Methods  In an institutional review board–approved protocol for patients with amblyopia who do not adhere to the use of conventional patching, shield occluders were fashioned from heat-moldable sturdy black or translucent (20/4000) plastic with holes drilled for attachment. Under brief general anesthesia, patients aged 5 to 10 years had a thorough examination before the shield occluder was sewn to the brow and cheek of the nonamblyopic eye with 3-0 monofilament polypropylene sutures.

Results  Ten children completed this protocol from December 1999 through January 2002. All tolerated the occluder for 12 to 36 days. The resultant skin scars were acceptable to parents, patients, and investigators. The amblyopic eyes improved from a mean (SD) of 0.77 (0.30) logMAR (Snellen equivalent, 20/119) to 0.45 (0.29) logMAR (Snellen equivalent, 20/57), a change of 0.32 (0.16) logMAR lines. There was no damage to the sound (occluded) eye.

Conclusion  Sew-on occluder shields are an alternative when adherence to the use of other types of patching (often referred to as compliance with patching) is not satisfactory.

Methods  Ten patients with skew deviation, 14 patients with unilateral peripheral trochlear nerve palsy, and 12 healthy subjects were prospectively recruited. With subjects first in the upright position and then in the supine position, ocular torsion was measured by double Maddox rods and vertical misalignment was measured by the prism and alternate cover test.

Results  In patients with skew deviation, the abnormal torsion and vertical misalignment in the upright position decreased substantially with change to the supine position, whereas in patients with trochlear nerve palsy, it changed little between positions. Torsion was decreased by 83% in patients with skew deviation, 2% in patients with trochlear nerve palsy, and 6% in healthy subjects (P < .001). Similarly, vertical misalignment was decreased by 74% in patients with skew deviation and increased by 5% in patients with trochlear nerve palsy and 6% in healthy subjects (P < .001).

Conclusions  Our findings provide the basis for additional clinical tests to support the classic 3-step test: ocular torsion and vertical misalignment that decrease from the upright position to the supine position indicate skew deviation, whereas torsion and vertical misalignment that do not change significantly between positions indicate trochlear nerve palsy.

Methods  We describe 4 patients who lack a foveal pit. Visual acuities ranged from 20/20 to 20/50. Stratus and Cirrus (Carl Zeiss Meditec, Dublin, California) optical coherence tomographs (OCTs) and multifocal electroretinograms were obtained. High-resolution retinal imaging on 2 of the participants was obtained by using a high-resolution Fourier-domain OCT and an adaptive optics flood-illuminated fundus camera.

Results  No participants had a visible foveal pit with conventional OCT. Central widening of the outer nuclear layer and lengthening of cone outer segments were seen with high-resolution Fourier-domain OCT. Adaptive optics imaging showed normal cone diameters in the central 1° to 2°. Central multifocal electroretinogram responses were normal.

Conclusions  We show that a foveal pit is not required for foveal cone specialization, anatomically or functionally. This helps to explain the potential for good acuity in the absence of a pit and raises questions about the visual role of the foveal pit. Because the term foveal hypoplasia commonly carries a negative functional implication, it may be more proper to call the anatomic lack of a pit fovea plana.

Methods  Eighty participants were divided into 4 groups: (1) those with XFS and ocular normotension (n = 25), (2) controls with ocular normotension without XFS, age-matched to group 1 (n = 25), (3) those with XFS and ocular hypertension (n = 15), and (4) controls with ocular hypertension without XFS, age-matched to group 3 (n = 15). Following washout of glaucoma medications, assessments were made of IOP, episcleral venous pressure, aqueous flow, outflow facility, and uveoscleral outflow. Differences were analyzed by group mean comparisons and linear regression analyses.

Results  Uveoscleral outflow was significantly decreased in individuals with XFS compared with age-matched controls and was independent of IOP. Patients with ocular hypertension (with or without XFS) exhibited decreased outflow facility compared with those with ocular normotension (with or without XFS). Aqueous flow was not affected by the level of IOP or the presence of XFS.

