Sunday, May 6, 8:30 AM - 10:15 AM Hall B/C

Transcription

Sunday, May 6, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 162-177 / B433-B448
108. Epidemiology and Risk Factors for Diabetic Retinopathy Organizing Section: CL Contributing Section: VI
162 - B433
The Effect of Gender, Diabetic Retinopathy, Hypertension and Glycemic
Regulation on Survival Among Type 1 Diabetic Patients From Fyn County,
Denmark
163 - B434
Macular and Foveal Thickness as Measured by OCT in Diabetic and NonDiabetic Latinos: The Los Angeles Latino Eye Study (LALES)
S.Fraser-Bell, M.Torres, L.Bree, S.P. Azen, R.Varma, Los Angeles Latino Eye Study Group.
Ophthalmology, Doheny Eye Institute, Los Angeles, CA.
J.Grauslund1A, A.Green1B, A.Sjolie1A. ADepartment of Ophthalmology, BDepartment
of Applied Research and Health Technology Assessment, 1Odense University
Hospital, Odense, Denmark.
Purpose: It is known that type 1 diabetic patients live shorter than non-diabetic
patients. The aim of this study was to examine the survival of a previously defined
population based cohort of type 1 diabetic patients and to investigate the influence
of baseline parameters on survival 25 years later.
Methods: All insulin-treated diabetic patients from the Danish County of Fyn with an
onset before the age of 30 as of July 1st 1973 (n=728) have previously been identified.
In 1981-1982 91.9% (577 of 628) of those still alive and living in Denmark participated
in a clinical follow-up investigation focusing mainly on diabetic eye complications.
In November 2006 we examined survival status by means of the Danish Central
Office of Civil Registration.
Results: Of the original cohort initially consisting of 414 men and 314 women, 320 were
still alive (44.0%). 379 had died (52.1%) and the remainder 29 (4.0%) had either emigrated
or were unaccounted for. At baseline in 1973 there was no significant difference (p=0.79)
between mean age of men (31.6 years) and women (32.5 years). In 2006 225 (54.4%) men had
died compared to 154 (49.0%) women. Extended mean survival time was 61.8 and 66.4 years
for men and women respectively indicating a longer survival among women (p=0.02).
A Cox regression model based on the results of the follow-up investigation in 1981-1982
and adjusted for age and gender, showed a significantly increased hazard ratio (HR)
of death for patients with proliferative retinopathy (HR 2.48, p<0.001) and diabetic
maculopathy (HR 1.59, p=0.001) compared to those without. Hazard ratio was not
significantly elevated for patients with higher diastolic (CI 0.88-1.63) or systolic blood
pressure (CI 0.88-1.67), nor did it depend on the quartile of HbA1c (CI 0.94-1.20) as
measured once.
Conclusions: Life expectancy of type 1 diabetic patients is shorter among men
compared with women. Development of proliferative diabetic retinopathy or
maculopathy leads to an increased hazard ratio for death. Blood pressure and glycemic
regulation 25 years ago did not affect hazard ratio for survival.
CR: J. Grauslund, None; A. Green, None; A. Sjolie, None.
Support: None
164 - B435
The Impact of Diabetic Retinopathy on Vision-Related Quality of Life
Purpose:We hypothesized that diabetic persons may have increased macular thickness
compared to nondiabetics even in the absence of macular edema and that a different
normative database may be required for diabetics. The purpose of this study was
to determine whether this is the case in a subset of Latinos who underwent optical
coherence tomography (OCT) as part of the Los Angeles Latino Eye Study (LALES).
Methods:The LALES is a population-based prevalence study of eye disease among
Latinos aged 40 years and older. Participants underwent a standardized interview
and detailed eye examination including dilated stereophotography and OCT
measurements. Presence of diabetes was defined by self-reported history of diabetes,
and/or Hemoglobin A1c greater than 7.0% and/or random glucose greater than
200mg%. The diagnosis of macular oedema was made from photographic grading by
masked trained graders. Fast macular thickness scans were taken using the STRATUS
OCT™ Carl Zeiss Meditec. T-tests were performed to compare the difference in macular
thickness between diabetics and nondiabetics and the GLM procedure to examine
the mean difference after adjusting for age and gender. The average values of both
eyes were used in the analyses.
Results:Gradable optical coherence scans were available in 842 nondiabetics and in 188
diabetics. The mean age of the participants was 53 years (SD + 9.8) and 59% were female.
Diabetics were older than nondiabetics (diabetics: 57 + 10.4 years; nondiabetics: 52 + 9.4
years, P=<0.0001). There was no difference in the proportion of males and females in
both groups. The mean foveal retinal thickness was 187.5µm in diabetics and 181.0µm
in nondiabetics (P=0.02). The mean macular thickness was 210.2µm in diabetics and
204.8µm in nondiabetics (P=0.02). There was no difference in mean macular volume
between the 2 groups, but the mean central foveal volume was 0.17cubic microns vs.
0.16 in diabetics vs. nondiabetics (P=0.02). After age-sex adjustment, the differences
remained significant, all P<0.02). Macular oedema was present in 18 participants,
including 15 diabetics and 3 nondiabetics. When the data were re-analyzed after
exclusion of these participants with macula edema, no statistically significant
differences in any macular thickness measurements remained.
Conclusions:There was no difference in mean macular thickness and foveal thickness
in diabetics compared to nondiabetics without macular edema.This study supports
that a separate normative database for diabetics is not required.
CR: S. Fraser-Bell, None; M. Torres, None; L. Bree, None; S.P. Azen, None; R. Varma,
None.
Support: U10 EY-11753 and EY-03040
165 - B436
Screening for Diabetic Retinopathy in a Rural Population With an Itinerant
Non-Mydriatic Camera
V.I. Johnson, S.M. Hariprasad, M.A. Grassi, J.Green, R.D. Jager, W.F. Mieler.
Ophthalmology, University of Chicago, Chicago, IL.
Purpose: To test the hypothesis that the National Eye Institute’s Visual Function
Questionnaire-25 (NEI-VFQ-25) survey is a better instrument for assessing visionrelated quality of life (VR-QOL) than visual acuity in patients with diabetic retinopathy.
With the better instrument, differences in VR-QOL between patients with nonproliferative diabetic retinopathy (NPDR) versus proliferative diabetic retinopathy
(PDR) will be assessed.
Methods: A retrospective review of 109 patients examined at the University of Chicago
Department of Ophthalmology Vitreoretinal Service was conducted (NPDR= 51 /
PDR= 58). The 2 questionnaires directed to measure VRQOL [VFQ-25 and Vision
Preference Value Scale (VPVS)] _were administered by telephone. Information that
may act as co-variants to VRQOL was collected from patients and medical records. To
determine if VFQ-25 was a better measure than visual acuity, Spearman correlation
coefficients were calculated by comparing the subject’s VFQ-25 score and visual acuity
to the VPVS. To determine why VFQ-25 was the better measure, partial correlation
coefficients while controlling for other ocular co-morbidities were analyzed to
determine which of 12 VFQ subscales correlated strongest with VPVS scores. Finally,
comparisons were made in VFQ scores to assess differences in VRQOL between
patients with NPDR and PDR.
Results: The absolute Spearman correlation coefficient between VPVS and VFQ-25
scores was 0.44 (p<0.01) and between VPVS and visual acuity scores was 0.35 (p<0.01).
The 5 out of 12 VFQ-25 subscales with the strongest partial correlation coefficient
to Utility scores were Role Differences, Near Activities, Distance Activities, Mental
Function and Peripheral Vision (p<0.05). There was a significant decrease in the mean
scores of total VFQ, Role Differences, Near Activities, Distance Activities, Mental
Function and Peripheral Vision subscales in patients with PDR versus NPDR.
Conclusions: These data indicate that the VFQ-25 is a more accurate measure of
VRQOL than visual acuity for patients with diabetic retinopathy. VFQ’s superiority
lies in its ability to better incorporate mental and emotional aspects of diabetic
retinopathy as well as visual function. Finally, there is a significant decrease in
VR-QOL in subjects with PDR versus NPDR, particularly in the domains of mental,
emotional and visual function.
CR: V.I. Johnson, None; S.M. Hariprasad, None; M.A. Grassi, None; J. Green,
None; R.D. Jager, None; W.F. Mieler, None.
Support: University of Chicago Summer Research Program
J.Beynat1A, S.Arnavielle1A, M.Soulie-Strougar1A, A.Charles1A, K.Astruc1B, P.Metral1C,
A.M. Bron1A, C.Creuzot-Garcher1A. ADepartment of Ophthalmology, BDepartment of
Medical Information, CDepartment of Medical Computering Science, 1University
Hospital, Dijon, France.
Introduction:The aim of this study was to evaluate the yield of diabetic retinopathy
(DR) screening in a rural population with an itinerant non-mydriatic camera.
Patients and methods:1974 diabetics were screened between 2005 and 2006: 676
the first year and 1298 the second. The 72 lowest medicalised areas of Burgundy
were visited. An orthoptist performed fundus photographies with a Topcon’s TRCNW200 non-mydriatic camera (4 fields: posterior pole, nasal, temporal and upper).
The photographies analysis was performed in the department of Ophthalmology,
according to the International Clinical Diabetic Disease Severity Scale. The private
ophthalmologists agreed to receive the positive or doubtful patients within one
month.
Results:On the 1974 screened patients, 103 presented a DR (5.2%), including 70 mild
non-proliferative DR (68%), 21 moderate non-proliferative DR (20.4 %), and 12 severe
non-proliferative DR (11.6%). The rate of non interpretable photographies was 27.6%.
The average age of the patients with a DR was 67.5 (27 to 94). The average onset
of the diabetes was 16.5 years. Insulinic treatment was founded in 48 patients
(46.6%) and 35 were aware of there HbA(1c) (34%) with an average of 7.8%.
Lastly, 19 have had an ophthalmologic visit within one year before screening
(18.4%), 38 between 1 and 2 years (36.9%), 28 more than 2 years (27.2%) and
10 more than 5 years (9.7%); 7 had never seen an ophthalmologist (6.8%).
Discussion:The average cost due to the organization of the screening
was 142 euros per patient. The proportion of positive screening was 5.2%.
More half of the patients presenting a RD did not have the recommended annual
eye visit. The majority of the detected RD were non-proliferative forms, which may
benefit from a preventive treatment or a monitoring.
Conclusion:This screening improves the quality of the ocular follow-up of the diabetics
in rural area. The increase of the number of patients per meeting as well as a better
recruitment would improve the medical and economic performances of the future
campaigns.
CR: J. Beynat, None; S. Arnavielle, None; M. Soulie-Strougar, None; A. Charles,
None; K. Astruc, None; P. Metral, None; A.M. Bron, None; C. Creuzot-Garcher,
None.
Support: None
Copyright 2007 by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved.
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
162-165
166 - B437
Cerebrovascular Disease in Patients Undergoing Diabetic Vitrectomy
167 - B438
Indicators of Success on a Diabetic Eye Disease Health Campaign Targeted to
the Latino Population
A.El-Sanhouri1, J.Law1, J.Gasperini1, A.G. Sharma1, D.Eliott2. 1Department of
Ophthalmology, Wayne State University, Kresge Eye Institute, Detroit, MI;
2
University of Southern California, Doheny Eye Institute, Los Angeles, CA.
Purpose: To determine the presence of cerebrovascular disease in patients undergoing
diabetic vitrectomy.
Methods: Hospital records of 350 patients that underwent diabetic vitrectomy by one
vitreoretinal surgeon (DE) were reviewed for evidence of cerebrovascular disease using
the computer database of the Detroit Medical Center (affiliated hospital system of the
Kresge Eye Institute). Cerebrovascular disease in the form of a stroke was documented
based on neuroimaging and medical records of visits to the Detroit Medical Center.
The time interval between the strokes and the diabetic vitrectomies were studied.
Results: During hospital visits to the Detroit Medical Center for medical reasons
unrelated to their ocular disease, 79 patients underwent neuroimaging for reasons
such as syncope, loss of consciousness, trauma, stroke, or transient ischemic attack.
Of these, 47 patients had evidence of stroke on neuroimaging. In addition, 12 patients
had a well documented history of stoke on medical records (history and physicals,
discharge summaries, and emergency room reports). A total of 59/350 (17%) patients
who underwent diabetic vitrectomy had evidence of stroke. During these hospital
visits, most patients had evidence of chronic strokes, however, fifteen patients (15/59;
25%) had an acute stroke. Of patients with acute strokes, 2 patients had it greater
than one year prior to vitrectomy, 2 patients had it within 1 year of vitrectomy, 5
patients had it within 2 years after vitrectomy, and 6 patients had it greater than 2
years after vitrectomy.
Conclusions: Patients requiring vitrectomy for complications of their proliferative
diabetic retinopathy have severe systemic manifestations of diabetes including stroke.
The limitation of this study is that medical records were reviewed at one hospital
center. It is possible that some patients who underwent diabetic vitrectomy may have
presented with cerebrovascular disease at outside community hospitals. Therefore,
this study underestimates the prevalence of cerebrovascular disease in patients who
underwent diabetic vitrectomy. However, a significant number of patients undergoing
diabetic vitrectomy did have cerebrovascular disease leading to increased morbidity
and mortality in this subgroup of patients.
CR: A. El-Sanhouri, None; J. Law, None; J. Gasperini, None; A.G. Sharma, None; D.
Eliott, None.
Support: None
168 - B439
The Relationship Between Diabetic Patients’ Subjective Estimates of Daily
Capillary Blood Glucose and Objective Measures Including Hemoglobin A1C,
Insulin Use, Type of Diabetes and Presence of Diabetic Retinopathy
B.E. Munoz1, M.O’Leary1, M.Aguilar2A, E.Rosario3, I.Guardiola 3, C.Fickes3, P.Poppe2B,
S.K. West1. 1Ophthalmology, Johns Hopkins Wilmer Eye Inst, Baltimore, MD;
2
Center for Communication Programs, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD; BOphthalmology, 2Center for Communication Programs,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3The Hispanic
Apostolate, Baltimore, MD.
Purpose: The Hispanic population in the United States is the largest growing minority
community. One in five Latinos over the age of 40 has diabetes and almost half have
diabetic retinopathy. Appropriate care for diabetic eye disease is vital as it is the
leading cause of visual loss among working-age Latinos. Our aim is to examine
effect on knowledge and eye care seeking behavior among Latinos with diabetes
of a promotional health program. The goals of this program are:1) to increase the
knowledge of the ocular consequences of diabetes; 2) stress the importance of annual
ophthalmic exams; and 3) to reduce barriers to eye care
Methods: Two interviews, a year apart (summer 2005 and 2006), on knowledge of
diabetic eye disease and eye care seeking behavior, were obtained from a cohort of
Latinos with diabetes. During the interim year, the health communication campaign
was launched
Results: A total 183 Latinos with diabetes living in the Baltimore Metropolitan area
were identified. One hundred and forty six or 80% had both baseline and follow-up
interviews. There were improvements in the proportion of respondents reporting
access to routine care (56% vs. 69%, p=0.02), mentioning eye disease as a consequence
of uncontrolled diabetes (43% vs. 63%, p<0.01), knowing that timely treatment could
prevent vision deterioration (40% vs. 55%, p=0.003). There was an increase in the
proportion having a dilated eye exam within the previous 2 years (43% vs. 64%,
p<0.01).
Conclusions: The increase in both knowledge and access of eye care suggests that the
communication program is reaching the target population. However it is important
to identify ways to maintain the level of awareness, and reduced barriers provided
by the program to be able to have a long-term impact on the magnitude of visual
impairment due diabetic eye disease among Latinos.
CR: B.E. Munoz, None; M. O’Leary, None; M. Aguilar, None; E. Rosario, None; I.
Guardiola, None; C. Fickes, None; P. Poppe, None; S.K. West, None.
Support: EY015900
169 - B440
Serum Lipids and Hard Exudates in Diabetic Patients
D.J. Covert, R.Mancini, A.V. Mantravadi. Medical College of Wisconsin, Milwaukee,
WI.
Purpose: This investigation was undertaken to describe the relationship between
diabetic patients’ subjective estimates of daily capillary blood glucose (CBG) and
objective measures of diabetic control and severity including most recent hemoglobin
A1C (HgbA1C) and presence of diabetic retinopathy (DR).
Methods: This is an IRB approved observational study of patients with diabetes
mellitus at a regional Veterans Affairs Medical Center. Patients who routinely checked
their CBG at home were asked to estimate the average of recent measurements. Their
last HgbA1C, presence of diabetic retinopathy, insulin use, and type of diabetes
were noted.
Results: This analysis included 231 consecutive patients with diabetes--seven with
Type 1 and 224 with Type 2. The mean of patients’ estimates of CBG was 138 mg/dL
and the mean of the most recent HgbA1C was 7.71. Diabetic retinopathy was present
in 81 patients. Insulin therapy was present in 107 patients. A linear regression model
between CBG and HgbA1C was statistically significant (p<0.0001) with coefficient of
determination (r2) of 0.15. Using receiver-operator curve analysis, we determined a
threshold value of CBG (130 mg/dL) above which it was likely that the HgbA1C was
markedly elevated (>8.0), with 71% sensitivity and 61% specificity. Univariate analysis
of CBG to predict DR using logistic regression revealed an odds ratio of 1.016 per
one-unit increase in CBG (95% CI: 1.008-1.024). Multivariate analysis including CBG,
HgbA1C, insulin use, and type of diabetes to predict DR revealed only insulin use
as a statistically significant predictive factor with odds ratio 6.83 (95% CI: 3.42-13.6).
Mean CBG was greater among those using insulin (+22.2 mg/dL, 95% CI: 13.3-31.1),
Type 1 diabetics (+53.7 mg/dL, 95% CI: 27.5-79.9), and those with DR (+19.6 mg/dL,
95% CI: 10.2-29). Assuming a clinically established conversion of HgbA1C to average
blood glucose in the preceding 10-12 weeks, we found that 87% of patients (200)
underestimated their average glucose.
Conclusions: To the authors’ knowledge, this represents the first study to assess
the relationship between subjective patient-derived estimates of CBG and objective
measures of diabetes including HgbA1C. Patients’ estimates of CBG were positively
correlated with HgbA1C, were somewhat predictive of diabetic retinopathy in
univariate analysis, and were higher among those patients with Type 1 DM, those
using insulin, and those with diabetic retinopathy. The vast majority of patients
underestimated their average blood glucose.
CR: D.J. Covert, None; R. Mancini, None; A.V. Mantravadi, None.
Support: Unrestricted grant from Research to Prevent Blindness
R.Sreeraman1, G.Wu2, R.Chen 3, H.Uong4, B.Shanker5, J.Ha4, P.Nguyen6. 1Molecular and
Cellular Biology, University of California, Berkeley, Berkeley, CA; 2Ophthalmology,
Stanford University School of Medicine, Stanford, CA; 3Biomedical and General
Engineering, California Polytechnic State University, San Luis Obispo, CA;
4
Biology, Santa Clara University, Santa Clara, CA; 5Neuroscience, Pomona College,
Claremont, CA; 6Biology, San Jose State University, San Jose, CA.
While it is known that Diabetics have impaired lipid metabolism, no previous study
has investigated the relationship of lipids and hard exudates in Diabetic Asians
versus Diabetic Caucasians.
Purpose: To evaluate the serum lipid levels and hard exudates in Diabetic Asians
versus Diabetic Caucasians with Snellen visual acuity of 20/15 - 20/40.
Methods: A prospective observational case series was conducted in a referral retina
practice. Inclusion criteria: Snellen visual acuity of 20/15 - 20/40, no previous laser,
no pre-existing eye disease preventing retinal photography. Serum lipids such as
cholesterol, triglycerides, LDL, HDL, fasting blood glucose and HbA1c were obtained.
Hard exudates were measured using TOPCON TRC-50EX, OIS 3200 digital camera,
WINSTATION XP 10.2.44 with PDT computerized micrometer measurements.
Results: 127 patients, age range 19-86 yrs, mean age= 53.7 yrs ±14.1; 226 eyes, Diabetic
Asian eyes (DA) = 62; Diabetic Caucasian eyes (DC) = 46; Non-Diabetic Asian eyes
(NDA) = 71; Non-diabetic Caucasian eyes (NDC) = 47. In comparing HE size, DA with
HE (120.5 µ ± 90.5) vs DC with HE (88.2µ ± 29.8), p= 0.018. Significant differences include:
total cholesterol in DA (184.2mg/dL ± 39.9) vs DC (165.0 mg/dL ± 44.9) (p=0.023); total
cholesterol in DC (165.0 mg/dL ± 44.9) vs NDC (186.6 mg/dL ± 25.9) (p=0.006); HDL in
DA (54.4 mg/dL ± 13.7) vs DC (48.5 mg/dL ± 10.5) (p=0.013); HDL in DC (48.5 mg/dL
± 10.5) vs NDC (56.6 mg/dL ± 17.3) (p=0.008);LDL in DC (91.8 mg/dL ± 39.1) vs NDC
(107.0 mg/dL ± 22.5) (p=0.026).
Conclusion: In this small study, in Diabetic patients with hard exudates (HE), Asians
have larger HE than Caucasians. Diabetic Asians may have different HE characteristics,
cholesterol and HDL levels than Diabetic Caucasians, which may be associated with
impaired lipid metabolism.
CR: R. Sreeraman, None; G. Wu, None; R. Chen, None; H. Uong, None; B. Shanker,
None; J. Ha, None; P. Nguyen, None.
Support: None
166-169
170 - B441
Retinal Vascular Flicker Response in Patients With Diabetic Retinopathy
171 - B442
Diabetic Retinopathy Knowledge in University Clinic Patients
T.T. Nguyen1, J.-J.Wang1,2, S.Rogers1, A.Kreis1, A.Grosso1, J.Shaw3, T.Y. Wong1,4.
1
Centre for Eye Research Australia, University of Melbourne, Victoria, Australia;
2
Centre for Vision Research, University of Sydney, NSW, Australia; 3International
Diabetes Institute, Victoria, Australia; 4Singapore Eye Research Institute, National
University of Singapore, Singapore.
S.Albin, J.Benevento, J.Chang, R.D. Jager. Department of Ophthalmology & Visual
Science, University of Chicago, Chicago, IL.
Purpose: Previous studies show that retinal arteriolar and venular diameters dilate
in response to flickering light stimulation, possibly from a physiological response of
the retinal endothelium to neural and chemical activities induced by the flickering.
We aim to investigate whether this vessel response to light flickering is altered in
patients with diabetic retinopathy.
Methods: The study sample comprised 25 patients with type 1 or 2 diabetes seen
at a tertiary diabetes clinic. Retinopathy was defined on clinical ophthalmoscopic
examination. Of the 25 patients, 10 had early diabetic retinopathy. The Dynamic
Retinal Vessel Analyzer (Imedos, Germany) was used to measure the diameters of both
retinal vessels before, during and after the stimulation. Retinal arteriolar and venular
dilation in response to flickering light was defined using the maximal increase during
the stimulation proportional to the baseline diameter. One-way ANOVA was used to
compare the difference between groups, and then further adjusted for age, glycemia,
presence of hypertension and hypercholesterolemia using ANCOVA
Results: Of the 25 patients, 11 were type 1 diabetes and 14 were type 2 diabetes. The
mean age of the groups with and without diabetic retinopathy was 49.7 years and
52.0 years, respectively. The mean duration of diabetes in those with and without
retinopathy was 13.9 years and 8.0 years, respectively. The mean arteriole dilation
induced by light flickering in diabetic patients with and without retinopathy was 1.4%
and 3.2%, respectively, (p=0.17), whereas corresponding mean venular dilation was
1.9% and 3.9%, respectively (p=0.004). After adjusting for age, glycemia, presence of
hypertension and hypercholesterolemia, venular dilation in those with and without
retinopathy was 2.2% and 3.9%, respectively, (p=0.03).
Conclusions: Findings from this sample of diabetic patients suggest that retinal
venular dilation is diminished in response to flickering light stimulation in patients
with mild retinopathy. This observation suggests that endothelial function is reduced
in patients with early diabetic retinopathy, but further studies with larger sample size
is needed to clarify the exact mechanisms of this diminished response.
CR: T.T. Nguyen, None; J. Wang, None; S. Rogers, None; A. Kreis, None; A. Grosso,
None; J. Shaw, None; T.Y. Wong, None.
Support: None
172 - B443
Impact of an Internet-Based Diabetic Retinopathy Assessment Program on
Diabetic Retinopathy Surveillance Rates in a Primary Care Setting
Purpose: To determine the extent of knowledge of diabetic patients in a university
ophthalmology clinic regarding diabetic retinopathy (DR), its treatment, and the
effect of systemic comorbidities on DR.
Methods: A prospective study of diabetic patients from the University of Chicago
Hospitals was performed. Patients completed a detailed eighteen question survey
addressing their knowledge of diabetes, blood glucose levels, hemoglobin A1c, and
DR.
Results: Of 20 diabetic patients surveyed, only 65% correctly classified their diabetes
as Type 1 or Type 2. 90% of patients could identify normal blood glucose levels, and
20% recorded ever having had blood sugar levels above 300 mg/dL. Only 50% of
patients knew about hemoglobin A1c (HbA1c), and only 40% of patients correctly
identified an appropriate target HbA1c level. Patients who knew about HbA1c had a
higher average maximum blood sugar level (244 +/- 88 vs. 195 +/- 37 mg/dL) and were
three times more likely to report ever having a blood sugar level above 300 mg/dL.
Seven patients received laser treatment for DR, and 50% of patients correctly answered
that the laser treatment was performed to prevent their vision from worsening, while
33% believed it was performed to prevent diabetes from affecting their eyes, and 17%
did not know why they underwent laser treatment. Although the majority (75%) of
patients correctly answered that tight blood sugar control decreased the risk of DR,
they also reported higher average maximum blood sugar levels than those who
answered incorrectly (225 +/- 77 vs. 203 +/- 49 mg/dL) and were three times more
likely to report ever having a blood sugar level above 300 mg/dL. With regard to
systemic comorbidities, 70% of patients correctly answered that high blood pressure
worsened DR, 50% correctly answered that high cholesterol worsened DR, and only
35% of patients correctly answered that aspirin had no effect on DR.
Conclusions: The level of disease awareness of diabetic patients in a university clinic
is poor, and there is a significant need for greater patient education on monitoring
diabetes and recognizing confounding factors of diabetic retinopathy. Poor insight
into the disease was associated with lower reported blood glucose levels.
CR: S. Albin, None; J. Benevento, None; J. Chang, None; R.D. Jager, None.
Support: None
173 - B444
Diabetic Retinopathy in Eyes After Phacoemulsification Surgery
I.E. Zimmer-Galler1, R.Zeimer1, K.Quinn2. 1Wilmer Eye Institute, Johns Hopkins
Medical Institutions, Baltimore, MD; 2EyeTel Imaging, Inc., Columbia, MD.
A large percentage of patients with diabetes do not undergo recommended regular
evaluation or assessment for diabetic retinopathy. Telemedicine programs based on digital
retinal imaging have the potential to increase the rate of diabetic retinopathy detection.
Few systems have been implemented on a large scale and the impact of such screening
or assessment programs on the rate of diabetic eye evaluations is not known.
Purpose: To assess the impact of an Internet-based diabetic retinopathy assessment
program on overall surveillance rates for diabetic retinopathy in patients with diabetes
in a primary care practice.
Methods: A semi-automated Internet-based telemedicine diabetic retinopathy assessment
system, the DigiScope, was implemented in a primary care practice. Noncompliant patients
with diabetes who had not undergone an eye examination in the previous 12 months
were imaged with the DigiScope. The images were remotely reviewed to determine
whether referral to an ophthalmologist was recommended. Rates of evaluation for
diabetic retinopathy by an ophthalmic examination were assessed in the 12 months prior
to implementation of the system. Rates of evaluation for detection of diabetic retinopathy,
by either an ophthalmic examination or by DigiScope imaging, were again assessed in
the 11 months after implementation of the system.
Results: The rate of eye examinations for diabetic retinopathy in a primary care practice
was 34% (429 examinations out of 1,256 patients with diabetes) in the 12 months prior to
implementation of the diabetic retinopathy assessment system. The rate of eye evaluations
for diabetic retinopathy improved to 71% (988 evaluations out of 1,397 patients with
diabetes) in eleven months after implementation of the diabetic retinopathy assessment
system. This included 357 patients imaged with the telemedicine system. Both the overall
surveillance rate and the rate of an examination by an ophthalmologist increased after
implementation of the diabetic retinopathy assessment program.
Conclusions: Use of a telemedicine diabetic retinopathy assessment service appears to
be an effective method to improve the overall retinopathy surveillance rate of patients
with diabetes in the primary care setting. The improvement in the surveillance rate may
be a result of both the direct presence of the assessment system and the indirect impact
the system had on raising awareness, among patients and providers, of the importance
of an annual eye examination in patients with diabetes.
CR: I.E. Zimmer-Galler, EyeTel Imaging, Inc., C; R. Zeimer, EyeTel Imaging, Inc., C;
EyeTel Imaging, Inc., P; K. Quinn, EyeTel Imaging, Inc., E.
Support: NIH Grant EY017053
T.H. Hong1, P.Mitchell1, T.de Loryn1, E.Rochtchina1, S.Cugati1, J.J. Wang1,2.
1
Ophthalmology (Centre for Vision Research, Westmead Millennium Institute,
Westmead Hospital), University of Sydney, Sydney, Australia; 2Centre for Eye
Research Australia, University of Melbourne, Melbourne, Australia.
Purpose: Intra- and extra-capsular cataract surgery has been shown to exacerbate
existing diabetic retinopathy (DR). Modern phacoemulsification (phaco) cataract
surgery is considered less destructive to ocular structures than these earlier techniques.
It remains unclear, however, whether phaco surgery also exacerbates DR. In this study,
we aimed to assess DR progression in patients aged 65+ years who had undergone
phaco cataract surgery at Westemad Hospital, Sydney, from 2004-6.
Methods: Over the period, 139 cataract surgical patients with diabetes were recruited
and followed for at least 6 months postoperatively. Digital retinal photography was
performed after dilatation pre- and at 1, 6, 12 and 24 months postoperatively. DR was
graded using the ETDRS classification system. Preoperative and 1-month postoperative
photos (baseline) were compared to 6- and 12-month photos. Side-by-side grading
was conducted to confirm DR status change over time. Progression was defined if DR
level was one or more steps severer at follow-up, including progression from none to
minimal DR. Odds ratio (OR) and 95% confidence intervals (CI) were assessed after
adjusting for baseline age, glucose levels, sex and diabetic duration.
Results: Of those recruited diabetic patients with gradable photographs, 164 eyes were
non-phakic and 86 were phakic at baseline. DR was detected at baseline in 65.2% of
the non-phakic and 54.7% of the phakic eyes. The corresponding proportions were
67.5% vs 56.2%, and 63.7% vs 57.5%, respectively, for non-phakic and phakic eyes at
6- and 12-month visits. Non-phakic eyes had non-significantly higher odds of having
DR (baseline: OR 1.6, CI 0.95-2.7; 6-month: OR 2.0, CI 1.2-3.3 and 12-month: OR 1.5, CI
0.86-2.5). Of those followed for 6 months or longer, the DR progression rate was 14.2%
in non-phakic and 10.8% in phakic eyes, OR 1.9, CI 0.96-3.9 for the progression within
6-12 months. Among 81 of 93 patients with monocular surgery who had complete data,
paired comparison analysis confirmed that the proportion with DR progression was
higher in non-phakic than phakic eyes of the same subjects within 6-12 months after
surgery (27.2% vs 18.5%, OR 1.9 CI 0.9-4.0).
Conclusions: We document that phaco cataract surgery may still exacerbate DR
progression in diabetic patients aged 65+ years, although the extent of such worsening
seems to be much less than that documented with older surgical techniques.
CR: T.H. Hong, None; P. Mitchell, None; T. de Loryn, None; E. Rochtchina, None; S.
Cugati, None; J.J. Wang, None.
Support: Australian NHMRC grants 302010 and Retina Australia 2005 project
grant
170-173
174 - B445
Clinically Significant Macular Edema and Survival: Wisconsin Epidemiologic
Study of Diabetic Retinopathy
175 - B446
Impact of Visual Impairment on Service and Support Use by Individuals With
Diabetic Retinopathy
F.E. Hirai1,2, M.D. Knudtson1, B.E. K. Klein1, R.Klein1. 1Ophthalmology and Visual
Sciences, University of Wisconsin, Madison, WI; 2Ophthalmology, Federal
University of Sao Paulo, Sao Paulo, Brazil.
G.Matthews1, J.K. Schmier2, Z.N. Zakov3, D.W. Covert4. 1University of North Texas
Hlth Sci Ctr, Fort Worth, TX; 2Exponent, Alexandria, VA; 3Retina Associates of
Cleveland, Cleveland, OH; 4Alcon Research, Ltd., Fort Worth, TX.
Purpose: to investigate the association of clinically significant macular edema (CSME)
with all cause and cause-specific mortality in a long-term diabetic population.
Methods: the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an
ongoing prospective population-based cohort study initiated in 1980-82 of individuals
with diabetes diagnosed at either = 30 years of age (older-onset, n=1,370). Stereoscopic
color retinal photos were graded for retinopathy using the modified Airlie House
Classification scheme and CSME was defined by ETDRS criteria.
Results: the prevalence of CSME was 7.5% and 5.9% for the older- and younger-onset
groups, respectively. After 20 years of follow-up, 276 younger-onset and 1,123 olderonset persons died. When adjusting for age and gender CSME was not significantly
associated with all-cause (hazard ratio and 95% confidence interval 1.41 (0.96-2.07),
p=0.08) or ischemic heart disease mortality (1.14 (0.61-2.12), p=0.68) in the youngeronset group. In the older onset group, there was increasing all-cause and ischemic heart
disease mortality when CSME was present: 1.55 (1.25-1.92), p<0.01 and 1.56 (1.15-2.13),
p<0.01, respectively, when adjusting for age and gender. After controlling for other
risk factors, the association remained significant for all-cause (1.28 (1.02-1.61), p=0.03)
but was only marginally significant for ischemic heart disease (1.36 (0.97-1.89), p=0.07).
CSME was not significantly associated with stroke mortality by in either group.
Conclusions: CSME appears to be a risk indicator for decreased survival in persons
with older-onset diabetes mellitus. The presence of CSME may identify individuals
who should be under care for cardiovascular disease.
CR: F.E. Hirai, None; M.D. Knudtson, None; B.E.K. Klein, None; R. Klein, None.
Purpose: To assess the patient-reported use of caregiving, assistive devices and
services among individuals with diabetic retinopathy and evaluate the impact of
visual impairment level on this use.
Methods: Two ophthalmologists and their staff invited patients with diabetic
retinopathy to complete a survey on their use of visual aids, devices and caregiving.
The clinical staff provided data on best corrected visual acuity (BCVA). The study
was approved by a central IRB and respondents provided consent before completing
the survey. Responses were analyzed by BCVA categories based on the better eye:
normal (20/15 to 20/20), near normal (20/25 to 20/30), moderate low vision (20/40
to 20/60), severe/profound low vision (20/70 or worse). De-identified data were
analyzed in SAS.
Results: Interim analysis was conducted with 491 patients. Mean age was 64 and
44% were male. Most respondents (72%) were diagnosed at least three years earlier.
Respondents with normal vision comprised 17% of the population, and near normal,
moderate low and severe/profound groups comprised 39%, 32%, and 11%, respectively.
Few patients reported using services such as transportation or job training. In general,
the use of devices such as magnifying glasses, computer software and large print
materials, increased as BCVA decreased. Use of paid and unpaid help was significantly
associated with BCVA; while only 8% of those with normal vision reported caregiving,
71% of those with severe/profound low vision reported caregiving (p<0.05). Using
standard costs for devices and services and a national average for caregiver time,
annual costs for increased from $444 for respondents with normal vision to $45,136
to those with profound/severe low vision.
Conclusions: There are substantial differences in service and device use with
decreased BCVA in patients with diabetic retinopathy.
CR: G. Matthews, Alcon Research, Ltd., C; J.K. Schmier, Alcon Research, Ltd.
provided grant to Exponent., F; Z.N. Zakov, Alcon Research, Ltd., C; D.W. Covert,
Employee of Alcon Research, Ltd., E.
Support: Alcon Research, Ltd. VA10480
176 - B447
Optical Coherence Tomography Measured Retinal Nerve Fiber Layer Thickness
Using Two Different Scan Options
177 - B448
Comparison of JPEG and JPEG 2000 Image Compression on the Fidelity of
Digital Diabetic Retinal Imagery
C.Lastra Gonzalez, S.Fraser-Bell, M.Torres, R.Varma, Los Angeles Latino Eye Study
Group. Ophthalmology, Doheny/USC, Los Angeles, CA.
H.K. Li1,2, J.F. Florez2,3. 1Ophthalmology & Visual Science, The Univ of Texas Medical
Branch, Galveston, TX; 2School of Heatlh Information Sciences, University of
Texas Health Science Center, Houston, TX; 3Universidad De Antioquia, Medellin,
Colombia.
Purpose: Retinal Nerve Fiber Layer (RNFL) is thicker closer to the optic disc margin
and thins out as ganglion cell axons approach the retinal periphery.Current Optical
Cohenrence Tomography (OCT) protocols use a fixed diameter scan to measure RNFL
thickness. This study examined the difference in RNFL thickness measurements between
two different scan protocols, the circular 3.4mm fixed diameter scan the Proportional
Circle RNFL (Prop RNFL- scan protocol that uses a proportion of the disc diameter as
the scan diameter thus varying by disc size - larger discs have larger diameter scans
and smaller discs have smaller diameter scans) using the STRATUS OCT™ (Carl Zeiss
Meditec, inc., Dublin, CA).
Methods: Participants aged 40 years and older from the Los Angeles Latino Eye Study
(LALES) - a population-based prevalence study of eye disease among Latinos - underwent
a complete ophthalmologic examination a complete anterior and posterior segment
evaluation by an ophthalmologist, Humphrey Visual Field testing and optic disc and
fundus photography. OCT was performed on all participants using the RNFL 3.4 mm
scan and the Prop RNFL protocols. Paired t-tests were used to compare the difference
in RNFL thickness between the two scan patterns.
Results: OCT scans results from 655 normal eyes were included in this evaluation.
The mean (± standard deviation) overall RNFL thickness was 103 microns (± 11) using
the RNFL 3.4 scan and 133 microns (±15) using the Prop RNFL protocol, the mean of
absolute difference was 30 microns (p<0.0001). The mean temporal thickness was 69
microns (±11) using the RNFL 3.4 scan and 85 microns (±15) using the Prop RNFL scan.
The mean superior thickness was 129 microns (±17) using the RNFL 3.4 scan and 161
microns (±22) using the Prop RNFL scan. The mean nasal thickness was 84 microns
(±17) using the RNFL 3.4 scan and 118 microns (±25) using the Prop RNFL scan. The
mean inferior thickness was 132 microns (±17) using the RNFL 3.4 and 168 microns (±22)
using the Prop RNFL scan.
Conclusions: On average, the overall and quadrant specific mean RNFL thickness was
consistently and significantly greater when using the Prop RNFL scan compared to the
RNFL 3.4 scan. The use of the Prop RNFL scan protocol may provide a more anatomically
reliable measure RNFL thickness than the RNFL 3.4 because it minimizes the effect of the
interindividual variability due to different optic disc sizes. This Prop RNFL scan pattern
should be further assessed to determine if the RNFL thickness measurements provide a
better measure of disease related damage to the optic nerve.
CR: C. Lastra Gonzalez, None; S. Fraser-Bell, None; M. Torres, None; R. Varma,
None.
Support: NIH Grants EY11753 & EY03040
Purpose: The need for multiple digital color images for clinical research and
telemedicine remote evaluation of diabetic retinopathy can require significant
computer storage and high transmission speeds. Joint Photographic Experts Group
Compression (JPEG) algorithms are widely used techniques to lower computer file
storage and speed transmission requirements, though potentially at some “lossy”
degradation to image fidelity. Both JPEG & JPEG 2000 allow selection of compression
from a range of quality factor options. This study correlates image fidelity of JPEG
and JPEG 2000’s range of quality factors.
Methods: One hundred fifty-one 3008 x 2000 pixel diabetic retinal images were
compressed using JPEG and JPEG 2000 algorithms. Each image was compressed using
a quality factor of 100%, 95%, 85%, 80%, 65%, 50% and 1%. Just noticeable differences
(JNDs) between compressed images were measured and compared to uncompressed
images using Color JND-Metrix computational observer software.
Results: Image fidelity between 0.1 and 0.01 JND was achieved with quality factors
above 70% using either JPEG or JPEG 2000. At the same quality factor, JPEG 2000
achieved higher compression ratios than JPEG. The highest image fidelity was
produced with JPEG 2000 at 100% and JPEG at 90%, achieving a compression ratio
of 37:1 and 28:1 respectively.
Conclusions: JPEG and JPEG 2000 can both preserve image fidelity but JPEG 2000
achieves a higher compression ratio.
CR: H.K. Li, None; J.F. Florez, None.
Support: Juvenile Diabetes Research Foundation International
174-177
Sunday, May 6, 11:00 AM - 12:45 PM Hall B/C Poster Session Program Number/Board # Range: 318-334 / B416-B432
116. Epidemiology of Visual Impairment Organizing Section: CL Contributing Section: EY, PH
318 - B416
Estimation of Prevalence and Incidence Rates and Causes of Blindness in Israel
1998-2003
319 - B417
Predictors of Visual Impairment in an Urban Malay Population: The Singapore
Malay Eye Study (SiMES)
R.Avisar, I.Avisar, D.Weinberger. Ophthalmology, Rabin Medical Center, Hasharon
Hospital, Petah Tiqva, Israel, Petah Tiqva, Israel.
A.Idris1, C.Fong2, W.Wong3, A.Foong3, S.-M.Saw4, M.Sander3, A.Tin 3, D.T. H. Tan3,
T.Wong5. 1Singapore Eye Research Institute, Singaport, Singapore; 2Epidemiology &
Disease Control Division, Ministry of Health, Singapore, SINGAPORE, Singapore;
3
Singapore Eye Research Institute, Singapore, Singapore; 4Department of
Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore; 5Centre for Eye Research
Australia, University of Melbourne, Melbourne, Australia.
Purpose: To characterize the population who were registered as Blind in Israel in
the years 1998-2003 and estimate the prevalence and incidence of blindness by age
and causes of blindness.
Methods: A retrospective review of the annual report of the National Registry for the
Blind in Israel between 1998 and 2003 identified 21,585 blind persons who received a
certificate for blindness. Blind persons are identified by ophthalmologists throughout
Israel and referred to the Israel Registry of the Blind if they have a visual acuity of 3/60
or worse, or a visual field loss of < 20 degrees in their better eye. This report includes
prevalence data on 21,585 persons enrolled in this review still alive and living in Israel
in 2003. We estimated the prevalence rate of blindness nationwide and the incidence
rate for each cause of blindness for every year.
Results: The main leading causes of blindness in Israel in 1998 were (in percent of the
total number of newly registered patients): age-related macular degeneration (20.1%),
glaucoma (13.8%), myopic maculopathy (12%), cataract (10.4%), diabetic retinopathy
and maculopathy (10.1%), and optic atrophy (7.9%), and in 2003, 28%, 11.8%, 7.4%,
6.5%, 14.4% and 6.5% respectively.
Conclusions: The results indicate that the incidence of age-related macular
degeneration, diabetic retinopathy and maculopathy in Israel is increasing, while
that of glaucoma, myopic maculopthy, optic atrophy and cataract is decreasing.
CR: R. Avisar, None; I. Avisar, None; D. Weinberger, None.
Support: None
320 - B418
Ophthalmic Examination in a Mobile Unit in Brazil: Screening and Treating
Eye Diseases
Purpose: To describe predictors of visual impairment in an urban Malay adult
population in Singapore.
Methods: A population-based, cross-sectional study of 3,280 (78.7%) Malay persons
aged 40-80 years residing in Singapore. An age-stratified random sample of 5,600
Malay names residing in south-western Singapore (1,400 from each age decade) was
selected from a national database. Participants had a standardized interview and
examination at a centralized clinic . Presenting and best-corrected LogMAR visual
acuity (VA) was measured and visual impairment was defined as VA<0.30 (20/40)
and >1.00 (20/200).
Results: Of the 3,273 with presenting VA data, 790 (24.1%) who were visually impaired.
Older age was a predictor of presenting visual impairment (odds ratio [OR] 2.3, 95%
CI 2.1, 2.5, per decade age increase). While controlling for age, women were twice as
likely to be visually impaired than men (OR 2.0, 95% CI 1.6, 2.4). While controlling
for age and gender, visual impairment was associated with place of birth (OR 1.8,
95% CI 1.1, 2.8, Indonesia vs Singapore), education (OR, 2.8, 95% CI 2.0, 3.9, formal
education vs high school/tertiary education), occupation (OR 2.2, 95% CI 1.3, 3.7,
retired/unemployed vs professional occupation), housing type (OR 1.8, 95% CI 1.3,
2.4, 1-2 public flats vs 5 room flats/private housing), smoking status (OR 1.4, 95% CI
1.1, 1.9, current vs never smokers), systolic blood pressure (OR 1.7, 95% CI 1.3, 2.2
4th vs 1st quartile), body mass index (OR 1.6, 95% CI 1.2, 2.0, 1st vs 4th quartile ) and
serum creatinine levels (OR 1.4, 95% CI 1.0, 1.8). Of the 3269 with best-corrected VA
data, 263 (8.0%) were visually impaired. Predictors of visual impairment after best
correction were similar.
Conclusions: In this Singapore Malay population, older age, female gender, lower
socio-economic status, lower body mass index, and cigarette smoking were predictors
of visual impairment
CR: A. Idris, None; C. Fong, None; W. Wong, None; A. Foong, None; S. Saw, None; M.
Sander, None; A. Tin, None; D.T.H. Tan, None; T. Wong, None.
Support: National Medical Research Council Grants No 0796/2003 and Biomedical
Research Council Grant No 501/1/25-5
321 - B419
Predicting the Need for Low Vision Rehabilitation Services
P.M. O’Connor, E.L. Lamoureux, J.E. Keeffe. Ophthalmology, Centre for Eye Research
Australia, University of Melbourne, Australia.
S.A. Schellini1, F.E. Hirai2, P.Souza-Segundo1, C.R. Padovani 3. 1Ophthalmology,
Faculdade Medicina Botucatu - UNESP, Botucatu, São Paulo State, Brazil;
2
Ophthalmology, Universidade Federal de São Paulo - UNIFESP, São Paulo, São
Paulo State, Brazil; 3Biostatistics, Instituto de Biociências - UNESP, Botucatu, São
Paulo State, Brazil.
