Central Corneal Thickness: A Retrospective Comparison of Handheld Ultrasound Pachymetry and Optical Biometric Analysis Measurements

Purpose To determine if the measure of central cornea thickness among suspected and confirmed glaucomatous patients is significantly influenced by instrument device. Methods We retrospectively examined the charts of all patients having a central corneal thickness (CCT) measured with both ultrasound pachymetry and IOL Master 700 at the Kresge Eye Institute within the past year. Intraocular pressure and demographic data including age and race, were also collected. Significant corneal disease such as Fuchs corneal dystrophy, other corneal dystrophies, corneal transplant, and corneal edema were excluded. Statistical analysis of the paired CCT measurements were performed with a paired t-test and regression analysis. Results The total number of patients having a CCT measured with both ultrasound pachymetry and IOLMaster700 was 59. Mean CCT measured with ultrasound pachymetry was 539.38 ± 49.56 µm (n=118). Mean CCT measured with IOLMaster700 was 536.83 ± 42.52 µm (n=112). The intraparticipant mean of differences between the ultrasound pachymetry and the IOLMaster700 was 3.16 ± 25 µm. Analysis with a paired t-test did not find a significant difference between the two groups (p=0.19). A regression analysis of the paired CCTs yielded an R2 value of 0.74. Conclusion There is no significant difference between CCT measurements taken with handheld ultrasound pachymetry compared to the IOL Master 700. More data is warranted to confirm, but the IOL Master 700 may yield lower variability and a lower mean CCT, possibly due to greater instrument precision and increased likelihood of a central measurement. In practice, the IOL Master 700 may provide a more reliable measure of central cornea thickness when compared with ultrasound pachymetry

Factors Associated with 5-Year Glaucomatous Progression in Glaucoma Suspect Eyes

Background: The US Preventive Services Task Force found that treatment of early asymptomatic primary open-angle glaucoma reduces visual field defects. However, it remains unclear which factors are associated with glaucomatous progression and which patients are at higher risk. The purpose of this study was to assess demographic factors, medical comorbidities, Humphrey visual field (VF) results, and Cirrus optical coherence tomography variables that could be predictive for 5-year glaucoma progression. Methods: A retrospective longitudinal study was conducted with the following inclusion criteria: glaucoma suspect eyes (defined as an asymmetric cup to disc ratio or an intraocular pressure \u3e21mmHg), best-corrected visual acuity 20/100 or better, spherical equivalent better than −8 diopters and astigmatism less than 3 diopters. Two consecutive abnormal VF tests during a 5-year follow-up was considered glaucomatous progression. Results: A total of 365 eyes (288 patients) were included in the study, of which 55 (15%) converted to glaucoma after 5 years. Logistic regression analysis showed that baseline mean deviation (MD), pattern standard deviation (PSD), VF index, and retinal nerve fiber layer (RNFL) colors were statistically significant in predicting 5-year glaucomatous progression. Though there were differences in glaucoma progression rates when analyzing sex, age, hypertension, diabetes mellitus, family history of glaucoma, and baseline intraocular pressure, these factors were not statistically significant. Conclusions: The study found that VF test results (MD and PSD) and RNFL colors can strongly predict which patients are at an increased risk of glaucoma progression. Clinicians can consider these factors when initiating, or continuing, prophylactic treatment for patients with glaucoma suspect eyes

Long-Term Outcomes of Bleb Needling Following Primary Glaucoma Filtering Surgery in Primary Open Angle Glaucoma

Purpose: To determine the long-term success rate of bleb needling in a predominantly African American population and to identify factors associated with success. Methods: We conducted a retrospective, observational clinical study in patients with primary open angle glaucoma. Patients who underwent a primary trabeculectomy, with or without an express shunt placement, and then subsequently had a bleb needling procedure were selected for this study. Patients were followed every three months for a period of two years. Failure criteria included achieving an intraocular pressure (IOP) of greater than 20 mmHg or greater than 80% of the pre-needling value on two subsequent visits, an increase in the number of prescribed medications relative to pre-needling quantity, and the occurrence of other complications. Kaplan-Meier survival curves were used to calculate bleb needling success rates and variables associated with failure were analyzed using multivariate Cox regression analysis. Results: Seventy-four eyes from 71 patients were included in the study, with the majority of eyes from African Americans. The overall success rate at 12 months and two years was 28.1% and 14.3%, respectively. However, the complete success rate (completely weaned off of medications) was 12.7% and 5.1% at 12 months and 2 years, respectively. The most frequent reasons for failure included increased number of glaucoma medications (40%), surgical revision (31.7%), and IOP that exceeded threshold (21.7%). Conclusions: The two-year bleb needling success rate reported in our study is lower than that reported in other studies, possibly due to the increased severity of glaucoma in our patient population

Factors Associated With 5-Year Glaucomatous Progression In Glaucoma Suspect Eyes: A Retrospective Longitudinal Study

