal cell morphology. Optic atrophy
(OA) was found in 5/13 children and young adults with KSS at first
examination and another three individuals developed OA over time.
Retinal degeneration was observed in 9/14 at onset and another four
developed retinal changes during follow-up. Full-field
electroretinogram (ff-ERG) had been performed in 10/13 patients
with pigmentary retinopathy of whom eight showed pathological ffERG recordings.
Conclusions: Besides CPEO and retinal degeneration, ptosis,
increased CCT, and OA were commonly found among individuals
with KSS and these ophthalmological findings seem to progress over
time.
Commercial Relationships: Marita A. Gronlund, None; Antovan
K. Seyedi Honarvar, None; Niklas Darin, None; Mar Tulinius,
None; Susann Andersson, None
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Support: Agreement concerning research and education of doctors
(grants no ALFGBG-11626 and ALFGBG-211671), and the Swedish
Medical Society.
Program Number: 5675 Poster Board Number: C0146
Presentation Time: 8:30 AM - 10:15 AM
How should we assess reliability of visual field assessment in
children?
Dipesh Patel1, 3, Phillippa Cumberland1, 2, Isabelle Russell-Eggitt4, 2,
Bronwen Walters4, 2, Jugnoo S. Rahi1, 5. 1MRC Centre of
Epidemiology for Child Health, UCL Institute of Child Health,
London, United Kingdom; 2Ulverscroft Vision Research Group,
London, United Kingdom; 3Moorfields Eye Hospital, London, United
Kingdom; 4Great Ormond Street Hospital, London, United Kingdom;
5
UCL Institute of Ophthalmology, London, United Kingdom.
Purpose: In the OPTIC study, we are investigating a number of
questions about kinetic and static perimetry in children using
Goldmann, Octopus and Humphrey perimeters. Here we report how
individual examiner-based assessment (EBA) compares with
automatically generated 'reliability' indices (RI) used commonly in
adult perimetry (fixation losses, false positive/negative rates).
Methods: To date 64 children aged 5-15 years, without ocular
pathology that could cause a visual field defect i.e controls/normative
subjects have undergone kinetic perimetry (Goldmann and Octopus)
and static automated perimetry (SAP, using Humphrey SITA 24-2
FAST) using standard protocols with testing by one examiner. For
each test, the examiner scored overall reliability (‘good’,’fair’ or
‘poor’) together with an assessment of the subjects’ comprehension
of instructions, fatigue, fixation, response to visual and auditory
stimuli and behaviour. Additionally, subjects self-rated the test
difficulty (using a 5-point Likert scale), and duration of each phase of
testing was recorded. The automatically generated SAP reliability
indices (RI) were noted, with a test being recorded as ‘unreliable’
with ≥20% fixation losses or ≥15% false positives, as per
conventional adult thresholds.
We examined agreement, by age, between RI and EBA.
Results: No significant agreement was found between EBA and
‘fixation losses’ as an RI (test for trend; p=0.887). EBA and ‘false
positive’ measures demonstrated good agreement (p<0.001; Table 1).
Analysis of EBA by age (2 groups; 5-8 and 9-15 years) showed 94%
(17 of 18) of older children and 41% (19 of 46) of younger children
achieved a ‘good’ rating (χ2, p<0.001). Only 1 child, aged 8, had
difficulty understanding test instructions. Rest breaks were required
to complete testing in 8.7% of younger participants but older children
could complete the assessment without these.
Conclusions: In comparison to a qualitative examiner assessment,
automated fixation loss measurements may have limited value in
assessing reliability in children, with traditional thresholds used for
adult testing erroneously under-estimating the reliability of paediatric
perimetry. Where false positive rates are to be used to assess
reliability, we advocate they are complimented by a qualitative
assessment to avoid potentially informative perimetric tests being
disregarded.
Table 1. Agreement between EBA and false positives as an RI.
Commercial Relationships: Dipesh Patel, None; Phillippa
Cumberland, None; Isabelle Russell-Eggitt, None; Bronwen
Walters, None; Jugnoo S. Rahi, None
Support: Research grant - The Guide Dogs for the Blind Association
Program Number: 5676 Poster Board Number: C0147
Presentation Time: 8:30 AM - 10:15 AM
Intraocular Pressure and Traumatic Hyphema in Children
Jeffrey SooHoo1, Emily A. McCourt1, 2. 1Ophthalmology, University
of Colorado Denver, Aurora, CO; 2Ophthalmology, Children's
Hospital Colorado, Aurora, CO.
Purpose: To evaluate the relationship between traumatic hyphema
and intraocular pressure (IOP) in a pediatric population
Methods: This is a retrospective review of all 138 patients seen in
the emergency department at Children’s Hospital Colorado between
September 1, 2003 and December 31, 2011 and diagnosed with
traumatic hyphema. The medical record of each patient was reviewed
to determine the mechanism of injury and the incidence of secondary
glaucoma and ocular hypertension.
Results: The majority of hyphemas (122/138, 88%) occurred in male
patients; the mean age for all patients was 10.1 years (range 1-19).
Sixteen patients (12%) did not have initial IOP measurements due to
age, cooperation, or concern for globe trauma. The mean IOP at
presentation for the remaining 122 patients was 19.9mmHg (range 651) with a median of 18.5mmHg. Thirty-three patients without
sufficient follow-up were excluded from the remainder of the data
analysis, leaving 89 patients in this review.
Thirty-three of these patients (37%) had elevated IOP (>21mmHg) in
the injured eye either at presentation or during follow-up. Patients
with increased IOP were either observed closely or treated with
topical and/or oral ocular hypertensive medication(s) at the discretion
of the treating physician. Twenty-three of these patients (70%) had
normal IOP off treatment at one month following their injury. Six
patients required prolonged medical treatment and four patients
required surgical intervention for persistently elevated IOP. Two
patients underwent anterior chamber washout within one week of
injury for large hyphemas and associated ocular hypertension. Two
patients required glaucoma filtering surgeries less than three months
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
post-trauma.
The mechanism of injury for three of the four patients needing
surgery was a plastic or metal projectile (BB) from an air-gun. Half
of the patients with IOP >40mmHg at presentation (n=4) required
surgery. The average initial IOP of patients requiring surgery was
35mmHg compared to 19.4mmHg for patients not requiring surgery
(p<0.001).
Conclusions: Elevated IOP is a common occurrence after pediatric
trauma resulting in hyphema. The majority of patients respond well
to medical management. IOP >40mmHg at presentation increases the
odds of needing surgical intervention. High-velocity plastic or metal
pellets are the most likely mechanism for traumatic hyphema
requiring surgery.
Commercial Relationships: Jeffrey SooHoo, None; Emily A.
McCourt, None
Program Number: 5677 Poster Board Number: C0148
Presentation Time: 8:30 AM - 10:15 AM
A comparison of non-cycloplegic and cycloplegic autorefraction
using Spot™ (PediaVision LLC, Pompano Beach, FL) to manual
cycloplegic retinoscopy in a pediatric population
Adil Bhatti, Rami Abo-Shasha, Rejean Munger, Michael O'Connor.
Ophthalmology, University of Ottawa, Ottawa, ON, Canada.
Purpose: Cycloplegic manual retinoscopy is the gold standard for
determining pediatric refractive error. As an alternative to this labourintensive technique, there is continued interest in autorefraction,
particularly for use in pediatric vision screening programs. This study
compares autorefraction using Spot™ (PediaVision LLC, Pompano
Beach, FL) to manual retinoscopy in a pediatric population.
Methods: Case series (retrospective chart review). Forty-five
children underwent autorefraction (non-cycloplegic and cycloplegic)
and manual cycloplegic refraction by a staff ophthalmologist in the
pediatric ophthalmology clinic.
Refractive errors were converted to spherical equivalents. Data from
the right eye of each subject were used. Statistical measures of
performance (sensitivity, specificity, positive and negative predictive
values) were then calculated for both non-cycloplegic and
cycloplegic autorefraction conditions: myopia (< -1D), hyperopia
(+>2D), cylindrical (>1D), and anisometropia (>1.5D in equivalent
sphere), using manual retinoscopy as the gold standard.
Results: The mean differences between non-cycloplegic
autorefraction and cycloplegic retinoscopy, non-cycloplegic
autorefraction and cycloplegic autorefraction, and cycoplegic
autorefraction and cycoplegic retinoscopy were -1.85 +/- 2.20, -2.10
+/- 2.52, and 0.20 +/- 2.16, respectively. Sensitivity and specificity
for non-cycloplegic autorefraction were as follows: myopia
(sensitivity 40%, sensitivity 90%), hyperopia (sensitivity 18.8%,
sensitivity 96.6%), cylinder (sensitivity 75%, sensitivity 79.3%), and
anisometropia (sensitivity 21.8%, sensitivity 95.4%). Cycloplegic
autorefraction for myopia revealed sensitivity 66.7% and sensitivity
100%; for hyperopia, sensitivity 83.3% and sensitivity 92.9%; for
cylinder, sensitivity 50% and sensitivity 71.4%; and for
anisometropia, sensitivity 84.2% and sensitivity 90.5%.
Conclusions: These results suggest that the Spot™ autorefractor is
fairly effective at detecting clinically significant refractive errors
under cycloplegic conditions. Under non-cycloplegic conditions,
induced accommodation may limit the instrument’s ability to
effectively detect hyperopia and anisometropia in pediatric subjects.
This factor should be taken into consideration when using these types
of devices for pediatric vision screening.
Commercial Relationships: Adil Bhatti, None; Rami Abo-Shasha,
None; Rejean Munger, None; Michael O'Connor, None
Program Number: 5678 Poster Board Number: C0149
Presentation Time: 8:30 AM - 10:15 AM
Statistical evaluation in pediatric patients of Lang I stereo-test
for the diagnosis of microesotropia in daily practice
Davide Allegrini1, Manuela Spera2, Luca M. Rossetti1, Laura
Ottobelli1, Andrea C. Piantanida2. 1Eye Clinic, San Paolo Hospital,
Milano, Italy; 2Eye Center, C.O.L. Centro Oculistico Lariano,
Cernobbio (Como), Italy.
Purpose: The usefulness of diagnostic tests for microesotropia is stil
a mismatching problem. We have examined the most common and
used test to detect microesotropia in daily practice: Lang I stereo-test.
The aim of our study was to analyze statistically this test to detect its
real effectiveness in children.
Methods: We considered 313 patients whose age ranged from 3 to
18 years (mean age 7.5) suspected to be microesotropic. Children
younger than 3 years of age were excluded from the study since it
was not possible to detect any answer from the Lang 1 stereo-test due
to the early age. All underwent a full orthoptic and ophthalmological
examination. The stereo-test was presented at a distance of 40-50 cm.
“Paliaga 8 diopters base- in test” was considered the “gold standard”
diagnostic test.
Results: Among all the patients, 282 ( 90,1%) were considered
normal (without strabismus) and 31 (9,90%) were considered
affected (with strabismus). The authors found a specificity of 99%
and a sensitivity of 87%. We could also calculate the positive
predictive value (90%) and the negative predictive value (91%) of the
test since we knew the prevalence of microesotropia in our
population. Likelihood ratio was detected to evaluate the efficacy of
the test in daily practice and it corresponds to 87,10.
Conclusions: Lang I stereo-test is a simple test with high specificity
and good sensitivity. Positive and negative predictive values
correspond to a test with a good reliability in young children.
Likelihood ratio stresses the importance of Lang I stereo test in
diagnosing microesotropia in children elder than 3 years of age.
Infact the problem we encountered in our practice was the
cooperation of young patients, since we were obliged to exclude in
our statistical analysis children younger than three years due to the
impossibility to register reliable data. We stress the importance to
involve children aged more than three to have a good reliability of
this test in practice to detect microesotropic patients. Younger
children don’t allow to collect answers to make the correct diagnosis
and should be monitored with other tests with good statistical
evaluation according to age.
Commercial Relationships: Davide Allegrini, None; Manuela
Spera, None; Luca M. Rossetti, None; Laura Ottobelli, None;
Andrea C. Piantanida, None
Program Number: 5679 Poster Board Number: C0150
Presentation Time: 8:30 AM - 10:15 AM
Demographic Trends in Pediatric Cataract Surgery at a Tertiary
Referral Center
Monica L. Bratton1, Aimee Lam2, David Weakley1, Serena Wang1.
1
Department of Ophthalmology, University of Texas Southwestern,
Dallas, TX; 2University of Texas Southwestern Medical School,
Dallas, TX.
Purpose: Pediatric Cataract case series from 2000-2012 were
evaluated at Children’s Medical Center in Dallas, Texas in order to
evaluate patient demographics, etiology, and trends in management.
Methods: A retrospective chart review of all patients undergoing
primary cataract extraction from 2000 to 2012.
Results: Six hundred and twenty three eyes of 457 patients were
included. Two hundred and sixty seven (58%) were male and 190
(42%) female. Racially 41% were Hispanic, 33% Caucasian, 21%
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Black, 3% Asian, and 2% other. Cataracts were classified by etiology
with the most common being congenital followed by traumatic and
idiopathic. Two hundred sixty eyes (42%) were left aphakic and 363
(58%) eyes had a primary intraocular lens. Overall the mean age at
surgery was 5.3 years, (2.5 years for aphakic eyes and 7.3 years for
eyes with primary IOL implantation). For patients under one year of
age only 6%(10/178) has a primary lens implantation (all unilateral)
vs. 61% (25/41) in patients 1 to 2 years of age and 81% (328/404) in
patients older than 2 years of age. Eighty-three (32%) of the aphakic
eyes (mean age of initial surgery 1.7 years) later underwent a
secondary IOL placement at a mean age of 4.5 years.