Purpose: to investigate the prevalence of ophthalmic diseases and the role of a
mobile unit for screening and treatment of eye diseases in individuals enrolled in a
Community Ocular Health Program in Brazil.
Methods: the study was a population-based cross-sectional study, with a randomized
stratified sample of households in 11 cities of an urban Brazilian population in the
West region of the State of São Paulo, Brazil. The sample consisted of 11,121 individuals
(age range: 1-70+ years) who underwent complete ophthalmic examination (visual
acuity (VA), refraction, anterior segment biomicroscopy, fundoscopy, and tonometry).
Subjects received treatment at the time of the examination when possible or were
referred to a reference hospital for proper care.
Results: of all individuals examined, 43.2% improved their VA achieving normal
levels with eyeglasses, 1.4% presented low vision, 2.3% were blind, and 39.9% had
emmetropia. Approximately 8.4% of the individuals needed to be referred to the
University Hospital for further treatment. The main diseases presented by the cases
that needed to be referred were: pterigyum and eyelid affections (38.4%), cataract
(27.7%) and glaucoma (19.5%).
Conclusions: the high rates of ophthalmic problems solved using the mobile unit
showed the importance of this approach in providing primary care to general
population; only few individuals needed to be referred to the University Hospital
for more complex treatment.
CR: S.A. Schellini, None; F.E. Hirai, None; P. Souza-Segundo, None; C.R. Padovani,
None.
Support: FAPESP 13713/5
Purpose: To determine the independent predictors of rehabilitation needs of people
with low vision.
Methods: Patients attending low vision clinics completed the Impact of Vision
Impairment questionnaire (IVI) and provided general sociodemographic and clinical
information. Rasch analysis was used to generate person measures for the IVI overall
and three domain scores. Four models of linear regression analysis (LRA) were used
to determine independent predictors of rehabilitation needs.
Results: 477 patients (56% women) with a mean age 72 yrs (SD±15.3) were recruited.
Most (74%) had moderate or severe vision loss (presenting visual acuity (PVA) <6/18)
and Age-Related Macular Degeneration (43%). Age, duration and main cause of vision
impairment, PVA, the impact of comorbidities on daily living and reliance on family
or friends for meal provision were univariately associated with poorer IVI overall
and domain scores (p<0.05). Patients requiring family assistance with chores also
had poorer scores on all the IVI scores except for the emotional well-being domain.
Females performed significantly worse on the mobility and independence domain and
participants from culturally and linguistically diverse backgrounds recorded poorer
emotional well-being domain scores (p<0.05). LRA consistently ranked PVA, the effect
of comorbidity on life activities and reliance on family or friends for meals as the
highest independent predictors of need in each of the four IVI dependent scores. The
IVI overall regression model explained 29% of the variance. PVA made the largest
unique contribution (β=.39 and R 2= 13.96) followed by the effect of comorbidity on life
activities (β=.17 and R 2=2.59) and reliance on family or friends for meals (β=.15 and
R 2=1.52). The reading and accessing information domain model replicated these values.
The emotional well-being and mobility and independence models explained 16.7% and
24.6% of the variance respectively. PVA, the effect of comorbidity on life activities
and reliance on family or friends for meals remained the highest three predictors in
each (β=.19 and R 2=3.27, β=.22 and R 2= 4.51, β=.12 and R 2= 1.30) and (β=.31 and R 2=
8.67, β=.21 and R 2= 4.10, and β=.15 and R 2= 1.50) respectively.
Conclusions: Rasch-calibrated person measures confirmed PVA as the strongest
consistent predictor of overall quality of life and three domain scores in people
with low vision. Comorbidity and ‘needing home help’ also featured. Critically,
the association between poorer vision and decreased independence indicates that
PVA can be used by clinicians to determine who should be referred to low vision
rehabilitation services.
CR: P.M. O’Connor, None; E.L. Lamoureux, None; J.E. Keeffe, None.
Support: None
318-321
322 - B420
Deprivation and Visual Impairment in Pakistan. The National Blindness and
Visual Impairment Survey
323 - B421
Is All Cataract Blindness Avoidable?
C.E. Gilbert1, S.P. Shah1, M.Z. Jadoon2, R.R. Bourne1, B.Dineen1, M.A. Khan2, M.D.
Khan2, On Behalf of the Pakistan National Eye Survey Study Group. 1ICEH CRU, London
School of Hygiene & Tropical Medicine, London, United Kingdom; 2Kyber Institute
of Medical Sciences, Pakistan Institute of Community Ophthalmology, Peshawar,
Pakistan.
Purpose: To explore the association between visual impairment and deprivation
in Pakistan.
Methods: Visually impaired adults (≥30years) were identified in a population based
national survey in Pakistan. A deprivation score (at district level stratified by urban/
rural location; 0 = least, 100 = highest deprivation) similar to the UNDP’s Human
Poverty Index, was obtained from national census data. Subjects were categorized
as living in low (<25th centile), medium (25-75th centile) or high deprivation (>75th
centile) areas.
Results: 16,507 (95.3% response rate) participants were examined. Adults in Sindh
province had the lowest deprivation whereas rural areas in Balochistan had the highest.
The prevalence of blindness (<3/60 in the better eye) in adults with low deprivation was
2.2%, compared with 3.7% in medium and 3.9% in high deprivation areas (p<0.001). The
highest prevalence of blindness was found in rural Balochistan (5.2%). The prevalence
of total blindness (bilateral no light perception) was more than three times higher in
highly deprived areas compared to low deprivation areas (0.24% vs. 0.07%, p<0.001).
Cataract was the leading cause of blindness in all areas (51.5%), and in high deprivation
areas the proportion was 52.8% compared with 46.9% in low deprivation areas
(p<0.001). In adults with <6/18 in the better eye, cataract remained the leading
cause in the high and medium deprived areas (47.2% and 49.4% respectively) but
uncorrected refractive error was the leading cause in low deprivation areas (40.1%).
10.2% of adults in low deprivation areas presented with spectacles compared to 6.7%
and 4.4% in medium and highly deprived areas respectively. Spectacle coverage
was more than double in low deprivation areas compared to high deprivation areas
(24.8% vs 11.8%, p<0.001). Reflecting access to eye care, the cataract surgical coverage
was highest in the least deprived areas (80.6%) compared to 76.8% and 75.1% in the
medium and highest deprived areas.
Conclusions: Visual impairment and poor access to services is associated with
deprivation. Control strategies need to focus on poor communities, and combating
visual impairment may impact on global deprivation.
CR: C.E. Gilbert, None; S.P. Shah, None; M.Z. Jadoon, None; R.R. Bourne, None; B.
Dineen, None; M.A. Khan, None; M.D. Khan, None.
Support: This study was supported financially by the ‘International Blindness
Prevention Collaberative Group’
324 - B422
Ocular Findings in Patients From 80 to 108 Years Old
M.Wu, J.L. Y. Yip, H.Kuper, S.Polack, A.Foster. International Centre for Eye Health,
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Purpose: To determine the prevalence of cataract blindness from a Rapid Assessment
of Avoidable Blindness (RAAB) survey in Kunming, south-west China, and to estimate
the proportion of cataract blind that may not be avoidable.
Methods: A sample size of 2760 was estimated from an expected blindness prevalence
of 2.3% in adults aged 50 years and over; a precision of 30% and an expected design
effect (DEFF) of 1.4 for cluster size of 60 was used. Forty six clusters in the Kunming city
district were randomly selected using probability proportional to size methodology.
Individual participants from each cluster were selected using compact segment
sampling (CSS) or quota sampling when CSS was not logistically feasible. Survey
fieldwork took place between June and August 2006. Two ophthalmologists and their
teams used an established standardised protocol for a RAAB survey to determine the
population prevalence of cataract blind. The lens was examined with a bright torch or a
direct ophthalmoscope. In addition, the pupils were tested for an afferent or a relative
afferent pupillary defect using a bright torch and the swinging flashlight method in
all participants diagnosed with blindness due to cataract. The prevalence of blindness
was calculated using the RAAB package. Blindness was defined as presenting visual
acuity (PVA) in the better eye of ≤3/60. Severe visual impairment (SVI) was defined
as PVA ≤ 6/60, and visual impairment (VI) as PVA ≤6/18.
Results: Out of 2760 enumerated participants, 2558 (93.8%) were examined during
the survey. Blindness was detected in 95 out of 2558, which gives a crude blindness
prevalence estimate of 3.7% (95% CI: 2.4-4.0, DEFF=1.6); the age and sex adjusted
prevalence was 2.3%. The prevalence of SVI was 2.5% (1.5-4.0%) and VI was 9.1%
(7.5-10.7). Sixty out of 2558 (2.3%, 1.7-2.9%) were diagnosed as cataract blind, which
represents 63.2% of cases with blindness. An abnormal pupillary reaction was detected
in 10 out of 60 (16.7%) participants with cataract blindness.
Conclusions: An estimated 16.7% of participants diagnosed with cataract blindness
had an abnormal pupillary reaction in this large survey from southwest China. Cataract
is an avoidable cause of blindness. However, the presence of a pupillary defect indicates
ocular co-morbidity, and blindness in these cases may not be avoidable. Vision 2020
initiatives direct resources into programs that aim to eliminate avoidable blindness based
on needs assessments. Extrapolations to predict global estimates of avoidable blindness
and resource allocation using rapid assessment techniques should be taken with care.
Characters: 2227 (max= approx 2250)
CR: M. Wu, None; J.L.Y. Yip, None; H. Kuper, None; S. Polack, None; A. Foster,
None.
Support: Orbis International, Swire Foundation
325 - B423
Prevalence of Blindness and Ophthalmic Diseases in a Remote Rural Tropical
Area - Screening of 1248 Citizens in the Ghanian Volta Region
M.C. Cypel1A, P.E. C. Dantas2, C.L. Lottenberg1A, L.R. Ramos1B, R.Belfort, Jr.1A.
A
Ophthalmology, BEpidemiology, 1UNIFESP, Sao Paulo, Brazil; 2Ophthalmology,
Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil.
Purpose: To determine vision conditions and ocular findings in patients older than
80 years of age.
Methods: Total of 150 patients, divided in three groups: 70 between 80 and 89 years
(Group 1); 50 between 90 and 99 years (Group 2) and 30 over 100 years old (Group 3)
were examined (visual acuity, ectoscopy, refraction, biomicroscopy, tear film break-up
time, Schirmer basal test, aplannation tonometry, ophthalmoscopy, optical coherence
tomography and fluorescein angiography).
Results: The gender ratio was 61.4% females in Group 1, 70% in Group 2 and 83.3%
in Group 3. Arterial hypertension was the most common systemic disease in all three
groups. Percentage of patients already submitted to ocular surgery was: 31.4% in
Group 1, 56% in Group 2 and 50% in group 3. Cataract surgery had been performed
in 23% in Group 1, 54% in Group 2 and 46.67% in Group 3.The number of patients
satisfied with their current vision was: 74.3% in Group 1, 54% in Group 2 and 40% in
Group 3. The initial Best Corrected Far Visual Acuity (BCFVA) was 20/40 or better at
least in one eye in 47% patients from Group 1, 20% in Group 2 and none in Group 3.
After refraction changed to: 64% in Group 1, 30% in Group 2 and none in Group 3. The
percentage of blind patients considering the BCFVA (< 20/400) was: 5.8% in Group 1,
8% in Group 2 and 23.3% in Group 3. The initial Best Corrected Near Visual Acuity
(BCNVA) was 20/40 or better at least in one eye in 75% of Group 1, 58% of Group 2
and 26.7% from Group 3. After refraction it changed to 76% (114): 88.6% Group 1,
72% Group 2 and 53.4% Group 3. The most frequent visual complaint was low vision
for reading. Age related macular degeneration was found in 31% in Group 1, 66% in
Group 2 and in 90% in group 3.
Conclusions:The number of females increased significantly from Group 1 to Group
3. Visual acuity improved with refraction allowing better quality of life. AMD and
cataract were the main cause of visual impairment and blindness. Current findings
indicate that we should concentrate efforts in accurate refractive prescriptions, cataract
and AMD for patients that age.
CR: M.C. Cypel, None; P.E.C. Dantas, None; C.L. Lottenberg, None; L.R. Ramos,
None; R. Belfort, None.
Support: None
A.Frimpong-Boateng1, F.Rüfer1, S.Fiadoyor2, J.Nkrumah-Mills2, C.Kandzia1, J.Roider1.
1
Ophthalmology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel,
Germany; 2Ophthalmology, Volta River Authority Hospital Akosombo, Akosombo,
Ghana.
Purpose: Ophthalmic diseases are supposed to depend on life conditions. Thus the
need for ophthalmic care may differ in secluded rural tropical areas from that in urban
settings. The following study provides data of the citizens of 8 villages in a secluded
peninsula in the Volta river reservoir in Ghana which can be only accessed by boat.
Methods: 1248 citizens were screened by 4 ophthalmologists, one optometrist and
one ophthalmic nurse for eye diseases. After ophthalmic and general history visual
acuity was determined. Patients with reduced visual acuity underwent refraction.
The anterior segment was examined using hand slit lamps. After pupil dilation
indirect binocular ophthalmoscopy was performed. Results were documented using
a standardized WHO form. The prevalence of eye diseases was calculated. Blindness
was defined visual acuity being 20/400 or less on the better eye, visual impairment
20/200 on the better eye. Visual results were calculated in logMAR.
Results: 641 participants were female, 607 male. The mean age was 23.6 ± 19.1 years. 5.4%
had refractive errors. 2.2% were myopic, 3.2 % were hyperopic. 94.6% were emmetropic.
The overall mean visual acuity both of the right and the left eye was 20/25 (logMAR
0,1 ± 0,3). The prevalence of eye diseases were 8.3% pterygium, 17.5% Glaucoma
suspicious optic discs, 1.1% manifest glaucoma, 5.0% vision impairing cataract, 3.8%
presbyopia, 2.0% severe retinal disorders (e.g. toxoplasmosis, onchocerciasis), 1%
corneal scarring. 1.5% of the population were blind. 1.8% were visual impaired.
Causes of blindness were 47.4% cataract, 26.3% optic nerve atrophy (10.5% due to
hereditary diseases, 15.8% due to unknown diseases), 5.3% Onchocerciasis, 5.3%
retinal detachment and 5.3% glaucoma.
Conclusions: The main cause of blindness was cataract. The second most cause turned
out to be optic nerve atrophy, which was related half to hereditary diseases with
history of consanguinity and half to unknown origin, which requires further research.
Opposite to industralised countries only few refractive errors were seen, whereas
glaucoma may be an underestimated problem in rural areas of African countries.
CR: A. Frimpong-Boateng, None; F. Rüfer, None; S. Fiadoyor, None; J. NkrumahMills, None; C. Kandzia, None; J. Roider, None.
Support: None
322-325
326 - B424
Registered Blindness Among Adults In Israel: 1996-2005
M.Matanes, Y.Hod, O.Geyer. Ophthalmology, Carmel Mediacal Center, Haifa, Israel.
Purpose: To estimate the population-based incidence rates of blindness registration
and their trends over time in the Israeli adult population.
Methods: We performed a retrospective review of the data on bilateral blindness
in adults ≥ 40 years of age registered with the Association of the Blind of Israel
between 1996-2005. The causes of blindness were ascertained and the incidence rates
of blindness due to various causes were calculated.
Results: A total of 18666 blind certificates were examined. The most commonly
recorded cause of blindness was age-related macular degeneration (AMD), followed
by glaucoma and diabetic retinopathy. From 1996 to 2005, the annual incidence of
registered bilateral blindness decreased significantly at an average rate of 4.8% per
year (P<0.0001). Glaucoma blindness significantly decreased at an average rate of
8.1% per year (p>0.0001), but there were no similar changes in the incidence of AMD
blindness (1% rise per year, p =0.17) or diabetic retinopathy blindness ( 1% decrease
per year, p=0.62).
Conclusions: Advances in treatment management of ocular pathology has led to
a significant decrease in the number of adults with glaucoma-associated bilateral
blindness in Israel from 1996 to 2005.
CR: M. Matanes, None; Y. Hod, None; O. Geyer, None.
Support: None
328 - B426
Visual Acuity as a Component of a Digital Diabetic Eye Screening Protocol
L.F. Kehler1,2, B.Barahimi1, U.S. Rao1, L.M. Merin1, C.C. Recchia1, A.S. Chomsky1,2, F.M.
Recchia1,2. 1Vanderbilt Eye Institute, Vanderbilt University, Nashville, TN; 2Veterans
Administration, Tennessee Valley Healthcare System, Nashville, TN.
Purpose: Diabetic eye screening at Nashville VAMC is performed by the Vanderbilt
Ophthalmic Imaging Center (VOIC.) VOIC protocol includes mydriatic digital fundus
photographs and visual acuity testing. The purpose of this study was to determine
how well visual acuity measurements taken via VOIC protocol correlate with those
measured in the eye clinic. A secondary aim was to determine if these data are
predictive of eye disease not detected in the digital fundus photograph.
Methods: 483 patients were screened using VOIC protocol from January 2, 2004 to
December 22, 2004. Of this group, 204 patients were referred exclusively for a diagnosis
of decreased visual acuity (<20/40) in one or both eyes. These patients were sorted
alphabetically, and a convenience sample of the final 75 consecutive records was
chosen. Of these, 68 charts were available for review. The following elements were
recorded from the eye clinic visit: date, spectacle use, entering visual acuity, etiology
of decreased vision, presence or absence of diabetic retinopathy, and severity of
diabetic retinopathy. If visual acuity data were not present in the chart or if visual
acuity could not be quantified, the data were excluded. Visual acuity in 82 eyes of 43
patients was converted to logMAR notation and compared.
Results:Of the 68 charts reviewed, 48 patients followed up in the eye clinic, and their
visual acuity measured in the eye clinic correlated well (ρ = 0.745) to the VOIC data.
The most common reasons for decreased visual acuity were uncorrected refractive
error (35.7%), false-positive on screening (23.2%), cataract (10.7%), and amblyopia
(8.9%). Combined mechanisms of decreased vision (visual acuity plus other ocular
pathology) accounted for 10.7% of patients. The remaining etiologies were functional
vision loss, known retinal or optic nerve pathology, and known glaucoma. Presence or
absence of diabetic retinopathy as determined by VOIC and by the eye clinic examiner
agreed in 85% of cases. No patient was found to have severity of disease greater than
mild non-proliferative diabetic retinopathy, and none of the patients had decreased
visual acuity secondary to diabetic retinopathy.
Conclusions: A significant proportion of patients were referred (42.2%) solely because
of decreased visual acuity, yet no patient was found to have decreased visual acuity
due to diabetic retinopathy. VOIC visual acuity data correlates well with clinical
measures and seems useful for detecting eye and vision problems unrelated to diabetic
retinopathy.
CR: L.F. Kehler, None; B. Barahimi, None; U.S. Rao, None; L.M. Merin, None; C.
C. Recchia, None; A.S. Chomsky, None; F.M. Recchia, None.
Support: Research to Prevent Blindness, Inc.
327 - B425
Design of a Blindness Prevention Reporting and Planning Tool Utilising the
Results of a Population Based Study of Visual Impairment in a Health District
in Kwazulu-Natal
K.S. Naidoo1, B.Holden2, D.Sweeney3, M.Colvin4. 1Optometry, ICEE/UKZN,
Chatsworth K2N, South Africa; 2Vision CRC, ICEE/UNSW, UNSW, Australia;
3
Vision CRC, UNSW, Australia; 4MRC, UKZN, South Africa.
Purpose: To develop a blindness prevention tool for planning and monitoring of
eye and vision care by utilising the epidemiological data from the Lower Tugela
health district
Methods: A comprehensive population-based study of blindness and visual
impairment was conducted to develop a profile of the Lower Tugela health district. A
cross-sectional study was conducted on a randomly selected sample of 3444 individuals
from the district. Quantitative data from the epidemiological study was mined to
develop the Blindness Prevention Tool (BPT).
Results: 6.4% of the population studied were visually impaired. The main causes of
visual impairment (presenting vision in the best eye of less than 6/18) were refractive
error (44.5%), cataract (31.2%), glaucoma (6.0%), hypertensive retinopathy (4.1%) and
diabetic retinopathy (1.4%).
Thirty-one subjects (0.9%) were bilaterally blind with the main causes being cataracts
(54.8%) and refractive error (12.9%). Glaucoma and hypertensive retinopathy were
responsible for 6.4% of bilateral blindness. Diabetic retinopathy, other retinal
conditions (Coloboma) and corneal scarring were each responsible for 3.2% of bilateral
blindness. Albinism, Colomboma and AMD accounted for 9.7% of bilateral blindness.
The Blindness Prevention Tool developed using the prevalence data was used to
project human resource needs; generate basic epidemiological calculations and
provide standardized reporting to motivate for a greater culture of reporting and
monitoring.
Conclusions: This study reflects the value of epidemiological evaluations beyond
just describing trends in different communities. Integrating epidemiological data
in program work can ensure maximum output from eye care programs by ensuring
good planning, monitoring and reporting activity.
CR: K.S. Naidoo, None; B. Holden, None; D. Sweeney, None; M. Colvin, None.
Support: ICEE
329 - B427
Trend in Reported Visual Impairment in US Adults: The 1997-2005 National
Health Interview Survey
K.L. Arheart1A, D.J. Lee, II1A, B.L. Lam1B, D.D. Zheng1A, S.L. Christ2, A.J. Caban1A.
A
Epidemiology & Public Health, BBascom Palmer Eye Institute, 1University of
Miami Miller School of Medicine, Miami, FL; 2Sociology, University of North
Carolina, Chappel Hill, NC.
Purpose: The prevalence of visual impairment (VI) may be changing over time due
to improvements in the treatment of eye diseases and the reduction in risk factors
associated with ocular conditions. This study assesses nine-year trends in reported VI
in a representative US sample.
Method: The National Health Interview Survey (NHIS) is a population-based annual
survey of the US non-institutionalized civilian population. Nearly 32,000 adults
participated each year in the NHIS from 1997-2005, representing an average annual
population of over 205 million community-residing adults 18 years of age and older.
Participants were asked, “Do you have any trouble seeing, even when wearing glasses
or contact lenses?” (mild/moderate VI), and “Are you blind or unable to see at all? (severe
VI). SAS survey procedures were used to compute annual prevalence of VI adjusted for
survey weights and design effects. General linear models, weighted by the inverse of
the standard error of the prevalence estimate, were used to determine the trend (slope)
in the prevalence of VI. The trend was computed for the entire sample and for groups
determined by age, gender, race/ethnicity, access to general health care, and visit to an
eye doctor in the last year.
Results: The average annual prevalence of any VI (mild/moderate or severe) was
significantly greater in older versus younger adults, females versus males and in nonHispanic blacks relative to all other race ethnic groups. There were no significant overall
trends in the prevalence of mild/moderate, severe, or any VI. However, there was a
significant annual decrease of 0.44% (SE=0.14; p=0.001) in the prevalence of any VI for
adults ≥80 years of age. Further analysis showed an annual decrease of 0.54% (SE=0.18;
p=0.004) for males and 0.39% (SE=0.14; p=0.023 for females in the 80+ age group and
annual decreases of 0.87% (SE=0.40; p=0.032) for Hispanics, 0.93% (SE=0.37; p=0.026)
for non-Hispanic Blacks; and 0.44% (SE=0.26; p=0.094) for Non-Hispanic Whites. Access
to healthcare and a visit to an eye doctor in the last year were not significantly related
to VI.
Conclusions: The downward trend in VI reported in adults age 80 years and over may be
due to improvements in the treatment of ocular disease or other secular trends such as
improvements in the health/risk factor status of older Americans. Additional monitoring
in the coming years is necessary to confirm this encouraging trend and to determine if
downward trends eventually extend to younger age groups.
CR: K.L. Arheart, None; D.J. Lee, None; B.L. Lam, None; D.D. Zheng, None; S.L. Christ,
None; A.J. Caban, None.
Support: NEI grant R03 EY016481-01A2
326-329
330 - B428
Serum Protein Profiling in Persons With Ocular Disease: The Los Angeles
Latino Eye Study
331 - B429
Diaparity in Prevalence of Reported Visual Impairment Among US Race-Ethnic
Subgroups Age 65 Years and Older: The 1999-2005 National Health Interview
Survey
J.R. Chao1, R.N. Khurana1, M.-Y.Lai2, R.Varma1, Los Angeles Latino Eye Study Group.
1
Ophthalmology, Doheny Eye Institute, Los Angeles, CA; 2Department of
Preventive Medicine, Keck School of Medicine at USC, Los Angeles, CA.
Purpose: To evaluate the protein expression profiles from serum samples of persons
with proliferative diabetic retinopathy, end-stage open angle glaucoma, and age-related
macular degeneration as compared to individuals without ocular disease.
Methods: Serum samples from 38 participants were selected for this study. This
included 6 case-control pairs of persons with end-stage open angle glaucoma and
proliferative diabetic retinopathy, and 7 case-control pairs of those with age-related
macular degeneration. Controls were free from glaucoma, diabetic retinopathy,
and age-related macular degeneration, and they were matched to age, gender,
smoking status, history of cardiovascular disease, hypertension, and alcohol use.
Controls paired to those with proliferative diabetic retinopathy were also matched
to duration since diabetes diagnosis and hemoglobin A1c levels. Equalized serum
sample fractions were analyzed using SELDI-TOF-MS ProteinChip Arrays with two
different chromatographic surfaces (CM10 weak cation exchange and H50 hydrophobic
or IMAC30 metal-affinity). The data were analyzed by univariate and multivariate
statistical techniques.
Results: Several hundred protein peaks (mass/charge ratios) were consistent across
samples and chip sites. After exclusion of peaks with poor resolution and low
signal-to-noise ratios, univariate analysis was performed, and 6-10 differentially
expressed protein biomarkers were found between the disease versus control groups.
Select candidate proteins were identified by off-line purification and tandem mass
spectrometry (MSMS).
Conclusions: The identification of serum biomarkers for ocular diseases such as
proliferative diabetic retinopathy, end stage glaucoma, or age-related macular
degeneration could provide insight into the pathogenesis of the diseases.
CR: J.R. Chao, None; R.N. Khurana, None; M. Lai, None; R. Varma, None.
B.L. Lam1A, K.L. Arheart1B, D.J. Lee, II1B, D.D. Zheng1B, S.L. Christ2, A.J. Caban1B.
A
Bascom Palmer Eye Institute, BEpidemiology & Public Health, 1University of
Miami Miller School of Medicine, Miami, FL; 2Sociology, University of North
Carolina, Chappel Hill, NC.
Purpose:The US population is aging and becoming more diverse. Population-based
prevalence estimates for visual impairment (VI) are unavailable in all but the largest race
and ethnic subgroups, particularly for older adults. This study documents VI prevalence
estimates in these smaller subgroups using data representative of the US population
aged 65 years and older.
Methods:The National Health Interview Survey (NHIS) is a population-based annual
survey of the US non-institutionalized civilian population. Nearly 42,000 adults 65 years
of age and older participated in the NHIS from 1999-2005. Participants were asked, “Do
you have any trouble seeing, even when wearing glasses or contact lenses?”, and “Are
you blind or unable to see at all? Participants were classified as “VI” if they responded
yes to either question. SAS survey procedures were used to compute 1999-2005 pooled
VI prevalence adjusted for survey weights and design effects.
Results:The average annual prevalence of any VI for adults 65 years of age and older
was 17.1% [95% Confidence Interval 16.6-17.6], which was similar to the rates reported
by whites (16.7% [16.2, 17.3]). Asian Indians, Filipinos, and Other Asians and Pacific
Islanders were the only race groups with reported VI rates below whites (12.9% [5.427.8], 12.4% [7.0-21.1], and, 13.0% [9.2-18.0], respectively). American Indians had the
highest prevalence rate (23.4% [16.2-32.6]) followed by multiple race (23.2% [10.6-43.6]),
African-Americans (20.4% [18.8-22.1]), and Chinese (19.5% [12.9-28.3]). VI prevalence
in non-Hispanics (17.0% [16.5-17.5]) was almost identical to the rate for all US adults 65
years and older. Only Cuban-Americans reported rates (14.5% [9.9-20.8]) below the level
for non-Hispanics. Hispanic subgroups with rates higher than non-Hispanics included:
those reporting more than one Hispanic designation (40.3% [25.1-57.6]), Dominicans
(23.8% [15.7-34.5]), Central/South Americans (21.7% [16.3-28.2]), Puerto Ricans (21.1%
[17.5-25.3]) and Mexican-Americans (17.1% [15.1-19.4]).
Conclusions:There is 3-5 fold difference in reported VI rates when comparing race and
ethnic differences in older Americans. American Indians and participants indicating
multiple Hispanic designations report the highest rates of VI. Understudied race/ethnic
groups with higher rates of VI include Dominicans, Central/South Americans, and
Puerto Ricans. Ocular epidemiology studies directed at these subgroups should be
considered.
CR: B.L. Lam, None; K.L. Arheart, None; D.J. Lee, None; D.D. Zheng, None; S.L. Christ,
None; A.J. Caban, None.
Support: NEI Grant R03 EY016481-01A2
332 - B430
Worse Vision Associated With Driving Behaviors, Increases in Driver Errors:
Salisbury Eye Evaluation Driving Study (SEEDS)
333 - B431
Reported Eye Care Utilization Among US Adults: The 1997-2005 National
Health Interview Survey
S.K. West1, B.Munoz1, K.T. Turano1, S.Hassan1, C.Munro2, K.Lyketsos2, K.BandeenRoche3, SEEDS Team. 1Ophthalmology, Johns Hopkins Wilmer Eye Inst, Baltimore,
MD; 2Psychiatry, Johns Hopkins University, Baltimore, MD; 3Biostatistics, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD.
S.Arora1, D.J. Lee2, B.Lam3A, D.D. Zheng3B, K.L. Arheart3B, S.L. Christ4, A.J. CabanMartinez3B. 1Epidemiology & Public Health, University of Miami, Pembroke
Pines, FL; 2Epidemiology & Public Health, University of Miami, Miami, FL;
A
Opthamology & Bascom Palmer Eye Institute, BEpidemiology & Public Health,
3
University of Miami, Coral Gables, FL; 4Department of Sociology, University of
North Carolina, Chapel Hill, FL.
Purpose: to determine the visual and cognitive factors associated with driving
behaviors and driving errors in a cohort of older drivers.
Methods: A cohort of 1425 drivers age 67-87 years was recruited from the Maryland
Vehicle Administration rosters. Visual acuity, contrast sensitivity, and visual fields
were measured using standard procedures. The extent of the attentional visual field
was assessed using a new device, and a cognitive test battery was administered.
Driving behaviors were assessed in real time over a 5 day period, using a Driver
Monitor System developed for this project which was mounted in the participant’s
vehicle. Video, accelerometer and GPS data for each driving episode were obtained
and analyzed for multiple indices of driving behaviors and errors. Parallel parking
was assessed by questionnaire. We report baseline associations with night driving,
parallel parking, and errors in stopping for traffic lights and stop signs.
Results: This cohort in general had good vision and good cognition. Adjusted for
age and sex, those who reported no longer parallel parking were more likely to have
worse scores on cognitive tests of spatial reasoning, and a smaller extent of visual
field (p<.02). Those who did not drive at night were also more likely to have worse
visual fields (p< .003), adjusted for age and sex. Drivers who failed to stop at red traffic
lights were more likely to have a smaller extent of attentional visual field (p<.0031),
although this was not associated with failure to stop at stop signs.
Conclusions: Visual factors are associated with observed and reported driving
behaviors. The extent of the attentional visual fields is associated with some types of
driver errors, which may be important for risk of crashes. Prospective data from this
cohort will be key to predicting driver behavior change, errors, and crash risk.
CR: S.K. West, None; B. Munoz, None; K.T. Turano, None; S. Hassan, None; C.
Munro, None; K. Lyketsos, None; K. Bandeen-Roche, None.
Support: NIA Grant AG023110
Purpose: Rates of eye care utilization (ECU) among US adults are unavailable in many
race and ethnic subgroup categories. This study examines ECU using data representative
of the US population aged 18 years and older.
Method: The National Health Interview Survey (NHIS) is a population-based annual
survey of the US non-institutionalized civilian population. Nearly 290,000 adults 18 years
of age and older participated in the NHIS from 1997-2005. Participants were asked, “Do you
have any trouble seeing, even when wearing glasses or contact lenses?” (mild/moderate
VI), and “Are you blind or unable to see at all? (severe VI). Participants were also asked,
“During the past 12 month have seen or talked to any optometrist, ophthalmologist, or
eye doctor?” Participants were classified as having utilized eye care if they responded
yes to the question. SAS survey procedures were used to compute 1997-2005 pooled eye
care utilization rates adjusted for survey weights and design effects.
Results: The overall ECU rates were 58.3% [95% confidence interval: 55.0-61.5] for severe
VI, 49.6% [48.8-50.4] for some VI, and 33.7% [33.3-34.0] for no VI. Within VI categories the
prevalence of ECU without health insurance was markedly lower for participants (33.3%,
24.7%, and 13.5%), was greater in older versus younger adults, in females versus males,
and in participants with more than a high school education versus adults reporting less
education. There were no large differences in ECU prevalence across US race groups.
Hispanics reporting no VI reported lower rates of ECU relative to non-impaired nonHispanics with the lowest rates reported by Mexican-Americans (17.1%). Compared to
non-Hispanics and other Hispanics, Mexican-Americans with severe VI or some VI
reported the lowest rates of ECU: 46.1% and 36.1%, respectively.
Conclusion: Rates of reported ECU was higher in participants with more severe VI,
older participants, females, and those with higher levels of educational attainment.
Irrespective of VI status, ECU rates are at least 50% lower in adults without health
insurance. Interventions designed to increase the number of men, Mexican-Americans
and those with a high school education or less undergoing routine eye examinations are
warranted. ECU utilization rates would also be improved if the number of Americans
without health insurance could be reduced.
CR: S. Arora, None; D.J. Lee, None; B. Lam, None; D.D. Zheng, None; K.L. Arheart,
None; S.L. Christ, None; A.J. Caban-Martinez, None.
Support: NEI grant R03 EY016481-01A2
330-333
334 - B432
Visual Impairment, Sleep Duration, and Depression: The National Health
Interview Survey
M.Singh1, G.Jean-Louis1, F.Zizi1, D.Lazzaro1, F.McKoy1, M.Dweck1, D.Blanco2.
1
Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY; 2CUNY-City
College, Sophie Davis School of Biomedical Education, New York, NY.
Introduction: In this study, we examined whether the relationship between visual
impairment and depression is mediated by habitual sleep duration.
Method: In our analysis, we used data from the National Health Interview Survey
conducted in 2005. The survey used a cross-sectional, multistage area probability
design to acquire data from U.S. households. A total of 29,818 adults representative
of the non-institutionalized U.S. population (mean age = 48 ± 18 yrs) participated in
the study. Respondents answered questions during face-to-face interviews about
chronic conditions. They also provided sociodemographic data, estimated habitual
sleep duration, and rated depressed moods experienced in past 30 days (low scores
represented greater depression).
Results: Of the sample, 44% were men and 56% were women; Whites and Blacks
represented 85% and 15%, respectively. At the time of the interview, 61% had a job.
Overall, 35% indicated functional limitation due to chronic conditions: 28% reported
hypertension; 8%, heart disease; 8%, cancer; 9%, diabetes; and 23%, arthritis. Ten
percent reported visual impairment even with glasses or lens. The average respondent
slept 7 hrs habitually. Fisher’s Exact test indicated visually impaired individuals were
more likely to report short (≤5 hrs) or long (≥9 hrs) sleep duration [28% vs. 16%; χ2=258,
p<0.0001] than their counterparts. ANOVA results indicated that they were more
depressed [18 ± 3 vs. 16 ± 4; F=1239, p<0.0001]. However, effects of visual impairment
on depression were dependent on habitual sleep duration [F=27, p<0.0001]; individuals
reporting both visual impairment and short/long sleep tended to be more depressed.
The model adjusted for age, sex, and race effects on depression.
Discussion: Individuals with visual impairment experience more depression and
are characterized by a higher prevalence of short and long sleep. Depression is worse
among respondents who reported visual impairment and sleeping unusually less or
more than the population mode.
CR: M. Singh, None; G. Jean-Louis, None; F. Zizi, None; D. Lazzaro, None; F. McKoy,
None; M. Dweck, None; D. Blanco, None.
Support: NIH (1R24MD001090)
334
Sunday, May 6, 2:30 PM - 4:15 PM Hall B/C Poster Session Program Number/Board # Range: 1011-1027 / B986-B1002
148. Epidemiology of Myopia and Refractive Error Organizing Section: CL Contributing Section: AP
1011 - B986
Assess of Thickness of the Fovea and the Peripapillary Retinal Nerve Fiber
Layer in Myopia Using Optical Coherence Tomography
1012 - B987
Detection of Significant Refractive Error With SureSight Vision Screener
S.Lee, S.Jung. Ophthalmology, Yonsei Univ-Wonju Coll of Med, Wonju, Kangwondo,
Republic of Korea.
Purpose: To investigate any changes in thickness of the fovea and the peripapillary
RNFL, according to axial length, corneal power, and degree of myopia.
Methods: Sixty five Korean adults (130 eyes) between 23 and 26 years of age were
selected as the test subjects. Thirty eight test subjects were male, and twenty seven were
female. Anyone having glaucoma or any other identified ocular diseases was excluded
from the test. For all subjects, refractive error, axial length and corneal power were
measured. Patients who scored manifest refraction measurements between 0 to -2D
were classified as group one(emmetropia and low myopia), those who scored between
-2 to -5D were classified as group two (moderate myopia), and those who scored more
than -5D were classified as group three (high myopia). Using the OCT, thicknesses of
the fovea and the peripapillary RNFL were measured for all subjects.
Results: The thickness of the fovea was 142.16 ± 8.99 um in group one (45 eyes), 153.58
± 17.63 um in group two (43 eyes) and 158.86 ± 11.93 um in group three (28 eyes). This
data showed significant differences in thicknesses of the fovea among three groups.
The average thickness of the peripapillary RNFL was 113.29 ± 10.80 um in group one,
103.85 ± 14.48 um in group two and 100.74 ± 9.15 um in group three. A statistically
significant difference between group one and the other two groups (p<0.05) was
identified. As the axial length increased, the thickness of the fovea also increased, yet
the thickness of the peripapillary RNFL decreased(p<0.05). Statistically, there was no
correlation between corneal power and the thickness of fovea. Also no correlation was
found between corneal power and the thickness of peripapillary RNFL.
Conclusions: In this study, as the degree of myopia and axial length increased, the
data demonstrated that the thickness of the fovea also increased, and conversely,
the thickness of the peripapillary RNFL decreased. Therefore, when interpreting
the results of the OCT in the clinic, careful consideration should be given to these
changes associated with myopia.
CR: S. Lee, None; S. Jung, None.
Support: None
M.T. Kulp, Vision in Preschoolers (VIP) Study Group. College of Optometry, The Ohio
State University, Columbus, OH.
Purpose: The Vision In Preschoolers (VIP) Study Group has shown that screening
tests of refraction perform best in identifying significant refractive error in preschool
children. However, the ability of the tests to identify children with specific types of
significant refractive error has not been investigated. The purpose of this study is to
evaluate the ability of the SureSight Vision Screener to detect hyperopia, myopia,
astigmatism, and anisometropia.
Methods: As part of the VIP Study, 1446 Head Start preschool children had refractive
error measured by the SureSight Vision Screener in child mode, followed on a later
day by cycloplegic retinoscopy by a pediatric eyecare professional masked to the
SureSight results. Significant refractive errors on cycloplegic retinoscopy were defined
as: hyperopia >+3.25D in any meridian; myopia > -2.00D in any meridian; astigmatism
> 1.50D between principal meridians; and anisometropia > 1.00D interocular difference
in hyperopia, or > 3.00D interocular difference in myopia, or > 1.50D interocular
difference in astigmatism. The ability of the SureSight measurements to identify each
refractive error was summarized by the area under the receiver operating characteristic
(ROC) curve using all possible cutpoints for defining failure. Detection of refractive
error type was based upon the child’s worse eye and using the following SureSight
results: most positive meridian for hyperopia, most negative meridian for myopia,
cylinder for astigmatism and difference in spherical equivalent for anisometropia.
Results: The mean spherical equivalent was 1.43 D (± 1.52D) and the range was from
-17.00D to +9.50D. The criterion for significant refractive error was met by 168 children
for hyperopia, 25 for myopia, 156 for astigmatism and 94 for anisometropia. Area
under the ROC curve ranged from a high of 0.95 for myopia (95% CI: 0.93 to 0.98) and
astigmatism (95% CI: 0.94 to 0.96) to 0.83 for hyperopia (95% CI: 0.80 to 0.86) to 0.69
for anisometropia (95% CI: 0.63 to 0.75).
Conclusions: Detection of significant refractive error with SureSight Vision
Screener was very good for astigmatism and myopia, good for hyperopia, and fair
for anisometropia.
CR: M.T. Kulp, None.
Support: NEI, NIH, DHHS: U10EY12534, U10EY12545, U10EY12547, U10EY12550,
U10EY12644, U10EY12647, U10EY12648 CT: www.clinicaltrials.gov, NCT00038753
1013 - B988
Myopes With Onset Between 18 and 30 Years of Age Develop Greater Refractive
Error With More Years of University Study
1014 - B989
Optical Coherence Tomography Findings of Highly Myopic Eyes With Posterior
Staphyloma
R.Iribarren, M.F. Cortinez, J.P. Chiappe. Ophthalmology, Centro Medico San Luis,
Buenos Aires, Argentina.
Y.-P.Chen, C.-C.Lai, T.-L.Chen, W.-C.Wu, K.-J.Chen, Y.-S.Hwang, N.-K.Wang, L.Yeung.
Dept of Ophthalmology, Chung Gung Memorial Hosp, Taoyuan Hsien, Taiwan.
Purpose: Myopia prevalence has been found to be increased in populations with
greater academic achievement. In this study we searched for a relationship between
the number of years of University study and the amount of myopic refractive error
developed.
Methods: 1518 refractively unselected consecutive adult office-workers were
studied during the year 2005. They received a subjective refractive examination and
a questionnaire concerning age of onset of lens use, years of University study, and
parental history of myopia. Subjects with myopia onset at University study years were
considered for the analysis (recalled age of onset from 18 to 30 years). The median of
years of University study was 6 years. The refractive error developed was compared
for subjects with high vs. low academic achievement (above or below the median).
Results: The mean age of the whole sample was 43.2 ± 9.8 years, 81.9 % were males,
29.2 % were myopes and 18.1% were hyperopes (± 0.50 diopters criterion). The
prevalence of myopia increased with greater academic achievement: 26.3 % (284/1080)
for subjects with 6 or less years of study, compared to 36.3 % (159/438) for subjects
with 7 or more years of study (p < 0.0001). There were 413 myopes who could recall
their age first prescription, ranging from 3 to 58 years at onset. The median age of
first prescription for this myopic group was 20 years (mean 20.9 ± 9.3 years). In the
group of 220 myopes with onset between 18 and 30 years of age, a difference in the
final refractive error developed in adulthood was observed according to academic
achievement. Those subjects who had studied less than six years had 0.4 diopters less
myopia than those who had studied seven years or more (average refractive error -1,86
± 1,16 for less than 6 years vs. -2,26 ± 1,41 for seven or more years; p = 0,026). Parental
history or age of onset were not related to the amount of refractive error developed.
On the other hand, the 142 subjects who were already myopic at age 17 had on average
a +0.8 significant difference in years studied vs. their emmetropic pairs (6.3 ± 1.9 years
for myopes vs. 5.5 ± 2.0 years for emmetropes, p = 0.00002).
Conclusions: A positive significant association was found between the final myopic
refractive error developed in adulthood and the number of University study years.
Those subjects who had studied more years had greater myopic refractive error. Besides,
myopic subjects tend to be engaged in more years of study than emmetropes.
CR: R. Iribarren, None; M.F. Cortinez, None; J.P. Chiappe, None.
Support: None
Purpose: To describe the clinical features and optical coherence tomography (OCT)
findings of highly myopic eyes with posterior staphyloma.
Methods: A retrospective review of all patients with high myopia (≥-8.0D) and
posterior staphyloma underwent biomicroscopy, OCT examination and met the study
inclusion criteria at the Linkou Chang Gung Memorial Hospital was performed. The
data recorded from the patients included age, gender, refractive status,, best-corrected
visual acuity. The relationships between the presence of macular retinoschisis and
age, refractive error, visual acuity were compared.
Results: 111 eyes of 57 patients (37 female, 20 male), aged from 28 to 80 years (mean,
51.6 years) were included in the study. There were 40 eyes (36.04%) with abnormal
OCT finding that included outer retinoschisis, inner retinoschisis, macular hole, foveal
detachment. 2 cases of macular retinoschisis proceeded with spontaneous resolution
during following up. There were no significant difference between the incidence of
retinoschisis and age (P-value: 0.444, t-Test), refractive status (P-value: 0.600, t-Test)
in these highly myopic eyes.
Conclusions: Macular retinoschisis is not uncommon in highly myopic eyes with
posterior staphyloma and is well demonstrated by OCT. The major cause of decreased
visual acuity was the development of foveal detachment during the follow-up
period.
CR: Y. Chen, None; C. Lai, None; T. Chen, None; W. Wu, None; K. Chen, None; Y.
Hwang, None; N. Wang, None; L. Yeung, None.
Support: None
1011-1014
1015 - B990
Non-Cycloplegic Photorefractive Screening in Pre-School Children With the
Powerrefractor in a Pediatric Practise
1016 - B991
Ocular Biometry in an Adult Malay Population in Singapore: The Singapore
F.Schaeffel, U.Mathis, G.Brüggemann. Section Neurobiology of Eye, University Eye
Hospital, Tubingen, Germany.
C.D. Luu1,2A, T.Y. Wong1,3, T.Aung1,4, P.J. Foster5, D.T. H. Tan1,4, S.M. Saw1,2B. 1Singapore
Eye Research Institute, Singapore, Singapore; ADepartment of Ophthalmology,
B
Department of Community, Occupational and Family Medicine, 2National
University of Singapore, Singapore, Singapore; 3Centre for Eye Research Australia,
University of Melbourne, Melbourne, Australia; 4Singapore National Eye Centre,
Singapore, Singapore; 5Institute of Ophthalmology, University College London,
London, United Kingdom.
Purpose: (1) To describe typical refractive development in preschool children, as
measured non-cyclopleged with a commercial infrared photorefractor. (2) To evaluate
how useful screening for refractive errors might be in a pediatric practise.