Conclusions  Exfoliation syndrome in normotensive and hypertensive eyes is associated with a decrease in uveoscleral outflow, whereas in hypertensive but not normotensive eyes, it is associated with reduced outflow facility.

Methods  Forty consecutive eyes with closed globe injury and a chronically elevated intraocular pressure (IOP) of at least 21 mm Hg for a minimum of 3 months were diagnosed as having traumatic glaucoma and compared with 52 eyes with closed globe injury and no evidence of glaucoma.

Results  The median grade of trabecular pigmentation on gonioscopy in eyes with traumatic glaucoma was 3 compared with 2 in eyes without glaucoma (P = .001). On UBM findings, 18 eyes with closed globe injury without glaucoma showed evidence of cyclodialysis, compared with 7 eyes with glaucoma (P = .001). The relative risk of developing traumatic glaucoma was also significantly higher with hyphema, elevated baseline IOP, angle recession of more than 180°, lens displacement, and wider angles on UBM.

Conclusions  Clinically, the presence of increased pigmentation at the angle, elevated baseline IOP, hyphema, lens displacement, and angle recession of more than 180° were significantly associated with the occurrence of chronic glaucoma after closed globe injury. On UBM findings, a wider angle and the absence of cyclodialysis were significant predictors for the subsequent development of traumatic glaucoma.

Methods  This was a retrospective medical record review of 421 eyes of 304 patients who underwent cataract surgery with the IOLm and ultrasound biometry from January 3, 2002, to December 2, 2005. The mean difference between the prediction with each technology and the final spherical equivalent was compared. Circumstances in which both technologies failed to make accurate predictions were investigated.

Results  The mean (SD) of the difference between predicted refraction and final spherical equivalent was –0.43 (0.84) diopters (D) for the IOLm and –0.60 (0.87) D for ultrasound biometry, indicating that on average the IOLm was a closer predictor than ultrasound biometry of the final spherical equivalent (P < .001). The IOLm had a 5% higher likelihood of predicting a spherical equivalent within 0.25 D than ultrasound biometry (P = .06), an 8% higher likelihood of predicting a spherical equivalent within 0.50 D (P < .001), and an 8% higher likelihood of predicting a spherical equivalent within 1.00 D (P < .001).

Conclusions  To our knowledge, this is the most eyes examined for cataract surgery in a prospective fashion with both the IOLm and ultrasound biometry. The IOLm is a better predictor of postoperative refraction than ultrasound biometry, particularly within close ranges.

Methods  Twenty-one subjects with DM and 21 healthy age-matched control volunteers were subjected to retinal imaging using 1-ms flashes of 467-nm light. Flavoprotein autofluorescence for each flash at 535 nm was recorded using an electron-multiplying charged-coupled device camera with a 512x512-pixel chip. The average intensity and the average curve width of retinal flavoprotein autofluorescence were determined by analyzing histograms of pixel intensities plotted for each eye.

Results  When stratified by age, the mean average intensity and average curve width levels in subjects with DM were significantly greater than those in controls across all 3 consecutive decades of life studied (P ≤ .004 and P ≤ .006, respectively). An overall comparison of the mean average intensity and average curve width levels in all subjects with DM vs all controls, with adjustment for age, was consistent with the results found in each age category (P =.001 and P < .001, respectively). Subjects having DM with retinopathy in at least 1 eye had significantly greater average intensity and average curve width than subjects having DM without retinopathy in either eye (P =.002 and P =.005, respectively).

Conclusions  Flavoprotein autofluorescence measurements may be clinically useful to rapidly and noninvasively identify diabetic metabolic tissue stress and disease severity. Development of flavoprotein autofluorescence technology is likely to result in a tool that will improve DM screening and disease management.

Methods  We performed a retrospective analysis of eyes that received intravitreous bevacizumab, 1.25 mg, for subfoveal non-AMD CNV at a referral-based retinal practice. Repeated treatment with intravitreous bevacizumab occurred if there were signs of persistent or recurrent exudation. The main outcome measure was visual acuity (VA).