Conclusions: Younger patients were more likely to be left aphakic,
particularly if under one year of age though about 1/3 underwent
secondary IOL implantation. In spite of significant advances in
pediatric cataract surgery, IOL implantation under one year of age is
still uncommon at our institution.
Commercial Relationships: Monica L. Bratton, None; Aimee
Lam, None; David Weakley, None; Serena Wang, None
Program Number: 5680 Poster Board Number: C0151
Presentation Time: 8:30 AM - 10:15 AM
Relation between grade and gender and reasons for spectacle
non-compliance among school aged children
Mabel Crescioni1, John D. Twelker1, 2, Joseph M. Miller1, 2, Tina K.
Green1, Irene Campus1, Erin M. Harvey1, 2. 1Ophthalmology and
Vision Science, University of Arizona, Tucson, AZ; 2Public Health,
University of Arizona, Tucson, AZ.
Purpose: To examine the self-reported reasons for spectacle noncompliance among 6th thru 11th grade students and to determine if
reasons for non-compliance varied by grade or gender.
Methods: Subjects were 6-11th grade students (53% female) enrolled
in a longitudinal study on refractive error. The majority of students
were members of a Native American tribe with a high prevalence of
astigmatism. Students received an eye examination during the
2010/11 school year and were provided eyeglasses free of charge.
During the next school year, students received a follow-up exam and
new eyeglasses. At the time of dispensing, they completed a
compliance survey. This survey includes 4 Likert scale items
regarding frequency of spectacle use and 12 true/false items
regarding specific reasons for not wearing spectacles. Descriptive
statistics and chi square were used to analyze the data.
Results: Of the 175 students that completed the survey 79 (45%)
reported that they always wear their glasses. Among those who
reported that they do not always wear their glasses, the most common
reasons reported were “only wear glasses when I feel like I need
them” (71%), “glasses are broken, scratched or lost” (69%) and “take
them off when I go out to play so they don’t get broken” (65%).
Least common reasons were “glasses make things look distorted,
blurry or funny” (12%), “teased when I wear the glasses” (17%) and
“worry that glasses will make my eyes ‘weak’ or ‘worse’” (21%).
Girls were significantly more likely than boys to report that they did
not wear their glasses due to “worry that glasses will make my eyes
‘weak’ or ‘worse’” (p=0.05) and boys were significantly more likely
than girls to report that they did not wear their glasses because they
“take them off when I go out to play so they don’t get broken”
(p=0.04). The percentage of students who reported that they did not
wear their glasses due to appearance significantly differed by grade
(p=0.03).
Conclusions: Reasons for spectacle non-compliance differ by age
and gender. Further studies are needed to determine if age and gender
specific interventions may be necessary.
Commercial Relationships: Mabel Crescioni, None; John D.
Twelker, None; Joseph M. Miller, None; Tina K. Green, None;
Irene Campus, None; Erin M. Harvey, None
Support: NIH/NEI 13153 and Research to Prevent Blindness
Program Number: 5681 Poster Board Number: C0152
Presentation Time: 8:30 AM - 10:15 AM
Pilot testing of a multi-functional device for pediatric vision
screening application
Ying-Ling Chen1, Lei Shi1, James W. Lewis2, Ming X. Wang3. 1Center
for Laser Applications, Univ of Tennessee Space Inst, Tullahoma,
TN; 2E-Vision Technologies, Inc, Tullahoma, TN; 3Wang Vision
Institute, Nashville, TN.
Purpose: Comprehensive pediatric vision screening requires
objective, non-cycloplegic, and binocular assessments of no less than
a refraction, an ocular alignment, and a pupil tests. This pilot study
tested the feasibility of integrating these 3 functions into one versatile
device, the Dynamic Ocular Evaluation System (DOES) [U.S. patent
#7,427,135 & 7,878,652]. The specific objectives were to (1) test
feasibility of using 3D images to relax accommodation in the
refraction test, (2) determine eye alignment precision that is required
for strabismus assessment, and (3) test feasibility of a dynamic
pupillogram.
Methods: DOES functions as a versatile near-infrared (NIR) video
retinoscope. Subject: 71 patients of ages 4 to 81 years were recruited
in Walmart vision center in Tullahoma, TN. DOES testing: (1)
Accommodation test: In 2 room-lighting conditions, 8 measurements
were acquired as the patient viewed a cartoon figure projected by a
3D screen at 4 distances (0.75, 1.5, 2.7, and >6 m); a 6 cm IPD was
assumed. (2) DOES used dynamic Hirschberg analysis to track the
eye gaze. Calibration was performed with 5 fixation-points on screen.
(3) Binocular pupil video was recorded during 3D visible stimulation
from the 3D screen at 75-cm distance. All patients received standard
clinical refraction eye examinations, ocular alignment assessment,
and pupil assessment.
Results: (1) Without cycloplegic eye drops, young hyperopic patients
showed significant variation in the measurement results due to active
accommodation. The tested eyes relaxed as the stimuli distance was
increased from 75 cm. Although not perfectly, the measured
refractions approached the targeted clinical gold standard values at
far stimulus distances. (2) Tracking capability of sub-prism spatial
gaze/strabismus- angle resolution at 20-50 Hz was achieved. Fixation
discrepancy was identified for various fixation target designs and
analyzed for 3 age groups. No significant age-dependence was found.
(3) Pupillograms were achieved with 20Hz speed and 0.1mm pupil
resolution. Pupil sizes were recorded while the 2 eyes were
stimulated independently.
Conclusions: This study demonstrated the feasibility of a low-cost
and multi-functional device for pediatric vision screening. A 3D
display may be utilized to connect multiple tests into one objective
vision screening test.
Commercial Relationships: Ying-Ling Chen, University of
Tennessee Research Foundation (P), E-Vision Technologies (I); Lei
Shi, None; James W. Lewis, University of Tennessee Research
Foundation (P), E-Vision Technologies (P); Ming X. Wang, None
Support: NIH Grant EY018385; UTRF Maturation Funding
Program
Program Number: 5682 Poster Board Number: C0153
Presentation Time: 8:30 AM - 10:15 AM
Ophthalmologic correlates of disease severity in Wolfram
Syndrome
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Smith Ann Chisholm1, 2, James Hoekel2, Tamara Hershey3, 4,
Lawrence Tychsen1, 2. 1Ophthalmology, Washington University in St.
Louis, Saint Louis, MO; 2Ophthalmology, Saint Louis Children's
Hospital, Saint Louis, MO; 3Neurology, Washington University in St.
Louis, Saint Louis, MO; 4Radiology, Washington University in St.
Louis, Saint Louis, MO.
Purpose: Wolfram Syndrome (WFS) is a rare, autosomal recessive
syndrome that consists of diabetes insipidus, diabetes mellitus, optic
nerve atrophy, and sensorineural deafness. Although clinical
ophthalmologic manifestations have been reported in advanced WFS,
it is unknown when these symptoms emerge and whether retinal
imaging provides insight into the pattern of degeneration. To address
this issue, we assessed several patients with the disease and
determined whether ophthalmic parameters correlate with overall
disease severity.
Methods: Eighteen WFS patients, aged 5 to 25, were recruited
through the Washington University Wolfram Syndrome International
Registry website for comprehensive ophthalmic assessment (visual
acuity, assessment of nystagmus, color vision testing, pupillary
reflexes, slit-lamp and dilated fundus exams, visual field testing, and
retinal tomography imaging) at the Washington University Wolfram
Syndrome Research Clinic. Patients were also assessed with the
Wolfram Syndrome Unified Rating Scale (WURS), which rates
severity of overall WFS symptoms. Correlations were performed to
determine how ophthalmic parameters related to overall disease
severity.
Results: Visual acuity (VA) in the patients ranged from 20/20 to
hand motion with an average VA of 20/60. Clinically apparent optic
atrophy was present in 17/18 patients, color vision was abnormal in
17/18 patients, pupils were abnormal in 10/18 patients, cataracts were
present in 4/18 patients, and nystagmus was present in 4/18 patients.
All of the patients who were able to participate in visual field testing
(10/18) had abnormal visual fields. All of the patients, including the
patient with no clinically apparent optic atrophy, had thin retinal
nerve fiber layers (RNFL) on optical coherence tomography (OCT)
imaging of the retina. The average RNFL thickness was nearly 5
standard deviations below normal for a pediatric population. Figures
1 and 2 show the correlation of ophthalmic parameters with disease
severity.
Conclusions: Wolfram Syndrome is a rare monogenic disorder with
multiple manifestations. Our study provides a detailed ophthalmic
phenotype in patients with WFS identifying dramatic abnormalities in
color vision and retinal thickness, even at young ages. In addition, we
identified measures that may be useful in tracking disease
progression. These parameters will be followed longitudinally to
determine if they are sensitive to the progression of disease.
Commercial Relationships: Smith Ann Chisholm, None; James
Hoekel, None; Tamara Hershey, None; Lawrence Tychsen, None
Support: Jack and J.T. Snow Fund at Washington University,
American Diabetes Association, George Decker and Julio V.
Santiago Pediatric Diabetes Research Fund, and National Institutes of
Health (HD070855; DK016746-39, NCRR 1S10RR022984-01A1,
and UL1 RR024992)
Program Number: 5683 Poster Board Number: C0154
Presentation Time: 8:30 AM - 10:15 AM
Detecting Tumor Progression in Optic Pathway Glioma
John P. Kelly, Avery H. Weiss. Ophthalmology W-4743, Seattle
Children's Hospital, Seattle, WA.
Purpose: : Detection of progressive tumor volume in children with
optic pathway gliomas (OPG) using visual acuity and visual evoked
potentials (VEP).
Methods: Patients (ranging from 0.3 to 13 years age at presentation)
who were treated with chemotherapy (n = 31) or radiotherapy (n= 4)
were compared to patients with stable disease and no subsequent
treatment (n = 19). Patients were followed by serial magnetic
resonance imaging, age-corrected visual acuity measurements in log
minimum angle of resolution (logMAR), and pattern VEP.
Longitudinal visual outcome data was on average 7.9 years (range 0.5
- 16 years). Sensitivity and specificity of visual acuity and VEP data
were used to detect tumor volume progression as defined by 25% or
greater increase in volume. We also measured longitudinal variation
of acuity in patients with stable disease.
Results: Visual acuity had poor sensitivity and specificity for
detecting tumor volume progression. True positives (visual decline
with tumor progression) were less frequent than false positives
(visual change without tumor progression). Sensitivity/specificity
improved if the analysis used a subset of patients with 0.6 logMAR
acuity in the better eye, but remained poor (Sensitivity = 0.50,
specificity = 0.77). VEPs were slightly better than visual acuity
(sensitivity = 0.82, specificity = 0.56). In patients with stable MRI
findings, longitudinal visual acuity fluctuated from -0.55 to 0.55
logMAR from the prior examination (mean = 0.0; s.d. = 0.15 log
MAR).
Conclusions: Decreased visual function does not reliably detect
tumor progression. Conversely, tumor progression does not reliably
indicate decreased visual function. Objective visual function and
serial MRIs are complementary in management of OPG. Multiple
factors can account for suboptimal sensitivity/specificity. First, visual
function can decline when tumor volume is stable. Second, children
with radiological stable disease show large variation in visual acuity
between visits. Third, increase in tumor volume may not directly
affect the visual pathway.
Commercial Relationships: John P. Kelly, None; Avery H. Weiss,
None
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Support: unrestricted grant from grant from the Peter LeHaye,
Barbara Anderson, and William O. Rogers Endowment Funds
Program Number: 5684 Poster Board Number: C0155
Presentation Time: 8:30 AM - 10:15 AM
Down Syndrome and Accommodation: The Added Advantage of
Bifocals
Brinda Muthusamy, Rohit Adyanthaya, Sheena Isenor, Kristina Irsch,
Kathryn Klein, David L. Guyton. Pediatric Ophthalmology & Adult
Strabismus, The Wilmer Eye Institute, Johns Hopkins Hospital,
Baltimore, MD.
Purpose: Traditionally most children with Down syndrome have
been non-compliant with spectacle wear, often attributed to their
inability to cooperate. Recent studies have documented that
approximately 80-92% of children with Down syndrome have
reduced accommodation. The purpose of this study was to evaluate
whether the use of bifocals increased spectacle compliance in these
children.
Methods: Records from 1983 to 2007 were retrospectively reviewed
of 86 Down syndrome children who were prescribed either bifocals
with +3.00 D high flat-top adds or single vision spectacles (“nonbifocal” children). Compliance with spectacle wear was assessed by
telephone and was available for 59 children: 33 with bifocals and 26
with single vision spectacles. Accommodative ability had been
assessed by dynamic retinoscopy in 44 of these children.
Results: In the 33 bifocal children, all had poor accommodation on
dynamic retinoscopy. Only 11 of the 26 non-bifocal children had
dynamic retinoscopy (9 had good accommodation and 2 had poor
accommodation).
Of the 33 non-bifocal children, 28 were compliant with spectacle
wear (84.8%), while only 12 of the 26 non-bifocal children were
compliant (46.2%). This association between type of spectacle
prescribed and compliance with wear was statistically significant by
chi square testing (p value = 0.002). Even among the 9 non-bifocal
children with known good accommodation, the compliance was only
44%, indicating that children with Down syndrome have inherent
difficulties with single vision spectacles.
