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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 to reproduce any abstract, contact the ARVO Office at [email protected]. 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 to reproduce any abstract, contact the ARVO Office at [email protected]. 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 to reproduce any abstract, contact the ARVO Office at [email protected]. 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 to reproduce any abstract, contact the ARVO Office at [email protected]. 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