Results  The study included 39 eyes of 36 patients with subfoveal CNV secondary to multifocal choroiditis (n = 12), angioid streaks (n = 11), myopic degeneration (n = 10), idiopathic disease (n = 4), or other disease (n = 2). The median baseline VA was 20/60 (logMAR, 0.48). The mean follow-up was 58.8 weeks, and the mean number of injections per eye was 3.4. After 3-month follow-up, the median VA was 20/30 (logMAR, 0.18) (P = .004 vs baseline). At last follow-up, the median VA was 20/40 (logMAR, 0.30). This remained an improvement compared with baseline (P < .02) but was worse than 3-month follow-up (P < .03). There was no correlation between underlying diagnosis and VA change during follow-up.

Conclusion  Subfoveal CNV secondary to non-AMD causes treated with intravitreous bevacizumab responded favorably and similarly, despite varying underlying etiologies.

Methods  In drug-treated and control groups, CNVMs were induced by laser trauma. Immediately after undergoing the laser procedure, animals received intravitreal injections of pegaptanib sodium, 8 or 17 µg; triamcinolone acetonide, 200 µg; or a vehicle solution. After 21 days, fluorescein angiography was performed. The CNVM mean diameters and radial thicknesses were measured histologically.

Results  Mean CNVM diameters were 10% to 13% smaller in pegaptanib-treated eyes and 43% smaller in triamcinolone-treated eyes compared with laser-only control eyes. Late-stage fluorescein angiography leakage scores, on a scale of 0 to 3, suggested a statistical difference between triamcinolone- (0.6) and pegaptanib_{8 µg}-treated (1.5) groups compared with the laser-only control group (2.0). The CNVM mean thicknesses were greater in the pegaptanib_{8 µg}- (79 µm) and pegaptanib_{17 µg}-treated (71 µm) groups and significantly smaller in the triamcinolone-treated group (26 µm) compared with the laser-only control group (67 µm).

Conclusion  In this animal model of choroidal neovascularization, intravitreal pegaptanib exhibited marginal or no effect on CNVM development; whereas intravitreal triamcinolone evoked robust inhibition of CNVMs.

Clinical Relevance  Pegaptanib treatment may be insufficient to prevent CNVM formation.

Methods  The antiangiogenic effects of bevacizumab were evaluated in a coculture of a Y-79 human retinoblastoma cell line and a human umbilical vein endothelial cell line by means of a cell proliferation assay kit and a VEGF enzyme-linked immunosorbent assay. The Y-79 xenotransplanted nude mice were treated with bevacizumab intraperitoneally twice weekly for 4 weeks, during which each tumor was measured once a week. The mice were then euthanized, and the weight of each tumor and its microvessel density were determined via CD34 immunohistochemical staining.

Results  The mean (standard error of the mean) increased human umbilical vein endothelial cell proliferation, when cocultured with Y-79 (156% [1%]), was suppressed 58% (5%) by the blockage of VEGF induced by bevacizumab. By causing a 2-fold reduction in microvessel density in the Y-79 xenograft model, bevacizumab induced a 75% reduction in the growth of the retinoblastomas without producing significant systemic toxicity.

Conclusions and Clinical Relevance  Treatment with bevacizumab suppressed the angiogenesis and growth of retinoblastoma in vitro and in vivo. Bevacizumab is likely to be of benefit in the treatment of retinoblastoma.

Methods  Medical records of 18 773 adults in the Personalized Medicine Research Project were searched to extract all IOP measurements for subjects who had been prescribed a topical β-blocker. Five single-nucleotide polymorphisms in the β₁-, β₂-, and β₃-adrenergic receptor genes and 6 polymorphisms in the CYP2D6 gene were genotyped.