Conclusions: Our study provides evidence that the extra spectacle
power for near is appreciated, and improves compliance of spectacle
wear in these children. Dynamic retinoscopy helps identify children
with poor accommodation. Improved spectacle compliance will likely
aid management of strabismus and amblyopia that is common in
these children.
Commercial Relationships: Brinda Muthusamy, None; Rohit
Adyanthaya, None; Sheena Isenor, None; Kristina Irsch, None;
Kathryn Klein, None; David L. Guyton, Smith-Kettlewell Eye
Research Inst (S), U.S. 6,027,216 - Rebiscan (P)
Program Number: 5685 Poster Board Number: C0156
Presentation Time: 8:30 AM - 10:15 AM
Retrospective Review of Refractive Error in Two Age Groups of
Hispanic and African American Children Seen in a Chicago
Vision Clinic
Sandra S. Block, Melissa A. Suckow, Kathleen O'Leary, Valarie
Conrad. School-Based Vision Clinic, Illinois College of Optometry,
Chicago, IL.
Purpose: The study was designed to compare refractive error
findings in Hispanic and African American children aged 6-7 years
and 11-12 years who were seen in a community based vision clinic
serving the Chicago Public School students.
Methods: This retrospective cross-sectional study looked at the
autorefraction findings (dry and cycloplegic) in the Hispanic and
African American children seen at the Illinois Eye Institute at
Princeton School-based vision clinic from Jan 2011 through Aug
2012. The study was limited to 6-7 year olds and 11-12 years old
children seen for exams. A univariate analysis of right eye only was
done for dry and wet cylinder, sphere, and spherical equivalent. In
addition, a comparison of each variable with age (young versus older
subjects) was included to observe if shifts in refractive error occurred
over time.
Results: Subjects included 974 Hispanics (n-356, 6-7 yr olds, n-618,
11-12 yr olds) and 1642 African Americans (n-552, 6-7 yr olds, n1090, 11-12 yr olds). Univariate analysis compariing findings
between each age group and each race showed a significant
difference (p<0.001) in refractive cylinder in both dry and wet states
but no difference in sphere or spehrical equivalent with the Hispanic
subjects showing more cylinder. The data also showed a significant
myopic shift from the younger age group to the older group (p<.005).
Means (standard deviations) in dopters of each variavle are found in
the following table:
Conclusions: Hispanic children show significantly more cylinder in
both dry and cycloplegic states than African American children. This
finding is in agreement with literature on refractive error in these
races reported in other geographic areas in the US. In addition, a
myopic shift is seen in the subjects frm the age of 6-7 years to the age
of 11-12 years. Limitations include the fact that this is a crosssectional and not a longitudinal study.
Commercial Relationships: Sandra S. Block, None; Melissa A.
Suckow, None; Kathleen O'Leary, None; Valarie Conrad, None
Support: Alcon, Anonymous, Blue Cross and Blue Shield of Il,
Chicago Community trust, Grant Healthcare Foundation, Lloyd A.
Fry Foundation, Polk Bros. Foundation and CVS CareMark
Program Number: 5686 Poster Board Number: C0157
Presentation Time: 8:30 AM - 10:15 AM
Development and validation of a novel functional vision
instrument for children and young people with visual
impairment
Val Tadic1, Andrew Cooper2, Gillian Lewando Hundt3, Jugnoo S.
Rahi1, 4. 1MRC Centre of Epidemiology for Child Health, UCL
Institute of Child Health, London, United Kingdom; 2Psychology
Department, Goldsmiths, University of London, London, United
Kingdom; 3School of Health and Social Studies, University of
Warwick, London, United Kingdom; 4UCL Institute of
Ophthalmology, London, United Kingdom.
Purpose: Robust patient-reported outcome measures in paediatric
ophthalmology are lacking. To complement our vision-related quality
of life (VQoL) instrument for visually impaired (VI) children to selfreport the impact of living with impaired vision, we have now
developed a self-report measure of Functional Vision (FV). Here, we
report development and validation of a novel FV instrument for VI
(LogMAR worse than 0.48) children aged 10-15 years.
Methods: Qualitative interviews (n=32 VI children) supplemented
by narrative feedback (n=15) were used to generate a draft FV
instrument, with further review and reduction through individual
consultations (n=17) about item relevance and comprehensibility, and
instrument instructions, format and administration methods. The
instrument was piloted with 94 VI children by postal survey to 21
NHS Trusts. Initial item reduction was guided by missing data and
item distribution. Rasch Rating Scale Model, supplemented by Factor
Analysis and internal reliability statistics, was applied to assess
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
unidimensionality, precision, targeting and response category
ordering.
Results: 712 qualitative statements were reduced to 56 items
capturing difficulty in performing vision-dependent activities.
Following the pilot, 8 items were removed based on high percentage
of missing data, and a further 3 on the basis of skewness. 12 items
were removed based on inadequate item infit and outfit values in
Rasch. 11 items were removed, exhibiting differential item
functioning across age and gender. The remaining 22-item scale
showed infit and outfit values in Rasch within acceptable limits and
the person-item map indicated good targeting of items to respondents.
Visual inspection of the ICC plots for each item revealed ordered
response categories. The reduced scale has high internal consistency
(Chronbach Alpha=0.95) and a clear unidimensional structure.
Conclusions: Our novel 22-item FV instrument is a psychometrically
robust measure for capturing the functional impact of visual disability
from the child’s own perspective, complementing assessment of
VQoL and offering an adjunct to clinical assessments in routine
paediatric ophthalmology practice.
Commercial Relationships: Val Tadic, None; Andrew Cooper,
None; Gillian Lewando Hundt, None; Jugnoo S. Rahi, None
Support: Fight for Sight Project Grant 2014, NIHR BRC at
Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of
Ophthalmology BMRC 098, NIHR CLRN Central and East London
Grant CEL1293
Program Number: 5687 Poster Board Number: C0158
Presentation Time: 8:30 AM - 10:15 AM
A novel measure of visual function and vision related quality of
life for childhood uveitis
Sheila Angeles-Han1, 2, Steven Yeh1, 3, Courtney McCracken1, Larry
Vogler1, 2, Kelly Rouster-Stevens1, 2, Christine Kennedy2, Scott R.
Lambert1, 3, Kirsten Jenkins2, Sampath Prahalad1, 2, Carolyn DrewsBotsch4. 1Pediatrics, Emory University, Atlanta, GA; 2Children's
Healthcare of Atlanta, Atlanta, GA; 3Ophthalmology, Emory
University, Atlanta, GA; 4Rollins School of Public Health, Emory
University, Atlanta, GA.
Purpose: Studies on outcomes of juvenile idiopathic arthritisassociated uveitis (JIA-U) focus on the ocular exam and physical
disability from arthritis. This assessment could improve by measuring
the impact of uveitis on daily life. No instruments measure visual
function and vision related quality of life (QOL) in this specific
population. Our aim is to validate our measure, the “Effects of
Youngsters’ Eyesight on Quality of Life” (EYE-Q), in children with
uveitis.
Methods: Focus groups were held to modify the EYE-Q for children
with uveitis. The new version has uveitis specific items.
Rheumatology and ophthalmology medical records were reviewed.
Questionnaires were completed on QOL (Pediatric QOL Inventory PedsQL), physical function (Childhood Health Assessment
Questionnaire - CHAQ), and visual function (EYE-Q).
Results: There were 108 children with JIA, 29 with JIA-U and 18
with idiopathic uveitis (I-U) (Table 1). Children with JIA-U were
more frequently African American, had oligoarticular JIA, and were
younger at arthritis onset (all p<0.001). There were no significant
differences in gender, ANA, or HLA-B27. Children with I-U had
worse visual acuity (VA) (p=0.005), and more ocular complications.
There were significant differences in the EYE-Q, CHAQ, and VA,
and no differences in PedsQL scores in all groups (Table 2). The
EYE-Q had moderate correlations with VA (r = - 0.39, -0.31),
PedsQL (r = 0.45) and CHAQ (r = -0.41). There were strong
correlations between the parent and child EYE-Q (r = 0.72), and the
old and new versions of the EYE-Q (r = 0.92). Cronbach’s α for the
new EYE-Q child report was 0.91.
Conclusions: Children with I-U may have poorer visual outcome.
Race, ethnicity, age of arthritis onset, RF status, and JIA subtype may
be important risk factors for developing uveitis, whereas gender,
ANA and HLA-B27 need further investigation.
Compared to JIA and I-U, children with JIA-U have more
components of disability. To improve the assessment of outcomes in
JIA-U, a comprehensive approach incorporating all aspects of
disability should be considered. The EYE-Q, with items specific to
uveitis, is a valid measure of visual function and vision related QOL
in uveitis. It is a promising global measure of pediatric vision that
may complement the ophthalmic exam and arthritis specific
measures. Longitudinal studies examining the performance of the
EYE-Q in uveitis are ongoing.
Commercial Relationships: Sheila Angeles-Han, None; Steven
Yeh, Bausch and Lomb (C); Courtney McCracken, None; Larry
Vogler, None; Kelly Rouster-Stevens, None; Christine Kennedy,
None; Scott R. Lambert, None; Kirsten Jenkins, None; Sampath
Prahalad, None; Carolyn Drews-Botsch, None
Support: NIH Grant K23 EY021760 and the ACR/REF AF Career
Bridge Funding Award
Program Number: 5688 Poster Board Number: C0159
Presentation Time: 8:30 AM - 10:15 AM
Effects of Lighting on Test Performance on the Odom-Robin
Visual Efficiency Near Vision Chart in a School Aged Population
Robin B. Mumford1, Stephen Silva2, Eric Stoddard2, J V. Odom3.
1
Mumford Institute, Highlands, NJ; 2After-School All- Stars of NY
CampUs, New York, NY; 3WVU Eye Institute, Morgantown, WV.
Purpose: The purpose of this study was to determine the effect of
luminance on the performance on a new near vision, number reading
chart designed to measure visual efficiency, the Odom-Robin Visual
Efficiency Chart.
Methods: 81 students whose mean age was 12.61 years (range 9-15
years; SD=1.2 years) who were participating in an After School All
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Stars Reading Camp at St. John’s University were tested using the
first three panels of the Odom Robin Visual Efficiency Chart under
two lighting conditions, using room lighting of 20 ft-candles and a
Spring Light with an illuminance of 100 ft-candles. The two lighting
conditions both had color temperatures of approximately 2700K. The
Odom-Robin Chart is a near vision number reading chart which
consists of numbers which must be read and compared as same and
different. The chart consists of 10 blocks of numbers whose sizes
range from 0.9 LogMAR to 0 LogMAR in 0.1 LogMAR steps. Five
lines and two columns of the same print size are grouped into a block.
Students read each line of the three largest sizes (15 lines), indicating
whether the two numbers on each line were the same or different.
Test distance was 40 cm. The time required to read the 15 lines with
no more than one error per block of 5 lines was recorded. Students
were tested twice on the same day, one light in the morning and the
other in the afternoon. The sequence of lighting conditions was
varied so that half of the students received one light first and the
other half the other light first.
Results: Students completed the test in 76.5±26.0 sec on average in
the room lighting condition and 80.95±36.0 sec using the Spring
Light. The mean difference -4.4±21.6 sec was not statistically
significant (p = 0.0687). Performance on the Odom-Robin chart
correlated significantly across the two lighting conditions (r = 0.81, p
< 0.0007). The slope of the linear regression relating the two values,
1.18, was not different from 1 (p > 0.10).
Conclusions: Consistent with visual acuity research and data from
other vision charts, performance on the Odom Robin Chart is
relatively insensitive to changes in illumination within the photopic
range. Scores obtained with classroom lighting and with special
lighting will be comparable.
Comparison of Lighting Conditions
Commercial Relationships: Robin B. Mumford, Mumford Institute
(I), Mumford Institute (P); Stephen Silva, None; Eric Stoddard,
None; J V. Odom, None
Program Number: 5689 Poster Board Number: C0160
Presentation Time: 8:30 AM - 10:15 AM
Prevalence of Anisocoria and Association Between Age and Pupil
Size in Children
Jillian Silbert1, Noelle S. Matta1, Jing Tian2, Eric Singman2, David I.
Silbert1. 1Vision Research Department, Family Eye Group, Lancaster,
PA; 2Wilmer Eye Institute, Johns Hopkins University, Baltimore,
MD.
Purpose: The plusoptiX photoscreener is able to measure
noncycloplegic refraction as well as pupil size and deviation. It is an
ideal instrument to measure the magnitude of anisocoria and pupil
size in children because both pupils are measured simultaneously. In
an initial pilot study an association was noted between pupil size and
age. We decided to expand the study to include 1306 children under
age 18 to see if these associations were valid and to report the
incidence of anisocoria.
Methods: Retrospecitve medical record review was performed on
1306 children aged <1 to 17 years who had a plusoptiX performed as
part of a pediatric ophthalmology examination. The plusoptiX was
performed by an orthoptist or ophthalmic technician in dim
illumination. Data collected included size of left and right pupils, age,
gender, laterality and magnitude of anisocoria.