Methods: During the standard regular preventive examinations of all young children
in Germany by a pediatrician, 736 children were also measured with the first generation
PowerRefractor (made by MCS, Reutlingen, Germany, but no longer available in this
version). Of those, 172 were also measured with +3D spectacles to find out whether
this would facilitate the detection of hyperopia. Children measured with >2D of
hyperopia or astigmatism, >1.5D of anisometropia, or >1D of myopia in the second
year of life were referred to an eye care specialist. The actions taken by the eye care
specialist were recorded to evaluate the merits of the screening.
Results: The average non-cycloplegic spherical refractive errors in the right eyes
declined about linearly from +0.93D to +0.62D over the first six years (p<0.001) - between
1.5D and 0.5D less hyperopic than in published studies with cycloplegic retinoscopy.
As expected, +3D spectacle lenses moved the refractions into the myopic direction (by
2.41D, SD 0.65D), but this shift was not smaller in those children that were measured
hyperopic with the PowerRefractor. Negative cylinder magnitudes declined from 0.89D to -0.48D (linear regression: p<0.001). Cylinder axes displayed significant mirror
symmetry in both eyes (p<0.001). The average absolute anisometropias (difference of
spheres) declined from 0.37 to 0.23D (linear regression: p < 0.001). Of the 736 children,
85 (11.5%) were referred to an eye care specialist. Of these, 52 received spectacles
(61.2%), 14 (16.4%) were identified as “at risk” and remained under observation, and
18 (21.2%) were considered “false positive”.
Conclusions: Non-cycloplegic photorefraction provided considerably less hyperopic
readings than retinoscopy under cycloplegia. Refractions through binocular +3D
lenses did not facilitate the detection of hyperopia. With the referral criteria above,
11.5% of the children was referred to an eye care specialist, but about every 5th was
judged “false alarm”. This type of screening had some success in identifying children
at risk but the number of false negatives remained uncertain.
CR: F. Schaeffel, None; U. Mathis, None; G. Brüggemann, None.
Support: None
Purpose:To describe the distribution and correlates of ocular biometry in an adult
urban Malay population.
Methods:A population-based, cross-sectional study of Malays aged 40-79 years
residing in Singapore was conducted. Assessments were carried out at a centralized
clinic. Ocular dimensions, including axial length (AL) and anterior chamber (AC) depth
were measured using an optical biometric device (IOL Master). Corneal curvature (CC)
and cycloplegic refraction were measured with an autorefractor, with refraction further
refined subjectively. Lens nuclear opacity was graded clinically using the modified
Lens Opacity Classification System III (LOCS III) score. Analyses were restricted to
phakic subjects and only data from the right eye were presented.
Results:Of the 4,168 eligible participants, 3,280 (78.7%) were examined. Of these, ocular
biometry data were available in 2,869 (87.5%) subjects. After adjusting for age and
height, women had significantly shorter AC depth (3.06mm vs 3.15mm, p=0.003) and
higher LOCS III score (3.18 vs 3.15, p=0.026) than male. The differences in AL (p=0.189),
CC (p=0.786) and refractive status (p=0.577) between gender were not significant. Older
people were more likely to have shorter AL (p<0.001) and AC depth (p<0.001), less
negative refractive error (p<0.001) and higher LOCS III score (p<0.001). No significant
changes in corneal curvature with increasing age were found (p=0.227).
Conclusions:Malay women have shallower AC depth and higher LOCS III score than
men. AL, AC depth and LOCS III score increased with age, but corneal curvature
remained fairly constant across age range. The shorter AC depth in women is consistent
with data on the higher prevalence and incidence of angle-closure glaucoma in
Asian women.
CR: C.D. Luu, None; T.Y. Wong, None; T. Aung, None; P.J. Foster, None; D.T.H.
Tan, None; S.M. Saw, None.
Support: Supported by the National Medical Research Council Grant No 0796/2003
and Biomedical Research Council Grant No 501/1/25-5
1017 - B992
The Associations of Eye Dominance and Laterality With Refractive Error and
Axial Length in Singaporean School Children
1018 - B993
A Study of The Repeatability of Peripheral Refraction Measurements and the
Effects of Spherical Soft Contact Lens Wear (SSCL)
A.Chia1, A.Jaurigue2, G.Gazzard 3, Y.Wang4, D.Tan4, R.A. Stone 5, S.Saw2. 1Paediatric
Services, Singapore National Eye Centre, Singapore, Singapore; 2National
University of Singapore, Singapore, Singapore; 3Institute of Ophthalmology,
UK, United Kingdom; 4Singapore Eye Research Institute, Singapore, Singapore;
5
University of Pennsylvania, Philadelphia, PA.
Y.Liu1A, J.Hsieh1B, C.Wildsoet1A. AVision Science, BOptometry, 1UCBSO, Berkeley, CA.
Purpose: The purpose of this study is to explore effect of dominance and laterality
on refractive error and axial length.
Methods: Eye dominance was assessed using the hole-in-the-card test in 543 children
during their 2006 follow-up visit in the Singapore Cohort study Of the Risk factors
for Myopia (SCORM) study. Data were compared to cycloplegic refractions and axial
lengths measured by ultrasound.
Results: The spherical equivalent refraction was essentially the same between right
and left eyes, although there was a small but statistically significant longer axial
length in right eyes. Right and left eye dominance was noted in 58% and 30% of
subjects, respectively. There was no significant difference in spherical equivalent
refraction [-2.56+/-2.46D (mean +/- standard deviation) versus -2.45+/-2.52D, P=0.22]
or axial length (24.36+/-1.19mm versus 24.32+/-1.18mm, P=0.05) between dominant
and non-dominant eyes. In subjects with anisometropia >0.5D, dominant eyes were
more myopic in 52%. Dominant eyes had less astigmatic power (-0.88+/-0.80D versus
-1.00+/-0.92D, p<0.001). On analyzing changes over the prior 5 years, there was no
significant difference in spherical equivalence but a small increase in axial length in
the dominant eye (1.04+/-0.66mm versus 0.99+/-0.66mm, p=0.01).
Conclusions: Spherical equivalent and changes in spherical equivalent refractions
were not associated with eye dominance, but slightly less astigmatism and minimally
greater increases in axial length were noted in the dominant eye. From a clinical
perspective, the differences in astigmatism and axial length were extremely small,
and eye dominance and laterality had very little effect on refractive error or on
myopic progression.
CR: A. Chia, None; A. Jaurigue, None; G. Gazzard, None; Y. Wang, None; D. Tan,
None; R.A. Stone, None; S. Saw, None.
Support: NMRC/095/2005
Purpose: To examine the reliability of peripheral refraction measurements using Grand
Seiko WR-5100K autorefractor and the effect of SSCL wear on peripheral refractions.
Speculation that peripheral refractive errors may underlie myopia development and
progression motivated this study.
Methods: Peripheral refractive errors were measured out to 40 degrees eccentricity
on fourteen eyes of 8 young adult subjects (mean age: 24.3yr; mean RE: -3.38D), using
Grand Seiko WR-5100K autorefractor. For off-axis locations, subjects viewed one of a
series of red LEDs mounted on a bar at 50cm and spaced at 5-degree intervals; they
were switched on in turn. Measurements were made under very low room illumination;
mydriatic drugs were not used. Two sets of measurements were obtained on the same
day (morning and afternoon), for both uncorrected and SSCL corrected conditions.
Equivalent sphere values (ES) were subject to multivariate regression (y=ax 2+bx+c;
critical p-value of 0.05) and descriptive analyses, adjusting for within-subject
correlation, time of day variation, inter-ocular variability, and SSCL correction.
Results: On average, ES values became more hyperopic with increasing eccentricity.
For eccentricities within ±25 degrees, differences between predicted and recorded ES
values, were neither clinically nor statistically significant after adjusting for possible
confounders. However for eccentricities greater than 25 degrees, both within- and
between-subject variations in measurements increased significantly, pupil size
constraints and CL decentration at extreme gazes being likely contributing factors.
SSCL wear significantly affected the value of the primary coefficient (a), in the model
(p=0.006; a=-0.0003; 95% CI: -0.0055, -0.0013).
Conclusions: The Grand Seiko WR-5100K autorefractor with add-on fixation bar
allowed reliable measurement of peripheral refractive errors out to 25 degrees
eccentricity. The repeatability of measurements at greater eccentricities could be
improved with the use of 2.5% phenylephrine, a mydriatic drug, and tighter fitting
SCLs. SSCLs significantly affected peripheral refractive errors. The effects of other
soft CL designs on peripheral refractions are likely to be different and warrant further
research.
CR: Y. Liu, None; J. Hsieh, None; C. Wildsoet, None.
Support: NIH K12 EY017269
1015-1018
1019 - B994
Association Between Stature and Ocular Biometry and Refraction in an Adult
Population in Rural Myanmar: the Meiktila Eye Study
1020 - B995
Intraocular Pressure, Ethnicity and Refractive Error in the Collaborative
Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Cohort
E.Wu, R.J. Casson, H.S. Newland, J.Muecke, D.Selva. Ophthalmology, South Australia
Institute of Ophthalmology, Adelaide, Australia.
R.E. Manny1, G.L. Mitchell2, S.A. Cotter3, L.A. Jones2, R.N. Kleinstein4, D.O. Mutti2,
J.D. Twelker5, K.Zadnik 2, CLEERE Study Group. 1College of Optometry, University
of Houston, Houston, TX; 2College of Optometry, Ohio State University,
Columbus, OH; 3Southern California College of Optometry, Fullerton, CA;
4
School of Optometry, University of Alabama, Birmingham, AL; 5Department of
Ophthalmology, University of Arizona, Tucson, AZ.
Purpose:To study the association between adult stature and ocular biometric
parameters and refraction.
Methods:In a population-based cross-sectional ophthalmic survey of 2418 adults
(40 years of age and older) living in rural villages in central Myanmar, height and
weight were measured using a standardized protocol, and body mass index (BMI)
was calculated. As part of a comprehensive ophthalmic examination, non-cycloplegic
refraction and corneal curvature were determinated by an autorefractor. Ocular
biometry, including axial length, anterior chamber depth, lens thickness and vitreous
chamber depth as well as were measured using A-mode ocular ultraonography and
corneal thickness was measured with a pachymeter.
Results:There were significant differences in height, weight and BMI between male
and female subjects: as expected, men were taller and heavier (denoted by both
weight and BMI; p < 0.001). Height and weight were significantly correlated with age,
gender, and ocular biometry parameters, except lens thickness. Taller and heavier
persons were more likely to have eyes with longer axial length, deeper anterior and
vitreous chambers, and flatter and thicker corneas than shorter persons. Height was
not significantly correlated with refraction, but heavier persons were more likely to
be less myopic (p < 0.001). In multivariate regression analysis, after adjusting for age
and gender, both height and weight were predictors of axial length, vitreous chamber
length and corneal cuvature.
Conclusions:Adult stature is independently associated with ocular dimensions and
refraction in this population of rural Myanmar.
CR: E. Wu, None; R.J. Casson, None; H.S. Newland, None; J. Muecke, None; D.
Selva, None.
Support: None
1021 - B996
Evaluation of Asthenopia in VDT Users
Purpose: The large ethnically diverse CLEERE cohort provides a unique opportunity
to explore associations between intraocular pressure (IOP), ethnicity and refractive
error (RE) while adjusting for potentially confounding variables.
Methods: Cross-sectional data from the first study visit (1995 to 2003) were used
for 4405 children 6 to 16 years old. IOP was measured by Tono-Pen (Mentor XL), RE
by cycloplegic autorefraction and ethnicity by parent report. Regression methods
were used to examine the relationship of age, RE and ethnicity with IOP. Only IOP
differences that are both statistically significant and clinically meaningful (> 2mm)
are considered relevant.
Results: Differences in IOP among the refractive error groups were noted in models
adjusting for age and ethnicity but all statistically significant differences were less
than 1mmHg (greatest difference = 0.94mmHg with IOP of emmetropes [-0.75 to +1D]
> hyperopes [≥ 2.5D]). Adjusting for RE, IOP varied by age and ethnicity. For Native
Americans, IOP was stable across age with a 0.5mmHg decrease from age 6 to 15. At
age 6, Whites and African Americans had the highest mean IOP (19.31 and 19.03mmHg,
respectively) and Native Americans and Asians the lowest (15.43 and 16.75mmHg,
respectively). IOP decreased with age in African Americans, Whites and Hispanics
(>2.5mm across 8 years) but increased in Asians (>1.5mmHg). By age 12 years the
IOP of Asians was 2.5mmHg higher than Whites and African Americans, 2.7mmHg
higher than Native Americans, and 4mmHg higher than Hispanics.
Conclusions: Cross-sectional analysis of this large and ethnically diverse cohort
showed interesting differences in IOP by age and ethnicity but not by refractive error.
Interactions between RE and age and/or ethnicity may be responsible for previous
reports of associations between refractive error and IOP in children.
CR: R.E. Manny, None; G.L. Mitchell, None; S.A. Cotter, None; L.A. Jones, None; R.
N. Kleinstein, None; D.O. Mutti, None; J.D. Twelker, None; K. Zadnik, None.
Support: NIH/NEI grants U10-EY08893 and R24-EY014792, the Ohio Lions Eye
Research Foundation, and the EF Wildermuth Foundation.
1022 - B997
Prevalence and Associated Factors of Refractive Errors Among Type 2 Diabetics
in Kinmen, Taiwan
M.Bregu, L.Tonini, R.Nuzzi, F.M. Grignolo. Ophthalmology Clinic, Faculty of
Medicine University of Turin, Torino, Italy.
Purpose: In this study we evaluated the possible factors determining asthenopia in
VDT (video terminal) users namely years, number of years, number of hours of VDT
use, refractive status and working environment conditions.
Methods: 500 VDT users answered a questionary covering their medical and
ophthalmological history. All 500 subjects underwent a complete ophthalmological exam
and were asked to grade their perception of asthenopia “0=absent, 1= mild, 2=medium,
3=high”.We divided subjects in 2 groups depending on their refractive status: “A” with no
need of lens prescription or change and “B” who needed lens prescription or change.
Results: Group A presented BCVA (best corrected visual acuity) = 18,4/20 ± 3,2
(SD) in OD and BCVA = 18,6/20 ± 2 (SD) in OS. Group A subjects had: emmetropia
(43 % in OD, 36% in OS), myopia (28% OD, 23% OS), astigmatism (24% OD, 33% OS),
hypermetropia (5% OD, 8% OS). In 80% of subjects in group A the use of VDT ranged
1-15 years, in 6% <1 year, in 6% = 16-20 years, in 8% = 21-25 years (8%). Daily use of VDT
was 1-7 hrs in all subjects of group A with no participant using VDT >1 hr or >7 hrs.
Group B presented BCVA= 15,6/20 ± 2,6 (SD) in OD and BCVA = 15/20 ± 3 (SD) in OS
with prior to adequate correction. Their BCVA after adequate correction was 19/20
± 2 (SD) in OD and 19,4/20 ± 1,2 (SD) in OS. Group B subjects had: myopia (13% OD,
24,5% OS), astigmatism (63,5% OD, 44% OS), hypermetropia (23,5% OD, 31,5% OS).
In 87% of subjects in group B the use of VDT ranged 1-15 years, in 6% <1 year, and 7% did not
answer to this question. Daily use of VDT was 1-7 hrs in 96% and 4% did not answer. Asthenopic
symptoms were various with anxiety, insomnia, asthenia being the most common followed
by headache, nausea, hyperlacrimation, blurred distant and near vision, dyplopia, red eye.
The following conditions were monitored in the working environment: windows, types
of light, protections, VDT screen height compared to the eye level, position of working
desk. No ocular disease was found in any of the subjects during full ophthalmological
exam.
Conclusions: BVCA in group A was significantly better (p= 0,008 in OD, p= 0,003 in
OS) than in group B. VDT use can cause a more significant asthenopia in subjects with
uncorrected or inadequately corrected visual acuity (Group B) than in subjects with
proper correction (Group A) for all degrees of asthenopia reported except for the highest
( 0= p < 0,00005, 1= p < 0,00005, 2= 0,0006, 3 = no statistic differences).BVCA was the
most important factor in reducing asthenopic symptoms of all factors described in our
study (hours and year of VDT use, working environment conditions, systemic and
ophthalmological history).
CR: M. Bregu, None; L. Tonini, None; R. Nuzzi, None; F.M. Grignolo, None.
Support: None
S.Chen1,2, T.-H.Tao-Hsin Tung3, J.-H.Liu 3, A.-F.Lee1, F.-L.Lee1, W.-M.Hsu1, P.Chou2.
1
Ophthalmology, Taipei Veterans General Hosp, Taipei, Taiwan; 2Community
Medicine Research Center & Institute of Public Health, National Yang-Ming
University, Taipei, Taiwan; 3Ophthalmology, Cheng Hsin Rehabilitation Medical
Center, Taipei, Taiwan.
Purpose: A community-based study was conducted to explore the prevalence and
associated factors of refractive errors among Chinese type 2 diabetic population in
Kinmen, Taiwan.
Methods: There were a total of 578 patients (>40 years old) with type 2 diabetes
examined with a complete eye screening including objective autorefraction. Spherical
equivalent refraction of right eyes were reported. Data collected include age, gender,
general medical information and serum biochemistry.
Results: The mean refraction was -0.83 + 2.49 D. Prevalence rates were determined for
myopia (44.1%), hyperopia (24.1%), high myopia (13.0%), and astigmatism (87.8%). Age
is an important factor for all the refractive errors. After adjustment for age, male gender
and >3 grade nuclear opacity appeared to be statistically significant factors for myopia.
For hyperopia, >7% HbA1c was a significant associated factor and for astigmatism,
>200 mg/dl total cholesterol was the risk factor. Multiple linear regression showed
that every increase of one year of age and one percent of HbA1c is associated with
0.04 D (p=0.003) and 0.13D (p=0.04) shift in hyperopia, respectively. Nuclear opacity
with grade 3-4 and grade 5-6 will shift toward myopia of -0.72D (p=0.02) and -5.34D
(p<0.0001) after adjustment for other risk factors.
Conclusions: This study provides epidemiological data on refractive errors in a
Chinese diabetic population in Kinmen, Taiwan. The myopia prevalence is higher
than the reported rates in the general population. This survey further confirmed
that myopia is more prevalent than hyperopia in the diabetic population. Age and
blood sugar shift the refraction toward hyperopia while nuclear cataract reverses it.
Prevention of refractive errors in the diabetes remained a challenge as that correction
will require not only spectacles but medical intervention.
CR: S. Chen, None; T. Tao-Hsin Tung, None; J. Liu, None; A. Lee, None; F. Lee,
None; W. Hsu, None; P. Chou, None.
Support: NSC-92-2320-B-010-102 & VTY90-P5-34
1019-1022
1023 - B998
Prevalence and Risk Factors for Refractive Error in Elderly Singaporean Adults
- The Singapore Longitudinal Ageing Study (SLAS)
G.Gazzard1, C.S. Tan2, Y.-H.Chan 3A, T.-Y.Wong4, M.Niti 5, T.-P.Ng3B, S.-M.Saw3C,6.
1
Glaucoma Research, Institute of Ophthalmology, London, United Kingdom; 2The
Eye Institute, Tan Tock Seng Hospital, National Healthcare Group, Singapore;
3
Yong Loo Lin School of Medicine, National University of Singapore, Singapore;
B
Department of Psychologic Medicine, CDepartment of Community, Occupational
and Family Medicine, 3Yong Loo Lin School of Medicine, National University
of Singapore, Singapore; 4Singapore National Eye Centre, Singapore, Singapore;
5
Department of Psychologic Medicine, Yong Loo Lin School of Medicine,, National
Unversity of Singapore, Singapore; 6Singapore Eye Research Institute, Singapore,
Singapore.
Purpose:To determine the prevalence rates and risk factors for refractive error and
distribution of biometry in a multi-racial elderly population in Singapore.
Methods:A population-based prevalence survey, the Singapore Longitudinal Aging
Study (SLAS), was conducted in residents aged 55 to 85 residing in five districts in
South-Eastern Singapore. Refractive error was determined using a table-mounted
autorefractor (Canon RK-F1; Tokyo, Japan) and biometry using the IOLMaster (Zeiss,
Oberkochen, Germany).
Results:From 3315 eligible people, 2413 (72.8%) were examined and 578 excluded
from this analysis due to prior cataract surgery or inability to obtain a refraction. The
prevalences of myopia (- SE < -0.5D), hyperopia (- SE > +1.0D), astigmatism (cylinder
> -1.0D), and anisometropia (difference > 1.0D) were 30.1% (95% confidence interval
[CI]: 28.0, 32.3), 41.5% (95%CI: 39.2, 43.8), 40.0% (95% CI: 37.7, 42.2), and 21.0% (95%
CI: 19.1, 23.0), respectively. The prevalence of myopia varied significantly with race:
Chinese 30.8%, Indians 22.6% and Malays 18.2% (p=0.04). The prevalences of myopia,
astigmatism and anisometropia were significantly higher for males compared to
females while the reverse was true for hyperopia (all p<0.05). The age pattern of
myopia was bimodal, while the prevalences of both astigmatism and anisometropia
increased with age. The axial length and anterior chamber depths decreased with
age (p’s < 0.001). Males and those with higher educational levels had higher rates of
myopia in multivariate analyses. Hypertension tended to be more hyperopic, but
this relationship was of borderline significance on multivariate analysis (OR 1.2
(95% CI, 0.99, 1.5)).
Conclusions:The prevalence of myopia is high in elderly Singaporeans and the rates are
higher in males and Chinese. The possible link between hypertension and hyperopia
needs further investigation.
CR: G. Gazzard, None; C.S. Tan, None; Y. Chan, None; T. Wong, None; M. Niti,
None; T. Ng, None; S. Saw, None.
Support: Biomedical Research Council 03/1/21/17/214.
1025 - B1000
Mathematical Models of Refractive Distributions Suggest Different Underlying
Mechanisms in Chinese and Western Myopes
F.Thorn. Myopia Research Center, New England Coll of Optometry, Boston, MA.
Purpose: Young infants have a broad Gaussian distribution of refractive errors.
This suggests uncontrolled and relatively independent development of refractive
components. Subsequent leptokurtotic narrowing of the distribution suggests feedback
control driving eyes toward emmetropia. In this study, the nature of subsequent
refractive distribution changes that occur in highly myopic populations are analyzed
to elucidate the processes underlying human myopia development.
Methods: Mathematical models have been developed to describe refractive data from
preschool, illiterate, and highly educated populations. The combination of mean,
variance, leptokurtosis, and skew is used to infer hypothetical mechanisms.
Results: Refractive data from preschool children and illiterate adult populations
show similar narrow, unskewed, highly leptokurtotic refractive distributions with
an emmetropic mean. In contrast, refractive distributions from highly educated
populations of European and ethnic Malaysian descent are leptokurtotic and highly
skewed toward myopia but with little change in the peak value of the distribution.
The refractive distribution of highly educated Chinese populations approaches
bimodality. Half the subjects show a distribution that is similar to Europeans and
Malaysians. However, the other half of the highly educated Chinese population has
a broad Gaussian distribution with a mean of about -4 diopters and SD of 2.5 to 3.0
diopters.
Conclusions: Leptokurtotic refractive distributions in European and Malaysian
populations indicate the presence of refractive feedback control, although a highly
myopigenic environment compromises this control in many individuals. The
bimodality of Chinese refractive distributions suggests two response mechanisms
to a strong myopigenic environment, one similar to Europeans, the other half using
a very different mechanism. The most parsimonious explanation of these results
is that most eyes have a genetic predisposition with variable penetrance levels for
resisting strong myopigenic factors. However, the refractive control response to strong
myopigenic factors follows a different path in half the Chinese eyes.
CR: F. Thorn, None.
Support: NIH Grants EY01191 and EY014817
1024 - B999
The Biometrics, Intraocular Pressure, and Topography in Very High Myopes
C.J. Shen, IV, N.-W.Kuo, V. Department of Ophthalmology, Kaohsiung Veterans
General Hospital,Taiwan, Kaohsiung, Taiwan.
Purpose: The aim of this study was to investigate refractive power, axial length,
topography, and intraocular pressure between very high myopes and nonmyopes .
Methods: 170 very high myopic eyes ( cycloplegic spherical equivalent was more than
-10.0 diopters) and 20 nonmyopic control participants (cycloplegic spherical equivalent
was within ±2.0 diopters ) . Age of them ranged from 20 to 29 years old. They received
a complete ophthalmologic examination, which include measurement of manifest and
cycloplegic refraction, best corrected visual acuity, intraocular pressure, keratometry,
Orbscan topography , and axial length.
Results: The mean spherical equivalent of high myopic group was -11.47 ± 1.38 D and
the mean spherical equivalent of nonmyopic control group was +0.14 ± 1.11 D . The
mean ocular axial length of high myopic group and control group was 28.08 ± 1.05 mm,
24.08± 0.98 mm, respectively. There was significant difference in spherical equivalent
, axial length , mean keratometric power . 3 mm zone-mean keratometric power , and
anterior float refractive power between these two groups. ( Mann -Whitney U test p
< 0.05). There was no significant difference in intraocular pressure, corneal diameter,
corneal thickness, anterior chamber depth, anterior and posterior float refractive
power in topography between these two groups. Furthermore , in high myopes, the
axial length was found to correlate significantly with cycloplegic refraction , mean
keratometric power , and anterior chamber depth, anterior float refractive power in
topography (Pearson correlation <0.05) . But axial length has no significant correlation
either with intraocular pressure, corneal diameter, nor corneal thickness in topography
in very high myopes. There were no significant differences in IOP, and corneal diameter
between the two groups ( T-test: p = 0.37 ;0.19 respectively).
Conclusions: People with very high myopia have longer axial length and steeper
keratometric values. Longitudinal elongation of the posterior vitreous chamber and
the greater corneal curvature contribute to the development of very high myopia.
Axial length plays a major role in the ocular biometry and refraction, but is not the
only main factor contributed to myopic shift. There was no significant difference in
the IOP between the very high myopes and nonmyopes.
CR: C.J. Shen, None; N. Kuo, None.
Support: None
1026 - B1001
Myopia in Children and Objectively-Measured Physical Activity
C.Williams1,2, K.Deere3, S.Leary3, C.Mattocks3, A.Ness3, C.Riddoch4, S.N. Blair5.
1
Ophthalmology, Bristol Eye Hosp, Bristol, United Kingdom; 2Community Based
Medicine, University of Bristol, Bristol University, United Kingdom; 3Social
Medicine, University of Bristol, Bristol, United Kingdom; 4London Sports Institute,
Middlesex University, London, United Kingdom; 5Exercise Science, University of
South Carolina, Columbia, DC.
Purpose: The prevalence of myopia is increasing in several countries. Most research
has concentrated on aetiological factors, ocular co-morbidity and treatments -there
has been little information about non-ocular associations of myopia that might be
important for health and well-being. We present data from an ongoing birth cohort
study regarding the physical activity levels of young myopic individuals.
Methods: Participants were children involved in the Avon Longitudinal Study of
Parents and Children (ALSPAC).The children had autorefraction at 10 years and
physical activity levels measured at 11 years. Physical activity was measured with
an accelerometer for up to 7 days. This instrument provides a continuous objective
measure of physical activity.
Results: Using multiple linear regression and adjusting for age, gender and body
mass index (BMI), children who were myopic at 10 years had lower levels of physical
activity (logged mean number of minutes per day of moderate or vigorous activity)
at 11 years, compared to non-myopic children: (β = -0.156; 95% CI-0.261, -0.051; p =
0.004). Myopic children also had a higher number of minutes per day of sedentary
activity: 15.7 minutes: 95% CI 5.8, 28.6; p = 0.002.
Conclusions: Myopic children in this cohort have lower levels of objectively-measured
physical activity compared to their non-myopic peers. This finding echoes previously
reported indirect accounts of myopic children spending less time on outside or
sporting activities than emmetropic children and it supports the recent hypothesis
that outside activities may be protective against myopia. The data may also suggest
that the current management of myopic refractive error puts children at increased
risk for ill-health associated with sedentary living.
CR: C. Williams, None; K. Deere, None; S. Leary, None; C. Mattocks, None; A.
Ness, None; C. Riddoch, None; S.N. Blair, None.
Support: NIH Grant R01 HL071248-01A1, Wellcome/MRC core grant
1023-1026
1027 - B1002
A Novel Presentation and Therapy for Topiramate Induced Myopic Shift
E.Edell1, S.A. Nissman2, A.Schwartz3. 1Ophthalmology, Georgetown/Washington
Hospital Center Ophthalmology Residency Program, Washington, DC; 2Soll Eye
Associates, Philadelphia, PA; 3Ophthalmology, Washington Hospital Center,
Washington, DC.
Purpose: Topiramate is a common anticonvulsant and migraine medication that has
a previously described side effect of ciliary body swelling with forward rotation of
the lens-iris diaphragm presenting as myopic shift and/or angle closure glaucoma.
This case alerts the clinician to a unique presentation and effective treatment for
this occurrence.
Methods: A 28 year old Caucasian -3.00 myopic woman presented with bilateral
painless blurred vision over several hours. Acuity on presentation was count fingers
OU.
Results: The patient refracted to 20/20 with -16.00 +1.00 x 165 OD and -14.50 +0.50
x014 OS. IOPs were 23 OU. Anterior and posterior exam was unremarkable except for
mild shallowing of the anterior chambers. History revealed tha the patient had started
topiramate 25mg one week previously for migraine prophylaxis and had increased
the dose on the day prior to experiencing her change in vision. Topiramate was
discontinued and she was started on cyclogyl 1% drops tid x 2 days and prednisone
20mg po daily. Her vision gradually improved and was back to baseline within 4 days.
Prednisone was rapidly tapered and she was continued off of topiramate.
Conclusions: To our knowledge, this case represents the largest reported myopic
shift associated with topiramate. Based on the proposed mechanism of ciliary body
swelling with forward rotation of the lens-iris diaphragm, we used cyclogyl to rotate
the diaphragm back and oral prednisone to decrease ciliary body edema. The patient’s
rapid improvement may support this therapy. Large myopic shift without frank angle
closure should alert the clinician to perform a detailed history for the possibility of
topiramate use.
CR: E. Edell, None; S.A. Nissman, None; A. Schwartz, None.
Support: None
1027
Monday, May 7, 8:30 AM - 10:15 AM Grand Floridian H Paper Session
213. Epidemiology and Risk Factors for AMD Organizing Section: CL
1148 - 8:30AM
Glycaemic Index and 10-Year Incidence of Age-Related Macular Degeneration
S.Kaushik1A, J.J. Wang1A, V.Flood1A,1B, E.Rochtchina1A, J.S. L. Tan1A, J.Brand-Miller1B,
A.Barclay1B, P.Mitchell1A, Blue Mountains Eye Study. ADepartment of Ophthalmology
(Centre for Vision Research, Westmead Millennium Institute), BDepartment of
Molecular and Microbial Biosciences, 1University of Sydney, Sydney, Australia.
Purpose: Glycaemic index (0 to 100) ranks carbohydrate foods based on the blood
glucose response to that food compared to 50 grams of glucose. Low glycaemic index
foods (<55) are thought to provide cardiovascular protection. We investigated the
relationship between average dietary glycaemic index and the 10-year incidence of
age-related macular degeneration (AMD) in the Blue Mountains Eye Study cohort.
Methods: Of 3654 baseline participants aged 49+years (1992-4); 2335 (75.1% of survivors)
were re-examined after 5 (1997-9) and 1952 (75.6% of survivors) after 10 years (2002-4).
At each visit retinal photographs were taken and participants completed a detailed
food frequency questionnaire. Glycaemic index was calculated from an Australian
database. AMD was assessed from retinal photos using the Wisconsin Grading System,
and the incidence was confirmed using a side-by-side grading method. Incident early
AMD was defined in subjects without early or late AMD, and incident late AMD was
defined in subjects without late AMD, in either eye at baseline.
Results: Mean glycaemic index of foods consumed in the baseline population was
57 (standard deviation 5), comparable to U.S. studies. Over 10 years, 72 of 2395 at risk
subjects developed late AMD, and 266 of 2255 developed early AMD. After controlling
for age, gender, smoking, history of heart disease, white cell count and consumption
of fish, anti-oxidants and either carbohydrates or fats, participants within the highest
quartile of energy-adjusted glycaemic index (compared to the lowest quartile) had an
increased risk of incident early AMD (risk ratio, RR, 1.69, 95% confidence interval, CI,
1.05-2.72), or indistinct soft or reticular drusen (RR, 1.65 CI, 1.01-2.80). Participants
consuming the highest quartile of breads and cereals (predominantly low glycaemic
index foods like oatmeal and wholemeal/grain breads) had a lower risk of incident
early AMD (HR, 0.86, CI, 0.75-0.98). Glycaemic index was not associated with incident
late AMD. Excluding persons with diabetes did not alter results.
Conclusions: Eating higher glycaemic index foods predicted the development of
early AMD, independent of other AMD risk factors, whereas eating lower glycaemic
index foods was protective against early AMD. The glycaemic index of foods provides
another potential area for dietary advice for patients at risk of AMD.
CR: S. Kaushik, None; J.J. Wang, None; V. Flood, None; E. Rochtchina, None; J.S.L.
Tan, None; J. Brand-Miller, None; A. Barclay, None; P. Mitchell, None.
Support: Australian RADGAC grant (1992-94) and NHMRC grant 932085, 974159,
211069
Program Number Range: 1148-1154
1149 - 8:45AM
Dietary Omega -3 Fatty Acids and Neovascular Age Related Macular
Degeneration: The Eureye Study
C.Augood1, U.Chakravarthy2, P.T. V. M. de Jong3, M.Rahu4, J.Seland 5, G.Soubrane 6,
L.Tomazzoli7, F.Topouzis8, J.Vioque9, A.E. Fletcher10. 1Epidemiology & Population Hlth,
London Sch of Hygiene & Trop Med, London, United Kingdom; 2Ophthalmology
and Vision Science, Queen’s University Belfast, Belfast, United Kingdom;
3
Netherlands Institute for Ophthalmic Research, Amsterdam, The Netherlands;
4
National Institute for Health Development, Tallinn, Estonia; 5Haukeland Sykehus,
University of Bergen, Norway; 6Clinique Ophthalmologique Universitaire de
Creteil, Paris-Creteil, France; 7Clinica Oculistica, Universita degli studi di Verona,
Verona, Italy; 8II Department of Ophthalmology, Aristotle University, Thessaloniki,
Greece; 9Dpto Salud Publica, Universidad Miguel Hernandez, Alicante, Spain;
10
Epidemiology & Population Health, London School of Hygiene & Tropical
Medicine, London, United Kingdom.
Purpose: To investigate whether oily fish and omega-3 fatty acids (docosahexaenoic
acid- DHA- and eicosapentaenoic acid -EPA) in the diet of European elderly people is
associated with neovascular age-related macular degeneration (NV-AMD).
Methods: Participants in the seven country EUREYE study underwent fundus
photography, and completed a food frequency questionnaire. Questionnaire data
were converted to nutrients (including EPA and DHA) using food composition tables
and adjusted for total energy intake. Survey logistic regression was used to investigate
the association of quartiles of EPA or DHA with NV-AMD.
Results: Dietary intake data and fundus images were available in 105 cases with
neovascular AMD and in 2173 controls without any features of early or late AMD. In
confounder adjusted analyses, eating oily fish at least once a week compared with less
than once a week was associated with a halving of the odds of NV-AMD (OR=0.47,
95%CI 0.33-0.69, p=0.003). Compared to the lowest quartile there was a significant
trend for decreased odds with increasing quartiles of either DHA or EPA. Odds ratios
in the highest quartiles were OR=0.32, 95%CI 0.12-0.90, p=0.04 for DHA and OR=0.29,
95%CI 0.12-0.74, p=0.02 for EPA.
Conclusions: Regular consumptions of marine oils may protect against neovascular
AMD in older individuals.
CR: C. Augood, None; U. Chakravarthy, None; P.T.V.M. de Jong, None; M. Rahu,
None; J. Seland, None; G. Soubrane, None; L. Tomazzoli, None; F. Topouzis, None; J.
Vioque, None; A.E. Fletcher, None.
Support: European Commission (QLK6-CT-1999-02094), Macular Disease Society
UK, Thomas Pocklington Trust
1150 - 9:00AM
Dietary Fat and the Risk for Age-Related Maculopathy: The POLANUT Study
1151 - 9:15AM
Dietary Antioxidants and Risk Factors for Age-Related Maculopathy
C.DelCourt1, I.Carrière2, J.-P.Cristol3, A.Lacroux4, M.Gerber5, POLANUT Study Group.
1
Inserm U593, Universite Victor Segalen Bordeaux 2, Bordeaux, France; 2Inserm
E361, Universite Montpellier I, Montpellier, France; 3Biochemistry Laboratory,
Lapeyronie University Hospital, Montpellier, France; 4UR04 Epidemiologie et
Prevention, IRD, Montpellier, France; 5Inserm- CRLC, Cancer Research Center,
Montpellier, France.
E.D. O’Connell1, S.Beatty2, J.Stack 3A, J.Nolan3B, Macular Pigment Research Group.
1
Department of Ophthalmology, Mater Misercordia Hospital, Dublin 7, Ireland;
2
Department of Ophthalmology, Waterford Regional Hospital, Waterford, Ireland;
A
Department of Physical and Quantitative Science, BDepartment of Chemical and
Life Science, 3Waterford Institute of Technology, Waterford, Ireland.
Purpose: This study aimed at assessing the associations of dietary fat with the risk
of age-related maculopathy (ARM), in the framework of a population-based study
from Southern France.
Methods: Nutritional data were collected using a dietitian-administered foodfrequency questionnaire in 832 subjects aged 70 years or more of the POLA (Pathologies
Oculaires Liées à l’Age) cohort Study. ARM was classified from retinal photographs
using the international classification and included neovascular age-related macular
degeneration, geographic atrophy, soft indistinct drusen and soft distinct drusen
associated with pigmentary abnormalities.
Results: After adjustment for age, gender, body mass index, smoking and self-reported
cardiovascular disease, subjects in the highest quintile of energy-adjusted total,
saturated and monounsaturated fat (MUFA) intake were associated with increased
risk for ARM (OR= 4.74, 95 % confidence interval (CI) : 1.32 - 17.0, p for trend=0.007;
OR=2.70, 95 % CI :0.94 - 7.7, p for trend=0.04 and OR= 3.50, 95 % CI : 1.09 - 11.2, p for
trend=0.03, respectively), by comparison with subjects in the lowest quintile. Total
polyunsaturated (PUFA) was not significantly associated with ARM (OR=1.02, 95 %
CI: 0.29 - 3.53, p for trend=0.94). After adjustment for potential confounders and total
fat intake, total and white fish intake were not significantly associated with ARM (OR=
0.97, 95 % CI : 0.41 - 2.31, p for trend=0.84 ; OR= 1.41, 95 % CI: 0.65 - 3.04, p for trend=
0.40), but fatty fish intake (more than once a month versus less than once a month)
was associated with a 60 % reduction in risk for ARM (OR=0.42, 95 % confidence
interval: 0.21 - 0.83, p=0.01).
Conclusions: Our study is consistent with increased risk of ARM in subjects with
high dietary intake of fat, and in particular high MUFA intake. The risk for ARM
was reduced in subjects consuming fatty fish more than once a month, suggesting a
potential protective effect of long-chain ω3 PUFA.
CR: C. DelCourt, Chauvin-Bausch&Lomb, DSM Nutritional Products, C; I. Carrière,
None; J. Cristol, None; A. Lacroux, None; M. Gerber, None.
Support: Laboratoires Théa, France
Purpose: There is a growing body of evidence that oxidative stress is aetiologically
important in the pathogenesis of age-related maculopathy (ARM), and that appropriate
antioxidants of dietary origin may protect against this condition. Risk factors for
ARM may be classed as established or putative, and we report a study designed to
investigate whether such risk factors are associated with a dietary lack of antioxidants
important for retinal health.
Methods: Dietary, anthropometric and demographic details relating to 828 healthy
Irish subjects, aged 20 to 60 years, were recorded in a cross-sectional fashion, and
analysed for associations between risk factors for ARM and dietary intake of nutrients
relevant to ocular health.
Results: Of the established risk factors for ARM, increasing age was associated with a
relative lack of dietary zeaxanthin (Z) (P<0.05) and tobacco use with a relative lack of
dietary vitamin C (P<0.05). Of the putative risk factors for ARM, alcohol consumption
was associated with a relative lack of dietary α-linoleic acid (ALA) (P<0.05), female
gender with a relative lack of dietary zinc (P<0.05), hypercholesterolaemia (selfreported) with a relative lack of dietary vitamin A (P<0.01) and of dietary zinc (P<0.05)
and blue irides with a relative lack of dietary lutein (L) (P<0.05).
Conclusions: We have demonstrated that several variables related to risk for ARM
are associated with a relative dietary lack of key nutrients. Our finding that age, the
most important and universal risk factor for ARM, is associated with a relative lack
of dietary Z, is an important finding which warrants further investigation.
CR: E.D. O’Connell, None; S. Beatty, None; J. Stack, None; J. Nolan, None.
Support: Fighting Blindness
1148-1151
Monday, May 7, 8:30 AM - 10:15 AM Grand Floridian H Paper Session
213. Epidemiology and Risk Factors for AMD Organizing Section: CL
1152 - 9:30AM
Folic Acid Plus B-Vitamins and Age-Related Macular Degeneration in a
Randomized Trial in Women
1153 - 9:45AM
W.G. Christen1, R.J. Glynn1, E.Y. Chew2, J.E. Manson1. 1Medicine, Brigham & Womens
Hosp/Harvard, Boston, MA; 2National Eye Institute, Bethesda, MD.
Purpose: To examine incidence of age-related macular degeneration (AMD) in a
randomized trial of folic acid/vitamin B6/vitamin B12.
Methods: The Women’s Antioxidant and Folic Acid Cardiovascular Study was a
randomized, double-blind, placebo-controlled trial of antioxidant vitamins and a folic
acid/vitamin B6/vitamin B12 combination in the prevention of cardiovascular (CVD)
events among female health professionals aged 40 years or older with preexisting CVD
or 3 or more CVD risk factors. A total of 8,171 women were randomized to vitamin E,
vitamin C, beta carotene, or placebos. Of these, 5,442 women were also subsequently
randomized to folic acid (2.5 mg/d), vitamin B6 (50 mg/d), and vitamin B12 (1 mg/d),
or placebo; 5,205 of these women did not have a diagnosis of AMD at baseline and were
included in this analysis. Main outcome measures were confirmed AMD, defined as a
self-report supported by medical record evidence of an initial diagnosis subsequent
to randomization, and AMD with vision loss, defined as confirmed AMD with vision
to 20/30 or worse attributable to this condition.
Results: During an average of 7.3 years of treatment and follow-up, a total of 137 cases
of AMD were documented, including 69 cases responsible for vision loss to 20/30 or
worse. For the endpoint of confirmed AMD, there were 55 cases in the folic acid/B6/B12
group and 82 in the placebo group (relative risk [RR], 0.66; 95% confidence interval
[CI], 0.47-0.93; p=0.02). For AMD with vision loss, there were 26 cases in the folic
acid/B6/B12 group and 43 in the placebo group (RR, 0.60; 95% CI, 0.37-0.98; p=0.04).
Conclusions: These randomized trial data from a large cohort of women with CVD
indicate that seven years of daily supplementation with folic acid/B6/B12 may reduce
the risk of AMD.
CR: W.G. Christen, None; R.J. Glynn, None; E.Y. Chew, None; J.E. Manson,
None.
Support: NIH Grants HL46959 and EY06633. B-vitamin pills and placebos were
provided by BASF. CT: www.clinicaltrials.gov, NCT00000161
Risk Factors for Choroidal Neovascularization and Geographic Atrophy in the
Complications of Age-related Macular Degeneration Prevention Trial (CAPT)
G.-S.Ying1, J.Folk 2, CAPT Research Group. 1Ophthalmology, Scheie Eye Institute,
University of Pennsylvania, PA; 2Ophthalmology & Visual Sciences, University of
Iowa Hospitals & Clinics, Iowa City, IA.
Purpose: To identify baseline participant and ocular risk factors for choroidal
neovascularization (CNV) and geographic atrophy (GA) in CAPT participants.
Methods: 1052 participants with >= 10 large drusen (>125µ) and VA >= 20/40 in
each eye participated with one eye randomly assigned to laser treatment and the
contralateral eye to observation.
At baseline, participants provided demographic information, history of diabetes
mellitus and cigarette smoking, use of anti-hypertension medications. Blood pressure
(BP) was measured. Trained readers evaluated color photographs for baseline drusen
characteristics and pigmentary abnormalities. During follow-up, readers identified
CNV (leakage on fluorescein angiography) and endpoint GA (> 1 DA combined area on
color photographs). Estimates of relative risks (RR) and 95% confidence intervals (95%
CI) were obtained from univariate and multivariate survival analysis of observed and
treated eyes, considered separately and combined with treatment as a covariate.
Results: CNV developed in 141 treated eyes and 141 observed eyes. Statistically
significant risk factors in the multivariate model for observed eyes were current
smoking vs. never [1.89 (1.03, 3.47)] and definite hypertension vs. none [1.55 (1.07, 2.25)].
For treated eyes, older age [5.98 (1.66, 15.0) for >79 vs. <60 yrs], current smoking vs.
never [1.95 (1.00, 3.81)], and focal hyperpigmentation >=250u vs. none [2.25 (1.34, 3.79)]
were significant risk factors. When both groups were combined, older age, current
smoking, hypertension, and focal hyperpigmentation were significant risk factors.
GA developed in 74 treated eyes and 78 observed eyes. Statistically significant risk
factors in the multivariate model for observed eyes were older age [1.59 (1.19, 2.12)
for every 10 years increase], greater retinal area covered by drusen (>63µ) 8.44 (4.31,
16.5) for >25% vs. <10%], retinal pigment epithelium (RPE) depigmentation vs. none
[2.63 (1.27, 5.44)], and focal hyperpigmenation [9.49 (3.41, 26.4) for >=250µ vs. none].
Similar associations were seen in the analyses for treated eyes only and for both
eyes combined.
Conclusions: Among CAPT participants with >=10 large drusen in each eye, risk
factors for CNV differed from those for GA. Cigarette smoking and hypertension
were associated with CNV only, while percent of retinal area covered by drusen and
RPE depigmentation were associated with GA only.
CR: G. Ying, None; J. Folk, None.
Support: EY12279, EY12211
1154 - 10:00AM
Variants of the CFH Gene, Smoking and the Risk of Early and Late Age-Related
Maculopathy
A.Farwick1A, D.Pauleikhoff 2, M.Stoll1B, H.W. Hense1A. AInstitute of Epidemiology
and Social Medicine, BLeibniz-Institute of Atherosclerosis Research, 1University
Muenster, Muenster, Germany; 2Ophthalmology Department, St. Franziskus
Hospital, Muenster, Germany.