Results  A total of 58.1% of the subjects were female; the mean age was 63.8 years. Topical β-blockers were prescribed for 343 eyes of 215 subjects. An IOP reduction of 20% or more in 1 or both eyes was observed in 61.0% of subjects. Men were significantly more likely than women to have an IOP decrease of 20% or more (69.3% vs 54.9%, respectively; ² = 4.48; P = .04). After adjusting for sex, family history of glaucoma, and use of systemic β-blockers, subjects with the CC genotype at coding single-nucleotide polymorphism rs1042714 in the ADRB2 gene were significantly more likely to experience an IOP decrease of 20% or more (odds ratio, 2.00; 95% confidence interval, 1.00-4.02).

Conclusion  We found that a coding single-nucleotide polymorphism in ADRB2 is associated with an increased likelihood of a clinically meaningful IOP response to topical β-blockers.

Clinical Relevance  Because topical β-blockers are the least expensive class of agents used to lower IOP, genotype-based drug prescribing could save health care dollars.

Methods  Interviews with a random sample of self-reported Hispanic individuals (n = 349), and a convenience sample of Hispanic individuals with diabetes (n = 204). Four groups were constructed: without diabetes, with and without a family history of diabetes, newly diagnosed with diabetes, and diagnosed with diabetes more than 1 year before the study.

Results  Less than 10% of participants preferred reading in English; 50% reported having providers who do not speak Spanish as a barrier to care. Knowledge of eye disease as a consequence of diabetes was reported by 18% of nondiabetic participants with no family history, 29% of nondiabetic participants with a family history, 36% of newly diagnosed diabetic patients, and 52% of participants diagnosed with diabetes more than 1 year before the study. Only 16%, 28%, 13%, and 34%, respectively, knew that strict control could prevent eye problems, and 33%, 51%, 31%, and 48%, respectively, knew that dilated eye examinations were important. A total of 30% of diabetic participants had had an eye examination in the previous year.

Conclusions  Knowledge of the ocular complications of diabetes is low. The frequency of eye examinations among Hispanic individuals with diabetes is less than the national average for Hispanic individuals. Culturally appropriate health education and innovations to reduce barriers to eye care are needed.

Methods  From 1986 through 1996, annual cross-sectional multistage area probability surveys of the US civilian noninstitutionalized population living at addressed dwellings were conducted by the National Center for Health Statistics. We performed mortality linkage through 2002 with the National Death Index of 137 479 adults 18 years and older. The relationships between reported visual impairment and suicide were examined using structural equation modeling.

Results  The mean duration of follow-up was 11.0 years, and 200 suicide deaths were identified. After controlling for survey design, age, sex, race, marital status, number of nonocular health conditions, and self-rated health, the direct effect of visual impairment on death from suicide was elevated but not significant (hazard ratio, 1.50; 95% confidence interval, 0.90-2.49). The approximate indirect effect of visual impairment on death from suicide via poorer self-rated health (1.05; 1.02-1.08) or number of nonocular health conditions (1.12; 1.01-1.24) was significant. The total effect of visual impairment on death from suicide was elevated but not significant (1.64; 0.99-2.72).

Conclusions  Visual impairment may be associated with an increased risk of suicide through its effect on poor health. This suggests that improved treatment of visual impairment and factors causing poor health may potentially reduce suicide risk.

Methods  We performed a population-based survey of inhabitants 40 years or older in Myanmar; of 2076 participants, data from 1909 nonglaucomatous subjects who underwent ultrasound pachymetry and Goldmann applanation tonometry were analyzed. Linear mixed effects models adjusting for nonindependence of right and left eye data were constructed.

Results  Mean (SD) CCT was 521.9 (33.3) µm, and the mean (SD) IOP was 14.5 (3.4) mm Hg. Intraocular pressure and spherical equivalent were significant predictors of CCT (P < .001 and P = .01, respectively). Age, sex, body mass index, and corneal curvature were not significant predictors. Central corneal thickness was the only significant predictor of IOP (ie, an increase of 100 µm in CCT predicted an increase of 1.3 mm Hg in IOP). The Spearman correlation between CCT and IOP for the right and left eyes was highly significant (P < .001), but the Spearman rank correlation values (R² = 0.016 and R² = 0.017, respectively) were weak.