Results: 80.9% of patients had 0 to 0.4 mm of anisocoria, 16.8% had
0.5 to 0.9 mm, 1.5% had 1.0 to 1.4 mm, and 0.8% had 1.5 or more
mm. ANOVA test showed that pupil size and age had a significant
relationship (P<0.0001), with older children having larger pupil size.
Pupil size of children under age 1 averaged 5.2 mm, increasing to 6.1
mm for children over age 16. Increase in pupil size levels off around
age 10, and then stays fairly constant through age 17. There is no
significant relationship between pupil size and gender (P=0.14).
Magnitude of anisocoria appears to increase with age (P=.0073).
There is not a significant difference in laterality of anisocoria
(P=0.38)
Conclusions: Pupil size is known to decrease in adults with
increasing age; however, there has been little reported on normative
data in children. Our study of 1306 children shows that pupil size
increases through childhood, beginning to level off at age 10, and that
19.1% of children in a clinic population have anisocoria greater than
0.4 mm.
Commercial Relationships: Jillian Silbert, None; Noelle S. Matta,
None; Jing Tian, None; Eric Singman, None; David I. Silbert,
iScreen (F), Pediavision (R), plusoptiX (R), Kaneka (C)
Program Number: 5690 Poster Board Number: C0161
Presentation Time: 8:30 AM - 10:15 AM
Mutation analysis in patients suspected to have PAX6-related
ocular malformations
Daniel Gratie, Edwin M. Stone, Jade East, Robert F. Mullins, Arlene
V. Drack. Ophthalmology, University of Iowa, Iowa City, IA.
Purpose: To determine the frequencies of specific mutations and
genotype-phenotype correlations in a cohort of patients with typical
or suspected aniridia.
Methods: DNA was extracted from whole blood using Gentra
Systems’ Autopure LS instrument. 12 ½ micrograms of DNA from
each patient were used as template in 8.35µl polymerase chain
reactions (PCR). Amplification products were denatured for 3
minutes at 94 degrees C and electrophoresed on 6% polyacrylamide,
5% glycerol gels at 25W for approximately 3 hours at room
temperature. Following electrophoresis, gels were stained with silver
nitrate. Abnormal PCR products identified by SSCP analysis were
confirmed using automated DNA sequencing with dye termination
chemistry on an ABI 3730 sequencer. All sequencing was bidirectional.Retrospective chart review was performed to collect
clinical data and all tabulated information was anonymized.
Results: Of the 79 probands samples referred for PAX6 testing, 66
had sufficient DNA for full gene analysis. Disease-causing mutations
were identified in 31/66 (47%). 94% of these individuals had aniridia
as their original diagnosis; the remainder had either ocular albinism
or nystagmus. Mutations were found in exons 4-11 and 13. The
mutation frequency distribution was 32% exon 5, 16% exon 7, 13%
exon 6, 10% exon 8, 10% exon 10, 6% exon 13, 3% exons 4, 9 or 11.
No mutations were found in exon 12. Family member samples were
available for 4 probands yielding 11 members of 4 multigenerational
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
families. Mutations in exons 5 or 7 were the most likely to have a
variable iris phenotype rather than typical aniridia. Iris phenotypes
included diffuse transillumination defects, elliptical iris anomaly, iris
coloboma, and pupillary notching. Expressivity was variable,
however presence or absence of congenital visually significant
cataracts and glaucoma were highly penetrant.
Conclusions: PAX6 mutations cause a host of ocular malformations,
many of which are not immediately recognizable clinically as
aniridia. Study of the phenotypes associated with mutations in
different exons may lead to better understanding of the function of
specific domains, and possibly to the development of specific
treatments. PAX6 exons 5 and 7 are hotspots for variable iris
phenotypes.
References: http://lsdb.hgu.mrc.ac.uk/home.php?select_db=PAX6; ;
Sharan S et al. JAAPOS 2008;12(4):340-3.; Netland PA et al.
JAAPOS 2011;15(6):562-6.
Commercial Relationships: Daniel Gratie, None; Edwin M. Stone,
None; Jade East, None; Robert F. Mullins, Alcon Research Ltd (F);
Arlene V. Drack, None
Support: Vision for Tomorrow
Program Number: 5691 Poster Board Number: C0162
Presentation Time: 8:30 AM - 10:15 AM
Risk Factors of Astigmatism in the Vision in Preschoolers (VIP)
Study
Jiayan Huang1, Gui-Shuang Ying1, Maureen G. Maguire1, Graham
E. Quinn2, Marjean T. Kulp3, Elise Ciner4, Lynn A. Cyert5, Deborah
A. Orel-Bixler6, Bruce Moore7. 1University of Pennsylvania,
Philadelphia, PA; 2Children’s Hospital of Philadelphia, Philadelphia,
PA; 3Ohio State University, Columbus, OH; 4Salus University, Elkins
Park, PA; 5Northeastern State University, Tahlequah, OK;
6
University of California, Berkeley, CA; 7New England College of
Optometry, Boston, MA.
Purpose: To determine demographic and refractive risk factors for
astigmatism among Head Start preschoolers in the Vision in
Preschoolers (VIP) Study.
Methods: Head Start preschoolers (aged 3 to 5 years, overrepresented with vision problems) were enrolled into the multicenter, cross-sectional VIP Study. All children underwent
comprehensive eye examinations, including monocular visual acuity
(VA), stereoacuity, and cycloplegic refraction. Astigmatism was
defined by the presence of > 1.5 diopters (D) cylinder in either eye,
measured with cycloplegic refraction. The odds ratios (ORs) and
corresponding 95% confidence intervals (95% CIs) associated with
age, gender, ethnicity and spherical equivalent were estimated using
logistic regression models.
Results: Among 4040 VIP participants, 505 (12.5%) had
astigmatism. Astigmatism was with-the-rule in 428 (84.8%), againstthe-rule in 23 (4.6%) and oblique in 54 (10.7%). In multivariate
analyses for all types of astigmatism (Table 1), African-American,
Hispanic and Asian children were more likely to be astigmatic when
compared with Caucasian children (all p<0.02). The OR for myopic
children (≤ -1.0 D) relative to emmetropic children was 4.6 (95% CI:
2.9 - 6.8), whereas the OR for hyperopic children (≥ 2.0 D) was 1.3
(95% CI: 1.1 -1.6). The association between spherical equivalent
refractive error and astigmatism was not linear (Figure 1). There was
a trend of increasing risk of astigmatism with older children (linear
trend p=0.12). The analysis for the risk factors of with-the-rule
astigmatism provided similar results as all types of astigmatism.
Conclusions: Among Head Start preschoolers, Hispanic ethnicity,
African-American and Asian race, and myopic and hyperopic
refractive error were associated with increased risk of astigmatism,
consistent with findings from the population-based Multi-ethnic
Pediatric Eye Disease and Baltimore Pediatric Eye Disease studies.
Table 1 Multivariate Analysis for the Risk Factors of Astigmatism in
Preschoolers (N=4040)
Figure 1: The relationship between spherical equivalent refractive
error and the prevalence of astigmatism in preschoolers in VIP study
Commercial Relationships: Jiayan Huang, None; Gui-Shuang
Ying, None; Maureen G. Maguire, Inspire Pharmaceuticals (F),
Amakem (F), IDx LLC (F), Merck (C); Graham E. Quinn, None;
Marjean T. Kulp, None; Elise Ciner, None; Lynn A. Cyert, None;
Deborah A. Orel-Bixler, None; Bruce Moore, EyeNetra Inc. (I)
Support: NEI/NIH, DHHS grants: U10EY12644; U10EY12547;
U10EY12545; U10EY12550; U10EY12534; U10EY12647;
U10EY12648 and R21EY018908
Program Number: 5692 Poster Board Number: C0163
Presentation Time: 8:30 AM - 10:15 AM
Quality Improvement in the Ophthalmic Care of Patients with
Down Syndrome through a Comprehensive, Center-Based Model
Daniel Hammer, Susan M. Culican. Washington University in Saint
Louis, Saint Louis, MO.
Purpose: A Down Syndrome Center coordinates comprehensive,
multi-specialty care at a large referral pediatric hospital. The purpose
of this study was to evaluate the incidence of ophthalmic
abnormalities in this large population of Down Syndrome patients,
the clinical features of nasolacrimal duct obstruction and their
surgical management, and the success of organizing combined
surgical procedures with the purpose of minimizing exposure to
general anesthesia.
Methods: A retrospective review of the electronic billing system to
include all of the patients with Down Syndrome who were seen by a
single ophthalmology provider between 2006-2010. The billed
ophthalmic diagnoses were enumerated. The medical records of
patients with a surgical diagnosis were reviewed with focus on the
number of surgical cases that were combined versus single, as well as
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
nasolacrimal system anomalies encountered.
Results: In n=322 patients, the no. of patients coded as having
strabismus was 28.9% (93, 84% esotropia, 16% exotropia, 3.4%
hypertropia), of whom 37% required surgery. 1.9% (6) had cataract, 3
of whom required surgery. 8.1% (26) had nystagmus. 9.9% (32) had
amblyopia. 1 patient had glaucoma. 26.4% (85) had nasolacrimal
duct obstruction, of which 36% had surgery. Nasolacrimal system
anomalies were nearly universal, as 77% required inferior turbinate
in-fracture, 52% required balloon dilation or stenting, and 23%
required punctoplasty. Eight patients had combined strabismus and
otolaryngological procedures, while 25 cases were strabismus only.
Fourteen patients had combined nasolacrimal and otolaryngological
procedures, while 18 cases were nasolacrimal only. There were 4
cases in which 2 separate surgeries occured within 6 months of each
other.
Conclusions: First, patients with Down Syndrome are at much higher
risk than the general population for strabismus and resultant
amblyopia and a system for prompt referral is important for maximal
visual development. Second, the nasolacrimal system of Down
Syndrome patients is usually anomalous and required a more
aggressive surgical algorithm. Third, a comprehensive, center-based
model seems to maximize combined surgical procedures which is
important in minimizing the number of exposures to general
anesthesia.
Commercial Relationships: Daniel Hammer, None; Susan M.
Culican, None
513 Myopia, CL
Thursday, May 09, 2013 8:30 AM-10:15 AM
Exhibit Hall Poster Session
Program #/Board # Range: 5693-5718/C0164-C0189
Organizing Section: Clinical/Epidemiologic Research
Program Number: 5693 Poster Board Number: C0164
Presentation Time: 8:30 AM - 10:15 AM
Predicting the onset of myopia: a retrospective study
Bjorn Drobe1, Roger de Saint-André2, 3. 1R&D Singapore, Essilor
International, Singapore, Singapore; 2Sarl Roger de Saint-André,
Gaillac, France; 3Centre d’Optométrie, Université Paris-Sud (Paris
11), Faculté des Sciences d’Orsay, Les Ulis, France.
Purpose: To propose a predictive model of myopia onset based on
fulfilling a percentage of risk criteria out of several standard
optometric tests.
Methods: A retrospective study on patient files of a single private
practice optometrist in the south-west of France (Gaillac). Patients
between 6 and 19 years with initial subjective spherical equivalent
(SE) of [0.00; +0.75] D in both eyes were selected. 73 patients in
which SE remained within [0.00; +0.75] D for at least 2 years were
classified as stable emmetropes (E); 52 patients in which SE became
strictly negative within less than 2 years were classified as premyopes (PM). Values of standard optometric tests were compared
between PM and E using Student’s t-test. For values showing
statistically significant differences (p<0.05), risk criteria were
determined as thresholds with Youden’s index J > 0.40. For
monocular tests, right eye values were used.
Results: 23 tests showed significant differences between PM and E,
out of which 8 reached J > 0.40: subjective binocular refraction ≤
0.25 D (p < 0.001, J = 0.44), first perceived blur at distance ≤ 0.50 D
(p < 0.001, J = 0.43), distance NRA ≤ +1.00 (p < 0.001, J = 0.45),
distance retinoscopy ≤ 0.00 D (p < 0.001, J = 0.42), quantitative
direct ophthalmoscopy ≤ -0.50 D (p < 0.001, J = 0.46), monocular
subjective refraction ≤ 0.00 D (p < 0.001, J = 0.41), distance
binocular red-green duochrome ≤ +0.25 D (p<0.001, J = 0.43) and
pupil diameter measured in low luminance ≥ 5.5 mm (p = 0.049, J =
0.45). ROC curve analysis showed that fulfilling at least 60% of
those risk criteria identified PMs with a sensitivity of 0.83 and a
specificity of 0.74, which was higher than for each test taken
separately.
Conclusions: Using a percentage of fulfilled risk criteria among 8
standard optometric tests allowed a better detection of the onset of
myopia than through criteria taken separately.
Commercial Relationships: Bjorn Drobe, Essilor Int. (E); Roger
de Saint-André, None
Program Number: 5694 Poster Board Number: C0165
Presentation Time: 8:30 AM - 10:15 AM
A genome-wide association study for simple myopia and
hyperopia in Twin Eye Study population
Li Deng. Vision Science, New England College of Optometry,
Boston, MA.
Purpose: Previous genomic studies on association of genes and
refractive errors focused on high myopia. In this study, we
concentrate on identifying single nucleotide polymorphisms (SNPs)
genotyped in Twin Eye Study which may be associated with simple
myopia and hyperopia.