Purpose:Numerous genetic variants within the Complement Factor H (CFH) gene
have been shown to be associated with established age-related macular degeneration
(AMD), i.e. geographic atrophy (GA) or neovascularisation (CNV). Less is known
about the genetic associations with maculopathy (ARM), i.e. drusen and/or pigment
abnormalities, the interaction between the different variants on risk, and about
potential environmental modifiers.
Methods:We investigated these questions in a large cohort of patients with ARM (N
= 440), AMD (n = 278) and controls (n = 177) from the Muenster Aging and Retina
Study (MARS) in which all phenotypes were assigned after standardised grading of
digital fundus photos. We genotyped all patients for CFH-SNPs: rs1061170, rs2274700
and rs1292487.
Results:We observed that both, rs10611770 and rs2274700, significantly increased
the risk of ARM in heterozygous (each OR = 1.9) and homozygous patients (OR
5.6 and 4.3, respectively). The AMD risk was substantially raised: OR = 2.0 and 1.9
for heterozygous 6.9 and 5.9, resp., in homozygous patients. Both SNPs were more
strongly associated with CNV than GA, and only for CNV we found a significant
risk increment due to smoking (homozygous smokers OR = 7.9 and 13.7, resp.; p <
0.0001). Furthermore, patients homozygous for both risk variants (30% of ARM and
35.4% of AMD) showed an 8.2-fold risk of ARM and 10.9 times higher risk of AMD
compared to people carrying only the wild-types. By contrast, rs1292487 showed a
significant and clear protective effect on both ARM and AMD (ORs from 0.73 to 0.19),
in particular among the homozygous.
Conclusions:Our results indicate that several CFH variants are associated with early
and late disorders of the ageing macula. The association is particularly pronounced for
the occurrence of CNV, and smoking seems to confer substantial risk increments. The
two risk variants act in a synergistical way and generate a cumulative risk of AMD.
However, there are also less common variants which confer protection against the
ageing disorders of the macula.
CR: A. Farwick, None; D. Pauleikhoff, None; M. Stoll, None; H.W. Hense, None.
Support: HE 2293/5-1/2/3
1152-1154
Monday, May 7, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 1163-1182 / B9-B28
215. Visual Function and Quality of Life I Organizing Section: CL
1163 - B9
Poor Contrast Sensitivity Predicts Subsequent Visual Acuity Loss in Patients
Referred for Vision Rehabilitation
1164 - B10
Impact of Long-Term Diabetic Control and Short-Term Acute Changes in Blood
Glucose Levels on the Visual Function of Diabetic Patients
M.Jackson1,2, K.Bassett3, E.Sayre4. 1Ophthalmology, Massachusetts Eye and Ear
Infirmary, Harvard, Boston, MA; 2Ophthalmology, VIHA, Victoria, BC, Canada;
3
Ophthalmology, University of British Columbia, Vancouver, BC, Canada;
4
Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby,
BC, Canada.
H.L. Workman1, S.L. Hosking1,2, B.Huntjens3, C.O’Donnell3. 1Aston Academy of Life
Sciences, School of Life and Health Sciences, Aston University, Birmingham,
United Kingdom; 2Department of Optometry and Visual Science, City University,
London, United Kingdom; 3Department of Optometry, University of Manchester,
Manchester, United Kingdom.
Purpose:To determine the association between measured contrast sensitivity at
baseline and change in measured acuity between baseline and one year follow-up in
patients referred for vision rehabilitation.
Methods: 225 patients were enrolled in a one year prospective cohort study. Measured
parameters included age, gender, acuity, contrast sensitivity, falls, hallucinations,
depression, independence and time-trade.
Results:After one year 19 were deceased, 54 were lost to follow-up and 152 patients
were seen in follow-up. At baseline 33% of patients had > 6/18 acuity, no patients
had > log 1.65 contrast sensitivity measured with Pelli-Robson chart and 52% had
measured contrast sensitivity better than log 0.75. Considering log contrast sensitivity
as a dichotomous variable (better than 0.75) measured contrast sensitivity at baseline
was a significant predictor of subsequent change in visual acuity at one year. Odds
ratio was 0.349 (95% confidence interval 0.144, 0.849) adjusting for baseline visual
acuity (by quartiles), gender, age, falls, depression and hallucinations.
Conclusions:Poor contrast sensitivity is a significant predictor of subsequent loss of
acuity in patients undergoing vision rehabilitation.
CR: M. Jackson, None; K. Bassett, None; E. Sayre, None.
Support: CNIB E.A. Baker Applied Research Grant
Purpose: To determine the impact of long-term diabetic control and acute fluctuations
in blood glucose levels on the visual function of patients with diabetes.
Methods: Two study groups were recruited: Group 1 comprised 20 Type 1 diabetic
patients (mean age 37.9±15.39y: range 17-66y). Group 2 comprised 21 Type 2 diabetic
patients (mean age 56.33±11.09y: range 37-72y). Patients attended 6 visits at 2 hourly
intervals over a 12h period. Blood samples were collected at the first visit to determine
haemoglobin (HbA1c) levels; blood glucose levels (Hemocue 201+), visual acuity (100%
and 10% logMAR), contrast sensitivity (Pelli Robson), central visual fields (Humphrey
Field Analyser Program using 10-2 white-on-white and 10-2 short wavelength
automated perimetry (SWAP)), were measured at each visit. A simultaneous regression
model was used to explore the relationship between test parameters and predictor
variables: type of diabetes, haemoglobin levels, duration of diabetes and glucose level
for each visit. Mixed between-within subject ANOVA and post-hoc analysis assessed
variation in test parameters over time for both groups.
Results: A significant multiple regression model emerged for contrast sensitivity only
at visits 1, 2, 3 and 4 (p=0.023, p=0.022, p=0.020 and p=0.043 respectively) with HbA1c
making the largest statistically significant contribution in explaining the variance
in contrast sensitivity (β= -0.455, p=0.005; β= -0.534, p=0.002; β= -0.565, p=0.001, β=
-0.591, p=0.003 respectively). A similar trend was observed for visits 5 and 6 with
HbA1c being the only significant predictor within the model (β= -0.520, p=0.006 and
β= -0.445, p=0.009 respectively). Statistical differences occurred over time for reduced
contrast (10%) logMAR acuity (p=0.030), Pelli Robson contrast sensitivity (p=0.000)
and SWAP visual fields MD (p=0.023). However, 100% logMAR acuity, white-on-white
perimetry (MD and PSD) and SWAP PSD were unaffected.
Conclusions: Long-term metabolic control impacts the visual function in diabetic
patients with an inverse relationship exhibited between contrast sensitivity scores
and HbA1c levels. Acute changes to blood glucose levels result in fluctuations of
visual function in diabetic patients and should be considered when interpreting
clinical examination.
CR: H.L. Workman, None; S.L. Hosking, None; B. Huntjens, None; C. O’Donnell,
None.
Support: None
1165 - B11
Patient Knowledge of Physician Responsibilities and Training in Three
Ophthalmology Clinics and Their Preferences for Care
1166 - B12
Associations of Reading Speed and Error Rates on the SKRead Test With PRL
Eccentricity and Scotoma Location
R.Guffey, M.S. Juzych, S.Wolfe, S.Lim, A.Gupta. Ophthalmology, Kresge Eye Institute,
Wayne State University School of Medicine, Detroit, MI.
U.K. Nair1,2, M.E. Schneck 2, D.C. Fletcher1,2. 1Ophthalmology, California Pacific
Medical Center, San Francisco, CA; 2Smith-Kettlewell Eye Research Institute, San
Francisco, CA.
Purpose: Good patient knowledge of physician responsibilities and training is
important for effective communication and a strong doctor-patient relationship.
Previous studies show that there is poor patient knowledge of physician training in
teaching hospitals. This could be negatively impacting patient compliance, malpractice
rates, and general satisfaction with their care. This study endeavors to determine how
well our patients know the hierarchy of a teaching hospital, what factors influence
their knowledge, its distribution across three different patient populations, and how
our patients feel about their role in training physicians.
Methods: Cross-sectional survey in three Ophthalmology clinics at the Detroit Medical
Center, in July 2006. Demographics, number of clinic visits, and objective questions
about the training and responsibilities of medical students, residents, and attending
doctors were asked, as well as subjective questions about patient comfort with being
treated by physicians in training. Objective Score was correlated with subjective
Comfort Score and demographics using ANOVA analysis.
Results: A total of 312 surveys were completed. 56% of questions were answered
correctly. Higher education was the most significant factor for increased Score on the
objective portion (p < 0.0001). Patients have a higher subjective Comfort Score, and
accordingly are significantly more comfortable with physicians in training (residents),
if they score higher on the objective section (p = 0.001). This relationship is independent
of education in high school educated participants. Clinic site (p = 0.03), presence of
higher education (p = 0.04), and number of visits (p = 0.02) are also significant factors
for increased comfort with physicians in training.
Conclusions: Patients have poor knowledge of the training and hierarchy of medical
students, residents and attending doctors. Increased patient knowledge is the most
significant factor for increased patient comfort with treatment by physicians in training.
Number of visits, clinic site and higher education are also significant factors for comfort
with treatment by physicians in training.
CR: R. Guffey, None; M.S. Juzych, None; S. Wolfe, None; S. Lim, None; A. Gupta,
None.
Support: None
Purpose: To compare reading times and error rates of the Minnesota Reading Acuity
(MNRead) and the Smith-Kettlewell Reading Test (SKRead) and study associations with
preferred retinal locus (PRL) eccentricity and scotoma location relative to the PRL.
Methods: 72 better seeing eyes of 72 patients with age-related macular degeneration
(AMD) had MNRead, SKRead and visual acuity (VA) testing performed in their initial
low vision evaluation. The SKRead chart utilizes the same 60 character per font size
format as the MNRead chart but instead of sentences uses random words and letters
designed to impede cognitive correction of errors. Reading speed and errors were
recorded for each test. Scanning laser ophthalmoscope (SLO) macular function testing
was also performed and PRL distance from the fovea was recorded. If scotomas were
present, these were noted to be either vertical, to the left, or to the right of the PRL.
Results: Median VA was 20/113. Age median/ range was 84/ 73-97. As expected,
reading speeds were lower (28.2 vs. 8.4 seconds/ 60 character block) and error rates
(errors/ 60 character block) were higher (2.9 vs 0.4) for the SK Read than the MN
read. This was true for all scotoma locations. Error rate and PRL eccentricity were
more strongly associated on the SKRead (0.64 characters/deg; R2 = 0.25) than on the
MNRead (0.11 characters/deg; R2 = 0.14). When a right-sided scotoma was present,
fastest reading times were significantly slower (t-test) on the SKRead (38.8 s) compared
with vertical/no scotomas (17.0 s) and left-sided scotomas (20.0 s). Visual acuity did
not differ among these groups. Further, reading speed did not differ between those
with right scotomas and those with combined right and left scotomas.
Conclusions: As previously found for those with normal vision, low vision patients
read more slowly and make more errors when reading random text, compared
with continuous text. With increasing PRL eccentricity, low vision patients make
more mistakes when reading random text; this finding is much less pronounced
for continuous text. Right-sided scotomas significantly hinder reading more than
scotomas in other locations.
CR: U.K. Nair, None; M.E. Schneck, None; D.C. Fletcher, None.
Support: Pacific Vision Foundation
For permission to reproduce any abstract, contact the ARVO Office at [email protected]. Commercial Relationships are noted at the end of each abstract by “None” or with codes.
1163-1166
1167 - B13
Contribution of Costs From Lost Productivity of Carers to Eye Care Costs
1168 - B14
Long-Term Visual Results and Post-Operative Patient Management Factors of a
Telescope Prosthesis for End-Stage AMD
J.E. Keeffe, E.L. Lamoureux, S.-L.Chou. Ophthalmology, Centre for Eye Research
Australia, University of Melbourne, East Melbourne, Australia.
Purpose: To enumerate the costs of carers for vision impaired people, a cost contributing
a significant proportion of total direct and indirect costs of vision impairment.
Methods: The time provided by carers were recorded daily in diaries over a period
of 12 months by adults with impaired vision recruited from eye clinics, rehabilitation
agencies and consumers groups. Times were recorded under headings of health care,
home help, outings and access to information and participation in activities. Costs
were computed by using the opportunity cost method multiplying times in hours by
the national average hourly wage rate.
Results: Their mean age of the 118 eligible participants (62.7% female) was 65 (±19.7) yr.
Most of the participants (56%) had severe vision impairment (<6/60) in the better eye
and the most common cause of vision loss was age-related macular degeneration (43%).
The mean duration of vision impairment was 17.5 (±18) yr. 73% of the participants had
other non-ocular comorbidity although 67% indicated it had little or no interference
on their lives. 90% (n=106) of the participants used carers and the three highest yearly
median utilisation rates were 42 (3-528), 21 (1-656) and 18 (1-188) for health care,
transport and personal affairs, respectively although the greatest time was used for
vision-related assistance to access information and participate in activities in and
outside the home. The median yearly amount of time a vision impaired person relies
on carers is 81.3 hr (0.6-850) (~ 2 working weeks of carers’ time). In particular, carers
spend time attending to personal affairs and transport (median= 35 (0.5-597) and 32
hrs (0.6-650), respectively). The median yearly total cost of carers was $915.00 (range=09,563). There was no effect for age, gender, other non-ocular co morbidity, the effect
of other non-ocular co morbidity, living conditions or private health insurance on the
utilization rate of the any of the eight categories of informal care and support.
Conclusion: Restoring vision or enhancing independence through eye care or vision
rehabilitation should contribute significant savings in the costs of vision impairment
but also increase possible productive time available for the person with impaired
vision and the carer.
CR: J.E. Keeffe, None; E.L. Lamoureux, None; S. Chou, None.
Support: Australian Research Council, Vision Australia
S.A. Primo, R.D. Stulting, IMT-002 Study Group. Ophthalmology, Emory University
Eye Center, Atlanta, GA.
Purpose: To evaluate visual acuity and visual rehabilitation after implantation of a
telescope prosthesis in patients with bilateral untreatable, end-stage AMD.
Methods: 217 patients aged 55 and older with bilateral disciform (no active CNV) or
atrophic AMD and best spectacle-corrected visual acuity (BSCVA) 20/80 to 20/800 were
enrolled in this prospective, multi-center trial. Patients were required to demonstrate
a 5 letter minimum improvement in BSCVA on the ETDRS chart with an external
telescope. 206 patients were successfully implanted with the telescope prosthesis
(IMT™ by Dr. Isaac Lipshitz, VisionCare, Saratoga, CA). Patients were treated and
managed by a multi-disciplinary team that included a retina specialist, anterior
segment surgeon, and low vision practitioner. Per study protocol, 6 visual rehabilitation
sessions were conducted during the first 3 months after surgery. Outcome measures
included change in BSCVA, NEI VFQ-25, and Activities of Daily Life (ADL) scores.
Fellow eyes served as controls.
Results: Mean baseline BSCVA was 20/316 at distance and 20/250 at near. At two years,
distance and near BSCVA improved 3.15 and 2.9 lines from baseline in implanted eyes
compared to 0.5 and 1.7 lines, respectively, in fellow eye controls (p<.0001). NEI VFQ25 scores improved significantly from baseline (p<.01) on 7 of 8 relevant subscales
at one-year. Statistically significant improvements were also observed in all ADL
subscales. 8/206 (3.9%) telescope prostheses were explanted due to device failure
(2), corneal decompensation (2), and patient dissatisfaction (4). Patient education
was important when near activity low vision aids were required in conjunction with
the telescope-implanted eye (patients require reduced magnification and use more
optimal working distance); to optimize ability to alternate eye viewing for central
and peripheral visual tasks; to understand depth perception cues; and locate optimal
eccentric viewing position if necessary.
Conclusions: Long-term results demonstrate this telescope prosthesis is effective in
improving both visual acuity and quality of life in patients with end-stage AMD. The
device works synergistically with existing visual rehabilitation practices; however,
pre-operative expectation management and post-operative visual rehabilitation are
important to assure successful outcomes with the prosthetic telescope.
CR: S.A. Primo, None; R.D. Stulting, Paid Medical Consultant, C.
Support: None
1169 - B15
Comparison of Standard and Modified Procedures for Measuring LogMAR
Visual Acuity Using Four Visual Acuity Charts
1170 - B16
Validation of Face Fields for Determining Fixation Location in Eyes With
Central Scotomas From Macular Disease
A.Pathak, D.Ah-Kine Ng Poon Hing, J.Vaidhyan, N.Quinn, L.Deng, B.Moore, S.Lyons.
The New England College of Optometry, Boston, MA.
J.S. Sunness, J.J. Stephens, C.A. Applegate. Hoover Rehab Serv Low Vsn & Blindn,
Greater Baltimore Medical Center, Baltimore, MD.
Purpose: LogMAR visual acuity charts are the recognized standard for measuring
visual acuity (VA). The length and complexity involved in completing the standard
procedure for measuring LogMAR VA is difficult for young children. The purpose of
this study is to compare LogMAR VA measured by standard and modified procedures
in adult subjects using 4 visual acuity charts: Lea Symbols (LS), Lea Numbers (LN),
Landolt C (LC) and Sloan Letters (SL).
Methods: 50 optometry students separated into two groups participated in the study.
Group 1 completed the VA measurements using the standard procedure of reading
all optotypes on each acuity chart until threshold was reached. Group 2 completed
a modified procedure whereby the first two optotypes of each line were read until
one was answered incorrectly. The subject then read every optotype beginning at the
preceding line. All subjects had best-corrected Snellen VA of better than 20/25 at each
session to be included in the study. LogMAR charts, calibrated for 4 meters (m) with
7 optotypes per line were constructed and supplied by the Goodlite Co. The middle 5
optotypes were scored to ensure constant crowding. VA of the right eye of each subject
was tested at 4m, with each chart presented randomly. Four measurements (two per
session separated by one week) were obtained for each chart. Repeated measures of
ANOVA and multiple comparisons were utilized in the statistical analysis.
Results: In Group 1, the mean LogMAR VA was LS -0.156, SL -0.140, LN -0.125 and
LC -0.119. In Group 2, the mean LogMAR VA was LS -0.128, SL -0.119, LN -0.099 and
LC -0.095. In both groups, LS was significantly different from LC and LN (p<0.001)
but not from SL. The difference between LS and LC was less than 2 optotypes. Group
2 had better VA on each chart than Group 1. These differences were not statistically
significant (p>0.2), amounting to a difference of less than 2 optotypes per chart.
Conclusions: In adults, both procedures for measuring LogMAR VA can be used with
similar results for LS, LN, LC and SL. Differences between the groups and between
acuity charts exist but are not clinically significant.
CR: A. Pathak, None; D. Ah-Kine Ng Poon Hing, None; J. Vaidhyan, None; N.
Quinn, None; L. Deng, None; B. Moore, None; S. Lyons, None.
Support: None
Purpose: To validate face fields, a simple clinical technique for determining how a
patient fixates, by comparing face field results to SLO and MP-1 findings
Methods: The charts of all patients who underwent SLO or MP-1 evaluation
between February 2005 and September 2006 were reviewed. Patients with scotomas
in the central visual field from macular disease were identified. All patients
who underwent face fields prior to but at the same visit as SLO/MP-1 evaluation
were included. The location of the scotoma relative to fixation on face fields was
compared with the positioning of the fixation cross on SLO/MP-1 evaluation.
To perform face fields, the patient occludes one eye. The examiner instructs the
patient as follows: “Look at my nose so you can see it as clearly as possible. While
you are looking at my nose, are there parts of my face that are missing, or blurry, or
distorted?” The response are recorded, for example, as ‘the eyes are blurry’, or ‘the
eye to his right is blurry’, or ‘the face to his left is blurry.’
Results: Two hundred seventy eyes of 154 patients were included. Face fields provided
the same fixation information as the SLO/MP-1 in 136 eyes (50%). Face fields differed
slightly from SLO/MP-1 in 66 eyes (24%); for example, face fields might show the
scotoma up and to the right, while SLO/MP-1 showed the scotoma above. In 65 eyes
(24%), the face field findings differed from the SLO/MP-1 findings. A scotoma was
not detected by face fields in only 25 eyes (9%).
Conclusions: Face fields provided insight into the location of the preferred retinal
locus for fixation in 74% of patients. It is a simple test which can be used in the clinic
or at the patient’s home by clinicians as well as by low vision therapists and OTs. Face
fields can help in coaching a patient to reinforce the PRL, to view the object of interest
optimally and to use low vision devices more effectively. Face fields also have a much
lower false negative rate than the Amsler grid.
CR: J.S. Sunness, None; J.J. Stephens, None; C.A. Applegate, None.
1167-1170
1171 - B17
An Investigation of Hope and Depression Among Older Adult Patients in Low
Vision Rehabilitation
1172 - B18
A New Method of Assessing Ability to Perform Activities of Daily Living:
Design, Methods and Baseline Data
L.E. Dreer1A, J.S. Cheavens2, J.Bambara1B, E.Bjelke1B, D.DeCarlo1A, M.Swanson1C, T.R.
Elliott3, C.Owsley1A. AOphthalmology, BPsychology, COptometry, 1Univ of Alabama
at Birmingham, Birmingham, AL; 2Psychiatry, Duke University Medical Center,
Durham, NC; 3Educational Psychology, Texas A&M University, College Station, TX.
L.L. Lorenzana, D.Lankaranian, J.Dugar, J.R. Mayer, N.Palejwala, K.Kulkarni, Z.Boghara,
J.Richman, S.Wizov, G.L. Spaeth. Glaucoma Service, Wills Eye Institute of Jefferson
Medical College, Philadelphia, PA.
Purpose: Examined associations between hope and depression among older adults
in low vision rehabilitation.
Methods: We used the Center for Epidemiological Studies of Depression-Scale (CES-D)
as the main outcome measure. Predictor measures included demographic variables
(gender, age, level of education), logMAR scores in the better eye, and an empiricallyvalidated Hope Scale which measures one’s perception of themselves as being capable
of generating workable routes to desired goals given potential impediments (pathways
scale) and a motivational component which evaluates the perceived capacity to initiate
and sustain movement along various pathways toward desired goals (agency). Multiple
regression was conducted to predict depression scores with demographic variables,
visual acuity (logMAR scores, better eye), “pathways thinking” (reflects the perceived
ability to produce successful avenues to desired goals), and “agency thinking” (i.e.,
involves thoughts about one’s ability to initiate and sustain movement along pathways
toward desired goals) as the predictor variables.
Results: Ninety-four persons (age range 65-98, M = 78); 34 men and 60 women who
entered a university-based low vision rehabilitation clinic completed measure following
their initial clinical evaluation. Eighty-eight of the participants were Caucasian, 6 were
African-American. Univariate correlations found that demographic variables and
better eye logMAR scores were unrelated to depression and thus were not included in
the final regression model. Perceived lack of an ability to produce successful avenues
toward desired goals (pathways) accounted for 13% of the variance in depression. An
additional 15% of the variance, over and above pathways scores, was related to an
inability to initiate and sustain movement along various pathways toward desired
goals (agency).
Conclusions: Components of hopeful thinking are important in the prediction of
depression among patients seen in a low vision rehabilitation clinic. Implications will
be discussed for fostering these key aspects of hope theory into brief interventions
that may help patients overcome obstacles in low vision rehabilitation and find more
adaptive ways to the goals that they have set for themselves or that they are faced
with in daily living due to changes in vision.
CR: L.E. Dreer, None; J.S. Cheavens, None; J. Bambara, None; E. Bjelke, None; D.
DeCarlo, None; M. Swanson, None; T.R. Elliott, None; C. Owsley, None.
Support: NEI Grant 1K23EY017327-01, EyeSight Foundation of Alabama (ESFA),
R21-EY14071
Purpose: To describe the study protocol and the baseline characteristics of the subjects. This
study seeks to determine the relationship of a third-generation performance-based measure
of visual function to clinical and subjective measures in glaucoma patients.
Methods: Cross-sectional study from March 2006 to December 2006 of 194 glaucoma patients
exhibiting the full range of visual loss caused by glaucoma. The study was performed at the
Wills Eye Hospital. Patients ranged in age from 15-95. Exclusion criteria were inability to
understand and respond to spoken English, low vision training, and presence of significant
neurological, motor or other problems that may have prevented the patient from completing
the study. After informed consent, patients were evaluated using a third-generation, novel,
performance-based measure, the Assessment of Disability Related to Vision (ADREV)
which comprises nine tasks which simulate various activities of daily living; these include:
1) putting a stick into 7 holes of different sizes, 2) entering numbers into different sized
calculators, 3) finding large and small objects spread around a room, 4) detecting motion,
5) matching socks, 6) reading print under dull and bright light, 7) following a prescribed
walking course, 8) recognizing signs at a distance and 9) recognizing facial expressions.
All patients also completed a battery of standard clinical tests of visual function including
visual acuity, bilateral visual fields test (Humphrey), binocular visual field test (Estermann),
contrast sensitivity and stereopsis, as well as the National Eye Institute’s Visual Functioning
Questionnaire (NEI-VFQ-25). Main Outcome Measures are the scores on the subtests (range
0-7 on each subtest) and the total scores of ADREV (range 0-63) and NEI-VFQ-25 (range
0-100).
Results: Mean age was 67.1. 50.5 % were females. 55.2 % were of European extraction. 71.6
% had primary open-angle glaucoma. A strength of this study was the inclusion of the full
range of clinical severities. For example, with regards to the mean defect as determined
by Humphrey visual field testing in the worse eye, the mean was -16 dB with a range from
+1 to -40 dB.
Conclusions: This study should show 1) how much and what types of disability are caused
by glaucoma, 2) how those difficulties in performing the activities of daily living relate to
standard clinical tests and 3) how they relate to the types and amount of change in quality
of life. We wish to share the methodology with others.
CR: L.L. Lorenzana, None; D. Lankaranian, None; J. Dugar, None; J.R. Mayer, None; N.
Palejwala, None; K. Kulkarni, None; Z. Boghara, None; J. Richman, None; S. Wizov,
None; G.L. Spaeth, None.
Support: Pfizer, The Perelman Fund through the Wills Eye Institute of Jefferson Medical
College, The Pearle Vision Foundation and The Glaucoma Service Foundation to prevent
blindness
1173 - B19
Assessing Vision-Related Quality of Life in Children With Bilateral Congenital
Cataracts
1174 - B20
Relationship Between Patient-Reported Visual Function and Visual Acuity in
Subjects With Neovascular AMD
M.C. Lopes, A.Berezovsky, S.R. Salomao. Ophthalmology, UNIFESP, Sao Paulo, Brazil.
E.B. Yu1A, N.M. Bressler2, J.T. Fine1A, J.F. Ward1B, C.M. Dolan1A, T.Klesert3, T.S. Chang4.
A
Hlth Economics & Outcomes Res, BBiostatistics, 1Genentech Inc, S San Francisco,
CA; 2Retina Division, Wilmer Eye Institute; Johns Hopkins University School
of Medicine, Baltimore, MD; 3Doheny Retina Institute, University of Southern
California, Los Angeles, CA; 4Retina Institute of California, Pasadena, CA.
Purpose: To assess vision-related quality of life in children with bilateral congenital
cataracts, using the recently developed Children’s Visual Function Questionnaire
(CVFQ).
Methods: CVFQ has two different presentations, one for children under 3 years of age
and the other for older children, and is divided in six subscales - general health; general
vision; competence; personality; family impact and treatment. Thirty-five children
previously diagnosed and treated (surgery, optical correction and/or patching) for
bilateral congenital cataracts were assigned to two age groups: Group I - 17 children,
12 female, age range from 4 to 34 months (mean age: 14.35±10.23 months); Group II
- 18 children, 8 female, age range from 3 to 7 years (mean age: 4.4± 1.5 years). Visual
impairment was classified, considering either grating or optotype visual acuity
compared to age-norms, as none (n=16), mild (n=7 children) and moderate or severe
(n=12 children). The CVFQ was applied in the hospital setting to parents or other
caretakers by personal interview. Scores obtained for the six subscales were compared
between the two age groups (I and II) using a t-test and among the three visual
impairment categories by means of an analysis of variance (ANOVA).
Results: All subscales presented low scores for the quality of life of children with
bilateral congenital cataracts. No differences between younger and older patients
could be found in any of the six subscales. Competence subscale was significantly
lower in the severe visually impaired patients compared to those not visually impaired
(ANOVA F 5.7, p< 0.01; Tukey test p<0.01).
Conclusions: Bilateral congenital cataracts influence the vision-related quality of
life of children as confirmed by low scores in all competences assessed by CVFQ.
This instrument should be incorporated in the clinical assessment of children with
bilateral cataracts as an outcome measure of the impact of visual impairment in their
quality of life.
CR: M.C. Lopes, None; A. Berezovsky, None; S.R. Salomao, None.
Support: CAPES
.
Purpose: To examine the relationship between patient-reported visual function as
assessed by the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25)
and visual acuity using data from the MARINA trial.
Methods: In MARINA, subjects were randomized 1:1:1 to monthly sham injection
or injection with 0.3 mg or 0.5 mg ranibizumab. Only one eye per subject received
treatment. Patient-reported visual function was collected using the NEI VFQ-25. Visual
acuity was measured using the number of letters on the ETDRS chart. Regression
analyses included only subjects whose better-seeing eye was the study eye at baseline.
The dependent variable was defined as the change from baseline to month 12 in the
overall composite score of the NEI VFQ-25. The independent variable was the change
from baseline at month 12 in visual acuity. A second multivariate regression model was
fit to the data with the same dependent and independent variables but controlling for
treatment group, baseline NEI VFQ-25 composite score and baseline visual acuity.
Results: In the uncontrolled regression model, the slope of the regression model for
the NEI VFQ-25 composite change scores was 0.492 (P<0.0001) with an R-square of
0.284. When treatment group, baseline NEI VFQ-25 composite score and baseline VA
were added to the model, the R-square increased to 0.40.
Conclusions: In the MARINA trial, The change in NEI VFQ-25 composite score was
moderately correlated with change in visual acuity over 12 months. A regression model
of change in visual acuity, treatment group, baseline NEI VFQ-25 composite score and
baseline visual acuity explained 40% of the variance in the NEI VFQ-25 composite
score. This finding demonstrates that while changes in visual acuity and changes in
patient reported visual function are related, visual acuity does not completely capture
all aspects of function important to patients.
CR: E.B. Yu, Genentech, Inc., E; N.M. Bressler, Acucela, F; Bausch & Lomb, F; Carl
Zeiss Meditec, F; Genentech, F; Notal Vision Inc., F; Novartis, F; OSI/Eyetech, F;
Othera, F; QLT, F; Regeneron, F; TargeGen, F; J.T. Fine, Genentech, Inc., E; J.F. Ward,
Genentech, Inc., C; C.M. Dolan, Genentech, Inc., C; T. Klesert, Genentech, Inc., C;
T.S. Chang, Genentech, Inc., C; Novartis, C.
Support: Genentech CT: www.clinicaltrials.gov, NCT00056836
1171-1174
1175 - B21
The Complex Role of Vision in Patients’ Overall Health-Related Quality of Life
1176 - B22
The Nursing Home Minimum Data Set for Vision and Vision Function
B.S. Lee1A, S.M. Kymes1A, R.F. Nease2, W.Sumner1B, C.J. Siegfried1A, M.O. Gordon1A. ADepartment of
Ophthalmology and Visual Sciences, BDivision of General Medical Sciences, 1Washington University in St.
Louis School of Medicine, Saint Louis, MO; 2Express Scripts, Inc., Saint Louis, MO.
M.W. Swanson1A, K.Scilley1B, B.Liu1B, G.McGwin, Jr.1B, C.Owsley1B. AOptometry,
B
Ophthalmology, 1Univ of Alabama at Birmingham, Birmingham, AL.
Purpose: Most previous utilities work in the visual sciences has used perfect vision as the upper anchor. However, common costeffectiveness standards were derived using perfect health-anchored utilities. Applying these standards to perfect vision-anchored
utilities requires the assumption that the visual component of perfect health is additive with non-visual components, but there is no
evidence to support this.
Methods: Patients with exactly one of the conditions of interest were recruited from academic practices.
All participants completed the NEI-VFQ and SF-36. Using the computer program U-Titer-II, standard gamble utilities were measured to
assess multiple scenarios: (1) given current health and vision, willingness to risk instant death for perfect health including perfect vision,
(2) given current vision, willingness to risk instant unilateral blindness for perfect vision, and (3) given current health but perfect vision,
willingness to risk instant death for perfect health. Spearman correlations between VFQ and SF-36 scales were also calculated.
Results: Scenario #2 (perfect vision) utilities were lower than Scenario #1 (perfect health) ones for the same participants, particularly with
increased disease severity. Scenario #3 (comorbidity) utilities were similar to Scenario #1, indicating that little of the overall perceived
loss of quality of life comes from visual disease if the scales are additive. Correlations between VFQ and SF-36 were weak for all domains
other than those related to general health.
Purpose: Since 1987 all nursing homes which participate in the Medicare and Medicaid
insurance programs have been required to administer the Long Term Care Resident
Assessment Inventory which includes the Minimum Data Set (MDS). The MDS contains
a short section on vision and represents the long term care facilities’ assessment of the
resident’s visual abilities. The MDS vision assessment evaluates three areas including
vision, vision symptoms and use of optical devices. Based on reading ability descriptors
vision is rated into one of five categories. This study evaluates the association of the
MDS vision categorization with questionnaire assessments of the VF-14, Activities of
Daily Vision (ADVS) and a vision-targeted health-related quality of life questionnaire
developed specifically for the nursing home (NHVQoL).
Methods: Subjects were 393 residents of nursing homes in the Birmingham, Alabama
metropolitan area (ages ≥ 55 years). Participants had Mini-Mental State Exam scores
of ≥ 13. Residents with severely impaired vision (MDS level 4) were excluded. MDS
assessment was obtained from the subject’s chart records. Interviews were conducted
with subjects at each facility by trained research staff. Analysis of variance was used
to evaluate the association between MDS categories and questionnaire responses.
Results Mean functional vision scores by MDS category are found below.
Standard Gamble Utilities for Five Common Ophthalmic Diseases
Condition
Diabetic
Retinopathy
Glaucoma
ARMD
Cataract
Refractive Error
Severity
N
SG-Perfect
Health (SD)
SG-Perfect Health Adjusted
for Age & Comorbidity
SG-Perfect
Vision (SD)
SG-Perfect Vision Adjusted
for Age & Comorbidity
All
58
0.87 (0.20)
0.94
0.77 (0.30)
0.79
Normal or minimal BDR or
macular edema not clinically
significant
0.89
33
0.93 (0.11)
0.91
0.91 (0.15)
Clinically significant macular
edema or non-proliferative DR
13
0.85 (0.22)
0.87
0.63 (0.39)
0.66
0.89 (0.18)
Proliferative diabetic
retinopathy
12
0.73 (0.28)
0.76
0.54 (0.31)
0.56
0.74 (0.29)
0.94 (0.07)
0.87
All
99
0.89 (0.23)
0.88
0.86 (0.22)
Ocular hypertension without
visual field loss
32
0.92 (0.13)
0.92
0.93 (0.12)
0.92
0.89 (0.21)
Early loss (small nasal steps,
early arcuate, paracentral
scotomas)
32
0.89 (0.22)
0.89
0.90 (0.17)
0.90
0.90 (0.22)
Marked loss encroaching on
central 10 degrees
35
0.86 (0.30)
0.86
0.76 (0.30)
0.76
0.89 (0.28)
All
44
0.83 (0.27)
0.84
0.63 (0.38)
0.66
BCVA 20/40 or better in
better eye
14
0.85 (0.31)
0.87
0.93 (0.14)
0.92
0.83 (0.36)
BCVA 20/50 to 20/100 in
better eye
0.72
0.84 (0.32)
0.78 (0.27)
9
0.82 (0.20)
0.84
0.74 (0.31)
BCVA 20/200 or worse in
better eye
21
0.79 (0.29)
0.79
0.39 (0.37)
0.40
All
124
0.92 (0.14)
0.91
0.86 (0.23)
0.84
Opacities comparable to LOCS
II Standard #1 in worse eye
49
0.92 (0.15)
0.91
0.92 (0.16)
0.95
0.91 (0.16)
48
0.93 (0.12)
0.94
0.86 (0.22)
0.84
0.92 (0.14)
0.94 (0.11)
27
0.93 (0.14)
0.95
0.77 (0.32)
0.74
All
109
0.91 (0.14)
0.89
0.88 (0.18)
0.88
Prescrption -1 to +1 diopter
34
0.92 (0.12)
0.93
0.92 (0.15)
0.92
0.93 (0.11)
Prescription -4 to -1 or +1 to
+4 diopters
41
0.89 (0.17)
0.89
0.85 (0.22)
0.84
0.91 (0.15)
34
0.93 (0.11)
0.93
0.89 (0.16)
0.89
0.94 (0.09)
434
0.90 (0.19)
Prescription +4 diopters
All
SG-Perfect Health
Assuming Ideal
Vision (SD)
MDS Vision
VF-14
NHVQOL
ADVS Far
ADVS Near
0 - Adequate
85.7
87.2
93.9
80.7
91.4
1 - Impaired
73.9
81.5
91.3
70.2
86.4
2 - Moderately Impaired
71.6
78.6
81.4
66.9
77.4
3 - Highly Impaired
39.2
56.1
100
60.4
73.3
<.0001
<.0001
.005
.0007
.0002
p-value
ADVS Glare
Conclusions: The MDS vision rating generated by nursing home staff was associated
with self-rated vision on each of the three functional assessment instruments
evaluated.
CR: M.W. Swanson, None; K. Scilley, None; B. Liu, None; G. McGwin, None; C.
Owsley, None.
Support: Supported by Retirement Research Foundation, the EyeSight Foundation
of Alabama, the Pearle Vision Foundation, NIH grant R21-EY14071, and Research to
Prevent Blindness, Inc.
0.83 (0.25)
Conclusions: If visual health were an additive component of perfect health, then the similarity of Scenarios #1 and 3 would mean that vision
is an insignificant part of overall health. Scenario #2, patient behavior, and the modesty of the correlation between VFQ and SF-36 domains
suggests instead that the conceptual relationship between vision and general health is complex and requires additional investigation.
CR: B.S. Lee, None; S.M. Kymes, Allergan and Pfizer, C; R.F. Nease, None; W. Sumner, None; C.J. Siegfried, None; M.O. Gordon,
None.
Support: NEI Grant #R01EY011871
1177 - B23
Effects of Yellow Lenses on Photopic and Mesopic Visual Performance in AgeRelated Macular Degeneration
M.C. Puell Marin, J.Carballo-Álvarez, A.Nieto-Bona. Optics (Optometry and Vision),
Univ Complutense de Madrid, Madrid, Spain.
Purpose: To investigate the effects of wearing yellow progressive-power lenses (PPLs)
on photopic and mesopic visual function, and self-reported visual difficulties in daily
activities in subjects with age-related macular degeneration (AMD).
Methods: Nine subjects with non-exudative AMD (18 eyes) wore clear and
commercially available yellow tinted organic (lumior 1 or 2, Essilor) PPLs with their
best spectacle correction, each for 7 days in random order. Visual acuity, contrast
sensitivity and glare were measured monocularly for each lens. Visual acuity was
measured using high-contrast (96%) and low contrast (5%) logMAR letter charts under
bright (photopic) and dim (mesopic) conditions. Contrast sensitivity was determined
with the Pelli-Robson letter chart under photopic conditions and glare sensitivity
was measured using the Brightness Acuity Tester (BAT). In adition, after each of the
7 days of lens wear, the Activities of Daily Vision Scale (ADVS) was used to assess
self-reported visual difficulties in performing every-day tasks expressed on a scale of
0 (extreme difficulty) to 100 (no difficulty). Measures of central tendency (medians),
and dispersion (25th and 75th percentiles) were used to describe the results obtained
with each lens.
Results: Under photopic conditions, the yellow PPLs significantly improved highcontrast visual acuities for near and far distance and contrast sensitivities (Table 1),
yet no significant effects were observed on contrast sensitivity with glare as measured
with the BAT. The ADVS glare subscale score was nevertheless significantly higher
for the yellow PPLs (67.63 (50/75) compared to the clear (83.25 (81.25/87.50). Table 1.
Visual acuity (VA), contrast sensitivity and glare values recorded using clear versus
yellow progressive-power lenses (PPLs). * p<0.05 **p<0.01
High-contrast/high-luminance VA **
High-contrast/low-luminance VA
Low-contrast/high-luminance VA
Low- contrast/low-luminance VA
Near high-contrast/high-luminance VA*
Contrast sensitivity*
Contrast sensitivity with glare
Clear PPLs
Median
25%/75%
Yellow PPLs
Median
25%/75%
0.55 (0.16/0.90)
0.7 (0.29/0.96)
0.75 (0.31/0.97)
0.75 (0.24/0.98)
0.46 (0.11/0.69)
1.35 (1.20/1.50)
1.50 (1.275/1.575)
0.47 (0.09/0.79)
0,71 (0.28/0.96)
0.78 (0.36/0.94)
0.76 (0.26/0.98)
0.31 (0.10/0.53)
1.35 (1.35/1.57)
1.50 (1.35/1.575)
1178 - B24
Can Yellow Lenses Improve Reading Ability in Poor Readers?
C.Palomo-Alvarez, C.Puell Marin. Universidad Complutense de Madrid, School of
Optometry, Madrid, Spain.
Purpose: Many poor readers have particular problems with the rapid visual processing
required for reading, involving the magnocellular pathway of the visual system. It has
been suggested that yellow filters can improve magnocellular function and reading
ability. Moreover, previous research suggests that the processing of single words
as opposed to single pseudo words or document processing cannot be assumed to
be equivalent. This study investigates the effect of wearing yellow lenses for three
months on reading isolated words, reading pseudo-words, reading speed and reading
comprehension in children with reading difficulties.
Methods: We selected 52 poor readers without dyslexia from grades 3 to 5 (9.6 years old)
of 8 primary schools in Madrid, Spain. Selection criteria were a normal IQ, a reading
evaluation score within the lower 25%, best corrected visual acuity 20/20, refractive
error less than ±2.00 D and no strabismus. The sample was randomly divided into two
groups for each school grade: a control group (n=20) and a yellow filter group (n=32).
Yellow tinted lenses with best spectacle correction were worn by each subject in the
filter group for 3 months for school and homework tasks. Reading words, reading
pseudo-words, reading speed and reading comprehension were measured using the
Spanish reading tests PROLEC (grades 3 and 4) and PROLEC-SE (grade 5). First, the
tests were completed without the yellow filter in both groups. Then, after the three
months, measurements were repeated with the yellow tinted lenses (filter group) or
without the lenses (control group).
Results: There were no significant differences between the filter and control groups
before treatment for each school grade. After the three months, all the variables
examined increased in both groups. Improvements in reading word times, reading
pseudo-words, reading speed and number of words/minute differed significantly
between the two groups for the 3rd and 4th grade children (p<0.05).
Conclusions: Reading word times, reading pseudo-words, reading speed and number
of words/minute improved after three months of wearing a yellow filter in the poor
readers from grades 3 and 4, but not in the 5th grade children. This difference is
probably attributable to the different visual presentations used in the test.
CR: C. Palomo-Alvarez, None; C. Puell Marin, None.
Support: Prats Optical S.A.
Conclusions: Yellow progressive-power lenses improved visual performance under
photopic conditions in patients with age-related macular degeneration.
CR: M.C. Puell Marin, None; J. Carballo-Álvarez, None; A. Nieto-Bona, None.
Support: Essilor, España Grant
1175-1178
1179 - B25
Self-Reported Visual Function and Quality of Life Following the Adoption of a
Closed Circuit Television (CCTV) Device for Low Vision
J.Huber1, J.Jutai2, G.Strong1, H.Ariizumi 3, A.Plotkin1. 1School of Optometry, University
of Waterloo, Waterloo, ON, Canada; 2Department of Physical and Medicine
Rehabilitation, University of Western Ontario & Lawson Health Research Institute,
London, ON, Canada; 3School of Business and Economics, Wilfrid Laurier,
Waterloo, ON, Canada.
1180 - B26
Relationships Between Visual Acuity, Visual Function, and Quality of Life
Among Visually Impaired Adults in India: A Structural Equation Modeling
Approach
R.Nutheti1,2, B.R. Shamanna1, J.E. Keeffe3. 1International Centre for Advancement of
Rural Eye Care, L V Prasad Eye Institute, Hyderabad, India; 2Vision Cooperative
Research Centre and School of Optometry and Vision Science, Sydney, Australia;
3
Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia.
Introduction: Successful rehabilitation using assistive technology devices, such as Closed
Circuit Television (CCTV) systems, occurs in a sequence of events that includes adoption
of the device, acceptance of the device, adherence to prescription, and satisfaction with
the device. The Consortium for Assistive Technology Outcomes Research (CATOR)
framework is a time-dependent model that acknowledges the potential for functional and
psychosocial outcomes to be coupled and uncoupled. We examined changes in functional
vision status and psychosocial status of elderly patients with ARMD who obtained a
CCTV device. The NEI-VFQ 25 measures the influence of vision loss on generic health
domains such as emotional well-being and social functioning, in addition to task-oriented
domains related to daily visual functioning. The Psychosocial Impact of Assistive Devices
Scale (PIADS) measures the impact of an assistive device on functional independence,
well-being, and quality of life.
Methods: Subjects were 65 years and older, had a primary diagnosis of age related macular
degeneration, and were first time users of a CCTV system. NEI-VFQ 25 and PIADS data
were obtained from an ongoing, prospective cohort study of low vision device outcomes.
Data from four assessments are analyzed (2 weeks, 1 month, 3 months, and 6 months
following CCTV adoption).These intervals were selected to examine the critical, early
period of device adoption, as well as the results associated with long term device use.
Results: The NEI-VFQ 25 results suggest that there is a relatively healthy and stable
effect of CCTV device use on visual function over a six-month post-adoption period. As
hypothesized, the PIADS findings indicated that the maximum, positive psychosocial
impact of CCTV devices was not experienced by the device users until around one month
following device adoption, but then attenuated over the longer term as we had observed
in previous research. The PIADS was sensitive to the difference between groups (Wet
vs. Dry ARMD) while the NEI-VFQ-25 was not.
Conclusion: Assistive devices, such as CCTV systems, have an immediate, positive and
robust impact on the functional status of their users. While functional benefit is stable
for some time following device adoption, the psychosocial impact of the CCTV is greatest
within the first month following adoption and then appears to wane.
CR: J. Huber, None; J. Jutai, None; G. Strong, None; H. Ariizumi, None; A. Plotkin,
None.