Conclusions  The CCT in this Burmese population was significantly associated with IOP and spherical equivalent. The weak association between CCT and IOP is consistent with that of other population-based studies. Other corneal factors are likely to influence Goldmann applanation tonometry.

Methods  A convenience sample of 12 general ophthalmologists and 10 retina specialists applied prespecified algorithms based on ICD-9-CM diagnosis codes to the billing claims of their practices and selected the associated medical records. Four ophthalmologists abstracted data from the medical records, which were then compared with the coded diagnoses. Main outcome measures were sensitivity, specificity, and the statistic for the DME algorithm (a combination of codes 250.xx and 362.53), treating medical record documentation of DME as the standard criterion.

Results  The DME algorithm had a sensitivity of 0.88 and a specificity of 0.96 for identifying DME. Excellent agreement was noted between the algorithm and the medical records ( = 0.84). The algorithm performed less well in identifying patients with a diagnosis of clinically significant DME (sensitivity, 0.86; specificity, 0.84;  = 0.64).

Conclusions  The results of this pilot study suggest that patients with DME can be identified accurately in claims data using ICD-9-CM diagnosis codes. Application of this algorithm could improve investigations of disease prevalence and disease burden and provide an efficient means of assessing care and interventions.

Methods  A high-speed anterior segment optical coherence tomography prototype was developed using a 1310-nm-wavelength swept light source. Six healthy subjects and 6 patients with glaucoma were imaged in an observational cross-sectional study.

Results  Schlemm’s canal and the trabecular meshwork were visualized in all of the patients. Fifteen-millimeter scans enabled entire anterior segment visualization providing configuration details of the iris with respect to the angle. Four-millimeter scans permitted detailed views of the angle configuration and its structures. Volumetric imaging was possible and Schlemm’s canal was visualized along part of its circumference.

Conclusion  Anterior segment Fourier-domain optical coherence tomography permits detailed noncontact imaging of the angle and its structures, providing a tool to improve our understanding of the pathogenesis of narrow-angle glaucoma.

Methods  Prospective analysis of 26 eyes from 15 patients who underwent placement of the Artisan lens for the correction of high and extreme myopia. The mean (SD) preoperative spherical equivalent was – 12.30 (2.69) diopters (D) (range, – 17.25 to – 8.25 D).

Results  At 5 years, the mean (SD) manifest refraction was – 0.37 (0.69) D, with 95% of eyes within 1 D of attempted correction and 74% of eyes within 0.5 D of the attempted correction. Ninety-five percent of eyes achieved an uncorrected visual acuity of 20/40 or better and 74% achieved an uncorrected visual acuity of 20/20 or better. No eyes experienced a loss of 1 or more lines of best-corrected visual acuity. Sixteen percent of eyes gained 2 or more lines of best-corrected visual acuity. From preoperative measurements, the mean endothelial cell density decreased by 14.05% at 5 years postoperatively.

Conclusions  Placement of the Artisan lens is predictable, stable, and effective at reducing high and extreme myopia 5 years after implantation. The rate of endothelial cell loss was significantly higher than has been reported in previous studies.

Methods  Retrospective review of interventional series of 38 patients who underwent choroidal neaovascular membrane (CNVM) extraction. Twenty-four patients received intravitreal bevacizumab 1 to 154 days preoperatively (bevacizumab CNV group). Fourteen patients received no preoperative therapy (control CNV group). The CNVM were stained for cytokeratin 18, CD68, CD45, intercellular adhesion molecule (ICAM)–1, E-selectin, Ki-67, Thy-1, and endostatin.