Methods: Genotype and phenotype data of Twin Study of Myopia
and Glaucoma were downloaded from NIH website. 2995 subjects’
genome data and 2992 subjects’ phenotype data were matched and
combined. We analyze data of single individuals without cataract
from 984 families (aged 43.46 +/- 17.32). Simple myopia is defined
as the average spherical equivalent (SER) of two eyes < -0.5D while
hyperopia refers the average SER>1D. Trend test and logistic
regression (LR) for association, adjusting for age effect, were
conducted in the first 100K SNPs.
Results: Among the 984 subjects, there were 364 simple myopes and
171 hyperopes. Two SNPs (rsrs11107851, rs10230686) were found
to be significantly associated with simple myopia (p-values in both
trend test and LR <0.0001) while 7 SNPs (rs11700084, rs11063447,
rs11063456, rs10832757, rs10766383, rs10517553, rs10010445)
were showed significant association with hyperopia with the same
cutoff criterion. However, only 2 SNPs (rs10139934, rs10060247))
were significantly associated with both simple myopia and hyperopia
(p-values in LR for both simple myopia and hyperopia<0.001).
Conclusions: The SNPs rs10139934 and rs10060427 were found to
be significantly associated with both simple myopia and hyperopia.
Further confirmation using different cohorts for the association is
needed before we can study and reveal the roles the related genes
play in myopia development.
Commercial Relationships: Li Deng, None
Program Number: 5695 Poster Board Number: C0166
Presentation Time: 8:30 AM - 10:15 AM
Heritability of Myopia and Ocular Biometrics in Koreans: The
Healthy Twin Study
Tae-Young Chung, Dong Hui Lim, Myung Hun Kim, Min gyu Lee,
Eui Sang Chung. Samsung Medical Center, Seoul, Republic of
Korea.
Purpose: To provide accurate estimates of the heritabilities and
intraclass correlations among different family types regarding a range
of refractive errors and ocular biometrics in Korean population.
Methods: We studied participants in the Healthy Twin Study, a
prospective cohort study that has recruited Korean adult twins and
their family members. Refraction, corneal topography, and A-scan
ultrasonography were assessed. To see the degree of resemblance
among different types of family relationships, intraclass correlation
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
coefficients (ICC) were calculated. Variance-component methods
were applied to estimate the genetic contributions to eye phenotypes
as heritability based on the maximum likelihood estimation. Narrow
sense heritability was calculated as the proportion of the total
phenotypic variance explained by additive genetic effects, and linear
and non-linear effects of age, sex, and interactions between age and
sex were adjusted.
Results: ICCs for spherical equivalent from monozygotic twins,
pooled first degree pairs, and spouse pairs were 0.85, 0.31 and 0.07,
respectively. The ICCs of other ocular biometrics were also
significantly higher in monozygotic twins compared to other relative
pairs, with greater consistency and conformity. The estimated narrow
sense heritability (95% CI) was 0.78 (0.71-0.84) for spherical
equivalent, 0.86 (0.82-0.90) for axial length, 0.83 (0.76-0.91) for
anterior chamber depth, and 0.70 (0.63-0.77) for corneal astigmatism.
Conclusions: The estimated heritability of spherical equivalent and
ocular biometrics in the Korean population suggests the compelling
evidence that all traits are highly heritable.
Commercial Relationships: Tae-Young Chung, None; Dong Hui
Lim, None; Myung Hun Kim, None; Min gyu Lee, None; Eui Sang
Chung, None
Support: National Research Foundation of Korea, Ministry of
Education, Science and Technology (grant numbers: 2011-220E00006, 2010-0029113 and 2010-0025814)
Program Number: 5696 Poster Board Number: C0167
Presentation Time: 8:30 AM - 10:15 AM
Larger refractive group differences in visual activities are found
in children than in young adults
Kara E. Gerger, Jane E. Gwiazda. The New England Coll of Optom,
Boston, MA.
Purpose: To investigate refractive group differences in time spent on
indoor and outdoor activities at the current age and at 10 years.
Methods: 46 young adults (mean age = 24.15±2.21 years) completed
a visual activities questionnaire asking them to recall their daily
activities at 10 years of age and currently, separately for winter and
summer. Subjects indicated the average time spent daily on a variety
of indoor and outdoor activities requiring either distance (e.g.,
exercise/sports) or near vision (e.g., reading). Hours of weekly
activity were calculated as follows: (weekday hours x 5) + (weekend
day hours x 2). Myopia was defined as spherical equivalent refraction
(SER) ≤ -0.50 D and non-myopia as SER between -0.49 D and +2.00
D. Refractive group differences in activity time were compared by ttests.
Results: 28 myopes (mean SER = -2.47±1.30 D) and 18 non-myopes
(mean SER = +0.39±0.38 D) were tested. Overall, significant
refractive group differences were found at 10 years, especially in
outdoor physical activity. At 10 years, myopes spent significantly
fewer hours per week in outdoor physical activity than non-myopes,
both in the winter (8.68±5.26 vs. 13.36±6.49 hrs/wk; p=0.015) and
summer (19.11±10.05 vs. 27.89±8.66 hrs/wk; p= 0.003). At 10 years
myopes also reported significantly more hours of indoor near activity
than non-myopes in the summer (19.07±8.07 vs. 13.67±7.51 hrs/wk;
p=0.026), but not in the winter (20.39±6.80 vs. 18.14±6.69 hrs/wk;
p=0.276). The correlation between outdoor physical activity and
indoor near activity in the summer was small and not significant
(R=0.165), suggesting no substitution effect. For the same activities
at the current age no significant refractive group differences were
found.
Conclusions: Myopes spent less time than non-myopes in outdoor
physical activity and more time on indoor near activity at 10 years,
especially in the summer, but not at their current age. In addition, the
majority (71%) of the myopes were first corrected after 10 years of
age. These results, taken together, suggest that more outdoor physical
activity and less indoor near activity might reduce the risk for
development of myopia in children.
Commercial Relationships: Kara E. Gerger, None; Jane E.
Gwiazda, None
Support: NIH/NEI T35EY007149
Program Number: 5697 Poster Board Number: C0168
Presentation Time: 8:30 AM - 10:15 AM
Refractive Errors and Ocular Biometry in Singapore Adults: The
Singapore Epidemiology of Eye Disease (SEED) Study
Gus Gazzard1, 2, Chen Wei Pan3, Yingfeng Zheng4, 5, Ainur R. Anuar4,
Paul Mitchell6, Tin Aung5, 4, Ching-Yu Cheng4, 3, Tien Y. Wong4, 3,
Seang-Mei Saw3, 4. 1Institute of Ophthalmology, UCL, London,
United Kingdom; 2NIHR Biomedical Research Centre, London,
United Kingdom; 3Saw Swee Hock School of Public Health,
Singapore, Singapore; 4SERI, Singapore Eye Research Institute,
Singapore, Singapore; 5SNEC, Singapore National Eye Centre,
Singapore, Singapore; 6University of Sydney, Sydney, NSW,
Australia.
Purpose: To determine the prevalence and risk factors for refractive
errors and ocular biometry in Singapore adults aged over 40 years of
Chinese, Indian and Malay origin.
Methods: The Singapore Epidemiology of Eye Diseases (SEED)
population-based prevalence survey (n=10033) comprises 3353
Chinese (SCES), 3400 Indians (SINDI) and 3280 Malays (SIMES).
Refractive error was determined by subjective refraction, ocular
biometric parameters including axial length (AL) by partial
coherence interferometry (IOLMaster, Zeiss) and education and life
style by questionnaire. Myopia and high myopia were defined as
spherical equivalent (SE) of less than -0.5 Diopters (D) and -5.0 D,
respectively, hyperopia as SE of less than 0.5 D and astigmatism
defined as cylinder less than -0.5 D.
Results: 8772 subjects remained after excluding subjects with
cataract surgery. The age and ethnicity-standardized prevalence of
myopia, high myopia, hyperopia and astigmatism in Singapore adults
over 40 years were 38.9 % (95% CI 37.1, 40.6), 8.4 % (95% CI 8.0,
8.9), 31.5 % (95% 30.5, 32.5) and 58.8 % (95% CI 57.8, 59.9),
respectively. The age and ethnicity-standardized mean AL was 23.88
mm (95% CI 23.85, 23.90). After adjusting for age and gender,
Chinese had higher odds ratios of 2.04 (p<0.001) for myopia, 3.28
(p<0.001) for astigmatism and longer ALs (0.43 mm longer, P
<0.001) compared with non-Chinese. In a multivariate logistic
regression model adjusted for age, gender, race, cataract, education
and smoking, the OR of myopia was 4.7 (95% CI 3.7, 5.9; p<0.001)
for those with university education compared with no education, 3.1
(95% CI 2.6, 3.7) for those with nuclear cataract compared with nonnuclear cataract, and 0.82 (95% 0.72, 0.94) for ever smoked vs never
smoked. The population attributable risk was 38.6%, 18.9%, and
22.4% for education in Chinese, Malays and Indians.
Conclusions: The prevalence of myopia and high myopia are high in
Singapore adults and higher than other Asian countries such as India
or European-derived populations. Besides nuclear cataract, education
is a major risk factor for myopia while smokers are less likely to be
myopic. However, the rates are lower compared with the younger
“myopia” generation in Singapore with myopia prevalence rates of
83%. Chinese had the highest prevalence of myopia, high myopia,
astigmatism as well as the longest AL compared with non-Chinese in
Singapore.
Commercial Relationships: Gus Gazzard, None; Chen Wei Pan,
None; Yingfeng Zheng, None; Ainur R. Anuar, None; Paul
Mitchell, Novartis (R), Bayer (R); Tin Aung, Alcon (R), Alcon (C),
Alcon (F), Allergan (R), Allergan (C), Carl Zeiss Meditec (F), Carl
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Zeiss Meditec (R), Ellex (F), Ellex (R), Santen (R); Ching-Yu
Cheng, None; Tien Y. Wong, Allergan (C), Bayer (C), Novartis (C),
Pfizer (C), GSK (F), Roche (F); Seang-Mei Saw, None
Support: Biomedical Research Council (BMRC), 08/1/35/19/550 &
National Medical Research Council (NMRC), STaR/0003/2008,
Singapore
Program Number: 5698 Poster Board Number: C0169
Presentation Time: 8:30 AM - 10:15 AM
Outdoor activity exhibit protective effect for myopia in children
having a moderate near workload
Yuanbo Liang1, 2, Zhong Lin3, 2, Balamurali Vasudevan4, Vishal
Jhanji2, Tieying Gao5, Ningli Wang3, Kenneth J. Ciuffreda6. 1Clinical
Research Center, The Joint Shantou International Eye Center (JSIEC)
of Shantou, Shantou, China; 2Department of Ophthalmology and
Visual Sciences, The Chinese University of Hong Kong, Hong Kong,
China; 3Beijing Tongren Eye Center, Beijing Tongren Hospital,
Beijing, China; 4College of Optometry, Mid Western University,
Glendale, AZ; 5Handan Eye Hospital, Handan, China; 6Department
of Biological and Vision Sciences, SUNY College of Optometry,
New York, NY.
Purpose: To assess the relationship between near work, outdoor
activity, their interaction and refractive error in school children in
urban Beijing, China.
Methods: In this cross-sectional study, students recruited through the
Beijing Myopia Progression Study (BMPS) were asked to complete a
detailed questionnaire on both their near work and outdoor activities.
In addition, cycloplegic and non-cycloplegic refraction were
performed in the children and their parents, respectively.
Results: A total of 370 students (172 boys and 198 girls) were
enrolled. The total time of near work (e.g., reading) and outdoor
activity (e.g., sport and leisure activities) was 4.04 ± 1.72 and 1.88 ±
1.25 hour per day, respectively. Activity levels were divided into low,
moderate and high using population tertiles of the average daily hours
spent in these different activities. The more time students spent on
near work activity, the more myopic they became in all three outdoor
activity tertile groups (p= 0.02, p< 0.001, and p= 0.01, respectively)
after adjusting for children’s age, gender and average parental
refractive error. However, significant protective associations with
increased outdoor activity were only found in the moderate near work
tertile group (near work activity ranged from 3.1 to 4.6 hours per day;
the multiple-adjusted mean spherical equivalent was -2.19, -1.52 and
-1.50D, p=0.03). No such protective effect was found in low (near
work activity less than 3.1 hours per day; the multiple-adjusted mean
spherical equivalent was -1.21, -0.89 and -1.18D, p=0.88) or high
near work tertile group (near work activity more than 4.6 hours per
day; the multiple-adjusted mean spherical equivalent was -2.02, -2.26
and -1.98D, p=0.81). No interaction was found between near work
and outdoor activity tertile groups (p=0.92).
Conclusions: Higher levels of near work activity were associated
with more myopic refraction in school age children in urban China.
The protective effect of outdoor activity may exhibit its effect in
children having a moderate near workload only.
Commercial Relationships: Yuanbo Liang, None; Zhong Lin,
None; Balamurali Vasudevan, None; Vishal Jhanji, None; Tieying
Gao, None; Ningli Wang, None; Kenneth J. Ciuffreda, None
Program Number: 5699 Poster Board Number: C0170
Presentation Time: 8:30 AM - 10:15 AM
The effect of light intensity and accommodation on short-term
axial length changes in myopes and emmetropes
Emma Chu, Jane E. Gwiazda. Vision Science, New England College
of Optometry, Boston, MA.
Purpose: To investigate the effect of light intensity and
accommodation on short-term axial length changes in myopic and
emmetropic young adults after reading.