Support: Funding for this project was provided in part by The Canadian Institutes of
Health Research (CIHR)
Purpose: To construct a model of relationships among perceived visual function,
quality of life (QOL), and visual acuity (VA) using the structural equation modeling
(SEM) technique in an older visually impaired population of India.
Methods: The World Health Organization QOL questionnaire adopted as a healthrelated QOL (HRQOL) questionnaire (Nutheti R et al, IOVS. 2006; 47: 4742-8) and a
16-item visual function questionnaire (VFQ) (Nutheti R et al, IOVS. 2004; 45:3458-3465)
were administered to adults in the population-based Andhra Pradesh Eye Disease
Study prior to their visual acuity assessment. A total of 1333 (97.9% of the eligible
1362) visually impaired subjects (presenting VA < 6/18) aged ≥ 40 years responded
to both questionnaires. The direct and indirect relationships between VA, VFQ, and
QOL scores were established using the SEM after adjusting for socio-demographic
and systemic morbidity variables.
Results: The mean age was 60.5 years ± 9.8 (SD) range from 40 to 102 years; 753 (56%)
were female; and 1133 (85%) resided in rural areas. The mean VA, QOL, and VFQ
scores were 0.84 ± 0.33 (logMAR), 73.7 ± 20.6, and 74.7 ± 15.8, respectively. For every
one logMAR unit (10 lines) worsening in the VA, there was a 29.1% decrease in the
perceived visual function and 18.4% decrease in the quality of life score. A total of
62.2% of the change in quality of life was due to the indirect association between VA
and QOL through functional vision. The remaining 38.8% change was due to the
independent association between VA and QOL. The fit of the hypothesized model
(i.e., VA is directly and indirectly through visual function associated with QOL) was
acceptable (Comparative Fit Index = 0.995). The percentage of the change in quality
of life due to the mediating effect of visual function between VA and QOL varied for
different age groups (50%, ≥ 70 years; to 100%, 40 - 49 years), area of residence (59.7%,
rural; 100%, urban), sex (56.2%, male; 67.2%, female), and level of visual impairment
(61.5%, blind; 100%, moderately visually impaired).
Conclusion: Perceived visual ability to perform the functional vision activities
mediates the relationship between visual acuity and quality of life.
CR: R. Nutheti, None; B.R. Shamanna, None; J.E. Keeffe, None.
Support: Supported by the Hyderabad Eye Research Foundation, Hyderabad, India;
and partly supported by the Australian Federal Government through the Cooperative
Research Centres Program.
1181 - B27
The Relationship of Quality of Life With Disability and Various Aspects of
Reduced Vision in Patients With Glaucoma
1182 - B28
A Self-Assessment Instrument Designed to Assess Restriction of Participation
in People With Low Vision: Generalizability to Patients With Age-Related
Macular Degeneration (AMD)
J.Richman, L.Lorenzana, G.L. Spaeth. Glaucoma Research Center, Wills Eye Institute
of Jefferson Medical College, Philadelphia, PA.
Purpose: To determine how glaucoma patients’ self-reported quality of life relates to
their ability to perform tasks of daily living and to clinical measures of vision.
Methods: In a prospective, observational, case-control study, 194 glaucoma
patients aged 24-93 with a full range of visual loss were evaluated subjectively by
a vision-specific quality of life indicator, the National Eye Institute Visual Function
Questionnaire (NEI-VFQ-25). The NEI-VFQ-25 scores were compared with a novel,
third-generation performance-based measure titled “The Assessment of Disability
Related to Vision” (ADREV). The quality of life scores were also compared to clinical
tests of visual function including visual acuity, visual fields, contrast sensitivity,
stereopsis, and the Disc Damage Likelihood Scale.
Results: None of the clinical tests correlated strongly with the NEI-VFQ-25 scores
(mean defect of both eyes (r = 0.571), the binocular visual acuity (r = -0.502), and the
Pelli-Robson contrast sensitivity (r = 0.501) had the highest correlations). The NEIVFQ-25 scores had a correlation of 0.605 with the ADREV scores. The ADREV scores
had stronger correlations than the NEI-VFQ-25 scores for the mean defect of both
eyes (r = 0.661), the binocular visual acuity (r = -0.815), and the Pelli-Robson contrast
sensitivity (r = 0.798). Of the ADREV tasks, entering numbers on a calculator (r =
0.556), recognizing facial expression (r = 0.544), and finding objects around a room
(r = 0.541) had the best correlations with the NEI-VFQ-25. Following a prescribed
obstacle walking course (r = 0.268) and reading in differing amounts of illumination
(r = 0.345) had the worst correlations with the NEI-VFQ-25.
Conclusions: Among glaucoma patients, the NEI-VFQ-25 scores had weaker
relationships with each of the traditional clinical indicators of visual function than
the ADREV scores. As subjective tests, the scores of vision-specific questionnaires
appear to be influenced by factors besides ocular disease such as personality, emotion,
and desire to please. Performance based measures such as ADREV may be a better
way of assessing how glaucoma affects people’s daily lives than the current vision
specific quality of life questionnaires.
CR: J. Richman, None; L. Lorenzana, None; G.L. Spaeth, None.
Support: Pfizer, The Perelman Fund through the Wills Eye Institute of Jefferson
Medical College, The Pearle Vision Foundation, and The Glaucoma Service Foundation
to Prevent Blindness
E.L. Lamoureux1, J.F. Pallant2, K.Pesudovs3, G.Rees1, J.E. Keeffe1. 1Ophthalmology/
Center Eye Reserach Australia, University of Melbourne, Melbourne, Australia;
2
Swinburne University of Technology, Melbourne, Australia; 3Ophthalmology,
Flinders University and Flinders Medical Centre, Adelaide, Australia.
Purpose: An appropriate instrument is necessary to assess the impact of AMD on
quality of life (QoL) across the spectrum of the disease. In this study, we assessed if
the Impact of Vision Impairment (IVI) was a valid instrument to measure participation
in daily activities and QoL in patients with AMD with varying levels of visual
impairment.
Methods: Participants were recruited from a public eye hospital and low vision
rehabilitation centres across Victoria (Melbourne). The IVI data and its three subscales
were assessed for fit to the Rasch model. Dimensionality, item fit, response category
performance, differential item functioning (DIF) and targeting of items to patients
were assessed.
Results: 220 patients (mean age=83.5 yr) were recruited and the majority (70%) were
females. 22.3%, 47.5 % and 28.8% of the participants had mild (6/12-6/18), moderate
(<6/18-6/60) and severe vision loss (<6/60), respectively. The 28-item IVI and its three
subscales i.e., ‘mobility and independence’, ‘reading and accessing information’ and
‘emotional well-being’ displayed ordered thresholds indicating that the respondents
had no difficulty differentiating between the response options of the scale. There was
no evidence of person and item misfit, DIF or multidimensionality. Internal reliability
was substantial ranging between 0.89 and 0.95. The IVI scale and its three subscales
recorded mean person values ranging between -0.2 and 0.1 which indicate effective
person-item targeting for this AMD population. The overall IVI scale and its three
subscales recorded non-significant probability values (p=0.1-0.6) when fitted to the
Rasch model which indicate that ordering of the IVI items is consistent across all
levels of participation in daily living and QoL.
Conclusions: The 28-item IVI is an appropriate and valid scale to assess overall
and three specific aspects of participation in daily activities in patients with AMD.
Importantly, the IVI has the potential to assess QoL outcomes across a range of visual
acuity loss in patients with AMD.
CR: E.L. Lamoureux, None; J.F. Pallant, None; K. Pesudovs, None; G. Rees, None; J.
E. Keeffe, None.
Support: Australian NHMRC Public Health Fellowship
1179-1182
Monday, May 7, 11:15 AM - 1:00 PM Grand Floridian H Paper Session
237. Epidemiology of Glaucoma Organizing Section: CL
1557 - 11:15AM
Myopia and Glaucoma in Adult Latinos: The Los Angeles Latino Eye Study
(LALES)
1558 - 11:30AM
Glaucoma and Mobility Performance: The Salisbury Eye Evaluation Project
H.S. Reddy1,2, M.Torres1,2, R.Varma1,2, Los Angeles Latino Eye Study (LALES). 1Doheny
Eye Institute, Los Angeles, CA; 2Ophthalmology, Keck School of Medicine,
University of Southern California, Los Angeles, CA.
Purpose: Myopic refractive error (MRE) has been proposed as a risk factor for open
angle glaucoma (OAG). However, because MRE increases in older adults due to
nuclear opacification, we propose to study axial length (AL) as an additional measure
of myopia. Specifically, this study examines 1) the association between MRE and the
prevalence of OAG in an adult Latino population, and 2) the association between AL
and prevalence of OAG.
Methods: Data for this analysis is derived from the LALES, a population-based
prevalence study of eye disease in Latinos aged 40 years and older. MRE was defined
as non-cylcoplegic spherocylindrical refractive error of <1 diopter. Pseudophakic and
aphakic eyes were excluded from analysis. The associations between MRE, AL and
the prevalence of OAG were calculated after adjusting for covariates including age,
gender, intraocular pressure, diabetes, and family history by using a logistic regression
model. Odds ratios (OR) and the 95% confidence intervals were calculated using the
logistic regression models.
Results: Of the 6357 participants who were examined, 5927 (93%) were included in the
analysis. Myopes were significantly more likely to have OAG (8.1%) than non-myopes
(3.7%), p<0.0001. After adjusting for covariates, MRE was more likely to be associated
with the prevalence of OAG (OR: 1.89, 1.36-2.62; p=0.0002). This association remained
after adjusting for severity of nuclear opacification (OR 1.86, 1.32-2.59; p=0.0003). After
adjusting for covariates, persons with longer AL had a higher risk of having OAG
compared to those with shorter AL (OR 1.33, 1.17-1.50; p<0.0001).
Conclusions: Our study demonstrates that myopic refractive error and longer axial
length are risk factors for OAG in adult Latinos. These biometric measures should be
included when assessing the risk of open angle glaucoma.
CR: H.S. Reddy, None; M. Torres, None; R. Varma, None.
Support: NIH Grant EY03040, National Eye Institute Grant EY11753, Research to
Prevent Blindness Unrestricted grant
1559 - 11:45AM
Rates of Glaucoma Medication Utilization Among Persons With Primary Open
Angle Glaucoma, 1992-2002: Findings From the Medicare Current Beneficiaries
Survey
J.D. Stein1A, F.A. Sloan1B, P.P. Lee1A. AOphthalmology, BEconomics and Center for
Health Policy, 1Duke University, Durham, NC.
Purpose:To characterize the usage of therapy for primary open angle glaucoma
(POAG) among a nationally representative sample of Americans 65 and older followed
over time.
Methods:Data analysis of the Medicare Current Beneficiary Survey (MCBS) was
undertaken for the years 1992 to 2002. The MCBS is a survey of Medicare beneficiaries
that uses face-to-face interviews to determine the type and dosage of each glaucoma
medication used in the preceding year by each beneficiary. By using MCBS data merged
with Medicare claims, rates of medical and surgical treatment for individuals aged
65 years and older with POAG were determined. Trends in utilization by glaucoma
medication class were identified over the eleven year period.
Results:The MCBS contained utilization data for 3,020 beneficiaries (7,965 person-years)
with POAG. During each year of the study period, approximately 30% of beneficiaries
with POAG were untreated medically or surgically. Over the study period, the use
of ß-blockers and miotics decreased considerably. In comparison, utilization rates
increased substantially for a-agonists, combination ß-blockers - carbonic anhydrase
inhibitors, and prostaglandin analogues.
Conclusions:In this nationally-representative study using patient-reported and
interviewer verified data to determine glaucoma medication utilization rates for
elderly Americans with POAG linked with claims data for prior surgery, almost 1/3
of older Americans with diagnosed POAG are not under therapy. Despite both the
availability of more efficacious classes of glaucoma medications with few side effects
and the findings of clinical trials underscoring the importance of intraocular pressure
reduction in POAG patients, many patients with POAG continue to go untreated. It
is of critical importance that clinicians and health-policymakers implement ways of
improving treatment among elderly Americans with POAG.
CR: J.D. Stein, None; F.A. Sloan, None; P.P. Lee, Allergan, Pfizer, Merck, F; Merck,
Allergan, Alcon, Pfizer, C; Allergan, Pfizer, Alcon, R.
Support: National Institute on Aging grant 2R 37-AG-17473-05A1, Research to Prevent
Blindness
D.S. Friedman1, E.Freeman2, B.Munoz1, H.D. Jampel1, S.K. West1. 1Ophthalmology,
Johns Hopkins Wilmer Eye Inst, Baltimore, MD; 2Ophthalmology, Université de
Montréal, Montreal, PQ, Canada.
Purpose: To determine the impact of glaucoma on mobility in a population-based
cohort.
Methods: Persons examined as part of a population-based eye disease study performed
a series of tasks including walking an obstacle course, climbing stairs, performing
tandem stands, and walking a 4- meter course. Persons with glaucoma were compared
to those without glaucoma to identify differences in mobility. The main outcome
measures were speed to complete the obstacle course, number of bumps, ability to
perform tandem stands, walking and stair climbing speeds.
Results: 1,250 subjects participated in the study. In an analysis adjusting for age,
race and sex, walking speed through the obstacle course was 2.3 meters/minute
slower for persons with bilateral glaucoma (which represents an age, race, and sex
adjusted decrease of 7%) and these individuals experienced 1.63 times the number
of bumps when compared to persons without glaucoma (p < 0.05 for both). None
of the associations were statistically significant comparing persons with unilateral
glaucoma to normals. These associations remained after adjusting for other potentially
confounding factors including visual acuity, body mass index, height, MiniMental
State Exam score, grip strength, arthritis, depressive symptoms, comorbidities, and
the use of mobility aids. Additional analyses indicate that visual field loss drove
these associations.
Conclusions: Bilateral glaucoma reduces mobility performance as measured in
multiple ways in this population-based study of community-dwelling individuals.
Persons with bilateral glaucoma completed the walking course more slowly and
had more bumps even after adjusting for use of a mobility aid, comorbidities, and
visual acuity. After adjusting for all other factors, persons with bilateral glaucoma
walked on average 2.3 meters less per minute through the course than those without
glaucoma.
CR: D.S. Friedman, None; E. Freeman, None; B. Munoz, None; H.D. Jampel, None; S.
K. West, None.
Support: National Institute on Aging, AG10184, and
1560 - 12:00PM
Impact of Visual Field Loss on Health Related Quality of Life in Glaucoma
Participants. The Los Angeles Latino Eye Study (LALES)
R.McKean-Cowdin1A, R.Varma1B, Y.Wang1B, J.Wu1C, S.Azen1A, LALES Group.
A
Preventive Medicine, BOphthalmology, CPharmaceutical Economics and Policy,
1
Keck School of Medicine, Univ of Southern California, Los Angeles, CA.
Purpose: To examine the association between self-reported, health related quality
of life (HRQOL) and visual field loss (VFL) in participants with glaucoma in The Los
Angeles Latino Eye Study (LALES).
Methods: Participants in LALES - a population-based prevalence study of eye disease
in Latinos residing in Los Angeles, CA - underwent a detailed eye examination
including an assessment of their visual field (VF) using the Humphrey Automated
Field Analyzer (SITA Standard 24-2). Open-Angle Glaucoma (OAG) was determined by
clinical examination; VF test results and optic disc photographs were independently
reviewed by 2 glaucoma specialists. Mean Deviation (MD) scores were used to assess
severity of VFL both as a continuous variable and stratified by severity: no VFL
(MD≥-2 decibels [dB]), mild VFL (-6dB<MD<-2dB), moderate/severe VFL (MD<6dB). HRQOL was assessed by the Medical Outcomes Study 12-Item Short-Form
Health Survey (SF-12) and the National Eye Institute Visual Function questionnaire
(NEI-VFQ-25). Linear regression and analysis of covariance were used to assess the
relationship between HRQOL scores and VFL. Models were adjusted for age, gender,
employment status, income, acculturation, co-morbidities, health insurance, vision
insurance, and visual acuity.
Results: The analyses include 218 participants identified with OAG; 93 (43%) had no
VFL, 106 (49%) and unilateral or bilateral peripheral VFL, 6 (3%) had central VFL, and
13 (6%) had unilateral or bilateral central and peripheral VFL. A monotonic decreasing
trend was observed between VFL and most NEI-VFQ-25 subscale scores and the
SF-12, such that glaucoma participants with severe VFL had lower QOL scores than
participants with no VFL. Persons with VFL had the greatest difficulty with driving
activities, dependency, role function and mental health. A 3 dB difference in VFL was
associated with a clinically meaningful 5 point difference in the NEI-VFQ driving
subscale. Glaucoma participants with central and peripheral VFL had lower HRQOL
scores than individuals with only peripheral or no VFL, however these differences
were statistically significant only for driving tasks.
Conclusions: Loss in HRQOL scores for glaucoma participants was present in people
with mild VFL and continuing through moderate/severe VFL. This relationship applies
to most NEI-VFQ-25 subscales and the SF-12. These data suggest that prevention of early
VFL in persons with glaucoma is important in preventing a worsening in HRQOL.
CR: R. McKean-Cowdin, None; R. Varma, None; Y. Wang, None; J. Wu, None; S.
Azen, None.
Support: NIH Grant EY11753 and EY03040c
1557-1560
Monday, May 7, 11:15 AM - 1:00 PM Grand Floridian H Paper Session
237. Epidemiology of Glaucoma Organizing Section: CL
1561 - 12:15PM
The Costs and Consequences of Progression to Glacuoma Related Visual
Impairment
1562 - 12:30PM
Prevalence of Pseudoexfoliation and Association With IOP, Corneal Thickness,
and Structural Optic Disc Parameters in the Reykjavik Eye Study
S.M. Kymes1, Z.Zhou2, M.R. Plotzke3, J.Fain2. 1Ophthalmology/Visual Science,
Washington Univ Sch of Med, St Louis, MO; 2U.S. Outcomes Research, Pfizer
Global Pharmaceuticals, New York, NY; 3Economics, Washington University, St
Louis, MO.
A.M. Arnarsson1, K.F. Damji2, T.Sverrisson1, H.Sasaki 3, F.Jonasson1. 1Ophthalmology,
University of Iceland, Reykjavik, Iceland; 2University of Ottawa Eye Institute,
Ottowa, ON, Canada; 3Kanazawa Medical University, Uchinada, Japan.
Purpose: We measured increased non-vision care cost associated with progression to visual loss due to
glaucoma using Medicare data.
Methods: We analyzed a random 5% sample of Medicare beneficiaries (1999-2003). Presence the ICD-9 code, 365.
xx, in a 1999 claim was considered evidence of glaucoma. Inclusion required survival from 1999-2003. Moderate
visual loss was defined as severe impairment in the worst seeing eye (ICD-9 > 369.60). Severe visual loss was
defined as severe impairment in best seeing eye (ICD-9 369.10 to 369.41). Blindness was defined as near total to
profound impairment in both eyes (ICD-9 369.0 to 369.09). We identified those who reported depression, injury
and living in long-term care settings. We report the mean total medical costs for each group and the increased
risk of depression or injury, and living in an institutional setting associated with progression.
Results: 57,664 beneficiaries were reported as having glaucoma. 54,596 did not experience severe impairment
in either eye, while 3,068 beneficiaries (5.3%) reported severe impairment in at least one eye during the five
year period. Increased visual impairment was associated with higher overall medical costs in 2003. Those who
were blind had the highest cost of those who did not progress ($11,568). Those who progressed from glaucoma
to blindness had the highest overall cost ($16,109) . Among those who progressed to vision loss, progression to
blindness had the highest incremental cost ($5,510). Those who progressed to any vision loss were more likely
to be diagnosed with depression or injury, or to be in long-term care or skilled nursing facility than those who
did not, including those who had visual impairment at the beginning of the period.
Conclusions: Among people with glaucoma, progression to loss of visual function in even a single eye is leads
to much higher medical costs during the period in which progression occurs. A substantial portion of this cost
is associated with avoidable conditions and institutionalization.
Cost of Glaucoma Progression to Visual Impairment Among Medicare Beneficiaries
Beneficiaries
Mean Annual
Cost
Glaucoma to Glaucoma
1999
53,723
$5,620
2003
53,723
$9,500
Glaucoma to Unilateral Visual
Impairment
1999
1,525
$6,663
2003
1,525
$12,832
Glaucoma to Bi-lateral Visual
Impairment
1999
853
$8,147
2003
853
$14,353
Glaucoma to Profound Blindness
1999
690
$6,719
2003
690
$16,109
Unilateral Impairment to Unilateral
Impairment
1999
438
$10,050
2003
438
$11,489
Bilateral Impairment to Bilateral
Impairment
1999
207
$13,123
2003
207
$10,700
Blindness to Blindness
1999
228
$12,145
2003
228
$11,568
Group
Incremental Cost
(1999-2003)
Percent Increase
(1999-2003)
Increased Cost
versus Glaucoma
Only (2003)
Magnitude Increase
Versus No Progression
$3,880
69.0%
N/A
N/A
$6,170
92.6%
$3,332
$2,290
$6,206
76.2%
$4,853
$2,326
$9,390
139.8%
$6,609
$5,510
$1,439
14.3%
$1,989
($2,441)
($2,423)
(18.5%)
$1,200
($6,303)
($579)
(4.8%)
$2,066
($4,459)
Purpose: To examine the prevalence of PEX and its possible associations with lens
opacification, optic disc size, central corneal thickness and intraocular pressure in a
population based sample
Methods: The participants were 1045 inhabitants of Reykjavik 50 years and older in
the RES. For the diagnosis of definite PEX, dilated slit lamp examination had to reveal a
partial or complete central shield on the anterior lens capsule and/or a peripheral band.
Possible PEX was diagnosed if any of the following was detected: flakes on anterior
segment structure, Krukenberg spindle, peripupillary trans-illumination, atrophy or
precapsular haze/frosting on the central lens capsule. Glaucoma was diagnosed on
the basis of structural optic nerve changes with or without field loss.
Results: Definite PEX was found in either eye of 108 subjects or 10.7% (95% CI 8.8-12.6).
Prevalence increased with age, and females were more frequently diagnosed in either
eye, 12.3% versus 8.7% in males (p<0.001). Possible PEX in the either eye was found in
further 15.3% (95% CI 12.9-17.6) of subjects. Prevalence of possible PEX also increased
with age (p<0.05), being more common in females than males, 21.1% versus 11.2%,
respectively (p<0.005). Glaucoma was present in 4% of right eyes with definite PEX,
3% of those with possible PEX, and 2% of those with no PEX. The mean IOP of right
eyes with definite PEX was 16.1 mm Hg (95% CI 15.2-16.9), possible PEX 16.1 mm Hg
(95% CI 15.6-16.7), and no obvious PEX 15.4 mm Hg (95% CI 15.2-15.7) (p<0.05). There
was no significant difference between eyes with and without PEX in central corneal
thickness, vertical disc diameter, mean disc area, and cup/disc ratio.
Conclusions: Definite PEX was found in either eye of 11% of those examined. The
prevalence increased significantly with age and females were more frequently affected
than males. PEX was associated with higher IOP compared to eyes without slit lamp
evidence of PEX. We did not find significant association between PEX and other
variables examined.
CR: A.M. Arnarsson, None; K.F. Damji, None; T. Sverrisson, None; H. Sasaki,
None; F. Jonasson, None.
Support: None CT: Icelandic Data Protection Commission
CR: S.M. Kymes, Pfizer, F; Allergan, C; Pfizer, C; Allergan, R; Pfizer, R; Z. Zhou, Pfizer, E; M.R. Plotzke,
None; J. Fain, Pfizer, E.
Support: Pfizer Grant to Kymes, “The Economic Burden of Glaucoma Related Visual Impairment”
1563 - 12:45PM
Comparison of Characteristics of Pseudoexfoliative vs Non-Pseudoexfoliative
Subjects in a Population-Based Study. Thessaloniki Eye Study
E.Anastasopoulos1, F.Topouzis1, A.Harris2, M.R. Wilson3, F.Yu4, A.Koskosas1, T.Pappas1,
P.Founti1, A.L. Coleman4. 1II Department of Ophthalmology, Aristotle University
of Thessaloniki, Thessaloniki, Greece; 2Department of Ophthalmology, Indiana
University, Indianapolis, IN; 3School of Medicine, University of Colorado Denver
and Health Science Center, Denver, CO; 4Center for Eye Epidemiology, Jules Stein
Eye Institute, UCLA, Los Angeles, CA.
Purpose: To compare the clinical characteristics between pseudoexfoliative (PEX) and
non-PEX subjects identified during the Thessaloniki Eye Study (TES) examination
process.
Methods: TES is a cross-sectional, population-based study in a Greek population.
PEX was identified in clinic-visit participants by the presence of pseudoexfoliative
material on the lens and/or the iris of either eye. Association of PEX with age and
sex was analysed with regression models. Subjects with PEX were compared to those
without PEX for IOP (higher between the two eyes), rate of IOP>22mmHg, rate of optic
disc damage (thinning or notching), vertical cup/disc ratio (VCD) (higher between the
two eyes), rate of VCD>0.7 and VCD asymmetry >0.2 (chi-square or Kruskall-Wallis
test). The analysis was repeated after the glaucoma cases were excluded.
Results: Among the 2261 clinic-visit participants in TES, 270 (12%) were
identified as having PEX in either eye. After adjusting for sex, increasing age
was associated with increasing prevalence of PEX (p<0.0001). Females were more
likely to have PEX (O.R.=1.26;CI:0.97-1.63) than males (results adjusted for age).
Subjects with PEX, compared to those without PEX, had higher screening
IOPs (16.8mmHg vs 15.9 mmHg, p=0.002), higher rate of IOP>22mmHg (10.9%
vs 5.8%, p=0.002), higher rate of optic disc damage (24% vs 14%, p<0.0001),
higher rate of VCD>0.7 (9% vs 3%, p<0.0001), higher non significant rate of
VCD asymmetry (12.1% vs 8.9%, p=0.09) and similar VCD (0.24 vs 0.21, p=0.19).
After excluding subjects with glaucoma, subjects with PEX had similar IOPs, rates
of IOP>22mmHg, rates of optic disc damage, VCD, and rates of VCD>0.7 and VCD
asymmetry, compared to those without PEX.
Conclusions: The prevalence of PEX increased with increasing age. PEX was not
associated with higher IOPs, VCD ratios or rates of optic disc damage when glaucoma
cases were excluded from the analysis, compared to non-PEX.
CR: E. Anastasopoulos, None; F. Topouzis, None; A. Harris, None; M.R. Wilson,
None; F. Yu, None; A. Koskosas, None; T. Pappas, None; P. Founti, None; A.L.
Coleman, None.
Support: International Glaucoma Association London UK, UCLA Center for Eye
Epidemiology CA, Health Future Foundation Creighton Univ. NE, Texas Tech Univ.
Health Sciences Center TX, Pfizer Inc., Merck & CO Inc
1561-1563
Monday, May 7, 11:15 AM - 1:00 PM Hall B/C Poster Session Program Number/Board # Range: 1564-1578 / B29-B43
238. Visual Function and Quality of Life II Organizing Section: CL
1564 - B29
Changes in Health-Related Quality of Life After Transsphenoidal Surgery for
Pituitary Adenoma
Y.Okamoto1, F.Okamoto1, T.Hiraoka1, S.Yamada2, T.Oshika1. 1Ophthalmology, Institute
of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai,Tsukuba, Japan;
2
Hypothalamic & Pituitary Surgery, Toranomon Hospital, Toranomon, Minato-Ku,
Tokyo, Japan.
Purpose: To evaluate the vision-related quality of life (QOL) in patients with pituitary
adenoma undergoing transsphnoidal surgery using the Japanese version of the 25-item
National Eye Institute Visual Function Questionnaire (NEI VFQ-25).
Methods: Subjects were 59 patients with pituitary adenoma undergoing transsphenoidal
surgery, ranging in age between 20 and 75 (49.8 ± 13.4, mean ± SD) years old. They
had no ocular diseases except for mild refractive errors. The VFQ-25 was recorded
before and 3 months after surgery, and the influence of various clinical parameters
was assessed. The VFQ-25 was also recorded in 81 healthy controls matched for age
and sex.
Results: Transsphenoidal surgery significantly improved VFQ-25 scores to the
level of healthy controls. Statistically significant improvements were observed in
subscales such as general vision, ocular pain, near activities, distance activities, social
functioning, mental health, role difficulties, dependency, driving, peripheral vision,
and total score (p<0.05, Wilcoxon signed-ranks test). The degree of improvement in
VFQ-25 total scores correlated with the degree of improvement in Humphrey perimetry
mean deviation in better eye (r=0.588, p<0.001), Humphrey perimetry mean deviation
in worse eye (r=0.605, p<0.001), Humphrey perimetry corrected pattern standard
deviation in better eye (r=-0.574, p<0.001), Humphrey perimetry corrected pattern
standard deviation in worse eye (r=-0.683, p<0.001), logMAR best corrected visual
acuity in worse eye (r=-0.34, p=0.027), critical fusion frequency in worse eye (r=0.541,
p<0.001). Age and duration of ocular symptom were not correlated with the degree
of improvement in VFQ-25 total scores.
Conclusions: The current study quantitatively demonstrates that vision-related
QOL in patients with pituitary adenoma dramatically improves by transsphenoidal
surgery.
CR: Y. Okamoto, None; F. Okamoto, None; T. Hiraoka, None; S. Yamada, None; T.
Oshika, None.
Support: None
1565 - B30
Quality of Life and the Spectrum of Glaucoma
K.J. Warrian, L.L. Lorenzana, G.L. Spaeth. Glaucoma Research Center, Wills Eye
Institute of Jefferson Medical College, Philadelphia, PA.
Purpose: To determine the relationship between self-reported quality of life (QoL)
and discrete stages of glaucomatous visual impairment.
Methods: 194 glaucoma patients ages 24-93, 98 female, 96 male, all without visually
significant ocular comorbidity completed the 25-Item National Eye Institute’s Visual
Functioning Questionnaire (VFQ) and monocular 24-2 SITA Standard Humphrey
visual fields in each eye. Patients were grouped into five discrete stages of impairment
using the Hodapp-Parrish-Anderson (HPA) grading system based on their worse seeing
eyes. Statistical analysis was conducted to identify significant differences in selfreported QoL between patients with different stages of glaucomatous impairment.
Results: Comparisons between early and late HPA stages were associated with
increasing numbers of statistically significant differences in VFQ total and subscale
scores. (Table 1) The earliest statistically significant differences in self-reported QoL
existed between HPA groups 1 & 2 and related to driving.
Conclusions: Patients generally remain asymptomatic until they have moderate
to severe visual field loss in their worse seeing eye; however, earlier self-perceived
limitations in driving may be present in the minimal to early stages of impairment.
Table 1: Statistically Significant Differences - HPA Worse Eye vs. VFQ Total and Subscale Scores*
HPA Stages Compared
VFQ Total and Subscale Scores
0-1
0-2
0-3
Total, General Vision, Near Activities, Mental health, Role Difficulties
Ocular Pain, Distance activities, Social functioning, Role Difficulties,
0-4
Dependency, Driving, Peripheral Vision
1-2
Driving
1-3
Total, Mental Health, Role Difficulties
Total, General Vision, Near Activities, Distance Activities, Social Functioning,
1-4
Role Difficulties, Dependency, Driving, Peripheral Vision
2-3
Total, Near Activities, Distance Activities, Mental Health, Role Difficulties,
2-4
Dependency
Total, Near Activities, Distance Activities, Role Difficulties, Dependency, Color
3-4
Vision, Peripheral Vision
* All results displayed
are significant to p <
0.05 using ANOVA and
the Least Significant
Difference (LSD)
correction for multiple
comparisons
CR: K.J. Warrian, None; L.L. Lorenzana, None; G.L. Spaeth, None.
Support: Pfizer, The Perelman Fund through the Wills Eye Institute, The Pearle Vision
Foundation, The Glaucoma Service Foundation to Prevent Blindness
1566 - B31
Health-Related Quality of Life in Graves’ Ophthalmopathy as Measured by the
SF-12
1567 - B32
Development and Testing of the Quality of Life in Children with
Keratoconjunctivitis (QUICK) Questionnaire
E.Bradley, J.A. Sloan, P.J. Novotny, J.A. Garrity, J.J. Woog. Ophthalmology, Mayo
Clinic College of Medicine, Rochester, MN.
M.Sacchetti1,2, I.Baiardini 3, A.Silvia1, A.Lambiase1,2, O.Fassio 4, S.Bonini 5,6, S.Bonini1,2.
1
Ophthalmology, University Campus Bio-Medico, Rome, Italy; 2GB Bietti Eye
Foundation-IRCCS, Rome, Italy; 3Internal Medicine, University of Genoa,
Genoa, Italy; 4Psychology, University of Turin, Turin, Italy; 5Internal Medicine, II
University, Naples, Italy; 6Inst Neurobilogy and Molecular Medicine, CNR, Rome,
Italy.
Purpose:To describe general health-related quality of life (HRQL) in Graves’
Ophthalmopathy and to compare results for Graves’ ophthalmopathy patients
compared to the general population.
Methods:The SF-12 general health survey was self-administered to Graves’
ophthalmopathy patients in a tertiary care setting. Patient responses to individual
items were converted to physical and mental standardized values, using standard
methods. Physical Component Summary (PCS) and Mental Component Summary
(MCS) scores were calculated and scores for male and female Graves’ ophthalmopathy
subjects were compared using the Wilcoxon rank sum test. Scores for female Graves’
subjects were compared to scores for the general population using an unpaired t-test.
The small number of male subjects precluded comparison to the general population
using a parametric test.
Results:37 Graves’ ophthalmopathy subjects (27 women, 10 men) with mean age
55.6 years completed the SF-12. Participants represented the full range of Graves’
ophthalmopathy disease severity. Female subjects had mean (SD) PCS score of 44.2
(9.8), and male subjects scored 45.7 (11.5). The difference in PCS by gender was not
statistically significant (p= 0.47) Mean MCS scores were 43.1 (11.7) for women, compared
to 50.8 (8.3) for men. This difference was not statistically significant (p= 0.09). Compared
to the general population of same mean age, women with Graves’ ophthalmopathy
scored a mean 2.6 (95% confidence interval -6.52 to 1.31) points lower on the PCS and
7.3 points lower (95% CI -11.95 to -2.65) on the MCS.
Conclusion:Men and women with Graves’ ophthalmopathy have similar physical
component SF-12 scores. There is a trend for women with Graves’ to have lower MCS
scores than men, but the trend was not statistically significant, possibly due to small
sample size. Women with Graves’ ophthalmopathy have statistically significantly
lower MCS scores than the general population, but similar PCS scores. The lower MCS
scores in women may reflect the emotional impact of altered physical appearance due
to Graves’ ophthalmopathy. Studies to evaluate how SF-12 scores compare to scores
on a Graves’ ophthalmopathy specific health-related quality of life instrument are
underway.
CR: E. Bradley, None; J.A. Sloan, None; P.J. Novotny, None; J.A. Garrity, None; J.
J. Woog, None.
Support: NIH EY13844
Purpose: Health related quality of life (HRQL) assessment in children with vernal
keratoconjunctivitis (VKC) is an unstudied area, and no disease-specific tool for
measuring HRQL has been developed for children with severe chronic allergic
conjunctivitis. The aim of this study is to develop and validate a questionnaire that
measures HRQL in children with severe allergic keratoconjunctivitis.
Methods: In the development phase, an initial list of 42 items covering the main
symptoms and problems related to VKC was compiled and administered to 30 children
with VKC in the active phase (6F, 24M; mean age 9±2 years). The 30 most significant
items were selected and converted into questions on a Likert scale of 3 steps for
validation. The validation procedure involved 41 children with VKC in the active
phase (8F, 33M; mean age 9.4±2 years). 22 children (5F, 17M) also completed the
generic KINDL® questionnaire. Clinical signs were evaluated and scored from 0 to
3 (0=absent, 1=mild, 2=moderate, 3 =severe) to correlate the QUICK scores to clinical
findings. The total signs score was calculated. The validation analysis was performed
by factorial analysis and Pearson’s correlation. Internal consistency was computed
by Chronbach’s alpha on the extracted factors.
Results: factorial analysis extracted 3 factors with a good internal consistency:
Symptoms (0.89), Mood (0.56) and Daily Activities (0.77). Correlations of the final
version of QUICK, (19 items) to KINDL® scores were in the expected direction.
Most patients complained of itching (93%), burning (90%), redness (90%), the need
to use eye-drops (90%), tearing (83%) and photophobia (80%). The children’s biggest
concerns were problems at school (41%) and limitations on going to the pool (71%),
playing sports (58%), meeting friends (58%) or playing outdoors (42%). The QUICK
Symptoms score was significantly correlated to clinical signs scores: conjunctival
hyperemia (p<0.001), secretion (p=0.042), chemosis (p=0.012), superficial punctuate
keratopathy (p<0.001) and to the total signs score (p=0.010).
Conclusions: QUICK questionnaire represents a new instrument to measure HRQL in
children with severe allergic conjunctivitis. It provides a short and simple assessment
useful for the global evaluation of VKC’s impact on children’s daily life.
CR: M. Sacchetti, None; I. Baiardini, None; A. Silvia, None; A. Lambiase, None; O.
Fassio, None; S. Bonini, None; S. Bonini, None.
Support: None
1564-1567
1568 - B33
Prospective Study of Fonctionnal Results After Nd:yag Capsulotomy
S.Milazzo, V, A.Bertout, II, S.Bijaoui, T.Nguyen. Department of Ophthalmology, Saint
Victor Center, Amiens, France.
Purpose: to determine the functional consequences and complications of Nd:YAG
capsulotomy
Methods: A prospective study was reported on 32 patients (37 eyes)having a Nd:
YAG capsulotomy. As excluded criteria were associated pathologies. All cases were
operated by the same surgeon, the procedure was phacoemulsification and the IOL
an hydrophobic acrylic. The mean diameter of the capsulotomy was of 2.5mm. Followup time was six months. Visual acuity, IOP, OCT, IOL,and contrast sensitivity were
evaluated, with a questionnaire of quality of vision. Statistical analysis was done
with the SSPS 13.0.
Results: Mean age was 74 y. Average apparition of posterior capsular opacification
was of 3+/-1.6 y. After laser treatment,VA did not change, like the contrast sensitivity
at different controls. No significative difference was observed on contrast sensitivity
between eye having capsulotmy and the other without PCO not, like on the values of
IOP pre and post laser.No other complications were observed, as retinal detachment,
macular edema.
Conclusions: Laser yag capsulotomy improve the visual acuity , and quality of vision,
only when PCO was present and must be treated.Even if complications are rare, the
systematic opening of posterior capsules does not present any visual benefit.
CR: S. Milazzo, None; A. Bertout, None; S. Bijaoui, None; T. Nguyen, None.
Support: None
1569 - B34
Stepping Adaptations When Negotiating a Raised Surface: A Comparison
Between Multifocal and Single Vision Spectacles in the Elderly
D.B. Elliott, L.Johnson, C.Harley, J.Buckley. Optometry, University of Bradford,
Bradford, United Kingdom.
Purpose: Epidemiological evidence indicates that elderly multifocal-wearers are at
increased risk of falling, especially on curbs or stairs. Yet little is known regarding
stepping strategies used by elderly multifocal-wearers during transitions between
levels. The purpose of this study was to determine the effects of wearing multifocal
compared to single distance vision spectacles upon stepping characteristics and toe
clearance parameters when negotiating a raised surface.
Methods: Nineteen healthy older adults (72.7 ± 4.2 yrs) repeatedly approached and
stepped up and along a raised platform (14.9 cm high, 3 m long, 1 m wide) the height
of which was randomly increased by 1.0 cm or decreased by 0.6 cm every fourth trial,
whilst wearing bifocal, varifocal or single distance vision spectacles. Toe clearance
parameters and step characteristics from lead limb heel contact before the platform
until lead limb foot contact on the platform were assessed using a 6-camera, Vicon
motion analysis system.
Results: When wearing multifocal compared to single distance vision spectacles the
trail limb was placed further from the platform (p=.05). Consequently the lead foot
crossed the raised edge later in swing phase and the foot landed closer to the step edge
when wearing bi- or varifocals (p = .003). Vertical toe clearance also increased (p<.001)
which may have been due to the changes in trail foot placement and/or the increased
ankle dorsi-flexion found in the multifocal conditions (p=.01). Forward centre-of-mass
velocity at foot contact during the penultimate and crossing steps was reduced when
wearing multifocal compared to single vision spectacles (p=.01), and there was an
increased incidence of ‘inadvertent’ heel (but not toe)-step contacts (p=.03).
Conclusions: Toe clearance and foot placement strategies when negotiating a raised
surface are adapted when wearing bi- and varifocal compared to single distance vision
spectacles. This suggests that the optical effects inherent in their design result in
unreliable visual information regarding the exact location and dimensions of a raised
edge. Although the adaptations utilised ensured vertical toe clearance increased,
the increase in heel contacts (which unlike a toe contact would likely not result in
a trip) suggest subjects may have adopted this strategy to increase propreoceptive
feedback.
CR: D.B. Elliott, None; L. Johnson, None; C. Harley, None; J. Buckley, None.
Support: Department of Health and Health Foundation (3991/3322)
1570 - B35
Preliminary Results of Validation of the Turkish Version of the National Eye
Institute Refractive Error Quality of Life Instrument (NEI-RQL-42)
1571 - B36
Correlation Between Near Visual Performance Tests to Sustained Reading
Performance
E.Toker, S.Onal, M.Eyriparmak, M.Eraslan. Ophthalmology, Marmara University
School of Medicine, Istanbul, Turkey.
M.V. Subbaram, I.G. Cox. Global R&D, Bausch & Lomb, Rochester, NY.
Purpose: Recent interest in refractive surgery has let to the development of refractive
error-specific quality of life surveys among which, National Eye Institute Refractive
Error Quality of Life Instrument (NEI-RQL-42) is a survey consisting of 42 items and
13 subscales. The original version is validated though a validated version in Turkish
is not available yet.
Methods: Twenty-five participants with a good visual acuity (better than 0.6 best
corrected visual acuity on each eye) on a Snellen scale completed the NEI-RQL-42
and VFQ-25 on two occasions to date.
Results: The internal consistency of the overall NEI-RQL-42 was excellent (Cronbach
α= 0.89). Three of the subscales had internal consistencies of less than 0.70 including
glare, suboptimal correction, and appearance. Two subscales had very high reliability
(expectations and near vision). The internal consistency of the previously validated
Turkish version of VFQ-25 was good (Cronbach α=0.83).
Conclusions: Preliminary results suggest a good reliability of the NEI-RQL-42 in
this sample population. The NEI-RQL-42 seems to be successfully translated and
culturally adopted from the English original.
CR: E. Toker, None; S. Onal, None; M. Eyriparmak, None; M. Eraslan, None.
Support: None
Purpose: To evaluate tests of visual performance and validate use of a letter counting
task as a surrogate measure of sustained reading performance.
Methods: 10 presbyopes and 10 non-presbyopes performed tasks of visual performance
using their habitual correction that provided a best-corrected visual acuity of 20/20
or better in each eye. Monocular visual acuity (ETDRS chart) and letter contrast
sensitivity were measured at distance 4m (Rabin chart), intermediate 65 cm, and
near 40 cm (MARS chart). Monocular reading speed was evaluated using the Radner
reading chart at near, and the letter counting task at intermediate (computer) and
near (print). Sustained reading speed was measured, monocularly at intermediate
(computer) and near (print), using texts that contained approximately 2500 words.
Following the sustained reading task, subjects answered 5 multiple choice questions
that served to ensure attention. The Student t-test was performed to test differences in
visual performance between presbyopes and non-presbyopes and right vs. left eyes.
Paired t-test was performed to test differences in visual performance within subjects at
intermediate and near test distances. Correlation analysis was performed to evaluate
use of letter counting task as a surrogate measure of sustained readability.
Results: No significant difference was measured between presbyopes and nonpresbyopes or between the two eyes of each subject across the different visual
performance tests included in the study. A significant difference in reading speed
was measured between the sustained reading task and Radner reading test (t = 6.47,
p < 0.001). A significant correlation was measured between the letter counting speed
(seconds) and the sustained text reading speed (r = 0.64, p< 0.0001).
Conclusions: Letter counting task can be used as a surrogate measure of readability.
No significant difference in best-corrected visual performance was measured between
presbyopes and non-presbyopes.
CR: M.V. Subbaram, Bausch and Lomb, E; I.G. Cox, Bausch and Lomb, E.
Support: None
1568-1571
1572 - B37
Physician Attitudes Regarding Prostaglandin Treatment for Glaucoma in the
United States and Europe
1573 - B38
Visual Field Loss and Brake Reaction Speed, a Measure of Driving Performance:
Salisbury Eye Evaluation Driving Study (SEEDS)
L.A. Nelson, B.Kruft, J.A. Stewart, W.C. Stewart. Pharmaceutical Research Network,
LLC, Charleston, SC.
L.Zhang1A, K.Baldwin2, B.Munoz1A, C.Munro1B, K.Turano1C, S.Hassan1C, K.Lyketsos1B,
K.Bandeen-Roche3, S.West1A. ADana Center for Preventive Ophthalmology,
B
Department of Psychiatry, CLions Low Vision Center, 1Johns Hopkins School of
Medcine, Baltimore, MD; 2Johns Hopkins University Applied Physics Laboratory,
Baltimore, MD; 3Department of Biostatistics, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD.
Purpose: To evaluate physician use of prostaglandins (latanoprost, travoprost and
bimatoprost) in the United States and Europe.
Methods: A physician survey distributed in the United States and Europe in which
physicians were randomly chosen to receive a multiple-choice survey by e-mail (and
fax in some cases). The survey was resent twice if no response was received. In total,
1000 surveys were distributed, 500 each in the United States and Europe.
Results: We received 71 responses (United States 40 [8%] and Europe 31 [6%]).
Physicians in both continents preferred prostaglandin monotherapy (United States
39 [98%] and Europe 22 [71%], P = 0.003), usually latanoprost (United States 32 [80%] and
Europe 22 [71%], P = 0.45). In both continents 45% of respondents stated bimatoprost
was more efficacious whereas a similar percent said all three were equally effective.
When more efficacy was required physicians in the United States would typically
switch (23 [58%]) and physicians in Europe add therapy (22 [71%], P = 0.007). Physicians
in both continents noted greater conjunctival hyperemia with bimatoprost. Physicians
in the United States generally believed bimatoprost caused greater: itching, ocular
pain or periocular pigmentation and that hyperemia adversely affected: cosmetic
appearance, number of office visits, compliance or ocular symptoms. Most physicians in
the United States and half of physicians in Europe (United States 32 [80%] and Europe
16 [52%], P = 0.01) continued a prostaglandin with cataract surgery.