Purpose: To study the association of 5-year glaucomatous progression with several demographic, clinical, visual field and optical coherence tomography (OCT) variables in glaucoma suspect eyes. Methods: A retrospective chart review of 365 eyes of 288 patients were included (323 eyes with suspicious cup-to-disc ratio and 42 eyes with ocular hypertension). The study subjects were divided into two groups: eyes that progressed to glaucoma and those that did not. We calculated the percentage of glaucoma suspect eyes that progressed to glaucoma within 5 years. The inclusion criteria were glaucoma suspect eyes (i.e., suspicious cup-to-disc ratio and/or intraocular pressure \u3e21 mm Hg), age ≥ 30 years old, follow-up time of 5 years, best-corrected visual acuity 20/100 or better, spherical equivalent better than −8 diopters and astigmatism less than 3 diopters. We excluded eyes with any significant retinal or neurological disease, and glaucoma which was determined by at least 2 consecutive reliable visual field tests regardless of the appearance of the optic disc. Results: Bivariate analysis showed eyes that progressed to glaucoma had significantly worse mean deviation, higher pattern standard deviation (PSD), less visual field index, thinner average, superior, and inferior retinal nerve fiber layer thickness (RNFL), and more severe average, superior, and inferior RNFL damages (i.e., color grading scale) at baseline. Logistic regression analysis showed only PSD and severe inferior RNFL damage (i.e., red color) were significantly associated with 5-year glaucomatous progression. Conclusions: Segmental RNFL damage and PSD are associated with 5-year glaucomatous progression in glaucoma suspect eyes

Intraocular Lens Formula Comparison of Flanged Intrascleral Intraocular Lens Fixation with Double Needle Technique

PURPOSE: To analyze visual outcomes and accuracy of intraocular lens (IOL) calculation formulas in predicting postoperative outcomes in patients undergoing flanged intrascleral IOL fixation. DESIGN: Case Series. SUBJECTS: Twenty-three patients who had undergone secondary IOL placement using flanged intrascleral fixation technique. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Corrected distance visual acuity (CDVA) and postoperative spherical equivalent based on manifest refraction. RESULTS: Visual acuity improved from 20/577 to 20/58. Overall, the actual refraction was 0.06 D more myopic than predicted. Holladay 2, Sanders Retzlaff Kraff/Theoretical (SRK/T) and Barrett Universal II resulted in mild myopic surprise (-0.55, -0.18 and -0.20 D). Haigis and Hill-RBF (Radial Basis Function) resulted in mild hyperopic surprise (+0.28 and +0.28 D). Hoffer Q and Holladay 1 were the most accurate (-0.02D and -0.08 D). CONCLUSION: Flanged intrascleral IOL fixation improved vision even in patients with other posterior segment pathologies. The effective lens positioning is likely similar to in-the-bag positioning. Hoffer Q and Holladay 1 formulas with in-the-bag calculations were the most accurate

Factors associated with conjunctival erosions after ahmed glaucoma valve implantation

Purpose: To investigate the frequency of conjunctival erosions in a series of patients who underwent Ahmed valve implantation in a tertiary referral center and to study risk factors associated with the conjunctival erosions. Methods: This is a single-center, retrospective case-control study of all patients who underwent Ahmed valve implantation between October 2006 and July 2016 at the Kresge Eye Institute in Detroit, Michigan. The series consisted of 306 eyes (277 patients) that underwent Ahmed valve implantation. The rate of conjunctival erosions was determined. Univariate, bivariate, and Cox-proportional hazard analyses were performed to identify factors associated with conjunctival erosions. Results: During the study period, 23 erosions occurred in 306 eyes (7.52%). Aphakia was significantly more common in eyes with erosions (P < 0.05). Aphakia (P = 0.02), uveitic glaucoma (P = 0.03), and longer post-operative use of topical steroids (P < 0.04) significantly increased the risk of erosions based on the Cox model. There were similar rates of erosions with each type of patch graft. No conjunctival erosion was observed after using the modified scleral tunnel method (n = 10). Conclusions: The overall erosion rate was 7.52% in our series. Uveitic glaucoma, aphakia, and longer post-operative use of topical steroids were significantly associated with conjunctival erosions

An Ophthalmology Virtual Externship during the COVID-19 Pandemic: A Pilot Study

Background The evolution of medical school curricula, characterized by truncated preclinical periods and reduced emphasis on ophthalmology, presents formidable obstacles to early exposure for aspiring medical students. The constraints imposed by the coronavirus disease 2019 pandemic further exacerbated the limitations on opportunities, compelling the implementation of innovative initiatives aimed at augmenting students' ophthalmology education through virtual means

The Vision Detroit Project: Integrated Screening and Community Eye-Health Education Interventions Improve Eyecare Awareness

Poor eye-health knowledge and health literacy are pervasive, contributing to worse outcomes. This study aims to examine short- and long-term eye-health knowledge retention following eye-health education interventions in adults. Vision Detroit was an outreach vision screening program that integrated a 5-Point Teaching Intervention (5PTI), at a Southwest Community Center (SW-CC) from 2015–2017. The 5PTI consists of eye-health learning points developed to verbally educate patients. During vision screenings, eye-health knowledge tests were administered before and after 5PTI (Test 1 and Test 2, respectively). In 2016, Community Eye-Health Education Interventions (CHEI) were initiated at the SW-CC. During CHEI, bilingual healthcare students taught voluntary SW-CC members the 5PTI learning points, regardless of participant interest to attend future screenings. CHEI sessions occurred on separate dates prior to vision screening events. Test 1 and Test 2 scores were compared for all participants. Test 1 scores were compared for those who underwent CHEI prior to vision screening (CHEI positive) versus those who did not (CHEI negative). Two-hundred-seventeen adult patients met inclusion criteria, with 75.8% women, 82.6% Hispanic, mean age 50.4 ± 16.2 years, 74.6% had high school or less education, and 49.2% had health insurance. Test 1 to Test 2 scores improved after 5PTI (71.2 ± 26.4% vs. 97.2 ± 9.9%, p Simple eye-health education interventions, delivered during vision screenings and via community-based education, can improve eye-health knowledge.</p