Methods: 23 young adults (mean age=23.8 years), 16 myopes (mean
spherical equivalent refraction [SER]=-3.63D) and 7 emmetropes
(mean SER=+0.14D), participated in the study. Measurements of
refractive error and accommodation (Grand-Seiko Autorefractor)
were taken. After baseline measurements of axial length (AL) (HaagStreit Lenstar), subjects engaged in 15 min of reading standardized
text at 33 cm under 4 randomly assigned conditions: dim
incandescent lighting (8-15 lux) wearing distance best corrected SER
(DimSER), dim lighting wearing distance SER with a +2.00D add
(DimAdd), bright fluorescent lighting (8000-10,000 lux) wearing
distance SER (BrightSER), and bright lighting wearing distance SER
with a +2.00D add (BrightAdd). AL measurements were recorded
immediately after each condition; subjects then took a 5 min break
before the next condition. The primary outcome was change in AL
with respect to baseline. Repeated measures ANOVA was used to
compare AL change with respect to baseline among the 4 conditions
and between the two refractive groups.
Results: Overall, there was no difference in the AL change with
respect to baseline across the 4 conditions (p=0.40). However, there
was a significant refractive group difference in mean AL change from
baseline; overall, the AL of myopes increased, while the AL of
emmetropes decreased (p=0.013). Specifically, paired t-tests showed
a significant difference in AL change between the myopes (mean+/SD= +2.6um, +/-0.07) and emmetropes ( -10.3um +/-0.12), p=0.005,
in the BrightAdd condition. The DimSER also showed a significant
difference in AL change between myopes ( +5.3um +/-0.14) and
emmetropes ( -6.9um +/-0.04), p=0.018. Refractive group differences
in AL change in the BrightSER and DimAdd conditions were in the
same direction and marginally significant, p=0.07 and p=0.09,
respectively.
Conclusions: Our results show that shortly after 15 min of reading,
the axial length of myopes increased compared to baseline, while the
axial length of emmetropes decreased, similar to a recent study
(Woodman et al, 2012). Furthermore, changes in AL did not vary
under different lighting conditions, suggesting that, contrary to
popular belief, reading in dim light may not increase the risk of
developing myopia.
Commercial Relationships: Emma Chu, None; Jane E. Gwiazda,
None
Support: NEI 5T35EY007149-14
Program Number: 5700 Poster Board Number: C0171
Presentation Time: 8:30 AM - 10:15 AM
International educational performance and myopia - a role for
cram schools?
Ian G. Morgan1, Kathryn A. Rose2. 1Research School of Biology,
Australian National University, Canberra, ACT, Australia;
2
Discipline of Orthoptics, University of Sydney, Sydney, NSW,
Australia.
Purpose: To examine the relationship between international
educational performance in the PISA surveys of educational
outcomes for 15 year-olds and the prevalence of myopia at a country
level.
Methods: Data were taken from the 2009 PISA report on
international educational outcomes, which covered 65 locations.
Prevalence rates for myopia were obtained from published research.
High myopia locations were defined as those in which the prevalence
of myopia was >70% in those completing secondary school, while
low myopia locations were defined as those in which the prevalence
was estimated to be <40%.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
Results: Six locations from the 2009 PISA participants were
identified as high myopia locations - Shanghai-China, Hong KongChina, Taiwan, Singapore, Japan and South Korea. All were in the
top quartile in terms of educational outcomes. Other countries in the
top performance quartile included Australia, Finland, Norway,
Poland and Denmark, in which sometimes limited data suggested that
the prevalence of myopia is low. For others, insufficient data was
available. PISA also reports on the amount of time children spend on
cram schools classes outside of school hours. Where comparison was
possible, in high myopia locations such as Shanghai-China and South
Korea, under 50% of students reported doing no additional classes,
whereas in Finland and Australia, over 90% of students reported
doing no additional classes. In the high myopia locations,
approaching 20% of students did more than 4 hours per week of
additional classes across four subject areas, while in the low myopia
locations, only 1-2% reported such high levels.
Conclusions: In locations which achieve high educational outcomes
in the PISA surveys, those with a high prevalence of myopia report
extensive involvement of students in cram school classes. In contrast
locations with high educational outcomes but low levels of myopia
report only limited involvement in additional classes out of school
hours. We suggest that participation in additional classes may be a
measure of educational pressures on children, perhaps preventing
them from spending time outdoors. Future epidemiological surveys
on refractive error should collect information on participation in cram
schools as well as homework hours, to complement information on
nearwork hours and time spent outdoors.
Commercial Relationships: Ian G. Morgan, None; Kathryn A.
Rose, None
Program Number: 5701 Poster Board Number: C0172
Presentation Time: 8:30 AM - 10:15 AM
Age of Spectacle Wear as a proxy for myopia severity in genetic
studies
Katie M. Williams1, Pirro G. Hysi1, Abhishek Nag1, Ekaterina
Yonova1, Cristina Venturini1, 2, Christopher J. Hammond1.
1
Departments of Ophthalmology and Twin Research, King's College
London, London, United Kingdom; 2Institute of Ophthalmology,
University College London, London, United Kingdom.
Purpose: Age of spectacle wear (AOSW) has recently been used as a
proxy for myopia severity in a successful genome-wide association
study (GWAS) of 43,000 people from the 23andMe personal
genomics company. This contradicts our expectation that careful
phenotyping of refractive error is needed for genetic studies. Given
most myopia heritability is currently unexplained, genetic effect sizes
are small, and large population studies may not have refractive error
data but could ask AOSW, these data challenge future research
strategies. We set out to examine the reliability of using AOSW as a
proxy for myopia severity using a large British twin cohort with
autorefraction, and to examine how well AOSW identifies
polymorphisms associated with myopia compared to spherical
equivalent.
Methods: Volunteers from the TwinsUK cohort were asked AOSW
via questionnaires in 2003 and 2008, and non-cycloplegic
autorefraction was performed on over 6,000 twins between 1998 and
2010, with the refractive error defined as the mean spherical
equivalent (SEq) of both eyes. Myopia was defined as <= -0.5 D.
Separate analyses were performed on 120 SNPs from 16 loci, from
the 23andMe GWAS for AOSW and SEq, to compare significance
levels. 2173 participants, who reported AOSW before 33 years were
included in the analysis, using Merlin to account for the family
structure.
Results: Data on AOSW and refraction was available for 4280 twins,
at a mean age of 54 years (SD 11.42, range 18 to 83). 1782 subjects
(42%) were myopic with a median AOSW of 16 years (mean 21.0
years, SD 12.0, range 1 to 74) and a mean refractive error of -3.1 D
(SD 2.54, range -25.13 to -0.50). AOSW for the myopes and SEq
were correlated (pearson correlation coefficient 0.49, p < 0.0001),
equating to AOSW explaining approximately 24% of the variance of
SEq. SNPs were generally more significantly associated with SEq
than AOSW (for example, rs745480 in RGR associated with SEq p =
0.0001 vs AOSW p = 0.846, rs524952 in the GJD2/GOLGA8B locus
associated with SEq p = 0.0001 vs AOSW p = 0.994).
Conclusions: AOSW reflects severity of myopia but only explains
approximately 24% of SEq variance. Associations with SNPs
previously identified with myopia were generally of greater
significance when using SEq rather than AOSW. However, these data
suggest that AOSW may be useful in large-scale population studies
where measurement of refractive error is not possible.
Commercial Relationships: Katie M. Williams, None; Pirro G.
Hysi, None; Abhishek Nag, None; Ekaterina Yonova, None;
Cristina Venturini, None; Christopher J. Hammond, None
Program Number: 5702 Poster Board Number: C0173
Presentation Time: 8:30 AM - 10:15 AM
Prevalence of myopia at age 6 in a Dutch Birth Cohort Study:
The Generation R Study
Jan Roelof Polling1, 2, Romy Gaillard3, Albert Hofman4, Vincent
Jaddoe3, Johannes R. Vingerling1, 4, Caroline C. Klaver1, 4.
1
Ophthalmology, Erasmus MC, Rotterdam, Netherlands; 2Orthoptics
& Optomery, University of Applied Sciences, Utrecht, Netherlands;
3
Generation R Study Group, Erasmus MC, Rotterdam, Netherlands;
4
Epidemiology, Erasmus MC, Rotterdam, Netherlands.
Purpose: The current notion is that the frequency of myopia is rising
in all parts of the world. This study aimed to investigate prevalence
of myopia in young children of a population-based multi-ethnic birth
cohort study of Rotterdam, the Netherlands.
Methods: 9,778 mothers (59% Caucasian; 16% Surinamese, Dutch
Antilles and Cape Verdian; 15% Mediterranean; and 10% others)
with a delivery date from April 2002 until January 2006 were
enrolled in the study. At age 6 years, children were invited for a
detailed investigation, including visual acuity by LEA charts,
keratometry, axial length, and fundus photography. Those with
LogMAR acuity > 0.1 were referred for detailed ophthalmological
examination including a cycloplegic refraction. Medical records of
those already receiving ophthalmologic care were evaluated.
Results: Of the 6690 examined children, the mean best corrected
visual acuity was 0.03 LogMAR and the mean axial length was
22.38mm. N=205 (3.1%) children had already been referred to an
ophthalmologist; of the remaining children, n=357 (5.3%) had visual
acuity > 0.1. Of the total population, 79 (1.2%) had myopia (≤-0.5D).
Conclusions: The prevalence of myopia among six year olds in our
study appears to be comparable to other studies of Caucasian
children, but lower than studies of Asian children. Myopia at this
stage in life will almost certainly lead to high myopia later in life.
Commercial Relationships: Jan Roelof Polling, None; Romy
Gaillard, None; Albert Hofman, None; Vincent Jaddoe, None;
Johannes R. Vingerling, None; Caroline C. Klaver, Bayer (F),
Novartis (F), Topcon (F)
Program Number: 5703 Poster Board Number: C0174
Presentation Time: 8:30 AM - 10:15 AM
Peripheral Refraction in a Population of Schoolage Children in
Central China: the Anyang Childhood Eye Study
Shi-Ming Li1, Si-Yuan Li1, Ningli Wang1, Paul Mitchell2. 1Beijing
Tongren Eye Center, Beijing Tongren Hospital, Beijing, China;
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
2
Centre for Vision Research, Department of Ophthalmology and
Westmead Millennium Institute, University of Sydney, Sydney,
ACT, Australia.
Purpose: We aimed to describe the distribution of peripheral
refraction and its associations with refractive error in a population of
year 1 Chinese children in central China.
Methods: Cross-sectional analysis of the Anyang Childhood Eye
Study (ACES), a school-based cohort study.Cycloplegic central and
peripheral refraction (15° and 30° at nasal and temporal retina,
respectively) was measured using an open field, infrared
autorefractor. Only right eyes were included for analysis.
Results: A total of 2645 year 1 students (85.0% of the ACES eligible
participants) aged 7.1 (5.7~9.3) years old had peripheral refraction
measured at baseline. At baseline, there were 1353 children with
hyperopia (>1.0 D, 51.2%), 1125 with emmetropia (-0.49 to 1.0 D,
42.5%), 161 with low myopia (-2.99 to -0.5 D, 6.1%), 6 with
moderate and high myopia (<=3.0 D, 0.2%). Peripheral refraction of
15° and 30° at nasal and temporal retina shifted to be more myopic
with increasing central myopia (P<0.001). Compared with central
refraction, hyperopic children had relative myopia at nasal 15°,
temporal 15°, nasal 30°, and temporal 30° retina (-0.49, -0.52, -0.33,
and -0.52 D, P<0.0001). Emmetropic children also had relative
myopia at nasal 15° and temporal 15° retina (-0.41 D, -0.37 D,
P<0.0001), which was decreased to be slightly relative myopia at
nasal 30° and temporal 30° retina (-0.13 D, -0.06 D, P<0.0001).
Children with low myopia had relative myopia at nasal 15° and
temporal 15° retina (-0.38 D, -0.20 D, P<0.0001), but relative
hyperopia at nasal 30° and temporal 30° retina (0.25 D, 0.37 D,
P<0.0001). Children with moderate to high myopia also had relative
myopia at nasal 15° and temporal 15° retina (-0.27 D, -0.09 D,
P<0.001), and higher relative hyperopia at nasal 30° and temporal
30° retina (0.60 D, 0.96 D, P<0.001).
Conclusions: In young Chinese children, peripheral refraction
presents to be relatively hyperopic in myopic eyes at 30° retina, and
relatively myopic in emmetropic and hyperopic eyes at all
eccentricities, with temporal retina being more hyperopic compared
to nasal retina.
Commercial Relationships: Shi-Ming Li, None; Si-Yuan Li, None;
Ningli Wang, None; Paul Mitchell, Novartis (R), Bayer (R)
Support: the Major State Basic Research Development Program of
China (‘‘973’’ Program) and the Major International (Regional) Joint
Research Project
Program Number: 5704 Poster Board Number: C0175
Presentation Time: 8:30 AM - 10:15 AM
Scleral Encircling Acceleration or Deceleration of Myopic
Progression in Myopic Eyes
Changho Kim, Sung Soo Kim. Ophthalmology, Severance hospital,
Yonsei Univ College of Medicine, Seoul, Republic of Korea.
Purpose: To determine the effect of scleral encircling on myopic
progression.
Methods: SETTING: Single-center academic hospital. STUDY
POPULATION: Patients who were treated at Shinchon and Gangnam
Severance Hospital from January 2005 to May 2011, retrospectively.