Conclusions: This study suggested that physicians in the United States and Europe
prefer prostaglandin monotherapy, most commonly latanoprost. However, bimatoprost
is perceived often as more effective, but having a higher incidence of conjunctival
hyperemia. Further, physicians in the United States more often believe bimatoprost
contributes to hyperemia related problems and demonstrates additional side effects
of itching, ocular pain or periocular pigmentation.
CR: L.A. Nelson, None; B. Kruft, None; J.A. Stewart, None; W.C. Stewart, None.
Support: This study was not supported by any public or private funding agency.
1574 - B39
Effect of Monocular Blur on Adaptive Gait
Purpose: Concern for driving safety has prompted research into understanding
factors related to performance. Brake reaction speed (BRS), the speed with which
persons react to a sudden change in driving conditions, is a measure of performance.
Our aim is to determine the visual, cognitive, and physical factors predicting BRS in
a population sample of 1425 older drivers.
Methods: The Maryland Department of Motor Vehicles roster of persons aged 6787, residing in Salisbury MD, was used for recruitment of the study population.
Procedures included: habitual, binocular visual acuity using ETDRS charts, contrast
sensitivity using a Pelli-Robson chart, visual fields assessed with 81 points screening
Humphrey field at a single intensity threshold, and a questionnaire to ascertain medical
conditions. Cognitive status was assessed using a standard battery for attention,
memory, visuo-spatial and scanning, and executive function. BRS was assessed
using a computer-driven device that measured separately the initial reaction speed
(IRS) (from light change to red until moving foot) and physical response speed (PRS)
(moving foot from accelerator to full depression). Five trial times were averaged, and
time was converted to speed.
Results: The median brake reaction time varied from 384 to 5688 milliseconds. Age,
gender, and cognition predicted total BRS, a non-informative result as there are two
distinct parts to the task. Once separated, decrease in IRS was associated with low
scores on cognitive factors and missing points on the visual field. A decrease in PRS
was associated with having three or more physical complaints related to legs and
feet, and poorer vision search. Vision was not related to PRS.
Conclusions: We have demonstrated the importance of segregating the speeds for
the two tasks involved in brake reaction. Only the initial reaction speed depends on
vision. Persons in good physical condition may perform poorly on brake reaction tests
if their vision or cognition is compromised.
CR: L. Zhang, None; K. Baldwin, None; B. Munoz, None; C. Munro, None; K.
Turano, None; S. Hassan, None; K. Lyketsos, None; K. Bandeen-Roche, None; S.
West, None.
Support: National Institute of Aging, AG16906
1575 - B40
Visual Acuity, Contrast Sensitivity and Night Driving Visibility in
Complaining LASIK Subjects
A.Vale1A, J.G. Buckley1A, A.Scally1B, D.B. Elliott1A. AOptometry, BInstitute of health
research, 1University of Bradford, Bradford, United Kingdom.
A.P. Ginsburg, S.V. Subramaniam. Vision Sciences Research Corp, San Ramon, CA.
Abstract
Purpose: Monocular blur may cause a reduction in contrast sensitivity by binocular
inhibition and has been shown to increase stereoacuity thresholds more than binocular
blur of the same magnitude. When negotiating obstacles/steps under conditions of
binocular blur subjects adopt a strategy of increasing toe clearance to reduce the risk
of tripping, but as yet no studies have investigated if monocular blur will lead to a
similar adaptation. The present study determined how toe clearance and stepping
kinematics was affected by monocular blur or occlusion.
Methods: 14 healthy subjects (age 25.8±5.64) with normal vision walked along the
laboratory onto a raised surface. Trials were performed with optimal refractive
correction, 2 dioptre blur over the dominant or non-dominant eye or the dominant
eye occluded. Foot placement and limb kinematics were analyzed via 3D motion
analysis.
Results: Stereopsis was reduced to 257secs of arc (dominant eye blurred) and 153
secs of arc (non-dominant eye blurred). Analysis shows an 18% (p<0.001) increase
in vertical toe clearance when the dominant eye is blurred but only a 10% increase
(p<0.001) when the non-dominant eye was blurred. The trail (support) foot was placed
further from the step (p<0.001) and knee and hip flexure increased when each eye
was blurred or the dominant eye occluded.
Conclusions: We conclude that a relatively small amount of monocular blur (which
leads to a reduction in stereopsis) can cause uncertainty in locating the step edge
and increase vertical toe clearance to increase margins of safety. Blur in front of the
dominant eye had a greater effect on step adaptations to blur in front of the nondominant eye.
CR: A. Vale, None; J.G. Buckley, None; A. Scally, None; D.B. Elliott, None.
Support: College of Optometrists
Purpose:To determine the relationship between loss in visual acuity (VA), contrast
sensitivity (CS) and night driving visibility distances in LASIK patients with
unsatisfactory visual outcomes.
Methods:This was a retrospective case control study of 21 patients who underwent
bilateral conventional LASIK (Mean age = 39 ± 10.3 years). Binocular data with best
correction was compared with 29 age-matched controls (Mean age = 44.9 ± 12.9 years).
VA was measured using the ETDRS chart, CS by the Functional Acuity Contrast Test
(FACT) chart and visibility distances of road signs/hazards by the Night Driving
Simulator (NDS).
Results:The mean logMAR VA of LASIK subjects was 0.056 ± 0.23 and that of the
controls was -0.05 ± 0.06. CS was lower in LASIK subjects than the controls by 0.3 log
units (50% loss) or more from 3 to 18 cpd under all visibility conditions (p=0.001).
Decrease in night driving visibility for identification of road targets was greater than
25% compared to age-matched controls (p<0.001). Loss in NDS distances correlated
better with loss in CS than with loss in VA. The best correlations were observed at
the middle spatial frequencies of 3 and 6c/d (p<0.01), which is the peak of the human
contrast sensitivity function (CSF). Regression predicted an increase in night driving
identification distance loss by 37-40% in rural roads and 28-29% in city roads for an
average increase in CS loss of 0.3 log units at 3 and 6c/d.
Conclusions:Standard VA alone may be insufficient in assessing functional aspects
of vision such as night driving visibility in complaining LASIK subjects. Sine-wave
grating CS, in addition to VA testing, can be useful in evaluating the quality of
functional vision in such patients.
CR: A.P. Ginsburg, Vision Sciences Research Corp., C; S.V. Subramaniam, Vision
Sciences Research Corp., E.
Support: None
1572-1575
1576 - B41
Quality of Life and Visual Function in Uveitis Patients
K.W. Tai1A, C.M. Samson1B, D.Eng2, E.Devora3, J.Paa1A, K.Narayana1A. AOphthalmology
Research, BOphthalmology, 1New York Eye and Ear Infirmary, New York, NY;
2
Cornell University, New York, NY; 3New York University, New York, NY.
Purpose: To measure the quality of visual function and quality of daily living in
patients with uveitis and to evaluate the changes within individuals over time.
Methods: Consecutive patients with noninfectious uveitis were enrolled. The National
Eye Institute Visual Functioning Questionnaire, version August 2000 (NEI VFQ-25) and
the Medical Outcomes Study (MOS) 36 Item Short Form Health Survey Instrument (SF36) (RAND 36-Item Health Survey 1.0 Questionnaire) were administered by a trained
interviewer. Socio-demographic and clinical data were collected by subject report and
chart review. Trained telephone interviewers administered the NEI-VFQ as part of 6
month follow-up data collection. Changes in visual acuity, NEI-VFQ, MOS SF-36 scores
from baseline to 6 months were analyzed using linear regression methods.
Results: Fifty patients were enrolled. Interim analysis of forty five patients was
performed. The demographic characteristics of these patients showed mean age
was 42 years old (range 18-72 years) and 71% were female. Forty four percent were
African American and 13 % were white. Twenty nine percent completed some college.
Twenty nine percent earned $30,000 or more in annual household income. The clinical
characteristics of this population twenty nine percent was diagnosed with anterior
uveitis, 7% had posterior uveitis, 22% had panuveitis and 4% had other inflammatory
eye disease involvement. All patients had chronic disease. Evaluation of the NEI VFQ25 scores. Patients with posterior uveitis or panuveitis had significantly lower general
health and vision specific mental health scores than patients with anterior uveitis.
Patients with posterior and panuveitis generally showed a lower visual functioning
score than patients with anterior uveitis. Twenty patients had both interviews at 6
months after enrollment. Changes within individuals in the overall NEI-VFQ score
and in medical outcomes were related to changes in ocular and medical comorbidity
based on linear regression analysis (P<.05)
Conclusions: This study confirms that uveitis profoundly affects vision-related quality
of life. The patients with posterior and panuveitis cases showed the visual functioning
and quality of life was slightly poorer than patients with anterior uveitis disease. The
NEI-VFQ can be a valuable tool used to measure mean change in visual function and
general health status over time which can assist clinicians and patients to understand
the impact of the disease and its therapy on their quality of life.
CR: K.W. Tai, None; C.M. Samson, None; D. Eng, None; E. Devora, None; J. Paa,
None; K. Narayana, None.
Support: None CT: www.clinicaltrials.gov, 07-A-6803
1577 - B42
Evaluation of Visual Function in Eyes With Cataract Using a Point Spread
Function Analyzer
T.Noda1, K.Fujiike1, K.Ohno1, K.Negishi2, K.Ohnuma1,3. 1Disability and Rehabilitation
Research, National Institute of Sensory Organs, Megro Ku, Japan; 2Ophthalmology,
keio University, School of Medicine, Tokyo, Japan; 3Chiba University Faculty of
Engineering, Chiba, Japan.
Purpose: To evaluate visual function in eyes with a cataract using a point spread
function (PSF) analyzer.
Methods: Double-pass PSF images were analyzed using a PSF analyzer (Topcon,
Tokyo) in 44 eyes with a cataract. Retinal images were simulated by convolution of the
calculated single-pass PSFs using a variety of sizes of Landolt rings. The vision was
estimated based on the contrast analysis of the simulated Landolt rings and compared
with the subjective best-corrected visual acuity (BCVA) values. Modulation transfer
functions of the optical systems were obtained through equal-sized apertures (the
entrance and exit pupils), and the phase transfer functions were obtained through
unequal-sized apertures. The simulated retinal images were reconstructed with and
without a phase-retrieval algorithm.
Results: No significant correlation between the subjective BCVAs and the estimated
visual acuity by PSF analysis based on the unequal-pupil method with the phaseretrieval algorithm was seen; vision estimation correlated better with the equal-pupil
method without the phase-retrieval algorithm in cataractous eyes.
Conclusions: Evaluation of the visual function in eyes with a cataract is difficult
using the double-pass method through unequal-sized apertures with the phaseretrieval algorithm. Better visual estimates were obtained without the phase-retrieval
algorithm in cataractous eyes.
CR: T. Noda, None; K. Fujiike, None; K. Ohno, None; K. Negishi, None; K. Ohnuma,
Topcon Japan, C.
Support: None
1578 - B43
New Concepts in Screening for Vision Threatening Disease
B.Szirth, A.Khouri, N.Bhagat, K.Shahid. Inst of Ophthal & Visual Sci, UMD New
Jersey Medical School, Newark, NJ.
Purpose: The process of screening with image acquisition, tonometry, and image
interpretation can be time consuming and therefore limits the number of subjects
screened. By reducing the procedure time, we can improve screening efficiency and
increase numbers served. We evaluated a novel set-up to screen subjects while in
a standing position using a high-resolution, digital, non-mydriatic retinal camera
coupled with a series of digital software filters to enhance image studies.
Methods: Our novel VTD screening set-up consists of: a mechanical table mount
that elevates to 6’5’’ height (Anthro, Tualatin, OR), a Canon CR-DGi 8.2 megapixel
non-mydriatic digital camera (Tokyo, Japan), a Canon TXF non-contact tonometer
(Tokyo, Japan), a SIFIMAV for visual acuity (Palermo, Italy), an ambulatory blood
pressure monitor (A&D Co., Tokyo, Japan), and a Laptop computer (Fujitsu, Tokyo,
Japan). Captured images were processed through software (Eye-Q capture, Irvine,
CA) to expedite archiving and clinical assessment of images. Software-driven digital
imaging filters (Eye-Q Pro, Irvine, CA) were used to separate monochromatic channels
of posterior pole layers. A blue (490 nm), green (550 nm) and red (610nm) digital filter,
and a 3-dimensional view of the posterior pole is created from a single image utilizing
this digital process (EyeScape, Synemed, California, USA).
Results: Over 328 color images were acquired during 11 screening sessions. The
monochromatic channels were useful for VTD detection: blue digital filter illustrated
NFL drop out and macular pucker, green digital filter best revealed diabetic
retinopathy and retinal hemorrhages, red digital filter displayed AMD associated
macular changes (drusen and pigment epithelial defects) and choroidal nevi. We
found that the 3-dimensional, embossed view of the posterior pole best enhanced
topographic changes (macular holes/traction, retinal edema, and NFL drop out).
Fifteen images with NFL defects or glaucomatous neuropathy, six images with AMD
and twenty with diabetic retinopathy were observed. Imaging and data acquisition
time per subject were reduced by up to 50% (3 minutes) when subjects (up to height
6’5”) were screened while in a standing position versus 6 minutes in the sitting position
by conventional method.
Conclusions: VTD capture rate can be enhanced by screening subjects that are
standing at a modified set-up with a non-mydriatic retinal camera, non-contact
tonometer, and software-driven digital imaging filters. Using this protocol, screening
time can be reduced by almost 50%. The digital image processing can further enhance
appearance of retinal pathology and may improve VTD detection.
CR: B. Szirth, Canon Medical, C; A. Khouri, None; N. Bhagat, None; K. Shahid,
None.
Support: Research to Prevent Blindness
1576-1578
Monday, May 7, 3:00 PM - 4:45 PM Hall B/C Poster Session
274. Epidemiology of AMD - USA Organizing Section: CL
Program Number/Board # Range: 2086-2106 / B695-B715
2086 - B695
Single Marker Associations of Nuclear-Encoded Mitochondrial Genes With
Advanced AMD
2087 - B696
Single Marker Associations of Cell Cycle Pathway Genes With Advanced AMD
J.P. SanGiovanni1, E.Y. Chew1, T.E. Clemons2, A.K. Henning2, J.Hoh 3, M.Elashoff 2.
1
Clinical Trials Branch - DECR, National Eye Institute/NIH, Bethesda, MD;
2
EMMES Corp., Rockville, MD; 3Yale University, New Haven, CT.
Purpose: To examine the association of allelic variants in nuclear-encoded
mitochondrial (mt) genes with advanced AMD.
Methods: We applied data from a whole-genome case-control association study
to interrogate SNPs of nuclear-encoded mt genes from 50 healthy elderly people
without AMD, 50 people with neovascular (NV) AMD, and 46 people with central
geographic atrophy (CGA). Details of the study design, outcome ascertainment,
genomic profiling, and participant characteristics exist in Klein et al. (Science; 308:385.
2005). We used a curated mt gene catalogue and the Ensembl and NCBI databases to
identify 1593 SNPs on our microarray with positional markers in nuclear-encoded mt
gene regions. Final analyses were restricted to SNPs that met our data quality filters
(based on call frequency and Hardy-Weinberg equilibrium); this amounted to 1329
SNPs in regions of 433 nuclear-encoded mt genes. We compared allele combinations
of these SNPs in healthy controls to those in people with advanced AMD. A p-value
threshold of 0.002 for allelic association with AMD was determined from a false
discovery rate analysis.
Results: Two markers for advanced AMD (NV AMD + CGA) emerged when we
modeled the association of allele frequency with disease. One marker existed each for
NV AMD and CGA. In all cases SNPs were located in non-coding regions.
Conclusions: These novel findings demonstrate an association of variants in nuclearencoded mt genes with advanced AMD. Results will be validated with forthcoming
data from AREDS.
CR: J.P. SanGiovanni, None; E.Y. Chew, None; T.E. Clemons, None; A.K. Henning,
None; J. Hoh, None; M. Elashoff, None.
Support: DHHS\NIH\NEI Contracts
2088 - B697
Single Marker Associations of NFkB Pathway Genes With Advanced AMD
S.N. Ajudua1,2, M.Elashoff 3, E.Y. Chew1, A.Vora1,4, G.F. Reed1, E.Agron1, A.K. Henning3,
T.E. Clemons3, J.Hoh 5, J.P. SanGiovanni1. 1NEI-NIH, Bethesda, MD; 2Brown Medical
School, Howard Hughes Medical Institute-NIH Research Scholar, Bethesda, MD;
3
EMMES Corp., Rockville, MD; 4Robert Wood Johnson Medical School, Clinical
Research Training Program-NIH, Bethesda, MD; 5Yale University, New Haven, CT.
Purpose: To examine the association of allelic variants in NFkB pathway genes with
advanced age-related macular degeneration (AMD).
Methods: We applied data from a whole-genome case-control association study to
investigate single nucleotide polymorphisms (SNPs) of a cohort of 146 elderly people;
50 healthy people without AMD, 50 people with neovascular (NV) AMD, and 46
people with central geographic atrophy (CGA). Details of the study design, outcome
ascertainment, genomic profiling, and participant characteristics exist in Klein et
al. (Science; 308:385. 2005). We used a curated gene catalogue and the Ensembl and
NCBI databases to identify all SNPs on a microarray with positional markers in
regions of genes in the NFkB pathway. Final analyses were performed on restricted
SNPs that met our data quality filters (based on call frequency and Hardy-Weinberg
equilibrium); this amounted to 167 SNPs in regions of 55 genes. We compared allele
combinations of these SNPs in healthy controls to those in people with advanced
AMD. A p-value threshold of 0.002 for allelic association with AMD was determined
from a false discovery rate analysis.
Results: Three markers for CGA emerged in our additive models. We did not observe
NFkB-AMD relationships for NV AMD or advanced AMD (NV AMD + CGA).
Conclusions: These novel findings demonstrate an association between SNPs in the
NFkB pathway genes and CGA. Results will be validated in gene set analysis with
forthcoming data from age-related eye disease study (AREDS).
CR: S.N. Ajudua, None; M. Elashoff, None; E.Y. Chew, None; A. Vora, None; G.
F. Reed, None; E. Agron, None; A.K. Henning, None; T.E. Clemons, None; J. Hoh,
None; J.P. SanGiovanni, None.
Support: DHHS/NIH/NEI/contracts; SNA is supported by a HHMI Research
Scholarship; AV is supported by a Pfizer Inc. grant for the Clinical Research Training
Program
A.Vora1,2, J.P. SanGiovanni1, E.Y. Chew1, S.N. Ajudua1,3, G.F. Reed1, E.Agron1, A.K.
Henning4, T.E. Clemons4, J.Hoh 5, M.Elashoff4. 1NEI-NIH, Bethesda, MD; 2Robert Wood
Johnson Medical School, Clinical Research Training Program-NIH, Bethesda, MD;
3
Brown Medical School, HHMI-NIH Research Scholars Program, Bethesda, MD;
4
EMMES Corp., Rockville, MD; 5Yale University, New Haven, CT.
Purpose: To examine the association of allelic variants in cell cycle pathway genes
with advanced age-related macular degeneration (AMD).
Methods: We applied data from a whole-genome case-control association study to
analyze single nucleotide polymorphisms (SNPs) from 50 healthy elderly people
without AMD, 50 people with neovascular AMD (NV AMD), and 46 people with
central geographic atrophy (CGA). Details of the study design, outcome ascertainment,
genomic profiling, and participant characteristics exist in Klein et al. (Science; 308:385.
2005). We used a curated gene catalogue and the Ensembl and NCBI databases to
identify all SNPs on a microarray with positional markers in cell cycle pathway gene
regions. Final analyses were restricted to SNPs that met our data quality filters (based
on call frequency and Hardy-Weinberg equilibrium); this amounted to 180 SNPs
in regions of 60 genes. We compared allele combinations of these SNPs in healthy
controls to those in people with advanced AMD. A p-value threshold of 0.002 for allelic
association with AMD was determined from a false discovery rate analysis.
Results: One marker for CGA and advanced AMD (NV AMD + CGA) emerged in our
additive models. Cell Cycle-AMD relationships were not observed for NV AMD.
Conclusions: These novel findings demonstrate an association between a variant in
a cell cycle pathway gene and advanced AMD. Results will be validated in gene set
analyses with forthcoming data from the Age-Related Eye Disease Study (AREDS).
CR: A. Vora, None; J.P. SanGiovanni, None; E.Y. Chew, None; S.N. Ajudua, None; G.
F. Reed, None; E. Agron, None; A.K. Henning, None; T.E. Clemons, None; J. Hoh,
None; M. Elashoff, None.
Support: DHHS/NIH/NEI contracts; AV is supported by Pfizer Inc. grant for the
NIH Clinical Research Training Program; SNA is supported by an HHMI Research
Scholarship
2089 - B698
Association of NGF1-A Binding Protein 1 With Age-Related Macular
Degeneration
L.J. Kopplin1A, B.E. K. Klein2, R.Klein2, D.V. Leontiev1B, K.E. Lee2, S.K. Iyengar1B,1C.
A
Department of Genetics, BDepartment of Epidemiology and Biostatistics,
C
Department of Ophthalmology, 1Case Western Reserve University, Cleveland,
OH; 2Department of Ophthalmology and Visual Sciences, University of Wisconsin
Medical School, Madison, WI.
Purpose: Age-related macular degeneration (AMD) is a progressive disease that can
lead to loss of central vision and in severe cases, blindness. Multiple linkage studies have
identified genomic regions that may contain susceptibility loci for AMD. Within one of
these regions, chromosome 2q, is an interesting positional candidate gene NGF1-A binding
protein 1 (NAB1). NAB1 is a known repressor of members of the NGFI-A family of zinc
finger transcription factors. The NAB proteins play a key role in appropriate Drosophila
eye development, are essential for Schwann cell differentiation, and NAB1 has recently
been implicated in photoprotection in C. reinhardtii.
Methods: We performed a family based association study in samples from the Family Age
Related Maculopathy Study (FARMS) to test for the association of NAB1 with AMD. In all,
we genotyped 293 individuals from 34 extended pedigrees. Six tag SNPs, chosen using
the Tagger program in HapMap (r2≥0.8, MAF≥0.1) and covering the gene, were tested for
association with a power transformed AMD phenotype, calculated from a fifteen point
quantitative severity scale. The 15-step AMD scale was derived from stereoscopic fundus
photographs of both eyes taken on all available family members. For each SNP, we tested
dominant, recessive and additive models of inheritance using the ASSOC program in
S.A.G.E. The p-values from the likelihood ratio test are reported.
Results: Using a variance component family-based association analysis model that
included sibling effects, 3 SNPs were significantly (p<0.05) associated with the AMD
phenotype and 1 SNP approached significance: rs958770 (p=0.002, recessive), rs2293765
(p=0.004, dominant), rs483515 (p=0.04, additive), rs2293765 (p=0.06, additive). Including
polygenic effects in the model, SNPs rs958770 (p=0.002) and rs2293765 (p=0.04) remained
significant. rs958770 and rs2483515 also showed significance under different models of
inheritance (additive and recessive respectively). The significant SNPs are all located
within intronic regions of NAB1; rs2293765 is located in an untranslated 5’ region of
the gene.
Conclusions: Our analysis indicates that NAB1 shows some association with the AMD
phenotype and may contribute to the pathogenesis of AMD. Replication of these findings
in additional study groups and the accumulation of further biological lines of evidence
is still necessary to confirm our work.
CR: L.J. Kopplin, None; B.E.K. Klein, None; R. Klein, None; D.V. Leontiev, None; K.
E. Lee, None; S.K. Iyengar, None.
Support: R01EY 015810 to Dr. Iyengar
2086-2089
2090 - B699
Refractive Error in the Complications of Age-Related Macular Degeneration
Prevention Trial (CAPT): Risk of Late AMD and 5-Year Changes
2091 - B700
Environmental Association and Interaction With the Complement Factor H
Gene in Early Bilateral Age-Related Macular Degeneration: the Los Angeles
Latino Eye Study
C.Liu, M.Maguire, G.-S.Ying, CAPT Research Group. Scheie Eye Institute,
Philadelphia, PA.
Purpose: To describe refractive error (RE) at baseline, examine RE as a risk factor
for late age-related macular degeneration (AMD), and describe 5-year changes in RE
among patients with bilateral large drusen.
Methods: 1052 participants with ≥10 large (>125µ) drusen and visual acuity ≥20/40 in
each eye were enrolled into CAPT. One eye of each participant was randomly assigned
to treatment, and the contralateral eye was assigned to observation. RE was measured
following a standardized protocol at baseline, 6 months and annually. The association
of baseline spherical equivalent (SE) and incident choroidal neovascularization (CNV)
and endpoint geographic atrophy (GA) was evaluated through survival analysis.
Endpoint GA was defines defined as a total of >1 MPS disc area of atrophy when all
areas of geographic atrophy were combined. Associations of demographic and clinical
factors with 5-year changes in SE were examined with multiple linear regression
analysis. The generalized estimating equations (GEE) approach was used to account
for the correlation between eyes of the same subject.
Results: Of the 2084 eyes (excluding 20 eyes with baseline CNV), the mean SE was
0.72± 1.81 D; 1125 (54.0%) were hyperopic (>0.5D), 566 (27.2%) were emmetropic, and
393 (18.9%) were myopic (<-0.5D) at baseline. After adjustment for other risk factors,
the relative hazard {95% CI} associated with +1 D was 1.04 ({0.97, 1.12}; p=0.26) for
CNV and 0.96 ({0.87, 1.06}; p=0.39) for GA. Among the 1502 eyes with RE measured at 5
years, the mean change was 0.02±0.95D and did not differ between treated (0.04±0.96D)
and observed (-0.005±0.95) eyes (p=0.27). Overall, 5 year-changes were more towards
hyperopia in males (mean +0.10D) than in females (mean -0.03D; p<0.01). The relation
between age and 5-year change depended on lens status (p for interaction <0.005).
Among eyes phakic at baseline, older baseline age was associated with an increased
myopic shift, while among pseudophakic eyes older baseline age was associated with
increased hyperopic shift. For example, among patients older than 75, phakic eyes had
SE decrease by 0.24D, but pseudophakic eyes increased by 0.29D.
Conclusions: Among CAPT participants, baseline SE was not associated with incidence
of CNV or endpoint GA. SE increased on average by 0.02D in 5 years. Older eyes with
a natural lens experienced a myopic shift. Pseudophakic older eyes experienced a
hyperopic shift.
CR: C. Liu, None; M. Maguire, None; G. Ying, None.
Support: Supported by NIH grant EY 12279, EY 12211.
2092 - B701
Prevalence of Age-Related Macular Degeneration Among Patients With
Alzheimer’s Disease
H.E. Volk, R.Varma, N.Tedeschi, D.Hinton, J.Buckley, T.Triche, S.Azen, LALES Group.
Preventive Medicine, Univeristy of Southern California, Los Angeles, CA.
Purpose: Significant interactions between the Y402H polymorphism in the complement
factor H (CFH) gene and modifiable risk factors such as smoking status and body
mass index (BMI) have been reported for advanced age-related macular degeneration
(AMD). These interactions have not been tested for early AMD. This study examines
genetic and environmental risk due to CFH, smoking status, BMI, and high blood
pressure in early bilateral AMD.
Methods: Prevalent early AMD cases (n=101) and control subjects (n=595) were
ascertained from the Los Angeles Latino Eye Study (LALES). Early AMD cases were
identified by the presence of intermediate to large soft drusen in both eyes by masked
grading of fundus photographs. Subjects were categorized as smokers if former or
current smoking was reported during the study visit. BMI and high blood pressured
were calculated from recorded height, weight, systolic (SBP) and diastolic (DBP)
blood pressure measurements. A BMI of <25kg/m 2 was classified as normal, 25 to
<30 overweight, 30 to <40 obese, and ≥40 morbidly obese. High blood pressure was
defined as having a SBP ≥140mmHg or DBP ≥90mmHg. The proportion of H alleles
was compared among cases and controls. Homogeneity tests were used to determine
if this relationship varied by environmental factors.
Results: CFH (HH/HY vs. YY, OR=1.71(1.11-2.63)) was associated with early AMD after
controlling for age and gender. High blood pressure (OR=1.73(1.08-2.78)) and age (60-69
years vs. 40-49 years, OR=1.90(1.04-3.49); ≥70 years vs. 40-49 years, OR=1.87(1.00-3.48))
significantly increased risk for early AMD. High blood pressure did not significantly
alter the relationship between CFH and early AMD (high blood pressure, 45.7% AMD
vs. 31.5% controls, p=0.12; regular blood pressure, 43.9% AMD vs. 32.3% controls,
p=0.06; test of homogeneity p=0.82). There was no significant increase in risk for
early AMD by BMI or smoking status. No differences were found in the prevalence
of early AMD by the presence of the H allele and smoking status.
Conclusions: The CFH H-allele and high blood pressure do not interact to increase
risk for early bilateral AMD in a population-based sample of Latinos.
CR: H.E. Volk, None; R. Varma, None; N. Tedeschi, None; D. Hinton, None; J.
Buckley, None; T. Triche, None; S. Azen, None.
Support: NIH Grants ES013678, EY 11753, EY 03040, Arnold and Mabel Beckman
Foundation, unrestricted grant from Research to Prevent Blindness
2093 - B702
UVR Exposure and Risk of Neovascular Age-Related Macular Degeneration
A.Baumritter1, C.M. Clark 2, R.Martin1, J.D. Steinberg1, R.A. Stoltz1, G.-S.Ying1,
M.Brightwell-Arnold1, M.G. Maguire1. 1Ophthalmology, Scheie Eye Institute,
University of Pennsylvania, Philadelphia, PA; 2Neurology, Penn Memory Center,
University of Pennsylvania, Philadelphia, PA.
Purpose: To estimate the prevalence of age-related macular degeneration (AMD)
among patients diagnosed with mild to moderate Alzheimer’s Disease (AD) and
compare it to estimates for the general US population.
Methods: Fifty-nine of 194 patients with a diagnosis of probable AD receiving care
at the PENN Memory Center (PMC) at the University of Pennsylvania were recruited
into this cross-sectional pilot study. After pupil dilation, fundus photographs of each
eye were taken by certified fundus photographers. Trained graders at the Scheie
Image Reading Center, University of Pennsylvania evaluated photographs using
the International Classification and Grading System for Age-Related Maculopathy
as the basis for the grading of drusen and late AMD. Early AMD was defined as 1 or
more large (>125µ) drusen in one or both eyes. Late AMD was defined as presence of
choroidal neovascularization or geographic atrophy in one or both eyes. The observed
numbers of both early and late AMD were compared to their expected numbers based
on US age-sex-race specific prevalence rates. The standardized ratios and their 95%
confidence intervals were calculated by using the Confidence Interval Analysis (CIA)
software {version 2.1.}.
Results: Among 51 (86%) of 59 patients with gradeable photographs for at least one eye, 30
(59%) were female, 40 (78%) were white, and the mean age was 75 years with a range 52-91 years.
Five (10%) of 51 had late AMD. The standardized ratio of late AMD prevalence in AD
patients was 1.93 (0.63 - 4.49). Of the remaining 46 patients, 14 (30%) had early AMD
with large drusen present in at least one eye. The standardized ratio of early AMD
prevalence in AD patients was 2.15 (1.18 - 3.61).
Conclusions: Within this group of patients with AD, prevalence of early AMD was
higher than expected from prevalence rates for the US population. These results are
consistent with laboratory reports of amyloid � present in both drusen and AD plaques
that suggest that AMD and AD share some pathogenic pathways.
CR: A. Baumritter, None; C.M. Clark, None; R. Martin, None; J.D. Steinberg,
None; R.A. Stoltz, None; G. Ying, None; M. Brightwell-Arnold, None; M.G. Maguire,
None.
Support: None
A.J. Harring1, A.M. Lane1,2, M.A. Morrison1, A.Copone3, T.P. Dryja1,2, J.W. Miller1,2,
I.K. Kim1,2, M.M. DeAngelis1. 1Ophthalmology, Mass Eye & Ear Infirmary, Boston,
MA; 2Ophthalmology, Harvard Medical School, Boston, MA; 3Associated Retinal
Consultants, PC, William Beaumont Hospital, Royal Oak, MI.
Purpose: Findings have not been in agreement as to a causative or protective effect
of sunlight exposure on risk of age-related macular degeneration (AMD). Therefore
we evaluated UVR (Ultraviolet Radiation) Index, UV-A, and UV-B as a measure of
sunlight exposure on risk of neovascular AMD.
Methods: We obtained epidemiological data by conducting telephone or in-person
standardized interviews with 135 extremely discordant sibpairs (index case with
neovascular AMD [mean age = 71.4 yrs] and sibling with normal maculae past the age
of diagnosis of the index patient [mean age = 72.8 yrs]) from 135 families. Disease status
was ascertained by two investigators by review of fundus photographs. If necessary,
a home retinal examination was performed (n =6). Exposure data were measured up
to the age of AMD diagnosis of the index subject. We determined UVR index, UV-A,
and UV-B measures by inputting the city and state at which the individual resided
for the majority of his or her lifetime using the following website: http://cprm.acd.
ucar.edu/Models/TUV/Interactive_TUV/. This calculator uses longitude, latitude and
elevation to estimate UVR levels. We assessed the relationship between neovascular
AMD and UVR levels using McNemar’s test.
Results: A decrease in risk of neovascular AMD was observed in subjects with
lifetime UV index exposure greater than or equal to 3.0 when compared to those
with a UV index of less than 3.0 (OR: 0.23, 95% CI: 0.08-0.52, p =.0002), (number of
informative sibpairs: n = 38). Similar results were obtained when we caluclated UVA or UV-B exposures separately. Individuals with a lifetime UV-B exposure of 0.60
or greater compared to individuals who had measures less than 0.60, had a 14-fold
reduction in risk of neovascular AMD (p < 0.001.), (number of informative sibpairs:
n = 30). Subjects with a lifetime UV-A exposure of 31.6 or greater compared to those
with a measure of less than 31.6 had a 2.7 fold decrease in risk ( p = 0.009), (number
of informative sibpairs: n = 37) .
Conclusion: In this cohort of extremely discordant sibpairs, preliminary analysis
revealed that subjects who were exposed to higher UVR levels (UVR Index, UV-A,
or UV-B) for the majority of their lifetimes were less likely to develop neovascular
AMD than subjects who were exposed to lower UVR levels.
CR: A.J. Harring, None; A.M. Lane, None; M.A. Morrison, None; A. Copone, None; T.
P. Dryja, None; J.W. Miller, None; I.K. Kim, None; M.M. DeAngelis, None.
Support: The Ruth and Milton Steinbach Fund, the Lincy Foundation, the Knight
AMD Fund, the Mass. Lions, Friends of the MEEI., Genetics of AMD Fund, Research
to Prevent Blindness, NIH grants EY014458, EY14104
2090-2093
2094 - B703
Association Between Age-Related Macular Degeneration and Five-Year
Mortality Among Medicare Patients
2095 - B704
Reproductive Hormone Exposures and Five-Year Incidence of Age-Related
Macular Degeneration in Older Women
F.Yu1,2A, E.Anastasopoulos3, A.L. Coleman1,2B. 1Ophthalmology, JSEI, UCLA, Los
Angeles, CA; ABiostatistics, BEpidemiology, 2UCLA School of Public Health, Los
Angeles, CA; 3Ophthalmology, Papageorgiou Hospital, Aristotle University of
Thessaloniki, Thessaloniki, Greece.
R.Seitzman1, A.L. Coleman1, F.Yu1, J.A. Cauley2, K.E. Ensrud 3, K.Stone4, K.Pedula 5,
G.Thomas 6, C.Mangione7, Study of Osteoporotic Fractures Research Group.
1
Ophthalmology, UCLA/Jules Stein Eye Institute, Los Angeles, CA; 2Epidemiology,
University of Pittsburgh, Pittsburgh, PA; 3Medicine, Veterans Affairs Medical
Center, Minneapolis, MN; 4San Francisco Coordinating Center, San Francisco, CA;
5
Kaiser Permanente Center for Health Research, Portland, OR; 6The Retina-Vitreous
Associates Medical Group, Beverly Hills, CA; 7Medicine, UCLA, Los Angeles, CA.
Objective: To assess the five-year mortality rate from 1995 to 1999 among Medicare
patients with age-related macular degeneration (AMD).
Methods: Medicare beneficiaries with AMD in 1995 were identified by International
Classification of Diseases, Ninth Revision (ICD-9) diagnoses codes from a 5% random
sample of Medicare databases (Centers for Medicare and Medicaid Services (CMS) 5%
Physician/Supplier Part B Files), including neovascular AMD (ICD-9: 362.42, 362.43,
362.52), non-neovascular AMD (ICD-9: 362.51) and early AMD (ICD-9: 362.50, 362.57).
Patients were excluded if they were under 65 years of age, did not reside in the 50
United States or the District of Columbia, did not have Part-B coverage, had HMO
coverage that was not processed by CMS, or lacked follow-up information. Five-year
mortality rate from 1995 to 1999 was then determined by the death code in the CMS
5% Denominator files. Multiple logistic regression models were applied to estimate
the effects of AMD on the five-year mortality rate, adjusted for potential baseline risk
factors, including demographic factors (age, gender, race/ethnicity, CMS region of
residence, and length of follow-up) and clinical factors (the indicators for the presence
of primary open-angle glaucoma, cataract, hypertension, cardiovascular disease,
cerebrovascular disease, diabetes, and hyperlipidemia).
Results: Among 1,223,796 eligible Medicare patients in the 5% sample, a total of 82,017
(6.7%) AMD patients were identified in 1995, including 9,224 (0.8%) neovascular AMD
patients, 29,267 (2.4%) non-neovascular AMD patients, and 43,526 (3.6%) early AMD
patients. The overall five-year mortality rate was 26%. There was no relationship
between any AMD and five-year mortality rate in the adjusted model (OR=0.98; 95%
CI: 0.96, 1.00). Compared with patients without any AMD, there was a significantly
lower mortality rate in neovascular AMD patients (OR=0.87; 95% CI: 0.82, 0.92) and
a slightly higher mortality rate in non-neovascular AMD patients (OR=1.03; 95% CI:
1.00, 1.07).
Conclusions: Although there was no association between any AMD and the 5-year
mortality rate in the fully-adjusted model, which is consistent with the results from the
Beaver Dam Eye Study and the Blue Mountain Eye Study, neovascular AMD patients
have significantly lower mortality rates and non-neovascular AMD patients have
slightly higher mortality rates. These findings warrant further exploration.
CR: F. Yu, None; E. Anastasopoulos, None; A.L. Coleman, None.
Support: by the Center for Eye Epidemiology, Jules Stein Eye Institute, University of
California Los Angeles, CA, and by an unrestricted grant from Research to Prevent
Blindness, New York, NY.
2096 - B705
Psychometric Qualities of the National Eye Institute Visual Function
Questionnaire-25 in Age-Related Macular Degeneration Patients in Two
Clinical Trials
Purpose: To examine the associations of reproductive hormone exposures with
incidence of age-related macular degeneration (AMD) in older women.
Methods: Subjects included participants in the Study of Osteoporotic Fractures
attending the year 10 and year 15 follow-up visits that had fundus photographs
gradable for early or late AMD in both eyes at both visits (n=1699). Forty-five degree
stereoscopic fundus photographs were graded for AMD using a modification of the
Wisconsin Age-Related Maculopathy Grading System. History of postmenopausal
hormone therapy use, hysterectomy and surgical menopause were determined with
questionnaires. Estrogen therapy (ET) and estrogen plus progestin therapy (HT)
could be distinguished for Caucasians only. Total hip BMD, a potential surrogate
for lifetime endogenous estrogen exposure, was measured with dual energy x-ray
absorptiometry. Logistic regression was used to test whether these risk factors were
associated with incident early or late AMD. Interactions between each reproductive
factor and smoking were tested.
Results: Approximately 57% of subjects reported ET or HT use. The 5-year AMD
incidence was 18.6% for early and 5.5% for late. None of the reproductive factors was
associated with early AMD in the complete sample; however, HT use was associated
with a lower risk of early AMD in Caucasians (OR=0.45; 95% CI: 0.22-0.92). Compared
to the lowest BMD quartile, quartiles two and three combined, but not quartile four,
was associated with a significantly lower risk of late AMD (OR Q2+Q3 =0.56; 95% CI:
0.33-0.97; OR Q4=0.86; 95% CI:0.44-1.67).
Conclusions: Use of postmenopausal hormone therapy was not significantly associated
with early or late AMD in the complete sample; however, HT use was associated with
reduction of early AMD risk in Caucasians. This association should be examined in
other subgroups. Furthermore, BMD may be associated with late AMD risk. Further
research is needed to understand the biological mechanisms that underlie these
associations.
CR: R. Seitzman, None; A.L. Coleman, None; F. Yu, None; J.A. Cauley, None; K.E.
Ensrud, None; K. Stone, None; K. Pedula, None; G. Thomas, None; C. Mangione,
None.
Support: NIH grants EY013626, AG05407, AR35582, AG05394, AR35584, AR35583, and
AG08415; Research to Prevent Blindness; Emily G. Plumb Estate and Trust.
2097 - B706
Vascular Endothelial Growth Factor (VEGF) Polymorphisms and Their
Association With Age-Related Macular Degeneration
A.M. Rentz1, D.A. Revicki1, V.S. Thomas2. 1The Center for Health Outcomes Research,
United BioSource Corporation, Bethesda, MD; 2Health Economics & Outcomes
Research, Novartis Pharma, Basel, Switzerland.
Purpose: To evaluate the psychometric qualities of the National Eye Institute Visual
Function Questionnaire-25 (NEI VFQ-25) in two ranibizumab clinical trials - ANCHOR
and MARINA - in patients with age-related macular degeneration (AMD).
Methods: The NEI VFQ-25 was administered to 1,146 patients with subfoveal choroidal
neovascularization due to AMD with minimally classic or occult with no classic types
in MARINA and predominantly classic type in ANCHOR at baseline and months 1,
2, 3, 6, 9 and 12. The SF-36 Health Survey was administered at baseline, and months
6 and 12. Visual acuity and other clinical assessments were completed throughout
the studies. Internal consistency reliability, construct validity, and responsiveness
were examined.
Results: For the combined sample, average age was 77 (range 52-96) with 59% women.
Internal consistency reliability was 0.96 for the VFQ-25 total score and ranged from
0.62 (ocular pain) to 0.91 (near activities) for the subscales. At baseline, the VFQ-25 total
and subscale scores were significantly correlated with SF-36 subscale and summary
scores (p<0.05). Total score, and near activities, distance activities and dependency
subscale scores were significantly correlated with best corrected visual acuity (BCVA)
and contrast sensitivity, and all scores varied by different BCVA groups (p<0.001). The
VFQ-25 total, near activities, distance activities and dependency scores were most
responsive to changes in BCVA over 12 months (all p<0.001). Visual acuity responders
reported significantly better VFQ-25 scores compared to non-responders (p<0.001).
Conclusions: The VFQ-25 total and subscales scores, especially near activities, distance
activities, and dependency, are reliable and valid in patients with AMD. Based on these
findings, the VFQ-25 represents a good measure of patient-reported vision-related
quality of life outcomes for clinical trials comparing treatments for AMD.
CR: A.M. Rentz, Novartis, F; D.A. Revicki, Novartis, F; V.S. Thomas, Novartis,
E.
Support: Novartis
S.R. Smith, Z.-Z.Tong, R.Constantine, E.Brinton, J.Cameron, D.Gibbs, S.Schneider,
J.Harmon, Z.Yang, K.Zhang. Ophthalmology, Moran Eye Center, Salt Lake City, UT.
Purpose: Age-related macular degeneration (AMD) is the leading cause of severe
visual loss in people over 50 years of age in the United States. Vascular endothelial
growth factor (VEGF)-A has been found to play a major role in retinal and choroidal
neovascularization. The use of anti-VEGF medications has become the standard
treatment for neovascular AMD. Churchill and colleagues recently examined
the association between neovascular AMD and VEGF and reported a signifiicant
association with the SNP rs 1413711 and neovascular AMD. The purpose of this study
is to evaluate the assocation of rs1413711 and neovascular AMD in a Utah cohort and
investigate any association with different subtypes of AMD
Methods: Patients with AMD at the University of Utah Moran Eye Center in Salt
Lake City, Utah underwent dilated fundus examination and fluorescein angiography
if needed. Based upon these findings patients were grouped into 3 different AMD
subtypes: geographic atrophy, soft confluent drusen and neovascular AMD. Blood
samples were collected after obtaining informed consent and genotyped with snapshot
kits using a ABI 3130 sequencer. The allele frequencies of the SNP rs 1413711 were
compared in cases and controls and with the different AMD subtypes. Statistical
analysis was performed using the SPSS program, and p-values reported using Pearson’s
chi-square.
Results: 75 patients with geographic atrophy, 82 patients with soft confluent drusen,
292 patients with exudative AMD and 200 controls were genotyped. There was no
significant assocation found between SNP rs 1413711 and neovascular AMD (p=0.252).
Additionally, there was no assocation between the SNP rs1413711 and any of the other
subtypes of AMD, including those patients with geographic atrophy (p=0.323 ) and
soft confluent drusen (p=0.186).
Conclusions: Churchill and colleagues found a significant association with SNP
rs1413711 and neovascular AMD. However, our analysis showed no significiant
association. There was also no association found in the geographic atrophy and soft
confluent drusen groups. Additional analysis needs to be performed to investigate if
any other SNPs in VEGF play a role in AMD. Genotyping of additional SNPs in VEGF
is in progress and will be presented.
CR: S.R. Smith, None; Z. Tong, None; R. Constantine, None; E. Brinton, None; J.
Cameron, None; D. Gibbs, None; S. Schneider, None; J. Harmon, None; Z. Yang,
None; K. Zhang, None.
Support: NIH, Foundation Fighting Blindness and Research to Prevent Blindness
2094-2097
2098 - B707
Covariate-Specific Linkage Peaks From a High Density SNP Genome Screen for
Age- Related Macular Degeneration
S.Schmidt1A, M.A. Hauser1A, R.R. Allingham1B, P.Gallins1A, W.K. Scott2, A.Agarwal3A,
J.L. Haines3B, E.A. Postel1B, M.A. Pericak-Vance2. ACtr for Human Genetics, BDept
Ophthalmology, 1Duke University Medical Center, Durham, NC; 2Univ of Miami,
Miami, FL; AOphthalmology, BCtr for Human Genetics Research, 3Vanderbilt
University, Nashville, TN.
Purpose: AMD is a common complex disorder with both genetic and environmental
contributions. With two major susceptibility genes already identified, it is likely that
additional genes have smaller effects, confer subtype-specific risk, and/or act primarily
in the presence of environmental risk factors. We report results of incorporating
environmental and clinical covariates into an SNP-based genome-wide linkage screen
for AMD.