Results  No significant difference was detected in ICAM-1 and E-selectin expression between groups. The density of leukocytes in the bevacizumab CNV group (median, 271.61 cells/mm²) was higher than in the control CNV group (median, 116.87 cells/mm²; P = .07), but without significance. Density of macrophages (median, 4661.95 cells/mm²), proliferative activity (median, 160.19 cells/mm²), and percentage of Thy-1–expressing vessels (median, 100%) were significantly higher in the bevacizumab CNV group than in the control CNV group (median, 882.66 cells/mm², P < .001; median, 34.34 cells/mm², P < .001; and median, 80%, P < .001, respectively). Endostatin immunoreactivity was considerably stronger in the retina pigment epithelium (RPE)–Bruch membrane complex (median, 3; range, 2-3; P < .001), and stroma (median, 3; range, 1-3; P < .001) of the bevacizumab CNV group than control CNV group (median, 1.5; range, 0-3 and median, 1; range, 0-3, respectively).

Conclusions  Unexpectedly, CNVM from patients treated by bevacizumab are characterized by significantly high inflammatory and proliferative activity and enhanced endostatin expression. These characteristics need to be considered when protocols for combination therapies are established.

Methods  Longitudinal medical record review of all patients treated with rosiglitazone receiving both medical and ophthalmic care at the Joslin Diabetes Center from May 1, 2002, to May 31, 2003 (N = 124), and matched control patients not taking a glitazone drug (N = 158). The mean duration of follow-up was 2.8 years (range, 0.3-9.0 years).

Results  Baseline characteristics and final hemoglobin A_1c values (7.6% and 7.8%, respectively) were similar in the rosiglitazone and control groups (P = .10). In eyes with severe nonproliferative diabetic retinopathy at baseline (rosiglitazone group, 14 eyes; control group, 24 eyes), progression to PDR over 3 years occurred in 19.2% in the rosiglitazone group and 47.4% in the control group, representing a 59% relative risk reduction (Wilcoxon, P = .045; log-rank, P = .059). Fewer eyes in the rosiglitazone group experienced 3 or more lines of visual acuity loss (P = .03). The incidence of diabetic macular edema was similar in both groups.

Conclusions  Rosiglitazone may delay the onset of PDR, possibly because of its antiangiogenic activity. Future clinical investigations should consider analysis of this potential benefit along with ongoing evaluation of potential cardiac risk in studies where the risk-benefit profiles are deemed appropriate.

Methods  Case series of 10 children younger than 3 years who were fatally injured in motor vehicle crashes between January 1, 1994, and December 31, 2002. All children underwent autopsy that included eye examination. All available medical and autopsy records, pathology slides and photographs, and police and traffic department reports were reviewed for each case.

Results  Eight patients had retinal hemorrhages, which extended into the periphery in 13 eyes and were bilateral in 7 patients. Three patients had elevated circular retinal folds. Six patients had hemorrhages below the internal limiting membrane, but no patients had deeper splitting of the retina. Nine patients had optic nerve sheath hemorrhages.

Conclusion  The association of extensive, sometimes severe, ocular hemorrhages with fatal accidental trauma, compared with previous reports of accidental trauma with no or few hemorrhages, indicates the severity of injury required to cause hemorrhages of this magnitude.

Methods  Patients diagnosed as having XLRS underwent assessment. Visual function testing included visual acuity, color vision, and full-field electroretinography. We used a high-resolution Fourier-domain optical coherence tomography (FD-OCT) system (4.5-µm axial resolution; 9 frames/s; 1000 A-scans per frame) combined with a handheld scanner. Macular image evaluation included schisis localization and retinal layer integrity.

Results  Six patients with XLRS and identified mutations in the XLRS1 gene underwent testing. Visual acuity ranged from 0.2 to 1.6 logMAR (logarithm of the minimum angle of resolution). Results of FD-OCT revealed foveal schisis extending from the outer to the inner plexiform layer in 4 of 6 patients. Bullous foveal schisis was associated with younger age. All patients showed extrafoveal schisis within the outer and inner nuclear and ganglion cell layer, alone or in combination. Photoreceptor outer and inner segment layers were disrupted and irregular in all patients.