OBSERVATIONAL PROCEDURES: The study included 78 eyes
(39 patients) with rhegmatogenous retinal detachment and correction
by scleral encircling. We measured axial length with the IOLMaster
(Carl Zeiss Meditec, Dublin, CA, USA). Initial measurements were
taken at least 6 months after surgery, when eyes were stabilized.
MAIN OUTCOME MEASURE: We measured axial length, and
analyzed the changes in axial length per month. Results from
operated eyes and non-operated eyes were compared.
Results: The average changes in axial length per month were 0.011 ±
0.014 mm in all eyes, 0.015 ± 0.017 mm in the control group, and
0.0037 ± 0.0044 mm in the natural course group (P < 0.001). Thirtysix eyes fulfilled the initial criteria and more strict myopia definition
(> 26.5 mm). The changes in axial length per month were 0.012 ±
0.011 mm in all eyes, 0.017 ± 0.01 mm in the control group, and
0.005 ± 0.006 mm in the natural course group (P = 0.007).
Conclusions: Myopic progression is rapid in highly myopic eyes and
artificially myopia-shifted eyes. Scleral encircling itself has
detrimental effects on myopic progression. The initial greater axial
length effect is accelerated during myopic progression. Retinal
clinicians should be aware that scleral encircling could accelerate
myopic progression in patients.
Commercial Relationships: Changho Kim, None; Sung Soo Kim,
None
Program Number: 5705 Poster Board Number: C0176
Presentation Time: 8:30 AM - 10:15 AM
Curry consumption and high myopia in adults: A possible
protective effect
Ainur R. Anuar2, 1, Yingfeng Zheng1, 3, Lei Huang1, Baskaran Mani1,
Carol Y. Cheung1, Ching-Yu Cheng1, Merwyn Chew1, Jodhbir S.
Mehta1, 5, Tien Y. Wong1, 4, Tin Aung1, 4. 1Epidemiology, Singapore
Eye Research Institute, Singapore, Singapore; 2Ophthalmology,
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;
3
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic
Center, Guangzhou, China; 4Department of Ophthalmology, Yong
Loo Lin School of Medicine, National University of Singapore,
Singapore, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore; 5Duke-NUS Graduate Medical
School of Medicine, National University of Singapore, Singapore,
Singapore.
Purpose: To study the effects of curry consumption on the risk of
myopia and high myopia in adults.
Methods: Time outdoors has been shown to reduce the risk of
myopia, suggesting a possible relationship with vitamin D. A popular
spice in Middle Eastern and Asian countries, curcumin, the principle
ingredient in curry, is a potent nutritionally derived ligand to the
human vitamin D receptor (VDR), its coupling exerting bioeffects. In
this cross-sectional, population based study of Singaporean adults of
Indian ethnicity, the dietary effects of curry consumption on the risk
of adult myopia and high myopia was investigated. From 3400
subjects who underwent a standardized interview, ocular
examinations, and ocular biometry, 741 subjects (without prior
cataract surgery) were included. Diet was assessed using a semiquantitative food-frequency questionnaire. Frequency of curry
consumption was categorized into: frequent (daily), occasional (at
least once a week to once a month) and rarely or never (less than
once a month or never). Refractive error was determined via
autorefraction, followed by subjective refraction. Emmetropia was
defined as spherical equivalent (SE) of -0.5 to +0.5 D dioptre (D),
hyperopia as > +0.5 D, myopia as < -0.5 D but not less than -6.0 D,
and high myopia < - 6.0 D. Axial length (AL) was determined by
partial laser interferometry. As the Spearman correlation coefficient
for SE in the left and right eye was high, only right eyes were
analyzed.
Results: Out of 741 subjects, 656 reported frequent consumption, 31
occasional, and 54 rarely consumed curry. In univariate analysis,
except for education level (P<0.0001), neither axial length, height,
presence of cataract, nor the amount of time spent reading and
writing were found to be significantly associated with the frequency
of curry consumption. Using emmetropes as reference, and adjusting
for age, gender, and education level, the odds of high myopia were
low and significant in subjects who consumed curry daily (frequent) :
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
odds ratio (OR) of 0.25 , 95% Confidence Interval (95% CI) 0.08 to
0.83, P = 0.023. Curry consumption was however not protective
against myopia of less than -6.0 D.
Conclusions: Frequent (daily) consumption of curry may be
protective against high myopia in adults.
Commercial Relationships: Ainur R. Anuar, None; Yingfeng
Zheng, None; Lei Huang, None; Baskaran Mani, None; Carol Y.
Cheung, None; Ching-Yu Cheng, None; Merwyn Chew, None;
Jodhbir S. Mehta, None; Tien Y. Wong, Allergan (C), Bayer (C),
Novartis (C), Pfizer (C), GSK (F), Roche (F); Tin Aung, Alcon (R),
Alcon (C), Alcon (F), Allergan (R), Allergan (C), Carl Zeiss Meditec
(F), Carl Zeiss Meditec (R), Ellex (F), Ellex (R), Santen (R)
Support: Biomedical Research Council (BMRC), 08/1/35/19/550 &
National Medical Research Council (NMRC), STaR/0003/2008,
Singapore
Program Number: 5706 Poster Board Number: C0177
Presentation Time: 8:30 AM - 10:15 AM
Comparison of Cycloplegic refraction between Retinoscopy,
Closed field and Open field autorefraction in Pseudomyopia
JAMEEL RIZWANA HUSSAINDEEN, Krishna Kumar Ramani.
ELITE SCHOOL OF OPTOMETRY, SANKARA NETHRALAYA,
UNIT OF MEDICAL RESEARCH FOUNDATION, Chennai, India.
Purpose: Cycloplegic open field (OF) and closed field (CF)
autorefractors give similar results in refractive errors among normal
subjects according to previous literature. But in accommodative
anomalies as in Pseudomyopia/ Accommodative spasm, the
reliability of these techniques has not been tested. Hence we aimed to
assess the difference in cycloplegic refraction between standard
retinoscopy, CF and OF autorefraction techniques in Pseudomyopia.
Methods: This cross-sectional hospital based study wascarried
between November 2011 and November 2012. Pseudomyopia has
been defined as discrepancy of 0.50D or more myopic in subjective
acceptance compared to objective refraction along with a lead of
accommodation in Dynamic retinoscopy by more than 0.50D.
Subjects consented to undergo Cycloplegic refraction was prescribed
with 1% Atropine eye drops twice a day for three consecutive days
and the cycloplegic refraction values were documented on the fourth
day using standard Retinoscopy, CF (Topcon RM -8900R) and OF
(Grand Seiko WAM5500). The Spherical equivalent (SE) refractive
error was considered the main outcome of the study.
Results: Twenty eyes of ten pseudomyopic subjects were included.
The mean (SD) age of the sample was 21 years (+ 6) with 7 females
and 3 males. The mean (SD) SE using Retinoscopy was -3.21 D (2.50
D), using CF -4.13 D (2.83) and using OF was -3.39 D (2.67 D). The
mean (SD) SE of subjective acceptance was -3.85 D (2.80). Paired ttest with adjusted p-value revealed significant difference between
Retinoscopy and CF (Mean (SD) difference: 0.9 (0.7); CI (0.5 - 1.2);
p <0.0001) and between OF and CF ((Mean (SD) difference: -0.74
(0.58); CI (-1 to -0.46); p <0.0001). Statistically insignificant
difference was obtained between Retinoscopy and OF ((Mean (SD)
difference: 0.18 (0.63) p = 0.21)
Conclusions: Even under cycloplegia, closed field autorefraction
over-estimates myopia significantly compared to standard
retinoscopy and open field autorefraction techniques in
Pseudomyopia. The clinician should consider this discrepancy in the
management of Pseudomyopia.
Commercial Relationships: JAMEEL RIZWANA
HUSSAINDEEN, None; Krishna Kumar Ramani, None
Program Number: 5707 Poster Board Number: C0178
Presentation Time: 8:30 AM - 10:15 AM
Eye shape and peripheral refraction as predictors of myopia
progression in a population of Chinese children
David Troilo1, Li Qin Jiang2, Alexandra Benavente-Perez1, Xiangtian
Zhou2, Fan Lu2, Jia Qu2. 1SUNY College of Optometry, New York,
NY; 2Wenzhou Medical College, Wenzhou, China.
Purpose: Eye shape and peripheral refractive state may be related to
myopia development and progression. In this longitudinal study of
Chinese children we examined these factors as possible predictors of
the development of myopia using a multiple regression analysis.
Methods: Forty-one children (age: 11.5±0.98 years) were recruited
from primary schools in Wenzhou, China, and were classified as
emmetropes (n=23; axial MSE refraction: +0.75 to -0.25 D) or low
myopes (n=18; -0.5 to -2 D). Thirty-one children were reexamined
for follow-up after an average of 2.7 years (range 2.3-4.5 yrs).
Measures included in the analysis were on- and off-axis refractive
state (retinoscopy and Grand Seiko WAM-500 open field
autorefractor), axial length (IOLMaster), and eye shape (MRI).
Results: At the follow-up measurements, the average refractive
change for all subjects was -1.25±1.04D and only 6 out of 31 subjects
were not myopic. When all subjects were evaluated together, a
multiple regression model that included baseline measurements of
on-axis MSE refraction, axial length, the axial/equatorial eye length
ratio measured from the central sagittal plane, the nasal-temporal
asymmetry in VC depth, and the relative peripheral refraction at 30
deg temporal on the tangential plane significantly predict the on-axis
refractive change and growth rates at follow-up (R2=0.55 p<<0.01;
R2=0.31 p<0.05). However, when only the emmetropes at baseline
were analyzed, the best predicting models of changes in axial MSE
refraction and eye growth included only baseline measurements of
on-axis refraction, axial length, and relative peripheral refraction at
30 deg temporal on the tangential plane (R2=0.52 p<0.02; R2=0.52
p<0.02).
Conclusions: Baseline refractive state and eye length were
significant predictors of changes in refractive error and ocular growth
in this small-scale study. Specific measures of eye shape and
peripheral refraction combined to improve prediction to 55% of the
variability in developing myopia. These data support the hypotheses
that eye shape and peripheral refractive state are factors in the visual
control of eye growth and the development of refractive state.
However, only peripheral refraction, but not eye shape, was a factor
in the emmetropes that developed myopia at follow-up.
Commercial Relationships: David Troilo, None; Li Qin Jiang,
None; Alexandra Benavente-Perez, None; Xiangtian Zhou, None;
Fan Lu, None; Jia Qu, None
Support: Research Fund for the Doctoral Program of Higher
Education of China (20060343002)
Program Number: 5708 Poster Board Number: C0179
Presentation Time: 8:30 AM - 10:15 AM
Three-Dimensional Modeling of Highly Myopic Human Eyes
Using Optical Coherence Tomography Imaging
Yumiko Akagi-Kurashige, Kenji Yamashiro, Masahiro Miyake, Akio
Oishi, Akitaka Tsujikawa, Masanori Hangai, Nagahisa Yoshimura.
Department of Ophthalmology and Visual Sciences, Kyoto
University Graduate School of Medicine, Kyoto, Japan.
Purpose: To evaluate eyes with pathologic myopia by using volumerendering optical coherence tomography (OCT) images, and to
investigate the association between our findings and choroidal
neovascularization (CNV) in eyes with high myopia.
Methods: We reviewed 121 eyes of 121 consecutive patients with
high myopia who visited the Macula Service at Kyoto University
Hospital between May 2010 and May 2012. The inclusion criteria
were (1) highly myopic eyes, defined by an axial length ≥ 26.0 mm;
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
(2) age ≥ 40 years; and (3) use of spectral domain OCT (RS-3000®)
for examinations. We reconstructed a three-dimensional (3D) ocular
shape by using the Bruch’s membrane in 12 × 9 mm radial OCT
scans with its center at the fovea. The volumes calculated from these
reconstructed images were examined for their association with the
occurrence of choroidal neovascularization (CNV) in eyes with high
myopia.
Results: Out of the 121 eyes, 77 did not have CNV (group 1) and 44
had CNV (group 2). The mean age of the patients was 63.4 ± 12.1
years (group 1: 61.0 ± 12.6 years; group 2: 67.8 ± 9.9 years; P =
0.003), the mean axial length was 28.9 ± 1.8 mm (group 1: 29.0 ± 1.5
mm; group 2: 28.8 ± 1.7 mm; P = 0.52), and 81 of the 121 patients
were women. The 3D reconstructed images showed various ocular
shapes. Figure depicts the 3D ocular shape reconstructed from the
OCT images. At a height of 150 µm, the volumes of the eligible cases
were significantly smaller in group 1 than in group 2 (group 1: 0.56 ±
0.36 mm 3; group 2: 0.41 ± 0.16 mm3 ; P = 0.002).
The presence of CNV was found to be correlated with the volume
(odds ratio [95% confidence interval] = 0.46 [0.008-0.72], β=-0.78, P
=0.025) and axial length (odds ratio [95% confidence interval] = 0.62
[0.59-0.99], β=-0.48, P =0.043) using multiple regression analysis,
and the regression coefficient value was larger in the case of volume
than in the case of axial length.
Conclusions: Our findings suggest that development of CNV with
myopia is correlated with ocular shape.
The fundus photograph, OCT and 3D images of the representative
case.