Methods: The Illumina Bead Station platform (Linkage Panel IV) was used to genotype
339 individuals from 115 multiplex AMD families. After excluding markers that did
not meet quality control criteria, 5253 SNPs were analyzed with standard linkage
methods. To incorporate continuous environmental and clinical covariates, ordered
subset analysis (OSA) and quantitative trait locus (QTL) analysis were applied to the
following variables: age at exam, body mass index (BMI), intraocular pressure (IOP)
and pack-years of cigarette smoking.
Results: We replicated previously reported OSA results for chromosome 14q13 in our
current dataset, in which the multipoint lod score for a subset of 61 families with belowaverage IOP (≤15.5) values increased from 1.6 to 4.1 at 33 cM (p=0.02). Chromosome
12q23, which is one of the top nine susceptibility regions reported by a recent meta
analysis, may harbor a locus that influences the AMD risk specifically in cigarette
smokers: Analyzing pack-years of smoking as the trait in a QTL analysis yielded a lod
score of 3.6 at 117 cM. On chromosome 6p12, analyzing BMI as the trait gave a lod score
of 3.2 at 73 cM (~47.4 Mb), and using age at exam as the OSA covariate gave a peak
score of 2.5 at 75 cM for 63 families with average age at exam ≤80 years (p=0.04). BMI
and age at exam are significantly correlated in our dataset (r=-0.225, p<0.0001). It is
currently unclear whether this finding is partially explained by the recently implicated
factor B and complement component 2 genes located at ~37.0 Mb.
Conclusions: The incorporation of clinical and environmental covariates into our
genome screen analysis has narrowed down previously reported linkage regions, for
which the underlying susceptibility genes have yet to be identified.
CR: S. Schmidt, None; M.A. Hauser, None; R.R. Allingham, None; P. Gallins,
None; W.K. Scott, None; A. Agarwal, None; J.L. Haines, None; E.A. Postel, None; M.
A. Pericak-Vance, None.
Support: NIH Grant EY12118, EY015216
2099 - B708
Genetic Analysis of HTRA1 in Dry Age-Related Macular Degeneration
D.Cameron, Z.Yang, D.Gibbs, H.Chen, A.Jorgensen, L.Luo, G.Brinton, N.A. Zabriskie,
Z.Tong, K.Zhang. Ophthalmology and Visual Sciences, University of Utah, Moran
Eye Center, Salt Lake City, UT.
Purpose: Age-related macular degeneration (AMD) is the most common cause of
irreversible visual impairment in the developed world. The two forms of advanced
AMD, geographic atrophy (GA) and choroidal neovascularization (wet AMD),
represent two degenerative processes in the macula that lead to loss of central
vision. Soft confluent drusen, characterized by deposits in macula without visual
loss, are considered a precursor of advanced AMD. Recently, We have shown that
a common variant, rs11200638 in the promoter of HTRA1 increases the risk for wet
AMD. However, its impact on soft confluent drusen and GA or the relationship
between them is unclear.
Methods: We genotyped 250 patients with dry AMD (138 GA and 112 soft confluent
drusen) and 294 controls. We performed chi square analysis for an additive allelic
model to investigate dissease association. We also examined other variants in region
10q26 conditioned on rs11200638 using stepwise logistical regression.
Results: The HTRA1 rs11200638 has a highly significant association with GA (p=9.9
× 10 -9 for an additive allele-dosage model, OR het=2.06 (1.32, 3.22), OR hom=9.29 (4.14,
20.84)) and confers an estimated population attributable risk of 47.9%. We found that
soft confluent drusen is also associated with HTRA1 rs11200638 risk allele (p=3.6
x 10 -5 for an additive allele-dosage model, OR het=1.12 (0..70, 1.79), OR hom=5.73 (2.48,
13.23)). Furthermore, among the variants examined, none remained significant after
conditioning to rs11200638.
Conclusions: We show that the rs11200638 confers similar risks for GA as was
demonstrated for wet AMD. It also confers risk to soft confluent drusen, although to
a lesser extent. Our results suggest that HTRA1 is a major risk factor for GA and wet
AMD. Further genetic and functional investigations will provide important insight
in AMD pathogenesis and therapy.
CR: D. Cameron, None; Z. Yang, None; D. Gibbs, None; H. Chen, None; A. Jorgensen,
None; L. Luo, None; G. Brinton, None; N.A. Zabriskie, None; Z. Tong, None; K.
Zhang, None.
Support: NIH, Foundation Fighting Blindness, the Ruth and Milton Steinbach Fund,
Ronald McDonald House Charities, the Macular Vision Research Foundation, Research
to Prevent Blindness.
2100 - B709
Real-World Cost of Treating Neovascular Age-Related Macular Degeneration
With Bevacizumab
2101 - B710
Dietary Glycemic Index Is Related to Progression of Age-Related Macular
Degeneration
L.M. Smithen, J.S. Duker, E.Reichel, C.R. Baumal, A.H. Rogers. Ophthalmology, TuftsNew England Medical Center, Boston, MA.
C.-J.Chiu1, R.C. Milton2, R.Klein 3, G.Gensler2, A.Taylor1. 1HNRCA, Tufts University,
Boston, MA; 2AREDS Coordinating Center, EMMES Corporation, Rockville, MD;
3
Department of Ophthalmology and Visual Sciences, University of Wisconsin,
Madison, WI.
Purpose: To calculate the actual cost associated with treating neovascular Age-Related
Macular Degeneration (ARMD) with bevacizumab (Avastin) and to determine the
interval between injections.
Methods:Consecutive patients with neovascular ARMD treated with intravitreal
bevacizumab injections at the home institution were identified. Patient charts were
reviewed and the number and date of all injections was documented. Descriptive
information was gathered. Average cost of bevacizumab was obtained and average
real-world cost calculations were determined. Extrapolations were made to the overall
neovascular ARMD population and estimates of overall treatment cost were established.
The average interval between bevacizumab injections was also calculated.
Results:Consecutive patients with neovascular ARMD treated with intravitreal
bevacizumab injections at the home institution were identified. Patient charts were
reviewed and the number and date of all injections was documented. Descriptive
information was gathered. Average cost of bevacizumab was obtained and average
real-world cost calculations were determined. Extrapolations were made to the overall
neovascular ARMD population and estimates of overall treatment cost were established.
The average interval between bevacizumab injections was also calculated.
Conclusions:The real-world cost of treating neovascular ARMD for one year exceeds
$190 million.
CR: L.M. Smithen, None; J.S. Duker, None; E. Reichel, None; C.R. Baumal, None; A.
H. Rogers, None.
Support: None
Purpose: Cross-sectional studies indicate that diets that provide a higher dietary
glycemic index (dGI) are associated with increased risk of age-related macular
degeneration (AMD).1, 2 No prospective studies have addressed this issue.
Methods: Dietary information was obtained from 3977 participants aged 55 - 80 y
(58% female) in the Age-Related Eye Disease Study (AREDS). dGI was calculated as
the weighted average of foods 3 and evaluated as being above or below the gender
median (female = 77.9, male = 79.3). Eyes with advanced AMD (neovascular or central
geographic atrophy) at baseline were considered as not at risk of further progression
and excluded. The 7232 eligible eyes at risk of progression were classified into one of
three AMD categories: Group 1 (no drusen/nonextensive small drusen), 2 (intermediate
drusen/extensive small drusen/pigmentary abnormalities), and 3 (large drusen/
extensive intermediate drusen) according to the AREDS AMD Classification System.
To evaluate the relationship between dGI and AMD progression we modeled the
time to the maximal progression of studied eyes by multifailure Cox proportionalhazards models.
Results: During up to 8 years of follow-up (mean = 5.4 y), overall the multivariateadjusted risk of progression was significantly higher (risk ratio = 1.10; 95% confidence
interval, 1.00, 1.20; P = 0.047) in the high dGI vs. the low dGI group. The increased
risk of progression for Group 1, 2, and 3 eyes was 5%, 8%, and 17%, respectively. The
17% increased risk of developing advanced AMD for people with high dGI and at
high risk of progression to advanced AMD gives a population attributable proportion
of 7.8%. This allows an estimate that over 100,000 cases of advanced AMD and any
accompanying vision loss could be eliminated in the US during the next 5 y if people
aged 55+ y consumed diets which have dGI values below the median.
Conclusions: These data suggest that there is a benefit of consuming less refined
carbohydrates in persons at risk of AMD progression, especially for those at high
risk for advanced AMD. References 1. Chiu CJ, Hubbard LD, Armstrong J, et al. Am J
Clin Nutr 2006;83:880-6. 2. Chiu CJ, Milton RC, Gensler G, Taylor A. Am J Clin Nutr
(in revision) 2006. 3. Wolever TM, Nguyen PM, Chiasson JL, et al. Am J Clin Nutr
1994;59:1265-9.
CR: C. Chiu, None; R.C. Milton, None; R. Klein, None; G. Gensler, None; A. Taylor,
None.
Support: USDA Agreement 58-1950-4-401, 1950-5100-060-01A; NIH RO1-13250, RO3
HS1418 and RO3-EY014183-01A2, and Johnson and Johnson Focus Giving Program
2098-2101
2102 - B711
The Epidemiology of Reticular Drusen
R.Klein1, M.D. Knudtson1, S.M. Meuer1, S.K. Iyengar2, B.E. K. Klein1. 1Ophthalmology
& Visual Sciences, Univ of Wisconsin-Madison School of Medicine & Public Health,
Madison, WI; 2Epidemiology and Biostatistics, Case Western Reserve University,
Cleveland, OH.
Purpose: While reticular drusen (RD) have been reported to be associated with a
high risk of incident late age-related macular degeneration (AMD), little is known
regarding its epidemiology. The purpose of the study was to describe the prevalence
and 15-year cumulative incidence of and risk factors for RD, a sign of early AMD, and
its association with late AMD.
Methods: 4,926 persons, 43-86 years of age at the time of a baseline examination in
1988-1990, living in Beaver Dam, Wisconsin, of whom 3,684 participated in a 5-year
follow-up examination, 2,764 participated in a 10-year follow-up, and 2,119 participated
in a 15-year follow-up. Characteristics of RD and other lesions typical of AMD were
determined by grading stereoscopic color fundus photographs using the Wisconsin
Age-Related Maculopathy Grading System.
Results: The prevalence at baseline and the 15-year cumulative incidence in either
eye of RD was 0.6% and 2.5%, respectively. There was an increased incidence of RD
with age, varying from 0.4% in those 43-54 years of age to 5.2% in those 75 years or
older at baseline (p<0.001). The prevalence was higher in those homozygous (CC, 1.2%)
or heterozygous (TC,1.0%) for CFH gene polymorphism Y402H (12775T to C) than in
those without this polymorphism (TT, 0.1%, age-adjusted p=.04). While controlling
for age, risk factors associated with increased risk of RD included being female (OR
3.1, 95% CI 1.7-5.6), current smoking (OR vs never 2.3, 95% CI 1.2, 4.4, p=.01), while
drinking wine (OR 0.5, 95% CI 0.3, 0.7), and use of hormone replacement therapy
[HRT] in women (OR 0.7, 95% CI 0.5, 1.0) were associated with decreased risk. Eyes
with RD at baseline had higher cumulative incidence of geographic atrophy (26%)
than eyes without soft drusen (1%), eyes with soft distinct [SD] drusen (1%), or eyes
with soft indistinct [SI] drusen (7%) and had higher cumulative incidence of exudative
AMD (19%) compared to eyes without soft drusen (0%), eyes with SD drusen (3%),
and eyes with SI drusen (10%).
Conclusions: These population-based estimates document the low prevalence and
long-term cumulative incidence of RD and show its association with modifiable risk
factors, smoking, drinking, and use of HRT. While relatively infrequent, the presence
of RD is of importance because of increased risk for incidence of late AMD.
CR: R. Klein, None; M.D. Knudtson, None; S.M. Meuer, None; S.K. Iyengar, None; B.
E.K. Klein, None.
Support: Supported by National Institutes of Health grant EY06594 (R. Klein, B.E.K.
Klein), and, in part, by Research to Prevent Blindness R. Klein, Senior Scientific
Investigator Award), New York, NY.
2104 - B713
The Effect of Cataract Surgery on the Development of Geographic Atrophy
R.C. Milton1, F.L. Ferris, III 2, G.R. Gensler1, M.Ho1, M.D. Davis3, T.E. Clemons1, E.Y.
Chew2, AREDS Research Group. 1EMMES Corporation, Rockville, MD; 2National Eye
Institute, Bethesda, MD; 3University of Wisconsin, Madison, WI.
Purpose: Data from population-based studies have suggested that cataract surgery may
result in an increased risk of developing advanced age-related macular degeneration
(AMD). At ARVO 2005 we reported on finding no clear evidence of increased risk
of neovascular AMD with cataract surgery in the Age-Related Eye Disease Study
(AREDS). We now investigate this potential relationship with the geographic atrophy
form of advanced AMD.
Methods: Geographic atrophy (GA) was assessed annually from centrally graded
fundus photographs. Risk of GA and of GA involving the center point (CGA) associated
with cataract surgery was assessed using three complementary analytic methods:
ordinary logistic regression, cases (cataract surgery) vs matched controls, and Cox
proportional hazard with time-dependent covariates. Three methods were used
because no single method is clearly more informative than the others, and each
approach has both strengths and weaknesses compared with the other approaches.
Analyses were for RE and LE separately, and combined utilizing generalized estimating
equations where possible. Covariate adjustments included age, smoking, gender,
AREDS treatment, and AMD status on a 6-point severity scale.
Results: There were 1739 cataract surgeries and 526 CGA events after baseline among
7806 eyes with median follow-up 9 years. There was no evidence of an association of
cataract surgery with increased risk of CGA in any of the following analyses: Ordinary
logistic regression analysis of incidence (odds ratio [OR] 0.43, 95%CI 0.28-0.66), Case
control approach (ratio of the number of eyes with cataract surgery [cases] with
subsequent CGA before their matched controls to the number of eyes without cataract
surgery [controls] with CGA before their matched cases = 0.64, 95%CI 0.50-0.78), and
Cox proportional hazards (RE hazard ratio =0.83, 95%CI 0.56-1.23; LE hazard ratio
=0.72, 95%CI 0.47-1.10). Ratios <1 suggest reduced risk. Results were similar for GA.
Conclusions: In this large clinic-based longitudinal cohort study these analyses show
no clear evidence of an association between cataract surgery and CGA or GA. Patients
undergoing cataract surgery can probably be reassured that the surgery is unlikely
to increase their risk for progression to CGA or GA.
CR: R.C. Milton, None; F.L. Ferris, None; G.R. Gensler, None; M. Ho, None; M.D.
Davis, None; T.E. Clemons, None; E.Y. Chew, None.
Support: Supported by contracts from the National Eye Institute, NIH, DHHS
2103 - B712
The Incidence and Progression of Age-Related Macular Degeneration in Blacks
and Whites: Salisbury Eye Evaluation (SEE) Project
M.A. Chang, S.B. Bressler, B.Munoz, S.K. West. Ophthalmology, Johns Hopkins
Wilmer Eye Inst, Baltimore, MD.
Purpose: To determine the risk factors for the 2-year incidence and progression of agerelated macular degeneration (AMD) in a racially heterogeneous, older population.
Methods: A total of 2240 subjects underwent baseline examination and follow-up
2 years later. Fundus photography was performed at both sessions and was graded
by trained, masked readers. Multivariate logistic regression models adjusting for
age, sex, race, and clustering between eyes were used to determine risk factors for
AMD progression.
Results: Current smoking was a strong, dose dependent, risk factor for progression
from medium-sized drusen to large drusen or pigmentary abnormalities within
the central 1500 micron perimacular zone. Smoking was not associated with the
progression from central large drusen or pigmentary abnormalities to foveal
geographic atrophy (GA) or choroidal neovascularization (CNV). Caucasians were
significantly more likely than African-Americans to develop large central drusen,
develop central pigmentary abnormalities, and progress from medium-sized drusen
to large drusen or pigmentary abnormalities within the central 1500 micron macular
zone. However, Caucasians did not have an increased risk of progression from large
drusen or pigmentary abnormalities within the central 1500 micron perimacular
zone to foveal GA or CNV.
Conclusions: Smoking and race are important risk factors in the progression from
medium-sized drusen to large drusen or pigmentary abnormalities within the central
1500 micron macular zone. However, it is unclear whether smoking and race may have
less of an impact on the ultimate progression to foveal GA or CNV once central large
drusen or pigmentary abnormalities are present.
CR: M.A. Chang, None; S.B. Bressler, None; B. Munoz, None; S.K. West, None.
Support: Research to Prevent Blindness, National Institute in Aging (AG16294)
2105 - B714
Susceptibility to Age-Related Macular Degeneration Is Mediated by
Thrombospondin 1
Y.Wang1A, B.E. K. Klein2, R.Klein2, J.Capriotti1A, S.K. Iyengar1A,1B. ADepartment of
Epidemiology and Biostatistics, BDepartment of Ophthalmology, 1Case Western
Reserve University, Cleveland, OH; 2Department of Ophthalmology and Visual
Sciences, University of Wisconsin Medical School, Madison, WI.
Purpose: Age-related macular degeneration (AMD) is the leading cause of blindness.
In two previous genome scans for AMD we detected a major locus on chromosome
15q in samples from the Beaver Dam Eye Study (BDES) and the Family Age Related
Maculopathy study (FARMS). Genes associated with AMD on chromosome 15
have not been reported in previous association studies, but thrombospondin 1
(THBS1), a matricellular protein, which is involved in retinal biology is an attractive
candidate.
Methods: To test whether THBS1 is associated with AMD or related phenotypes,
we performed a family-based association study in the FARMS samples (34 extended
pedigrees, total 277 individuals). Sixteen single nucleotide polymorphisms (SNPs)
with an average intermarker distance of 1Kb in THBS1 selected as tagging SNPs, were
tested for association with five AMD measurements: a 15-step quantitative trait for
AMD (AMD), power transformed 15-step scale (Pow.ARM), pigmentary abnormalities/
geographic atrophy (PA/GA), drusen size (Size), and drusen type (Type), using the
ASSOC program in S.A.G.E. The AMD measures were obtained using 30 degree color
stereoscopic graded fundus photographs of the eye. Models for additive, dominant
and recessive modes of inheritance were tested for each SNP. To test whether they
account for the linkage signal, these SNPs were added as a covariate in the linkage
analysis using the SIBPAL program in S.A.G.E.
Results: Analysis of the FARMS samples provided evidence for association between
THBS1 with AMD. At a 0.05 significance level, SNPs rs11282 (P=0.0016), rs2664141
(P=0.03), rs2228263 (P=0.03), rs2228261 (P=0.0091), rs1051442 (P=0.05) were associated
with Pow.ARM or Type. After correction for false discovery rate, rs11282 was still
significant. SNPs rs2664141 (dominant), rs2228263 (dominant) and rs1051442 (additive)
accounted for a modest decrease in the linkage signal.
Conclusions: These findings suggest THBS1 may play a role in AMD pathogenesis,
however, this work needs confirmation from other studies. We continue to genotype
this gene in other samples, e.g. BDES, to obtain confirmation of association.
CR: Y. Wang, None; B.E.K. Klein, None; R. Klein, None; J. Capriotti, None; S.K.
Iyengar, None.
Support: R01EY 015810
2102-2105
2106 - B715
Balancing Visual Acuity Benefits With Systemic Adverse Effects in Anti-VEGF
Therapy
J.C. Javitt1,2, G.Zlateva 3, S.Wolowacz4, A.Pleil5. 1Potomac Institute for Policy Studies,
Washington, DC; 2Wilmer Ophthalmological Institute, Johns Hopkins University,
Baltimore, MD; 3Pfizer, Inc, New York, NY; 4RTI Health Solutions, Inc., Manchester,
United Kingdom; 5Pfizer, Inc, LaJolla, CA.
Purpose: VEGF inhibitors offer unprecedented benefits to patients with age-related
macular degeneration (AMD). However, concerns that pan-VEGF inhibitors may
carry an increased risk of systemic complications have implications in assessing their
risk/benefit ratio. We studied the potential quality of life tradeoff between selective
and non-selective VEGF inhibition, incorporating the benefits of vision preservation
and potential adverse consequences of stroke, as one such example.
Methods: Data from pivotal studies of two currently marketed therapies (ranibizumab
and pegaptanib) were used to estimate the efficacy of non-selective vs. selective VEGF
inhibition. Differences in quality-adjusted life years (QALYs) between treatments
were estimated over 10 years. The disutility (QALYs lost) of stroke was estimated
using published data. The population threshold risk ratio (RR) for stroke at which
the QALYs gained through improved vision are offset by QALYs lost from stroke
was estimated.
Results: Pan-VEGF inhibition saves an esitmated 0.4 QALY’s per patient treated,
compared with selective therapy. The incremental disutility for patients experiencing
a stroke was estimated as 5.6 QALYs per occurrence. Analysis was performed to
determine the theoretical increase in stroke risk at which the increased QALY benefit
from improved vision would be offset. The literature suggests a baseline stroke
incidence of 35/1000 over a two year treatment period. The threshold number of
additional strokes in the population of treated patients at which the overall disutility
of stroke in the population offsets the benefit of improved visual acuity was estimated
as 1 in 13 patients treated (74/1000). Thus, a 3-fold increase in the incidence of stroke,
associated with pan-VEGF inhibition (RR = 3.1) would negate the potential quality
of life benefit associated with improved vision. This point estimate is sensitive to
alternative assumptions regarding efficacy and safety.
Conclusions: The analysis suggests that increased risk of systemic complications
has the potential to offset gains in quality of life associated with improved vision.
Further multivariate modeling should consider what combined treatment strategies
maximize the utility of treatment and minimize the disutility of adverse events and
also the medical cost of therapy.
CR: J.C. Javitt, Eyetech, Pfizer, Alcon, C; G. Zlateva, Pfizer, Inc., E; S. Wolowacz,
RTI Health Solutions, E; A. Pleil, Pfizer, Inc., E.
Support: None
2106
Monday, May 7, 3:00 PM - 4:45 PM Hall B/C Poster Session Program Number/Board # Range: 2107-2120 / B716-B729
275. Epidemiology of AMD - International Organizing Section: CL
2107 - B716
Association Between HTRA1 Promoter Polymorphism and Polypoidal
Choroidal Vasculopathy
2108 - B717
Investigating the Scoring System of the Daily Living Tasks Dependent on
Vision (DLTV) Using Rasch Analysis
N.Gotoh1A,1B, H.Nakanishi1A,1B, A.Otani1A, A.Tsujikawa1A, M.Mandai1A, M.Sasahara1A,
R.Yamada1B, F.Matsuda1B, N.Yoshimura1A. AOphthalmology, BCenter for Genomic
Medicine, 1Kyoto University, Kyoto, Japan.
F.Denny1A, A.H. Marshall1A, M.R. Stevenson1B, P.H. Hart1C, U.Chakravarthy1C. ACentre
for Statistical Science and Operational Research, BPublic Health Medicine and
Primary Care, CCentre for Vision Science, 1Queen’s University Belfast, Belfast,
United Kingdom.
Purpose: To study preliminarily whether association is found between HTRA1
promoter polymorphism and polypoidal choroidal vasculopathy (PCV) in unrelated
Japanese patients, as an usual phenotype of wet age-related macular degeneration
(AMD) in Asians.
Methods: Ninty-six patients with PCV and 95 pupulation-based control were recruited.
All the cases were recuited at Center for Macular Diseases of Kyoto University Hospital.
Total 382 chromosomes were resequenced for rs11200638(G/A); A as risk allele, DeWan
et al. and Yang et al. (Science 2006) were reported with samples of wet AMD excluding
PCV.
Results: Minor allele frequnecy of A was 0.368 in controls versus 0.612 in PCV.
Japanese PCV samples had association in allele frequencies, p=2.2x10 -6 and odds
ratio 2.70 (1.78-4.09: 95%CI).
Conclusions: Association between rs1200638 and PCV was suggested in this relatively
small cohort.
CR: N. Gotoh, None; H. Nakanishi, None; A. Otani, None; A. Tsujikawa, None; M.
Mandai, None; M. Sasahara, None; R. Yamada, None; F. Matsuda, None; N.
Yoshimura, None.
Support: None
2109 - B718
Awareness of Age-Related Macular Degeneration and Its Risk Factors Among
Singapore Residents
S.Sanjay, H.Y. Neo, J.Y. Ku, S.Y. M. Chau, A.K. Rostihar, K.G. Au Eong. Ophthalmology
and Visual Sciences, Alexandra Hospital, Singapore, Singapore.
Purpose: To investigate the awareness of age-related macular degeneration (AMD)
among Singapore residents.
Methods: Cross-sectional survey. Households were randomly selected from the
Singapore phone book residential listings 2005/2006 and one subject from each household
was invited to participate in the survey using a structured questionnaire.
Results:520 subjects out of the 796 households contacted agreed to participate (response
rate = 65.3%). The mean age (range) of the subjects was 41 (18 to 85) years. The awareness
of AMD among the participants was 7.3%. There was increased awareness of AMD
with higher education (secondary level and above), age group 31-50 years, and those
who had a recent eye examination within the last one-year. Respondents with at least
secondary education (n=393) were 18.5 times (95% CI, (confidence interval) 2.3-150.8)
more likely to be familiar with AMD than respondents with no or primary education.
Respondents in the age group 31 to 50 years (n=225) were 18.9 times (95% CI, 11.331.8) mores likely to be familiar with AMD than respondents aged 18-30 and 51-85.
Respondents who have had their eyes tested (n=187) within the last one year were 8.8
times (95% CI, 5.5-14.2) more likely to be familiar with AMD than those who have had
their eyes tested more than one year ago, or never had them tested. Among respondents
who had their eyes tested within the last one-year, 106 (57.6%) were with an optician.
Among 105 (20.2%) who never had their eyes tested, 35 (33.1%) cited that they did not
have any problem with their eyes. Smoking was considered a risk factor for AMD by
17 (44.7%) of the respondents who were familiar with AMD. Among respondents who
were aware of AMD 9 (23.7%) smoked and 6 (75.0%) of them would smoke less or stop
completely if they were told that smoking may cause blindness.
Conclusion:The awareness of AMD among Singapore residents is low. Subjects who
are more educated, with at least secondary education and who had eye examination
within a year are more likely to be aware of AMD.
CR: S. Sanjay, None; H.Y. Neo, None; J.Y. Ku, None; S.Y.M. Chau, None; A.K.
Rostihar, None; K.G. Au Eong, None.
Support: None
Purpose: The Daily Living Tasks Dependent on Vision (DLTV) is a visual functioning
instrument which assesses the quality of life of patients with AMD. It is composed of
twenty-two items and uses a four point ordinal scale. The main objective of the study
was to assess whether the response scale of the DLTV was appropriate. A secondary
aim was to assess if the total score across all items was linear.
Methods: Rasch analysis was performed on data concerning a group of 186 AMD
patients who completed the DLTV. A reduced version of the DLTV (DLTV-11) which
employs a five point response scale was administered to a second group of patients (n
= 324). Rasch analysis calculated response odd ratios per item and per person. Outfit
mean square statistics for each category in the two instruments were examined to
ascertain which of the two scales was optimal. For the DLTV, the average score for
each individual was plotted against the Rasch person measure to assess whether the
total score is linear.
Results: Average measures were very close to the expected values and step calibrations
were evenly separated for the four point scale. For the DLTV-11, step calibrations were
unevenly separated suggesting that the five point scale was suboptimal and should
be reduced to a four or three point scale. The total score per individual of the DLTV
was non-linearly related to the Rasch person measure.
Conclusions: Of the two scoring systems, the four point scale proved to be the most
optimal for the DLTV. A double asymptotic non-linear regression of the total scores
would allow for adjusted Rasch person measures which may then be utilised as a
verification method for the response scale used.
CR: F. Denny, None; A.H. Marshall, None; M.R. Stevenson, None; P.H. Hart,
None; U. Chakravarthy, None.
Support: The Guide Dogs for the Blind Association, Northern Ireland, Department
for Employment and Learning, Northern Ireland
2110 - B719
Association Between Angiotensin I Converting Enzyme Gene Insertion/
Deletion Polymorphisms and Early Age-related Maculopathy in a Japanese
Population: The Funagata Study
Y.Tanabe1, R.Kawasaki1, H.Yamashita1, M.Daimon2, T.Kato2, S.Kawata2, T.Kayama2, J.J.
Wang3, T.Y. Wong4, P.Mitchell5. 1Department of Ophtalmology and Visual Science,
School of Medicine, Yamagata University, Yamagata, Japan; 2Yamagata University
Faculty of Medicine 21st Century COE study Group, Yamagata, Japan; 3Centre for
Eye Reseach Australia, University of Melbourne, Melbourne, Australia; 4Singapore
Eye Reseach Instiute, National University of Singapore, Singapore, Singapore;
5
Centre for Vision Reseach, Westmead Millennium Institute, University of Sydney,
Sydney, Australia.
Purpose: To assess the association between Angiotensin I Converting Enzyme
(ACE) Gene Insertion (I) or Deletion (D) polymorphisms and early stage age-related
maculopathy (early ARM) in a population-based Japanese sample.
Methods: The Funagata study is a cross-sectional population-based study in adult
Japanese aged 35 years or older (examined during 2000-02). Grading of early ARM
lesions was performed at the Centre for Vision Research (Sydney) using the modified
Wisconsin ARM Grading System. Early ARM was defined as presence of either large
indistinct soft or reticular drusen, or both large distinct soft drusen and retinal
pigmentary abnormalities within the macular area in the absence of late ARM. ACE
polymorphisms (D/D, I/D or I/I) were determined using PCR.
Results: Of the 1,667 participants, 687 (41.2 %) had data available on both early ARM
status and the ACE genotypes. Genotype D/D was present in 9.6%, I/D in 46.4% and
I/I in 44.0% of the sample; this distribution was in Hardy-Weinberg equilibrium. Early
ARM cases were more likely than people without ARM, to have the I/I genotype (50.3%
vs 42.0%) and less likely to have the D/D (6.7% vs 10.5%) and I/D genotypes (42.9% vs
47.5%). The I allele frequency was also higher in early ARM cases than controls (D:I =
27.8%:72.2% vs 34.2%:65.7%, p=0.032). Apart from older age in the cases, there were
no statistical differences between cases and controls in gender, systolic or diastolic
blood pressure, or the proportions with diabetes or smokers. After adjusting for age,
gender, smoking, and diabetes, higher systolic blood pressure (OR 1.2, 95% CI 1.021.35 per 10mmHg increase) and ACE I/I genotype (OR 2.2, 95% CI 1.02-4.64) were
significantly associated with early ARM.
Conclusions: In this Japanese adult population, we found that ACE gene I/D
polymorphisms could represent another susceptibility marker for ARM.
CR: Y. Tanabe, None; R. Kawasaki, None; H. Yamashita, None; M. Daimon, None; T.
Kato, None; S. Kawata, None; T. Kayama, None; J.J. Wang, None; T.Y. Wong, None; P.
Mitchell, None.
Support: None
2107-2110
2111 - B720
Inter-Country Differences in Patients’ Perception of Humanistic Burden of
Neovascular Age-Related Macular Degeneration (AMD)
2112 - B721
Dietary Antioxidants and Primary Prevention of Age-Related Macular
Degeneration:A Systematic Review and Meta-Analysis
A.J. Lotery1, A.F. Cruess2, X.Xu 3, G.Zlateva4, T.F. Goss3, T.Knight3. 1Ophthalmology
- Eye Unit, Southampton General Hospital, Southampton, United Kingdom;
2
Dalhousie University, Halifax, NS, Canada; 3Covance Inc., Gaithersburg, MD;
4
Pfizer Inc, New York, NY.
E.W. Chong1, T.Y. Wong1,2, A.J. Kreis1, J.A. Simpson3, R.H. Guymer1. 1Centre
for Eye Research Australia, the University of Melbourne, East Melbourne,
Australia; 2Singapore Eye Research Institute, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore; 3Centre for Molecular,
Environmental, Genetic and Analytic Epidemiology, the University of Melbourne,
Melbourne, Australia.
Purpose: Limited research has examined differences in patients’ perception of the
burden of AMD across countries. A multi-country, cross-sectional study was conducted
to examine by country the burden of bilateral subfoveal, neovascular AMD on patientreported functioning.
Methods: A total of 401 bilateral neovascular AMD patients from retina clinics and 471
elderly non-AMD (control) patients from general medical practices were surveyed in
Canada, France, Germany, Spain, and the United Kingdom (UK). Physicians recorded
demographic and clinical information. Patients completed a telephone survey of the
National Eye Institute Visual Function Questionnaire (NEI VFQ-25), the EuroQol
(EQ-5D), the Hospital Anxiety and Depression Scale (HADS), and health resource
utilization. We evaluated the impact of AMD on patients’ QOL and functioning using
multivariate regression models for each country.
Results: The average ages of AMD patients were similar across countries (76.2-79.6), and
the majority (63% -69%) were females. AMD patients consistently reported substantially
worse NEI VFQ, HADS, and EQ-5D scale scores than the control subjects after adjusting
for age, gender, and co-morbid diseases. However, substantial differences were also
observed in AMD patients across countries. The French AMD patients reported the
worst vision-related functioning (adjusted mean NEI VFQ overall scale score 12 points
[21%] lower than the Spanish AMD patients who had the best functioning) and the most
anxiety symptoms on the HADS anxiety scale (2.4 points [39%] higher [worse] than
the UK AMD patients who had the least symptoms). German AMD patients reported
the most depression symptoms on the HADS depression scale (4.3 points [74%] higher
than the Canadian AMD patients who had the least symptoms), but the best general
QOL on the EQ-5D (0.13 points [21%] higher than the French AMD patients who had
the worst QOL]. Compared to the control group, French AMD patients reported the
greatest decrement (57%) in vision-related functioning than in other countries, while
German AMD patients reported the least decrements (40%).
Conclusions: We observed a great variation in bilateral AMD patients’ perception of
their QOL, vision-related functioning, and anxiety and depression symptoms across
countries, even though within each country, AMD patients consistently reported
substantially lower QOL than the control patients.
CR: A.J. Lotery, Pfizer Inc, C; Pfizer Inc, R; A.F. Cruess, Pfizer, C; Novartis, C; Pfizer,
R; Novartis, R; X. Xu, Pfizer Inc, C; G. Zlateva, Pfizer, E; T.F. Goss, Pfizer Inc, C; T.
Knight, Pfizer Inc, C.
Support: Research supported by Pfizer Inc. CT: TBD
2113 - B722
Abnormal Glucose Metabolism and Retinal Angiomatous Proliferation
Purpose: The role of antioxidants in the primary prevention of age-related macular
degeneration (AMD) is unclear. We conducted a systematic review and meta-analysis
of the evidence on dietary antioxidants, including dietary antioxidant supplements,
in the primary prevention of AMD.
Methods: Seven databases including Pubmed, Web of Science, Embase, Medline,
Cochrane library and grey literature databases were systematically searched with
no limits on the year or language of publication. References identified from pertinent
articles were also retrieved. Articles in other languages were translated to English.
Two reviewers independently searched the above databases and selected the studies
using standardized criteria. Randomized clinical trials and prospective cohort studies
were included. Of the retrieved papers, two reviewers independently performed study
quality evaluation and data extraction; disagreements were resolved by discussion.
Results were pooled quantitatively using meta-analytic methods.
Results: Of the 4692 abstracts initially identified, 12 studies met the selection criteria
(9 prospective cohort studies and 3 randomized clinical trials). The 9 prospective
cohort studies provided data on a total sample size of 149,203 people, with 1878 early
AMD cases. The antioxidants investigated differed across studies and not all studies
contributed to the meta-analysis of each antioxidant. Pooled results from prospective
cohort studies suggested that vitamin A, vitamin C, zinc, lutein, zeaxanthin, αcarotene, β-carotene, β-cryptoxanthin, lycopene have little or no effect in the primary
prevention of early AMD (pooled odds ratio estimates range from 0.90 to 1.11). Vitamin
E had a modest protective association for early AMD, with borderline significance
(pooled odds ratio 0.83, 95% confidence intervals 0.68-1.02). The three randomized
clinical trials did not show antioxidant supplements to be protective in the primary
prevention of early AMD.
Conclusions: There is insufficient evidence from the published literature to support
the role of dietary antioxidants, including the use of dietary antioxidant supplements,
for the primary prevention of early AMD.
CR: E.W. Chong, None; T.Y. Wong, None; A.J. Kreis, None; J.A. Simpson, None; R.
H. Guymer, None.
Support: National Health & Medical Research Council Public Health Scholarship
(E.C.), Australia.
2114 - B723
Geographical Distribution of Genetic Haplotypes in Patients With Stage 4
Exudative Age Related Macular Degeneration (AMD) in the Northern Ireland
Population
J.Wang1A, M.Khuthaila1B, J.C. Chen1B. AMedical Student - faculty of medicine,
B
Department of Ophthalmology, 1McGill University, Montreal, PQ, Canada.
Purpose:To report the rate of abnormal glucose metabolism in patients with retinal
angiomatous proliferation (RAP).
Methods:Consecutive patients with the diagnosis of RAP were identified through
a computer search from a retina practice. We reviewed the charts of these patients.
Documented abnormal glucose metabolism including diabetes mellitus (DM), impaired
fasting glucose (IFG) or impaired glucose tolerance (IGT) were noted. Patients with
no established diagnosis of abnormal glucose metabolism were contacted for an oral
glucose tolerance test (OGTT). The results of OGTT were interpreted according to the
Canadian Diabetes Association (CDA) 2003 clinical practice guidelines
Results:A total of 61 patients are included in this study. The average age of the
patients is 80 year-old. Thirteen (21%) patients are male and 48 (79%) are female. All
are Caucasians. Ten out of sixty-one patients (16%) have established diagnosis of DM
based on chart review. Among the remaining 51 patients with no known history of
abnormal glucose metabolism, 14 patients agreed to undergo OGTT testing. Five (36%)
of these 14 patients have abnormal results: two (14.3%) have IFG and IGT, one (7.1%)
has IGT, and two (14%) patients’ results are consistent with the diagnosis of DM.
Conclusions:Our study suggests that the prevalence of abnormal glucose metabolism
amongst RAP patients could be as high as 52%. This rate is significantly higher than
reported in the literature for this age group (18% -28%). The possible explanation of
this association will be discussed.
CR: J. Wang, None; M. Khuthaila, None; J.C. Chen, None.
Support: None
E.Moore1, S.Subbiah2, G.J. McKay2, G.Silvestri2. 1Ophthalmology, Royal Victoria
Hopsital, Belfast, United Kingdom; 2Centre for Vision Sciences, Queens University,
Belfast, United Kingdom.
Purpose: To establish if risk and protective genetic haplotypes for genes associated
with AMD show geographic clustering across Northern Ireland.
Methods: All fluorescein angiograms carried out in 2001 were reviewed and 161 patients
identified with stage 4 exudative AMD. Demographic details were recorded and patient
birth location plotted on a map of Northern Ireland. Population demographics were
obtained from the Northern Ireland Statistics and Research Agency. The prevalence of
stage 4 eAMD was then calculated for each region and adjusted for age. Venous blood
samples were collected from 121 patients representing 75% of the study population
for the year 2001. Ascertainment of a control population in excess of 500 samples was
undertaken to provide an indication of the genetic stratification across the province.
Genetic haplotype analysis was undertaken for Complement Factor H (CFH), CFHR1,
CFHR3, LOC387715, Complement Factor B (FB), Complement component 2 (C2) and
Vascular Endothelial Growth Factor (VEGF). A questionnaire was answered by the
affected cohort detailing history of smoking, angiopathic disease, drug history,
refractive status, eye colour, body mass index and family history of migration.
Results: Geographical clustering of stage 4 AMD similar to that seen in 2002 and 2003
was confirmed in 2001 with a distinct East-West divide with increased prevalence of
AMD in the eastern counties. Preliminary analysis suggests a high incidence of AMD
risk haplotypes within the affected cohort with a decreasing incidence of protective
haplotypes. Comparisons between the incidence of these haplotypes and the general
population is being investigated to ascertain whether genetic stratification across the
province is likely to lead to a decreased risk of AMD for those living in the West.
Conclusions: Our results show a statistically significant bias in the incidence of
grade 4 eAMD reported across Northern Ireland over 3 successive time periods.
Our hypothesis that genetic stratification may support these findings is based on
an investigation by Dolan et al. (2005) where genetic stratification across Ireland
was proven. Comparison of genetic haplotypes of the risk loci implicated in AMD
between the affected cohort and the general population will identify if this is the
case in relation to the incidence of AMD. Interestingly there are 25% more sunlight
hours in the east compared to the west, this may be a confounding factor and this
will be further evaluated.
CR: E. Moore, None; S. Subbiah, None; G.J. McKay, None; G. Silvestri, None.
Support: HPSSNI R&D
2111-2114
2115 - B724
Fundus Autofluorescence Pattern in Patients With Early Age-Related
Maculopathy
2116 - B725
Elevated C-Reactive Protein Levels in Patients With Polypoidal Choroidal
Vasculopathy and With Neovascular Age-Related Macular Degeneration
M.R. Heldner1, S.Wolf 1,2, W.Einbock 2, C.K. Brinkmann1,2, U.E. K. Wolf-Schnurrbusch1,2.
1
Bern Photographic Reading Center, Inselspital, University of Bern, CH-3010 Bern,
Switzerland; 2Klinik und Poliklinik fuer Augenheilkunde, Inselspital, University of
Bern, CH-3010 Bern, Switzerland.
M.Nakamura1A, M.Kikuchi1A, K.Ishikawa1A, H.Nishihara1A, T.Yamakoshi1A, K.Nishio1B,
K.Taki1C, T.Niwa1C, N.Hamajima1B, H.Terasaki1A. AOphthalmology, BPreventive
Medicine/Biostatistics and Medical Decision Making, CClinical Preventive
Medicine, 1Nagoya Univ School of Medicine, Nagoya, Japan.
Purpose: The fundus autofluorescence in age-related macular degeneration study
group (FAM-Study group) aims at identifying autofluorescence (AF) changes as
predictive factors for the progression of age-related macular degeneration (ARMD). We
report changes in fundus AF pattern in patients with early age-related maculopathy
(ARM) according to the Rotterdam Classification stage 1-3.
Methods: All included patients with early ARM underwent a detailed ophthalmological
examination in study and fellow eyes. Examination included ETDRS visual acuity,
binocular funduscopy, AF imaging, fluorescein and ICG angiography, and color
fundus photography. AF imaging was performed with a confocal scanning laser
ophthalmoscope (HRA, Heidelberg Engineering, Germany) following a standard
protocol. AF images were analyzed for focal areas of increased or decreased fundus
autofluorescence. For description of the AF distribution eight different pattern of
retinal AF were defined. These included a nearly normal pattern, reticular patterns,
lace like pattern, linear pattern, speckled pattern, focal-increased pattern, focal-plaque
like pattern, and patchy pattern.
Results: In total 521 patients (521 eyes) were included in this analysis. Visual acuity
ranged from 20/100 to 20/20. AF pattern showed a nearly normal pattern in 16.9% eyes,
reticular pattern in 24.6% eyes, lace like pattern 2.6% eyes, linear pattern in 1.5% eyes,
speckled pattern in 19.5% eyes, focal-increased pattern in 9.2% pattern, focal-plaque
like pattern in 3.1% eyes, and patchy pattern 22.6% eyes. The intraobserver variability
of the first observer was κ= 0.81 (95% confidence interval (CI) 0.70-0.89) and for the
second observer κ= 0.79 (95% confidence interval (CI) 0.74-0.85). The interobserver
variability was κ= 0.78 (95% confidence interval (CI) 0.67-0.88).
Conclusions: Imaging of fundus autofluorescence in patients with ARM allows to
identify different patterns of fundus AF. There is relatively high degree of intra- and
interobserver agreement. The FAF changes do not necessarily correlate topographically
with visible fundus changes in patients with early ARM. Areas of increased AF may
or may not correspond with areas of hyperpigmentation or soft or hard drusen.
CR: M.R. Heldner, None; S. Wolf, None; W. Einbock, None; C.K. Brinkmann,
None; U.E.K. Wolf-Schnurrbusch, None.
Support: None CT: cantonal ethical committee Bern
Purpose: To determine the relationship between systemic C-reactive protein (CRP)
levels and polypoidal choroidal vasculopathy (PCV) and advanced, neovascular
age-related macular degeneration (AMD) in Japanese patients.
Methods: Ninety-seven patients with PCV, 176 with advanced, neovascular AMD,
and 262 control subjects without any macular abnormality were studied. Color fundus
photographs of the macular area were taken from both eyes in all subjects. Indocyanine
green angiography and fluorescein angiography were performed for diagnosis.
The CRP level was measured by a high-sensitivity assay using a latex aggregation
immunoassay, and the levels in patients with PCV and neovascular AMD were
compared to that in the control group using the Kruskal-Wallis test. The association
between CRP and PCV or neovascular AMD was compared using logistic regression
analysis by computing the odds ratios (ORs) and 95% confidence intervals (CIs) after
the study populations were divided into quartiles.
Results: The median CRP levels were significantly higher in cases with PCV (0.94
mg/L) or with advanced, neovascular AMD (0.95 mg/L) than in control subjects (0.43
mg/L; P <0.001 for Kruskal-Wallis test). After adjusting for baseline characteristics such
as age, gender, smoking status, alcohol use, body mass index, past history, and use of
anti-inflammatory drugs, the increase in risk was significant for the highest quartile of
CRP for both PCV (OR, 3.53; 95% CI, 1.49-8.40) and neovascular AMD (OR, 4.08; 95%
CI, 1.94-8.56), and for the third quartile of CRP for neovascular AMD (OR, 2.29; 95%
CI, 1.07-4.91). The trends for an increase in risk of disease with increase in CRP were
statistically significant for both PCV (P =0.001) and neovascular AMD (P <0.001).
Conclusions: The significant associations between elevated serum CRP levels and PCV
or neovascular AMD in the Japanese strongly suggest that inflammatory processes
are involved in the pathogenesis of PCV and neovascular AMD.
CR: M. Nakamura, None; M. Kikuchi, None; K. Ishikawa, None; H. Nishihara,
None; T. Yamakoshi, None; K. Nishio, None; K. Taki, None; T. Niwa, None; N.
Hamajima, None; H. Terasaki, None.
Support: None
2117 - B726
Inter-Country Difference in the Cost of Age Related Macular Degeneration:
Survey of Five Countries
2118 - B727
Nutritional Risk Factors for Age-Related Eye Diseases: The Alienor
(Antioxydants, Lipides Essentiels, Nutrition et Maladies Oculaires) Study
A.F. Cruess1, A.Lotery2, G.Zlateva 3, R.Buggage3, X.Xu4. 1Ophthalmology, Dalhousie
University, Halifax, NS, Canada; 2Ophthalmology, University of Southampton,
Southampton, United Kingdom; 3Pfizer Inc, New York, NY; 4Covance Inc.,
Gaithersburg, MD.
