Interpretation of uniocular and binocular trials of glaucoma medications: an observational case series

<p>Abstract</p> <p>Background</p> <p>To predict the effectiveness of topical glaucoma medications based on initial uniocular and binocular treatment. To test a traditional hypothesis that effectiveness following a uniocular trial is associated with the change in IOP in the initially treated eye minus the change in the initially untreated eye. To determine whether uniocular or binocular treatment trials are superior.</p> <p>Methods</p> <p>Based on a review of medical records, we identified 168 instances in 154 patients with bilateral primary open angle glaucoma of initial uniocular use of a topical glaucoma medication with well-documented intraocular pressure (IOP) readings at baseline (IOP_A), during the trial (IOP_B), and at follow-up (IOP_C). Abstracted data included demographic data, IOP, and medication use. Predictors of the IOP following the trial (IOP_C) in each eye were identified by multivariable linear regression. In 70 cases, the predictive ability of initial uniocular and binocular treatment could be directly compared.</p> <p>Results</p> <p>In a multivariable analysis, the follow-up pressure in the initially treated eye (IOP_1C) was directly correlated with treated eye IOP during initial uniocular use (IOP_1B, p < 0.001). In a multivariable analysis, the follow-up pressure in the initially untreated eye (IOP_2C) was directly correlated with its baseline IOP_2A(p < 0.001), and also tended to be associated with treated IOP_1B(p = 0.07). The multivariable regression coefficient (b) for the IOP change in the initially untreated eye was generally not close to the value of -1 expected by the classic teaching (for eye 1, b = 0.04, p = 0.35; for eye 2, b = 0.07, p = 0.50). In 70 cases, the uniocular and binocular trials predicted a similar fraction of the variance in follow-up IOP_1C(r²= 0.56 and 0.57, respectively) and IOP_2C(r²= 0.39 and 0.38, respectively).</p> <p>Conclusion</p> <p>1) For uniocular trials, the IOP change in the untreated eye should not be subtracted from that in the treated eye. 2) Uniocular and binocular trials have similar predictive value when interpreted correctly. Either may be selected based on clinical circumstances.</p

Cataracts and cataract surgery in mentally retarded adults

To examine the prevalence of cataracts and cataract surgery in a population of mentally retarded adults. The prevalence of cataracts and cataract surgery was examined in a retrospective chart review. A total of 119 consecutive patients from the Southside Virginia Training Center for mentally retarded adults were seen in the authors' ophthalmology clinic during a 3-year period from January 1, 1999 to December 31, 2001. Intraocular lens (IOL) implantation and postoperative complications were noted in patients who had undergone previous cataract surgery. Of the 119 patients seen, 64 (54%) had cataracts or a history of cataract surgery. Thirteen (20%) of these 64 patients had a history of cataract surgery (21 eyes total). Seventeen (81%) of these 21 eyes had IOL implantation (14 posterior-chamber IOLs [PCIOLs] and three anterior-chamber IOLs). Postoperative surgical complications occurred in 7 (33%) of 21 eyes and included anterior uveitis in three (14%) eyes, posterior capsular opacification in two (10%) eyes, rhegmatogenous retinal detachment in one (5%) eye, dislocated PCIOL in one (5%) eye, pseudophakic bullous keratopathy in one (5%) eye, and cystoid macular edema in one (5%) eye. There were no cases of postoperative endophthalmitis or retained lens fragments. The prevalence of cataracts in adult mentally retarded patients is higher in this series (P<0.001) than in the world literature. However, if only visually significant cataracts are considered, the results are consistent with previous studies. Postoperative complications were common. Patients experienced higher rates of anterior uveitis (P=0.001) and pseudophakic bullous keratopathy (P=0.002) in this study than in previous studies. In this population, careful preoperative screening is recommended to select those patients most likely to benefit from cataract surgery and least likely to experience severe postoperative complications

A set of principles and practical suggestions for equitable fieldwork in biology

Field biology is an area of research that involves working directly with living organisms in situ through a practice known as “fieldwork.” Conducting fieldwork often requires complex logistical planning within multiregional or multinational teams, interacting with local communities at field sites, and collaborative research led by one or a few of the core team members. However, existing power imbalances stemming from geopolitical history, discrimination, and professional position, among other factors, perpetuate inequities when conducting these research endeavors. After reflecting on our own research programs, we propose four general principles to guide equitable, inclusive, ethical, and safe practices in field biology: be collaborative, be respectful, be legal, and be safe. Although many biologists already structure their field programs around these principles or similar values, executing equitable research practices can prove challenging and requires careful consideration, especially by those in positions with relatively greater privilege. Based on experiences and input from a diverse group of global collaborators, we provide suggestions for action-oriented approaches to make field biology more equitable, with particular attention to how those with greater privilege can contribute. While we acknowledge that not all suggestions will be applicable to every institution or program, we hope that they will generate discussions and provide a baseline for training in proactive, equitable fieldwork practices