Commercial Relationships: Yumiko Akagi-Kurashige, None;
Kenji Yamashiro, None; Masahiro Miyake, None; Akio Oishi,
None; Akitaka Tsujikawa, Pfizer (F); Masanori Hangai, Topcon
(F), Canon (F), Nidek (C), Topcon (C); Nagahisa Yoshimura,
Canon (C), Canon (F), Nidek (C), Topcon (F), PCT/JP2011/073160
(P)
Support: None exactly
Program Number: 5709 Poster Board Number: C0180
Presentation Time: 8:30 AM - 10:15 AM
Biometric characteristics of the Marfan eye: From the Marfan
Eye Consortium of Chicago
Sarah Wehrli2, 1, Marilyn Mets1, 2, Iris S. Kassem3, 1, Amani A. Fawzi2,
1
, Nathalie F. Azar3, 1, Irene H. Maumenee3, 1. 1Lurie Children's
Hospital of Chicago, Chicago, IL; 2Northwestern, Chicago, IL; 3UIC,
Chicago, IL.
Purpose: To describe the ocular biometry in a group of 60
individuals with Marfan syndrome.
Methods: Seventy two patients were seen on August 2nd as a part of
the National Marfan Foundation 2012 Annual Conference. Of those,
60 consented to the study and underwent an ophthalmologic
examination including measurement of axial length (AL), anterior
chamber depth (ACD), lens thickness (LT), pachymetry and
keratometry using ultrasonic contact A scan, IOL master, Sonomed
pachymetry and Marco keratometer. Lens status and current spectacle
refraction were also recorded and spherical equivalent (SE) was
calculated. Data from the subjects’ right eye only were included in
these analyses.
Results: Biometric and refractive data were analyzed on 60 patients,
ages 23 months to 56 years, 25 of whom were male. Subjects were
analyzed in two separate groups according to age, group one less than
18 years and group two greater than 18 years. Group one average
measurements were AL 23.62mm (SD=4.07), ACD 3.63mm
(SD=0.59), LT 3.74mm (SD=0.18), pachymetry 544.27um
(SD=46.91), corneal power 41.61D (SD=2.39) and SE -5.83D
(SD=6.16). In subjects 18 years and older, average measurements
were AL 25.39mm (SD=1.91), ACD 3.6mm (SD=0.61), LT 3.84mm
(SD=0.48), pachymetry 542.24um (SD=42.25), corneal power
41.58D (SD=2.09) and SE -4.71D (SD=5.88). We were unable to
obtain all measurements from all patients because many of the
subjects were young children at the time of the examination.
Conclusions: This study provides a baseline of biometric data for
patients with Marfan syndrome. The biometric and refractive data
collected from this group of individuals will hopefully be used to
identify possible biometric risk factors for the development of retinal
detachment.
Commercial Relationships: Sarah Wehrli, None; Marilyn Mets,
None; Iris S. Kassem, None; Amani A. Fawzi, None; Nathalie F.
Azar, None; Irene H. Maumenee, None
Program Number: 5710 Poster Board Number: C0181
Presentation Time: 8:30 AM - 10:15 AM
Implementation of atropine treatment for progressive myopia in
children
Ruben Kok1, Jan Roelof Polling1, 2, Caroline C. Klaver1, 3.
1
Ophthalmology, Erasmus MC Rotterdam, the Netherlands,
Rotterdam, Netherlands; 2Optometry & Orthoptics, University of
Applied Sciences, Utrecht, Netherlands; 3Epidemiology, Erasmus
Medical Center, Rotterdam, Netherlands.
Purpose: To explore the implementation of atropine treatment for
progressive myopia in children.
Methods: In a children’s academic hospital, we initiated therapy with
atropine 0.5% eye drops daily in 50 children (3-17 years) with
documented progressive myopia. Both parents and children filled in a
questionnaires about lifestyle, adverse events, and adherence to the
therapy. Eye examination performed at baseline, and after 1, 4, and
10 months included cycloplegic refractive error, (near)visual acuity,
pupil size and axial length. Frequencies of categorical variables were
compared with Fisher’s exact test; interobserver variability was tested
with Cohen’s kappa test.
Results: 97.5% of all patients reported adverse events: photophobia
(93%), reading problems (59%) and headaches (30%). 78.9% of the
patients reported adhere to the therapy. Only 16.3% of all patients
discontinued therapy, most within 1 month after initiation.
Conclusions: Despite high frequency of adverse events, many
patients treated with atropine eye drops for high myopia manage to
stay on therapy.
Commercial Relationships: Ruben Kok, None; Jan Roelof
Polling, None; Caroline C. Klaver, Bayer (F), Novartis (F), Topcon
(F)
Program Number: 5711 Poster Board Number: C0182
Presentation Time: 8:30 AM - 10:15 AM
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
The Economic Cost of Myopia in Singapore
Seang-Mei Saw1, 2, Yingfeng Zheng2, Junxing Chay3, Chen Wei Pan1,
Ecosse L. Lamoureux2, 3, Eric A. Finkelstein3, 1, Tien Y. Wong2, 4.
1
Saw Swee Hock School of Public Health, National Univ of
Singapore, Singapore, Singapore; 2Singapore Eye Research Institute,
Singapore Eye Research Institute, Singapore, Singapore; 3HSSR,
Duke-NUS Graduate Medical School, Singapore, Singapore;
4
Ophthalmology, National University Health System, National
University of Singapore, Singapore, Singapore.
Purpose: To estimate the economic cost of myopia in Singapore.
Methods: A sub study of 113 Singaporean adults aged 40 and above
with myopia (spherical equivalent refraction (SE) of at least -0.5D) in
the population-based ancillary study of Singapore Chinese Eye Study
(SCES) was conducted. A health expenditure questionnaire included
the cost of each optometrist visit, spectacles, contact lenses, laser
refractive surgery and associated complications, and management of
pathologic myopic complications. The economic burden of treatment
of myopia was extrapolated to Singapore using data from the national
census and prevalence data from epidemiologic studies.
Results: A total of 113 out of 125 myopic subjects (90.4%)
participated in the survey. The mean cost was approximately
SGD$900 (USD$709) per person per year. The lifetime per capita
cost ranged from SGD$295 (USD$232) for those with 0 years
duration to SGD$21,616 (USD$17,020) for those with 80 years
duration. Costs of spectacles, contact lenses and optometry services
were the major cost drivers, contributing to an average of 65% of
total costs. Seven subjects (6.2%) had undergone Lasik surgery,
resulting in a cost of SGD$4,891 (USD$3,851) per patient per year.
Three subjects (2.7%) reported annual costs of (SGD$33 or USD$26)
for complications due to Lasik surgery or contact lenses. There was
an increasing cost of myopia in adults who started to wear glasses at
earlier ages. By applying our cost data to age-specific myopia
prevalence data in the whole population in the country, the total cost
was estimated to be approximately SGD$959 (USD$755) million per
year in Singapore.
Conclusions: Our study shows that myopia is associated with
substantial out of pocket expenditure, imposing considerable
economic burden for patients. Myopia is a disease with immense
societal costs and public health impact.
Commercial Relationships: Seang-Mei Saw, None; Yingfeng
Zheng, None; Junxing Chay, None; Chen Wei Pan, None; Ecosse
L. Lamoureux, None; Eric A. Finkelstein, None; Tien Y. Wong,
Allergan (C), Bayer (C), Novartis (C), Pfizer (C), GSK (F), Roche
(F)
Support: This study was funded by Biomedical Research Council
(BMRC),08/1/35/19/550 & National Medical Research Council
(NMRC), STaR/0003/2008, Singapore
Program Number: 5712 Poster Board Number: C0183
Presentation Time: 8:30 AM - 10:15 AM
Correlation in Myopia Progression between right and left eyes in
Chinese children with Myopia
Padmaja Sankaridurg1, 2, Brien A. Holden1, 3, Xiang Chen4, 2, Arthur
Ho1, 3, Li Li4, 2, Leslie Donovan1, 2, Jian Ge4. 1Optometry, Brien
Holden Vision Institute, Sydney, NSW, Australia; 2Research, Vision
Cooperative Research Centre, Sydney, NSW, Australia; 3School of
Optometry and Vision Science, University of New South Wales,
Sydney, NSW, Australia; 4State Key Laboratory of Ophthalmology,
Zhongshan Ophthalmic Centre, Guangzhou, China.
Purpose: To determine if the rates of progression of myopia correlate
between right and left eyes in children with myopia and to determine
if there are risk factors associated with asymmetric progression.
Methods: Data from 141 children with myopia (10.5 ±2.0 yrs, -0.50
to -4.0D spherical equivalent), wearing standard spectacle lenses,
enrolled in Vision CRC myopia clinical trials from 2007-2012 at
Zhongshan Ophthalmic Centre, China and having progression rates
for 1 year were considered. Spherical equivalent refractive error
using cycloplegic autorefraction and axial length measurements were
determined at baseline and 12 months. Rate of progression of myopia
was correlated between the eyes using Pearson's correlation. A
difference of > ±0.25D in progression rate between eyes was
considered to be asymmetric progression. A Chi-square analysis was
performed to determine if age, gender, parental myopia, and phoria
status played a role in asymmetry.
Results: At baseline, the mean M in right vs left eyes was 2.08±0.70D vs -2.08±0.74D ( r= 0.89, p<0.001). The progression at
12 months was -0.75±0.43D vs -0.73 ±0.43D (r=0.69, p<0.001).
Whilst the correlation was substantial, only 56% were within ±0.25D
between the eyes. 24.8% of participants had differences of ±0.26 to
0.50D between the eyes, 15.6% had ±0.51 to 0.75D difference and
3.5% had ±0.76 to 1.0D difference. The mean central axial length in
right vs left eyes was 24.51±0.81 mm vs 24.49±0.82
(r=0.98,p<0.001). The progression rate at 12 months was 0.35±0.18
mm vs 0.35±0.19 mm (r=0.87,p<0.001). 73% of the participants had
differences of ± 0.10 mm. 22.9% of participants had differences of
0.11 to 0.20 mm, 3.6% had differences of 0.21 to 0.30 mm and 0.7%
had difference of >0.31 mm. None of the factors i.e. age, gender,
parental myopia and near phoria status was found to influence
asymmetric progression. Only smaller axial length at baseline was
associated with asymmetric progression (p <0.05).
Conclusions: Whilst the correlation between right and left eyes for
both mean spherical equivalent and axial length was substantial, 25%
or more of the participants had interocular differences that were
significant in terms of spherical equivalent refractive error or axial
length change. Consideration of interocular asymmetries reduces
statistical bias and might offer potential clues to refractive error
development and progression.
Commercial Relationships: Padmaja Sankaridurg, None; Brien
A. Holden, Allergan (F), AMO (I); Xiang Chen, None; Arthur Ho,
None; Li Li, None; Leslie Donovan, None; Jian Ge, None
Support: Australian Federal Government through the CRC program,
Brien Holden Vision Institute
Clinical Trial: chiCTR-TRC 00000029
Program Number: 5713 Poster Board Number: C0184
Presentation Time: 8:30 AM - 10:15 AM
Prevalence of myopia in Chinese urban and rural children
Mingzhi Zhang. Ophthalmology, Joint Shantou International Eye
Center, Shantou, China.
Purpose: To investigate the prevalence of myopia in Chinese urban
and rural children.
Methods: A cross-section survey was performed on 7537 children
from 5 primary schools, 2 middle schools and 2 high schools. The
refractive status was examined with mydriasis. The criteria of myopia
was defined as spherical equivalent <=0.75D. The prevalence of
myopia in different grades was analyzed.
Results: The response rate was 99.03%. The male to female ratio
was 52.6% vs. 47.4%. The age ranged from 6 to 19 years old. The
prevalence of myopia was 5.8% in Grade 1 and increased to 71.9% in
Grade 12 (Figure 1). The prevalence of myopia was higher in urban
compared to rural children, especially in high school (Figure 1).
Conclusions: The prevalence of myopia increase with grade in
Chinese urban and rural children. It is more prevalent in urban
compared to rural children.
©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permission
to reproduce any abstract, contact the ARVO Office at [email protected].
ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Clinical/Epidemiologic Research
(C), CellMed AG (P); Tien Y. Wong, Allergan (C), Bayer (C),
Novartis (C), Pfizer (C), GSK (F), Roche (F); Seang-Mei Saw, None
Commercial Relationships: Mingzhi Zhang, None
Program Number: 5714 Poster Board Number: C0185
Presentation Time: 8:30 AM - 10:15 AM
Refractive Errors and Age-Related Macular Degeneration: A
Systematic Review and Meta-Analysis
Chen Wei Pan1, Mohammad K. Ikram2, 3, Carol Y. Cheung2, 3, Gemmy
C. Cheung2, 3, Jost B. Jonas4, Tien Y. Wong2, 3, Seang-Mei Saw1, 2.
1
Saw Swee Hock School of Public Health, National University of
Singapore, Singapore, Singapore; 2Singapore Eye Research Institute,
Singapore, Singapore; 3Ophthalmology, National University of
Singapore, Singapore, Singapore; 4Ophthalmology, Medical Faculty
Mannheim of the Ruprecht-Karls-University Heidelberg, Mannheim,
Germany.
Purpose: To determine the associations between refractive errors and
age-related macular degeneration (AMD) by systematic review and
meta-analysis of observational studies.
Methods: We searched PubMed from its inception till March, 2012
for population-based studies with data on refractive error and AMD
assessed from retinal photographs at baseline and/or follow-up.
Study-spec