Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents

Managing CMV Retinitis in the Developing World

Cytomegalovirus retinitis (CMVR) is a major opportunistic complication of the acquired immune deficiency syndrome (AIDS). In the developed world, prior to the availability of highly active anti-retroviral therapy (HAART), it was estimated that about 30% of patients with AIDS would develop CMVR during their lifetime. However, since the introduction of HAART, the incidence of CMVR has declined significantly in these countries. By far the most valuable intervention in the treatment of CMVR is the treatment of the underlying HIV disease with HAART. HAART is unfortunately not widely available in the developing world and it is here that the AIDS epidemic is continuing to grow. Sub-Saharan Africa leads the world with 25.3 million infected individuals with South-east Asia (5.8 million cases) the next area of concern. In South Africa alone there are an estimated 5 million people living with HIV/AIDS, most of whom are not receiving HAART

Childhood Cataract: Home to Hospital

Globally, there are 190,000 children who are blind from cataract.1 Cataract in children may be present at birth (congenital cataract) or may appear anytime during the first few years of life (developmental cataract). Childhood cataract is the most common treatable cause of childhood blindness, being responsible for 10-30% of all childhood blindness. A recent national study in Bangladesh showed that 1 in every 3 blind children is unnecessarily blind from congenital/developmental cataract

Keratoconus with Corneal ‘Pips’

Keratoconus is a common ectatic corneal disorder. There are several causes of corneal opacity in keratoconic patients. This case illustrates two different causes, in the same patient, in either eye, and diagnostic imaging characteristics on Fourier-domain optical coherence tomography (FD-OCT) that aided surgical management

Regular Visits to a Diabetes Clinic Were Associated with Lower Magnitude of Visual Disability and Diabetic Retinopathy-A Hospital-Based Historical Cohort Study in Yemen

Abstract Background: We associated regularity in visits to a diabetes clinic with the presence of diabetic retinopathy (DR) and visual disabilities. Methods: This historical cohort study was conducted in 2004. The physician reported details of diabetes mellitus (DM), hypertension, and other illness. The ophthalmologist examined eyes and noted visual acuity, DR, and other ocular morbidities. We calculated the relative risk (RR) of different complications of diabetes. Results: Our cohort consisted of 228 patients (114 in each group, one that attended diabetes clinics regularly [group A] and one that had irregular attendance [group B]). DR was found in 47 (41.2%) and 68 (61.4%) patients, respectively. The risk of DR was significantly higher in group B (RR ϭ 1.51, 95% confidence interval [CI] 1.23 to 2.18). The severity of DR was also positively associated with irregularity in clinic visits ( 2 ϭ 33.56, degrees of freedom ϭ 5, P ϭ 0.000003). The risk of bilateral blindness (RR ϭ 4.0, 95% CI 1.38 to 11.6) and low vision disability (RR ϭ 2.53, 95% CI 1.84 to 3.47) were higher in group B. The duration of diabetes and the regularity in clinic visits were the predictors of DR. Conclusions: The presence of DR and visual disabilities among patients with diabetes is associated with irregular attendance at diabetes clinics. The regularity of medical visits seems to be a proxy indicator of better primary prevention of eye complications of DM

Comparison of Peripapillary Vessel Density of Acute Nonarteritic Anterior Ischemic Optic Neuropathy and Other Optic Neuropathies With Disc Swelling Using Optical Coherence Tomography Angiography: A Pilot Study

The purpose of this study is to quantitatively compare the peripapillary vessel density (PPVD), measured with optical coherence tomography angiography (OCT-A), between acute nonarteritic anterior ischemic optic neurop- athy (NAION) and other causes of disc swelling ("others")

Artificial Intelligence in Retinal Imaging

Deep learning (DL) techniques are the latest iterations of artificial intelligence (AI) technology and has sparked significant interest in clinical medicine over the past few years. DL techniques may be used to detect diseases from medical images, including diabetic retinopathy and retinal diseases from retinal photographs, or from OCT. In other fields, DL techniques can diagnose lung conditions from chest X-rays, skin cancers from skin photographs and predict cardiovascular risk factors (e.g., blood pressure, smoking and body mass index) from retinal photographs