Conclusions  Retinal dystrophy in XLRS is reflected by morphological changes within the inner and outer retinal layers. Disturbed foveal photoreceptor integrity was identified in all patients. Retinal layer abnormalities correlated with age but did not appear to correlate with visual acuity or genotypic variation.

Methods  Optical coherence tomographic studies obtained during a 3-year period (October 1, 2003, to December 30, 2006) from 76 patients who developed ischemic optic neuropathy from 2 institutions were evaluated. The presence or absence, and the distribution, of subretinal fluid was determined.

Results  Seventy-six patients underwent macular optical coherence tomography within 4 weeks of developing sudden loss of vision in one eye, decreased visual acuity, a visual field defect, a relative afferent pupillary defect, and optic disc swelling with peripapillary hemorrhages. Eight patients had apparent subretinal fluid extending into the subfoveal space. Visual acuity improved in 5 of the 8 patients as the subfoveal fluid resolved.

Conclusions  Subretinal fluid develops in some patients with nonarteritic anterior ischemic optic neuropathy and may contribute to some of the visual loss associated with this condition. Furthermore, resolution of the subretinal fluid could account for some of the visual improvement that can follow anterior ischemic optic neuropathy.

Methods  A phacoemulsification probe was introduced into the anterior chamber of rabbits' eyes through a limbal incision, and ultrasound oscillation was performed without emulsifying the lens. Rabbits were assigned to 4 treatment groups: (1) no treatment (controls); (2) only irrigation with a salt solution; (3) ultrasound only; and (4) ultrasound oscillations with a salt solution of 0.001M ascorbic acid. The corneas were immunohistochemically examined for oxidative stress using 8-hydroxy-2-deoxyguanosine (8-OHdG), apoptosis by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) staining, and ultrastructural changes by electron microscopy. The lipid peroxide levels in the aqueous humor were also measured.

Results  In the ultrasound-only group, 8-OHdG–positive cells and TUNEL-positive cells were detected at 24 hours; necrotic cells were detected at 12 to 24 hours. Also, lipid peroxide levels were significantly increased at later times in the ultrasound group. Such changes were not observed in other groups.

Conclusion  Free radicals induced by ultrasound oscillation can cause corneal endothelial damages.

Clinical Relevance  Clinicians should be aware that free radicals associated with ultrasound oscillation can injure the corneal endothelial cells.

Methods  Twenty corneoscleral buttons underwent femtosecond laser top hat configuration dissections. Group A had complete dissections; group B, 100-µm gaps in the anterior side cut; group C, 50-µm gaps in the anterior side cut; group D, 100-µm gaps in the lamellar cut; and group E, 50-µm gaps in the lamellar cut. The pressure required to rupture each cornea was measured.

Results  The mean (SD) pressure required to rupture the corneas was 111 (74) mm Hg for group A, 1565 (509) mm Hg for group B, 747 (209) mm Hg for group C, 550 (303) mm Hg for group D, and 392 (166) mm Hg for group E (P = .03 for all compared with group A).

Conclusions  Incomplete femtosecond laser top hat dissections are highly resistant to rupture by direct pressurization. Gaps in the anterior side cuts are stronger than comparably sized gaps in the lamellar cuts.

Clinical Relevance  Undertaking femtosecond laser keratoplasty in a 2-site setting should, theoretically, have a high level of safety. Burst pressures are high enough to resist an inadvertent sudden increase in intraocular pressure providing that incomplete recipient laser dissections are undertaken.

Methods  Seven databases were systematically searched with no limits on publication year or language using standardized criteria. Randomized controlled trials and prospective cohort, case-control, and cross-sectional studies were included. Of 2754 abstracts identified, 3 prospective cohort, 3 case-control, and 3 cross-sectional studies met the criteria. Measures of associations were pooled quantitatively using meta-analytic methods.

Results  Nine studies provided data on a total sample of 88 974 people, including 3203 AMD cases. A high dietary intake of -3 fatty acids was associated with a 38% reduction in the risk of late AMD (pooled odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.82). Fish intake at least twice a week was associated with a reduced risk of both early AMD (pooled OR, 0.76; 95% CI, 0.64-0.90) and late AMD (pooled OR, 0.67; 95% CI, 0.53-0.85).

Conclusions  Although this meta-analysis suggests that consumption of fish and foods rich in -3 fatty acids may be associated with a lower risk of AMD, there is insufficient evidence from the current literature, with few prospective studies and no randomized clinical trials, to support their routine consumption for AMD prevention.

Methods  Alcohol consumption and risk of early or late incident AMD (iAMD) were examined among all participants in the prospective population-based Rotterdam Study, with complete data on alcohol consumption among 4229 subjects at risk of AMD. Aging macula disorder was graded according to the International Classification and Grading System for AMD by 2 trained professionals who were masked for all other determinants. We used Cox proportional hazards regression models to estimate hazard ratios and corresponding 95% confidence intervals.

Results  During a mean follow-up period of 8.0 years, 600 cases of iAMD were identified, of which 519 were early iAMD and 81 were late iAMD. After correction for age, sex, smoking, complement factor H genotype status, and other potential confounders, we did not find an association between overall or specific alcohol consumption and development of early iAMD or dry or wet late iAMD.

Conclusion  Our findings suggest that overall or specific alcohol consumption is not a risk factor for AMD.

Design  Population-based cohort study of persons aged 43 to 86 years at baseline (N = 4926), of whom 3779 participated in 1 or more follow-up examinations.

Methods  Stereoscopic photographs of the macula were graded to determine the presence of AMD. Existence of emphysema, asthma, and respiratory symptoms was determined from subjects' medical history questionnaires; the peak expiratory flow rate was measured using a Mini-Wright Peak Flow Meter (Clement Clarke International, Harlow, England). Discrete logistic hazard and logistic regression models were used.

Main Outcome Measures  Incidence and progression of AMD.

Results  While controlling for age, sex, and other factors, a history of emphysema at baseline was found to be associated with the 15-year cumulative incidence of increased retinal pigment (odds ratio, 2.08; 95% confidence interval, 1.06-4.06), retinal pigment epithelium depigmentation (2.40; 1.23-4.67), and exudative AMD (3.65; 1.24-10.73). Mild pulmonary symptoms were associated with the 5-year incidence of exudative AMD (odds ratio, 3.83; 95% confidence interval, 1.39-10.58), and the fourth (ie, highest) quartile of pulmonary expiratory flow rate showed a protective effect for progression of AMD among women (0.36; 0.15-0.86).

Conclusion  Independent of smoking, a history of emphysema and respiratory symptoms and function are modestly but inconsistently associated with the incidence and progression of AMD.

Methods  A retrospective cohort analysis was conducted using Medicare claims. Patients were stratified into 4 categories: no vision loss, moderate vision loss, severe vision loss, and blindness. Outcomes of interest were mean annual medical costs by category, component costs, and frequency of depression, falls and/or accidents, injury, femur fracture, and nursing home placement.

Results  Multivariate regression analysis showed that patients with any degree of vision loss had 46.7% higher total costs compared with patients without vision loss. Mean total and component costs increased with onset and severity ($8157 for no vision loss to $18 670 for blindness). Patients with vision loss were significantly more likely to be placed in a nursing home (odds ratio = 2.18; 95% confidence interval, 2.06-2.31), develop depression (odds ratio = 1.63; 95% confidence interval, 1.54-1.73), fracture a femur (odds ratio = 1.67; 95% confidence interval, 1.53-2.83), or experience a fall or accident (odds ratio = 1.59; 95% confidence interval, 1.50-1.68) vs patients without vision loss.

Conclusions  Vision loss in glaucoma is costly, and costs increase with severity. There is significantly increased risk of nursing home admission, depression, falls and/or accidents, injury, or femur fracture with vision loss compared with no vision loss.