M.-N.Delyfer1, J.-F.Korobelnik1, J.Colin1, M.-B.Rougier1, P.Barberger-Gateau2, J.F.Dartigues2, C.Delcourt2. 1Ophthalmology, Bordeaux University Hospital, Bordeaux,
France; 2INSERM U593, Bordeaux, France.
Purpose: This study was undertaken to document the economic burden of NV-AMD
on elderly patients in five countries.
Methods: A total of 401 bilateral NV-AMD patients recruited from retina specialists
in Canada, France, Germany, Spain, and the United Kingdom (UK) were surveyed in
a cross-sectional, observational study. Physicians’ records and patients’ standardized
telephone interviews were used to record medical resource utilization, assistance with
daily living, and social benefits. A societal perspective was taken to account for the
socioeconomic cost of bilateral NV-AMD.
Results: The mean age of NV-AMD patients was similar across countries (76.2-79.6
years). NV-AMD patients reported substantial health-related problems (i.e., falls and
depression treatment) and associated health resource utilization. The annual cost
included direct vision-related medical cost, direct non-vision related medical cost,
and direct non-medical related cost. The average annual societal cost per bilateral
NV-AMD patient treated was US dollars $9,667 in Canada, $8,457 in France, $14,321
in Germany, $6,597 in Spain, and $6,099 in UK. NV-AMD expense allocations were
substantively different by country in the following categories: medical vs. non-medical
cost; cost of unilateral vs. bilateral patients; cost of patients with different severity of
NV-AMD, i.e. normal vs. moderate vs. severe patients.
Conclusions: The societal costs of all NV-AMD cases are estimated to range between
$772 and $3,772 million in these countries. Differences in national healthcare systems
and NV-AMD treatment patterns were reflected in the wide variation of NV-AMD
expenses across the five surveyed countries.
CR: A.F. Cruess, Pfizer;Novartis, C; Pfizer;Novartis, R; A. Lotery, None; G. Zlateva,
Pfizer Inc, E; R. Buggage, Pfizer Inc, E; X. Xu, Pfizer Inc, C.
Support: Research supported by Pfizer Inc
Purpose: To describe the design of a French epidemiological study on the associations of
antioxidants, lipids and other nutritional factors with the risk of age-related eye diseases
(age-related maculopathy (ARM), glaucoma, cataract, dry eye syndrome)
Methods: Subjects will be recruited from an existing population-based cohort study on the
vascular risk factors of dementia. Subjects were initially aged 65 years or more, recruited
in the city of Bordeaux, France in year 1999-2001 and followed up every 2 years since. Data
were collected at baseline and at each follow-up included: cognitive function, vascular
risk factors, blood and DNA samples. Nutritional data include measurements of plasma
antioxidants and fatty acids at baseline; 24h recall and food frequency questionnaire at
first follow-up; short food frequency questionnaire at second and third follow-ups. The
ALIENOR study consists in an eye examination, simultaneous to the third follow-up
examination in 2006-7 . It includes ophthalmologic history, near and far visual acuity
(ETDRS) with current and optimal correction, non mydriatic retinal photographs of
the macula and optic disc, intraocular pressure, corneal thickness and break-up time.
Retinal photographs will be interpreted according to a modification of the International
Classification of ARM. Glaucoma will be classified according to the criteria of ISGEO and
subjects suspect of glaucoma will have complementary examination including visual
field. Dry eye syndrome will be classified according to the Ocular Surface Disease Index
and the break-up time.
Results: The expected number of participants is 1000. Using multivariate mixed models,
we will estimate the associations of:
- ARM and glaucoma with vascular risk factors and lipid metabolism (plasma lipids
and fatty acids, in particular omega 3 and 6, apolipoprotein E polymorphism, dietary
intake of saturated, monounsaturated and polyunsaturated omega 3 and 6 fatty acids).
- ARM and cataract extraction with antioxidant status (plasma vitamin A and E and
TBARS, dietary intake of vitamin C, E and carotenoids)
- Dry eye and potential risk factors (smoking, sunlight exposure, television and computer
exposure, medical history and current treatments…) and lipid metabolism (plasma and
dietary lipids).
Conclusions: This study will be one of the major epidemiological study combining data
on nutrition (past and present), age-related eye diseases and cognitive and vascular
diseases.
CR: M. Delyfer, None; J. Korobelnik, None; J. Colin, None; M. Rougier, None; P.
Barberger-Gateau, None; J. Dartigues, None; C. Delcourt, None.
Support: None
2115-2118
2119 - B728
Polymorphisms in the Vascular Endothelial Growth Factor Gene and Risk of
Aging Macula Disorder: The Rotterdam Study
2120 - B729
Relationship of Chronic Kidney Disease and Age-Related Maculopathy: The
Blue Mountains Eye Study
P.T. de Jong1, S.S. Boekhoorn2A, J.R. Vingerling2A, A.G. Uitterlinden2B, A.Hofman2A.
1
Ophthalmogenetics, NIN/Genetics, Amsterdam, The Netherlands; AEpidemiology
and Biostatistics, BInternal Medicine, 2ErasmusMC, Rotterdam, The Netherlands.
G.Liew1, P.Mitchell1, T.Y. Wong2,3, S.K. Iyengar4, J.J. Wang1,2, Blue Mountains Eye
Study Group. 1Dept of Ophthalmology (Centre for Vision Research, Westmead
Millennium Institute, Westmead Hospital), University of Sydney, Sydney,
Australia; 2Department of Ophthalmology, University of Melbourne, Melbourne,
Australia; 3Singapore Eye Research Institute, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore; 4Department of
Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH.
Purpose: Vascular endothelial growth factor (VEGF) is an important regulator of
angiogenesis and a target for inhibition therapy in wet aging macula disorder (AMD).
We examined whether genetic variations in the VEGF gene is associated with AMD
and especially with its wet end stage.
Methods: In a prospective population-based cohort study among men and women
aged 55 years and over, AMD was classified according to the modified International
Classification System on fundus color transparencies. We determined genotypes
and haplotypes for three functional VEGF single nucleotide polymorphisms (SNPs):
C-2578A, G-1154A, and C-634G. Cox proportional hazards regression analyses were
used to investigate the possible association between the individual SNPs and incident
AMD, and to test associations of VEGF gene haplotypes and incident AMD, we used
the program Haplo Stats.
Results: In 4228 participants at risk for early or late AMD, of whom blood specimens
were available for VEGF genotyping, 514 developed early AMD and 89 late AMD
(35 dry and 54 wet) after a mean follow-up of 7.4 years. None of the SNPs showed a
significant association with any incident and especially not with wet late AMD nor
was any association found in the haplotype analyses.
Conclusions: Our a priori hypothesis that three common SNPs in the VEGF gene
would be a risk factor for especially wet AMD could not be confirmed.
CR: P.T. de Jong, None; S.S. Boekhoorn, None; J.R. Vingerling, None; A.G.
Uitterlinden, None; A. Hofman, None.
Support: None
Purpose:. Chronic kidney disease (CKD) and age-related maculopathy (ARM)
may share common genetic risk factors, such as complement factor H (CFH) and
apolipoprotein E (APOE) genes, but no clinical studies have examined whether
these diseases are linked. We aimed to explore this relationship in a populationbased sample.
Methods: The Blue Mountains Eye Study (1992-4) surveyed 3654 residents aged 49+
living in 2 geographically defined areas west of Sydney, Australia. We measured
serum creatinine from 3183 participants (87.1%) who had blood collected and estimated
glomerular filtration rate (GFR) using the Modified Diet Renal Disease (MDRD)
equation. CKD was defined according to National Kidney Foundation criteria as
GFR<60 ml/min/1.73m 2. We graded stereoscopic retinal photographs of both eyes
for presence of early ARM (soft indistinct or reticular drusen or combined soft
distinct drusen and retinal pigment abnormality) and late ARM (neovascular ARM
or geographic atrophy).
Results: CKD was present in 1488 persons (46.7%) and either early or late ARM was
present in 149 persons (4.7%) and 61 persons (1.9%), respectively. Subjects with CKD
were more likely to have early (6.2% vs 3.4%) and late (3.5% vs 0.5%) ARM than those
without CKD. After adjusting for age (continuous), sex, smoking (current, ex, never)
and pack years of cigarette smoking, CKD was significantly associated with late ARM
(odds ratio [OR] 2.1, 95% confidence interval [CI] 1.0-4.5) but not with early ARM (OR
1.0, CI 0.7-1.5). Each standard deviation (SD) decrease in log GFR was associated with
higher prevalence of late ARM (OR 1.3, CI 1.1-1.7) but not early ARM (OR 1.0, CI 0.81.2). These findings were similar after additional adjustment for fibrinogen, white cell
count, hypertension,diabetes and diabetes duration (OR 1.3, CI 1.0-1.6 for late ARM,
and OR 1.0, CI 0.8-1.2 for early ARM, per SD decrease in log GFR.).
Conclusions: In this older Australian population, persons with CKD were more likely
to have late ARM. This could represent a further manifestation of the systemic effects
of common genes such as CFH on the vascular bed in the kidney and the eye.
CR: G. Liew, None; P. Mitchell, None; T.Y. Wong, None; S.K. Iyengar, None; J.J.
Wang, None.
Support: Australian RADGAC grant (1992-94) and NHMRC grant 974159 & 211069
2119-2120
Tuesday, May 8, 8:30 AM - 10:15 AM Grand Floridian H Paper Session
316. Epidemiology of Pediatric Eye Diseases I Organizing Section: CL
2379 - 8:30AM
Prevalence of Amblyopia and Strabismus in a Population-Based Sample of
Preschool African-American and Hispanic Children: The Multi-Ethnic Pediatric
Eye Disease Study
R.Varma, S.A. Cotter, J.Deneen, A.DiLauro, K.Tarczy-Hornoch, M.S. Borchert, S.P. Azen,
MEPEDS Group. Ophthalmology, USC Keck School of Medicine, Los Angeles, CA.
2380 - 8:45AM
Relationship of Fixation Preference to Amblyopia in Preschool Children: The
Multi-Ethnic Pediatric Eye Disease Study
S.A. Cotter, R.Varma, K.Tarczy-Hornoch, A.Dilauro, M.Torres, Y.Wang, M.Borchert,
S.Azen, Multi-Ethnic Pediatric Eye Disease Study Group. Ophthalmology, University
of Southern California, Los Angeles, CA.
Purpose: To determine the prevalence of amblyopia and strabismus in a populationbased sample of African-American (AA) and Hispanic (Hisp) children aged 6-72
months.
Methods: Participants aged 6-72 months were recruited from 37 census tracts in
Inglewood, Los Angeles County, Calif., as part of the Multi-Ethnic Pediatric Eye
Disease Study (MEPEDS). All eligible children underwent comprehensive age-specific
clinical examinations. Visual acuity was measured using the Amblyopia Treatment
Study (ATS) protocol (single surround HOTV optotypes) for those children who could
perform the task. Fixation preference testing was also performed on all participants and
was used as the surrogate visual acuity test for infants and toddlers. Amblyopia was
determined using a predefined definition of a reduction in best-corrected visual acuity
in the presence of a pre-determined amblyogenic factor. Strabismus was determined
on the basis of cover uncover testing at distance and near with Hirschberg testing
performed in those rare instances when cover testing was unsuccessful. Age-, gender-,
and ethnicity-specific prevalences were calculated and compared using chi-square
and analysis of variance testing.
Results: 5032 of the 6593 eligible children were examined (76% participation rate).
2303 children were AA and 2609 were Hisp. The overall prevalence of amblyopia was
1.4% (68/5032) with similar prevalences in AA and Hisp children (AA: 1.2% - 26/2303;
Hisp: 1.6% - 40/2609, p=0.22). Overall, the types of amblyopia were anisometropic
(55%), isoametropic (19%), strabismic (12%), combined strabismic/anisometropic (7%),
deprivation (1%) and other (6%). Older children were more likely to have amblyopia
compared to younger children (odds ratio per month older age 1.04, p<0.0001). The
overall prevalence of strabismus was 2.5% (125/5032) with similar prevalences in
AA and Hisp children (AA: 2.6% - 59/2303; Hisp: 2.5% - 63/2609, p=0.74). Overall,
61% had exotropia and 38% had esotropia. Children aged 49 months and older were
more likely to have strabismus compared to younger children (odds ratio 2.18-2.29,
p<0.04). No gender-related differences in the prevalence of amblyopia or strabismus
were present.
Conclusions: These data provide the first population-based prevalence estimates of
amblyopia and strabismus in minority preschool children in the U.S.
CR: R. Varma, None; S.A. Cotter, None; J. Deneen, None; A. DiLauro, None; K.
Tarczy-Hornoch, None; M.S. Borchert, None; S.P. Azen, None.
Support: EY014472, RPB
Purpose: To compare the clinical assessment of fixation preference (FP) testing to
amblyopia status in preschool children.
Methods: 3048 children aged 30-72 months from the population-based MultiEthnic Pediatric Eye Disease Study were testable both on FP testing and subsequent
visual acuity (VA) testing (Amblyopia Treatment Study HOTV protocol) during a
comprehensive eye examination. VA was re-tested with refractive correction in those
with abnormal VA. Unilateral amblyopia was defined as a 2-line final interocular (IOD)
VA difference with 20/32 or worse vision in the worse-seeing eye in the presence of a
unilateral amblyogenic risk factor (strabismus, anisometropia, or form deprivation). In
children with apparent strabismus, FP was assessed by observation of the fixating eye
and in those with no manifest or small-angle deviations (<=10 pd), it was assessed with
the induced-tropia test (12pd BD prism). A standardized protocol was used to grade
the length of time the non-preferred eye held fixation (A=spontaneous alternation,
B=holds well, C=holds momentarily, and D=will not hold). FP grade was compared
with the diagnosis of amblyopia.
Results:FP grade and amblyopia status for 3048 children were:
2381 - 9:00AM
Prevalence and Causes of Visual Impairment in Low-Income Urban School-Age
Children of Sao Paulo, Brazil
2382 - 9:15AM
The Impact of Parental Myopia and Children’s Refractions at 5 Years on the
Development of Myopia in Children by 15 Years of Age
S.R. Salomao1, R.W. Cinoto1, A.Berezovsky1, L.Mendieta1, E.Haro-Munoz1, F.Ejzenbaum1,
C.Lipener1, C.R. Nakanami1, R.Belfort, Jr.1, L.B. Ellwein2. 1Dept of Ophthalmology,
Federal University of Sao Paulo, Sao Paulo, Brazil; 2NEI, Bethesda, MD.
J.E. Gwiazda1, L.Deng1, F.Thorn1, J.D. Gwiazda2. 1Vision Science, New England Coll
of Optometry, Boston, MA; 2Graduate Center, City University of New York, New
York, NY.
Purpose: To assess the prevalence and causes of visual impairment in low-income
school-age children in urban Brazil.
Methods: The study population consisted of children from 5th to 8th grades from public
schools from the districts of Ermelino Matarazzo, Vila Jacui and Sao Miguel. Random
selection of schools from the four school grade levels was used to identify the study
sample. Children from 9 schools were examined from April to November 2005. The
examination included visual acuity (VA) testing; ocular motility for near and distance;
examination of the external eye, anterior segment and media. Cycloplegic autorefraction, cycloplegic subjective refraction and fundus examination were performed in
children with uncorrected visual acuity 20/40 or less in either eye. An ophthalmologist
assigned a principal cause of visual impairment for eyes with uncorrected visual
acuity 20/40 or worse. Refractive error was assigned routinely if acuity improved to
at least 20/32 with refractive correction or with pinhole testing.
Results: A total of 2,757 children were enumerated and 2,376 (86.2%) were examined.
Prevalence of uncorrected, presenting, and best-corrected VA ≤ 20/40 in the better
eye was 4.7%, 2.8%, and 0.4%, respectively. Cycloplegic auto-refraction and subjective
refraction was performed in 213 (9.0%) children. Fifty-two percent of those who
could achieve acuity ≥20/32 in at least one eye with best correction were without the
necessary spectacles. Refractive error was the cause in 79.8% of eyes with reduced
vision; amblyopia, 6.9%; retinal disorders, 4.8%; other causes, 2.4%; and unexplained
causes, 5.4%.
Conclusions: The prevalence of reduced vision is low in this sample of low-income
urban school-age Brazilian children, most of it because of uncorrected refractive
error. Cost-effective strategies are needed to eliminate this easily treated cause of
vision impairment.
CR: S.R. Salomao, None; R.W. Cinoto, None; A. Berezovsky, None; L. Mendieta,
None; E. Haro-Munoz, None; F. Ejzenbaum, None; C. Lipener, None; C.R. Nakanami,
None; R. Belfort, None; L.B. Ellwein, None.
Support: WHO/NEI, FAPESP #04/06670-9 to SRS and #06/01354-7 to RWC, CNPq
to SRS, FADA to SRS
Purpose: To investigate parental refractive error and children’s refractive error at age
5 years as risk factors for the development of myopia by age 15 years.
Methods: 185 children with annual refractions from ages 5 to 15 years and with
refractions from both parents were included in this analysis. All children were
refracted in the laboratory by non-cycloplegic distance retinoscopy. Parents were
either refracted in the laboratory or their prescriptions were obtained from their eye
care providers. Myopes were defined as having a spherical equivalent refraction <
-0.50 D. The effect of number of myopic parents (0, 1, or 2) on children’s refractive
error at 15 years stratified by children’s refraction at 5 years was evaluated by a chi
square test. Odds ratios were also calculated.
Results: The mean refraction at 5 years was 0.73 +/- 0.68 D and only one child was
myopic, while the mean Rx at 15 years was -0.42 +/- 1.35 D and 33% (61/185) were
myopic. For children with an Rx at 5 years < 0.75 D, twice as many were myopic at
15 years than for those with an Rx ≥ 0.75 D at 5 years (44/104 = 42.3% versus 17/81 =
21%). In the lower Rx group at 5 years, children with 2 myopic parents had a higher
risk of developing myopia by 15 years compared to those with 0 or 1 myopic parent
(p = 0.004). There was no assocation between number of myopic parents and myopia
by 15 years for children in the higher Rx group at 5 years. These same patterns also
were found at 10 years, but with fewer myopic children in each category. Comparing
the extreme categories, children with 2 myopic parents and lower refractive errors at
5 years had increased risk of developing myopia by 15 years compared with children
with no myopic parents and higher refractive errors at 5 years (Odds ratio = 33.6;
95% CI: 4.08, 276.4).
Conclusions: For children with refractions less than 0.75 D at 5 years, having 2 myopic
parents increases the risk of being myopic by 15 years. However, for children with
more positive refractions at 5 years, parental myopia does not appear to contribute
significantly to the development of myopia by 15 years.
CR: J.E. Gwiazda, None; L. Deng, None; F. Thorn, None; J.D. Gwiazda, None.
Support: NIH grants EY 01191 and EY 14817
Fixation Grade
A or B
C or D
Total
No Amblyopia
2966
28
2994
Amblyopia
38
16
54
Total
3004
44
3048
Of children with unilateral amblyopia, 70% (38/54) had grade A/B and 30% (16/54)
had grade C/D. FP grade A was seen both in mild amblyopia (66% of 41 cases with
2-3 line IOD) and more severe amblyopia (54% of 13 cases with >=4 line IOD). 69%
(27/39) of children with isolated anisometropic amblyopia and 30% (3/10) with isolated
strabismic amblyopia had FP grade A. 72% (18/25) of non-amblyopes with a 0-1 line
IOD and FP grade C/D had strabismus.
Conclusions:FP testing is not highly predictive of amblyopia. Strong FP (grade C/D)
is often seen in strabismic children without amblyopia. The majority of children with
anisometropic amblyopia do not show a FP (grade A/B). Therefore, clinicians should
be cautious when using FP as a surrogate measure of visual acuity for diagnosis and
follow up of preverbal children with amblyopia risk factors.
CR: S.A. Cotter, None; R. Varma, None; K. Tarczy-Hornoch, None; A. Dilauro,
None; M. Torres, None; Y. Wang, None; M. Borchert, None; S. Azen, None.
Support: EY014472
2379-2382
Tuesday, May 8, 8:30 AM - 10:15 AM Grand Floridian H Paper Session
316. Epidemiology of Pediatric Eye Diseases I Organizing Section: CL
2383 - 9:30AM
Early Life (Prenatal, Perinatal and Childhood) Biological and Social Factors
Influence the Development of Myopia
2384 - 9:45AM
Variabilty of the Axial Length Contribution to Refraction by Childhood Age
and Ethnicity
P.Cumberland, C.Peckham, J.Rahi. MRC Centre of Epidemiology for Child Health,
Institute of Child Health, London, United Kingdom.
J.M. Ip1A, S.C. Huynh1A, A.Kifley1A, K.A. Rose1B, I.G. Morgan2, R.Varma 3, P.Mitchell1A,
Sydney Myopia Study, Sydney Paediatric Eye Study. ADepartment of Ophthalmology
(Centre for Vision Research, Westmead Institute, Westmead Hospital), BSchool of
Applied Vision Sciences, Faculty of Health Sciences, 1University of Sydney, Sydney,
Australia; 2ARC Centre of Excellence in Vision Science and Research School of
Biological Sciences, Australian National University, Canberra, Australia; 3Doheny
Eye Institute, University of Southern California, Los Angeles, CA.
Purpose: To investigate early life biological and social influences (acting prenatally,
perinatally or in childhood) on development of primary myopia, using a life course
epidemiologiocal approach to elucidate pathways.
Methods: Subjects comprised a random 23% sub-sample of the 1958 British birth
cohort (all those born in one week in 1958), who have been followed up at intervals
from birth as part of a broader study of health and disease. Based on autorefraction
at 44 years, subjects were categorised by their spherical equivalent (SE): high myopia
(-6 or more), mild or moderate myopia (-5.99 to -0.75) or emmetropia (-0.74 to +0.5).
Myopia was also dichotomised as ‘early’ or ‘late’ onset, based on optical correction
by 16. A priori, we investigated factors (below) known to influence childhood growth
as well as postulated to influence refraction. Multinomial regression analysis was
undertaken using a conceptual framework which explicitly accounts for the temporal
sequence of factors being investigated, and allowing their primary and secondary
roles to be distinguished.
Results: Findings are based on 2130 subjects: 882 (41%) with emmetropia and 65 (3%)
with high and 1183 (56%) with mild or moderate myopia. After adjustment we found
myopia was significantly and independently associated with having a father in a
non-manual social class (OR 1.2 [1.05, 1.45]), an older mother (1.02 [1.01, 1.04] per year
of age) and having intra-uterine growth retardation (low birth weight for gestational
age, 1.2 [1.04, 1.25]); specific associations varied by time of onset of myopia. High
myopia was less likely in those whose mother continued to smoke during pregnancy
(0.41 [0.19, 0.90]. Greater adult height was associated with being myopic but patterns
of height and rate of growth during childhood differed for ‘early’ and ‘late’ onset of
myopia. Higher maternal education, housing-based socio-economic measures and
breast feeding were only associated univariately.
Conclusions: The development of myopia is influenced by ‘distal’ social and biological
early life factors that have an important impact on human growth and development
in general. This may partly explain the recent increase in frequency and severity of
myopia in some populations, and thus predict further changes in others. Research
directed at these factors will be important in elucidating the interplay of genetic,
environmental and social/behavioural determinants in refractive error.
CR: P. Cumberland, None; C. Peckham, None; J. Rahi, None.
Support: Medical Research Council, Great Ormond Street Hospital Special Trustees
and BUPA Foundation
Purpose: To evaluate the relationship between ocular biometric parameters (axial
length, corneal radius, etc) and refraction in a cross-sectional population-based sample
of Australian school children.
Methods: High school children in the Sydney Myopia Study, predominantly aged 12
years (n=2353, 75.3% response), participated in ophthalmic examinations including
cycloplegic autorefraction (1% cyclopentolate) and ocular biometry (IOLMaster). Sociodemographic data including ethnicity were derived from questionnaires completed by
parents. Linear regression analyses using ocular biometric parameters as explanatory
variables and spherical equivalent as the outcome variable were performed for the
whole sample, and for European Caucasian and East Asian subgroups separately.
Results: Axial length was significantly correlated with spherical equivalent (correlation
coefficient, r=-0.61, p<0.0001) in 12-year old children. In multivariate models that
adjusted for age, gender and ethnicity, axial length accounted for 37% of the variability
in spherical equivalent for all children, including 24% for children with European
Caucasian ethnicity and 65% for children with East Asian ethnicity. The correlation of
spherical equivalent with corneal radius or lens power was low (all r<0.20). Analyses
for 6-year old children showed that axial length explained only 19% of the variability
in spherical equivalent after adjusting for age, gender and ethnicity; with lower
proportions in the European Caucasian (18%) and East Asian subgroups (12%).
Conclusions: In this sample of over 4,000 school children, the correlation between
axial length and spherical equivalent refraction increased substantially from 6 to 12
years of age, and was a more predominant determinant of refraction in children of
East Asian ethnicity than in children of European Caucasian ethnicity.
CR: J.M. Ip, None; S.C. Huynh, None; A. Kifley, None; K.A. Rose, None; I.G. Morgan,
None; R. Varma, None; P. Mitchell, None.
Support: Australian National Health & Medical Research Council (Grant No. 253732);
Westmead Millennium Institute, University of Sydney
2385 - 10:00AM
Myopia Stabilization in the Correction of Myopia Evaluation Trial (COMET)
Cohort
L.Dong1, J.Gwiazda2, L.Hyman1, D.Kurtz2, R.Manny3, W.Marsh-Tootle4, M.Scheiman 5,
D.Everett6, COMET Group. 1Stony Brook Univ, Stony Brook, NY; 2New England
College of Optometry, Boston, MA; 3Univ of Houston College of Optometry,
Houston, TX; 4Univ of Alabama at Birmingham School of Optometry, Birmingham,
AL; 5Pennsylvania College of Optometry, Philadelphia, PA; 6NEI, Bethesda, MD.
Purpose: 1) To describe myopia stabilization after 7 yrs of follow-up in COMET
participants based on Gompertz curve fits to each subject’s refractive error data;
2) To evaluate the association between myopia stabilization and age, gender, and
ethnicity.
Methods: 469 myopic, ethnically diverse, 6-11 yr old (median age 9 yrs) children who
enrolled in COMET in 1997-1998 continued to be followed after the clinical trial phase
ended. Non-cycloplegic autorefraction measurements were collected semi-annually
for 4 yrs and annually thereafter. The Gompertz function R=Re+Rc*(0.07295)â^(x-t0),
where R is the spherical equivalent refractive error (SER) at age x, was fit to the right
eye SER for each subject. Myopia was considered as stable at a visit and subsequent
visits once the data point at that visit was within ±0.25D of the asymptote of the
curve. The status of subjects whose SER could not be fit by the Gompertz function was
determined by agreement of two independent investigators; subjects whose status
at a visit could not be determined as either stable or progressing were excluded for
that visit. Associations between 7-yr stabilization and SER, age, gender and ethnicity
were evaluated using the t-test or χ2 test.
Results: Stable myopia in COMET participants increased from 14% (58/418) at yr 3
(median age 12 yrs) to 50% (206/411) at yr 7 (median age 16 yrs). Of the 420 subjects with
SER data at yr 7, 411 had myopia stabilization status defined-387 based on Gompertz
fits and 24 based on investigator judgment. At yr 7, SER was lower in those subjects
with stable (mean±SD= −4.3±1.5D) vs. progressing myopia (−5.5±1.6D), p<0.0001, even
though their baseline SER was similar (−2.6±0.77D and −2.5±0.86D, respectively). The
percent with stable myopia increased with age, from 35% (14/40) for 13-14 year olds
to 63% (52/82) for 18 yr olds (p=0.04). In addition, the percent with stable myopia
differed by ethnicity (p=0.01): 63% (71/113) in African-Americans, 46% (85/184) in
Whites, and 38% (24/64) in Hispanics. The frequency of stable myopia was similar
for males and females.
Conclusions: At a median age of 16 yrs, 50% of COMET cohort had stable myopia
mainly based on Gompertz curve fits, with older or African-American subjects more
likely to have stable myopia. Longer follow-up is needed in order to obtain unbiased
estimates of age and amount of myopia at stabilization for this cohort.
CR: L. Dong, None; J. Gwiazda, None; L. Hyman, None; D. Kurtz, None; R. Manny,
None; W. Marsh-Tootle, None; M. Scheiman, None; D. Everett, None.
Support: NIH Grant EY11805, EY11756. CT: www.clinicaltrials.gov, NCT00000113
2383-2385
Tuesday, May 8, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 2386-2416 / B1-B31
318. Healthcare and Economic Impact Organizing Section: CL Contributing Section: EY
2386 - B1
Development of a Universally Accessible Ophthalmology Electronic Medical
Record
2387 - B2
Ophalmic Surgical Simulation: Developments to Enhance Surgical Training
C.Thiagarajah1, G.Patel M.D2, T.Hunter M.D2, V.Ngakeng M.D2, R.A. Copeland M.D2.
1
Ophthalmology, University of Cincinnati, Cincinnati, OH; 2Ophthalmology,
Howard University, Washington, DC.
Purpose: Ophthalmic surgery training requires significant investment and involves
risk; in these respects it is similar to aviation training. The aviation model, a Systems
Approach to Training, was used to analyse ophthalmic surgical prodcedures. A
curriculum was developed to profile performance metrics in simulated intraocular
surgery.
Methods: Medical students, ophthalmology residents, retinal fellows, and attending
staff from 4 major training programs in the United States were enrolled in a one
day training seminar. This seminar incorporated an introduction and overview of
VRMagic’s EYESI simulator as well as two intensive epiretinal membrane training
modules coupled with instruction based upon standard surgical textbooks or systemic
task breakdown and analysis. Multiple performance metrics were recorded including
% of ERM removed and incidence of retina damage.
Results: Of the 48 participants, there were 3 medical students (6%), 29 ophthalmology
residents (60%), ten retinal fellows (21%), and 6 attending staff (13%). 9 (19%) of the
48 participants reported limited experience with surgical simulation; the remaining
38 (81%) reported no experience. During the simulator-based training the % of ERM
removed increased from 89.97% to 94.56%. Out of 96 total attempts by 48 participants
only 1 atempt by an attending resulted in 100% removal. 90% of the retinal fellows
removed between 86% ans 95% on both attempts, and residents showed the most gain
from 29% removing more than 90% on the first attempt to 44% on the second. The
incidence of retina damage decreased from 12 to 9 and the area of retinal damage
decreased from 3.7% to 0.8% for all participants. The participants’ subjective assesement
of the courseware via a 5 point Likert scale survey strongly indicates that task analysis
is superior to current methods of instruction in two ways. First, it results in a superior
mental model for the surgical procedure (statement 1), and second it results in a better
understanding of risks associated (statement 4).
Conclusions: The emergence of a virtual reality simulator for intraocular surgery,
the EYESI allows repetition of procedures in a virtual environment with objective
performance metrics. Acurriculum based on systemic task breakdown and analysis
leverages this capability to enable surgical skill performance gains. Further studies
to validate the use of surgical simulation in ophthalmic training are warrented and
underway.
CR: M.H. Grodin, None; B. Glaser, None.
Support: None
M.H. Grodin, B.Glaser. National Retina Institute, Towson, MD.
Purpose: The purpose of this project was to create a universally accessible electronic
medical record tailored for an ophthalmology practice that would be fully functional
to include ophthalmic drawings, imaging from FA, OCT, Photos, Visual Fields.
Additionally, the system would be low in cost, secure, and be engineered from readily
available commercial software products. The system would be designed and created
by an ophthalmology resident physician.
Methods: The method of development of this project was over 8weeks using Microsoft
Infopath and Office Software, a Toshiba Portege Tablet Laptop PC and Microsoft
Server Software
Results: A simple yet highly effective electronic medical record was created that
includes a touchscreen, incorporation of on screen fundus and anterior segment
drawings, incorporation of visual fields, OCT, FA, photos. The files are saved utilizing
an electronic signature that prevents tampering or alteration. Additionally, diagnosis
and treatment along with patient characteristics and examination data are automatically
collated to a database. The system utilizes software that is compatible with Microsoft
Office which is universally available for most clinicians. Other physicians who do
not utilize this database system are able to access these files through Microsoft Word.
Finally, utilizing a server software, multiple computers are able to access this system
to input and extract data wirelessly. The costs for this project were under $3000.
Conclusions:Electronic Medical Records are accessories to health care delivery that
reduce costs, medical errors, time, and unnecessary repeat testing. The U.S Government
has mandated that electronic medical records be included in health care delivery within
the near future. This project shows that a highly effective electronic medical record
can be designed for ophthalmology by a clinician with limited computer knowledge
over a short period of time that can be secure,effective and user friendly.
CR: C. Thiagarajah, None; G. Patel M.D, None; T. Hunter M.D, None; V. Ngakeng
M.D, None; R.A. Copeland M.D, None.
Support: None
2388 - B3
Comparison of Statistical Significance Between Commercially Supported and
Non-Commercially Supported Studies Presented at the 2006 ARVO National
Meeting
C.Radhakrishnan1, D.A. Mazzulla1, A.Kukuyev2, M.P. Saidel1. 1Ophthalmology,
University of Chicago, Chicago, IL; 2College of Medicine, Northeastern Ohio
Universities, Rootstown, OH.
Purpose: There is the perception that commercial support may bias research results. In
our pilot study at the 2006 ARVO meeting we analyzed a subset of the abstracts from
the previous year to assess whether commercial support led to a greater incidence of
statistically significant outcomes. Aside from one small subset, we found no significant
difference overall. Herein we review all the abstracts from the 2006 ARVO meeting
to ascertain the effect of commercial support on research results.
Methods: A review of all the abstracts from the ARVO 2006 international meeting
was performed. We documented the type of study, commercial support, whether a
pharmaceutical agent was studied, whether statistical significance was achieved, and
the corresponding p-value. The study was considered to have commercial support if
a commercial entity was listed under the support section. We excluded studies that
did not quantitatively state significance with a p-value.
Results: 1576 of the abstracts stated significance with a p-value. 418 of these
documented commercial support. A total of 1284 outcomes were studied in these
commercially-supported abstracts. 990 of these outcomes were statistically significant.
2816 of the non-commercially supported outcomes were significant. Chi-square
analysis was performed to compare these two groups. There was no statistical
difference in the two groups (p=0.1175). We then subdivided the data to analyze
clinical studies of pharmaceutical agents. 347 abstracts met the criteria, and of those
123 reported commercial support. 291 of the 401 commercially supported outcomes
were statistically significant. The remaining 224 non-commercially supported clinical
studies of pharmaceutical agents studied 728 outcomes. 586 of these were statistically
significant. This difference was found to be statistically significant by chi-square
analysis (p=0.0022).
Conclusions: Our analysis of the abstracts from the 2006 ARVO meeting reveal
no overall statistically significant difference between the commercially and noncommercially funded studies. Similar to last year’s results, we noted a higher
rate of statistically significant outcomes in non-commercially funded studies of
pharmaceutical agents. On the whole, it appears that commercial funding did not exert
an undue influence on the reporting of results at the 2006 ARVO meeting.
CR: C. Radhakrishnan, None; D.A. Mazzulla, None; A. Kukuyev, None; M.P.
Saidel, None.
Support: Research to Prevent Blindness
2389 - B4
The Impact of NEI-Funded Multi-Center Trials: Bibliometric Indications of
Dissemination, Acceptance and Implementation of Trial Findings
P.C. Sieving. Informationist, NIH Library, Bethesda, MD.
Purpose: To use bibliometric techniques to examine the impact of 5 National Eye
Institute-funded multi-center clinical trials.
Methods: Trial findings and recommendations for treatment were identified for trials
of vision screening for preschool children, patching for amblyopia, supplements
for age-related macular degeneration, medical vs. surgical intervention for openangle glaucoma, and choroidal melanoma. Dissemination of the results of each
trial was tracked through citations to the trials’ official reports, by citation searches
of four bibliographic databases, the Cochrane Library, and one Internet resource.
Acceptance and implementation of results was measured by references in guidelines,
standards of care and expert panel recommendations, including those for optometrists,
ophthalmologists, other physicians, nurses and allied health workers, and by economic
analyses. Trial reports’ accessibility in open access sources was also examined.
Results: Reports of key findings may be cited more than 100 times, but most are cited
fewer than 30 times. Reports published in non-vision journals receive fewer citations,
on average. Guidelines, standards of care, and health care delivery recommendations
vary in their incorporation of informed appraisal of trial findings; those directed
to non-ophthalmologists and -optometrists are more likely to omit or incorrectly
incorporate these findings. Inconsistencies in citation information of the original
publications were identified as contributing to this problem. Few reports are available
free online.
Conclusions: Improvements in the accuracy of compilations of trial findings and
publications, increased numbers and use of systematic reviews, and consistency in
trial authorship statements and clarity of abstract wording could enhance retrieval,
dissemination and implementation of trial findings. Dissemination can also be
increased by open access publications, institutional repositories, and personal and
trial Websites.
CR: P.C. Sieving, None.
Support: None
2386-2389
2390 - B5
Evaluation of the Eye Health Care and Vision Conditions Provided to Nursing
Home Residents in Wealthy Norway
2391 - B6
Short-Term Changes in Diabetes Knowledge Among Providers After
Interventions to Improve Care
H.K. Falkenberg, J.Dugstad. Department of Optometry & Visual Science, Buskerud
University College, Kongsberg, Norway.
D.Lobach1A, P.Lee1B, L.Branch2, G.McGwin 3, M.Hunt1A, W.Rafferty1B, E.Postel1B,
P.Mruthyunjaya1B. AFamily Medicine, BOphthalmology, 1Duke University, Durham,
NC; 2Public Health, University of South Florida, Tampa, FL; 3Ophthalmology, UAB,
Birmingham, AL.
Purpose: The ageing of the population is resulting in an increase in the nursing home
population. We evaluated the eye health care and visual conditions in nursing home
residents, to assess whether the current system of identifying and providing vision
care is adequate in Norway.
Methods: In a pilot study an extended eye examination was used to evaluate visual
functions in 35 mentally healthy residents in Eikertun nursing home aged 70-101 years
and 49 age-matched ambulatory elderly living at home (control group). Measurements
included visual acuity (VA), contrast sensitivity (CS), refractive errors, reading speed
and ophthalmoscopy. A questionnaire was used to assess ocular history and symptoms.
All measurements were performed by optometrists, and new glasses and/or referrals
to an ophthalmologist were provided as appropriate. We also measured daylight and
evening lighting conditions in 8 long-term wards at Eikertun and compared it to
current nursing home lighting standards. Areas tested included bedrooms, bathrooms,
living rooms, kitchens, corridors and stairs.
Results: Nursing home residents have poorer vision than elderly living at home
(0.57±0.35 vs. 0.16±0.04 logMAR, p<0.01), contrast sensitivity (1.78±0.3 vs. 1.2±0.05,
p<0.001), and reading speed (86±60 vs. 164±27 wpm, p<0.05). 20 of the residents had
not had an eye test during the last 5 years (vs. 9 controls), 18 residents were referred to
an ophthalmologist (vs. 9 controls), and 9 residents were visually impaired (VA>0.55
logMAR, 20/70) vs. 0 controls. The illumination was only 1-15 % of standard in some
areas (bedrooms/stairs) and uneven (<50% recommended).
Conclusions: This pilot study indicates that residents in Eikertun nursing home do
not receive adequate eye health care, and would benefit from regular eye examinations
and improved eye health care routines, record keeping and follow-ups. The lighting
conditions could be improved in residents’ wards. We aim to design a protocol for
nursing staff to improve the current vision care procedures and routines.
CR: H.K. Falkenberg, None; J. Dugstad, None.
Support: Statens helse- og omsorgsdepartementet
2392 - B7
Documentation of Stage of Retinopathy Among Patients With Diabetes
Mellitus Among Primary Eye Care Providers
W.Rafferty1, P.Lee2A, D.Lobach2B, G.McGwin 3, E.Postel2A, M.Hunt2A. 1Ophthalmology,
Duke University, Winston-Salem, NC; AOphthalmology, BFamily Medicine, 2Duke
University, Durham, NC; 3Ophthalmology, UAB, Birmingham, AL.
Purpose: Management of diabetic retinopathy requires accurate assessment of
its presence and severity. Yet, while several studies have noted opportunities for
improvement for accurate recognition of diabetes findings, little is known about
the levels of documentation of the severity staging of diabetic eye disease. As such,,
we sought to assess the frequency and accuracy of documentation of the stage of
retinopathy in the charts of patients with diabetes mellitus cared for by primary
eye care providers.
Methods: The initial 663 chart abstractions of community-based optometrists and
comprehensive ophthalmologists in an ongoing study to improve diabetes eye care
were assessed for 1) the presence or absence of documentation of the severity (stage)
of retinopathy present and 2) whether the assigned stage conformed with the retinal
findings described in the chart using the International Classification of Diabetic
Retinopathy (ICDR) system.
Results: The stage of retinopathy was not documented for 11% (65/663) of right eyes
and 12% (71/663) of left eyes. In addition, documentation of findings to support an
assigned stage of retinopathy were absent in another 13% of right eyes and 15% of
left eyes, meaning that one quarter of charts lacked documentation of either specific
findings on examination or the stage of retinopathy. In addition, another 8% of eyes
did not specify the eye to which a stage of retinopathy was assigned. Staging using
the ICDR system was correct in approximately ¾ of eyes in which the stage was
documented, using an exact match for the ICDR stages (none, mild NPDR, moderate
NPDR, severe NPDR, and PDR).20% of eyes (or 80% of those with an incorrect stage)
were staged by the provider as being less severe than the findings documented on
the exam that day would indicate.
Conclusions: Findings suggest that significant opportunities exist to improve both
the degree of documentation of the severity of retinopathy and the underlying fundus
examination and to more appropriately stage the severity of retinopathy present.
Prior studies indicating mis-staging of retinopathy in patients thus probably reflect
both challenges in recognizing the findings present and, as shown in this study,
synthesizing the recognized findings into an appropriate severity classification.
CR: W. Rafferty, Duke University, P; P. Lee, Duke University, P; D. Lobach, Duke
University, P; G. McGwin, None; E. Postel, Duke University, P; M. Hunt, Duke
University, P.
Support: NIH Grant EY15559, Research to Prevent Blindness
Purpose: Prior work has demonstrated that important opportunities exist to assist
primary eye care providers (optometrists and comprehensive ophthalmologists) in
understanding and applying best-evidence care for their patients with diabetes and
diabetic retinopathy. We sought to assess the short-term (3 months - 8 months) impact
of interventions to enhance care across 3 groups - 1) CME course only; 2) CME plus
a templated written exam form and office poster (low technology) and 3) CME plus a
tablet computer with a decision support system (high technology).
Methods: Participating providers completed an instrument that had been
psychometrically balanced with a baseline survey based on the results of earlier
studies. The changes in each of the 3 groups was assessed using linear regression,
controlling for the scores at baseline prior to the interventions.
Results: Scores from the first 60 of 96 provider assessments showed that no changes
occurred in the group receiving CME only for 5 critical domains of care: a) recognition
of diabetic eye disease findings; b) benefits of treatment of diabetic eye disease; c)
components and intervals for exams; d) the natural history of untreated diabetic
eye disease; and e) the indications and contraindications for treatment. There was
improvement by at least 5 to 7 points (out of 100) for the recognition of diabetic
eye disease findings and exam components and intervals in the two intervention
groups.
Conclusion: As noted in other studies, non-interactive CME alone has little impact on
provider knowledge and skills. Use of interventions to improve the process quality
of care may result in modest improvements in knowledge and skill for certain critical
elements of care. Additional investigation of longer-term impacts and more detailed
analyses will be critical to understanding how to improve patient care and patient
outcomes.
CR: D. Lobach, Duke University, P; P. Lee, Duke University, P; L. Branch, None; G.
McGwin, None; M. Hunt, Duke University, P; W. Rafferty, Duke University, P; E.
Postel, Duke University, P; P. Mruthyunjaya, None.
Support: NIH Grant EY15559; Research to Prevent Blindness
2393 - B8
The EGS Glaucocard Project: Improved Digital Documentation of Medical Data
for Glaucoma Patients Based on Standardized Cross-National Datasets and
Development of a Teleconsultation Framework for Glaucoma Specialists
F.J. Grehn, M.Schargus. Dept of Ophthalmology, Univ Eye Hospital Wuerzburg,
Wuerzburg, Germany.
Background: There are no standardized cross-national datasets for the documentation
of medical data and disease history of glaucoma patients. Ophthalmologists and
patients have no possibility to transfer disease history or raw examination data
from one ophthalmologist to another in a simple, digitalized manner. Therefore,
many examinations are repeated and important information can get lost.
Purpose: To evaluate existing international IT-based ophthalmological medical data
projects and to define different stages of glaucoma data sets on existing international
standards of medical and ophthalmological documentation. To develop the technical
environment for easy data mining and data exchange in different countries in Europe
and to build a teleconsultation system.
Methods: Existing clinical and IT-based projects for documentation of medical data
in ophthalmology (e.g. OPTHEL, ICD, SNOMED, LOINC, IEE, EGS guidelines) were
analyzed to create new data sets for medical documentation in glaucoma patients.
Different types of data transfer methods were evaluated to find the best way of data
exchange between ophthalmologists in different European countries and to create a
glaucoma specialists teleconsultation system.
Results: Data sets from existing IT projects showed a wide variability in specifications,
use of codes, terms and graphical data (perimetry, optic nerve analysis etc.) in glaucoma
patients. New digital datasets for glaucoma patients were defined based on existing
standards with different levels of specification which can be used from general
ophthalmologists for follow up examinations and for glaucoma specialists to perform
teleconsultation also across country borders. Datasets are available in English, German,
Spanish, Italian and Flemish. Different types of data exchange methods using secure
medical data transfer by internet, USB stick and smartcard were tested for different
countries regarding legal acceptance, practicability and technical realization (e.g.
compatibility with EMR-systems).
Conclusion: By creating new glaucoma specific cross-national datasets it is now
possible to develop an electronic glaucoma patient record system for data storage
and transfer based on internet, smartcard or USB stick. The digital data can be used
in referrals and for teleconsultation of glaucoma specialists for optimizing glaucoma
treatment. This should lead to an increase of quality in glaucoma care and prevent
expenses in health care costs by unnecessary re-examinations.
CR: F.J. Grehn, None; M. Schargus, None.
Support: None
2390-2393
2394 - B9
Can Distance Be a Limit of Access to Care in a Small Country Like Hungary? An
Example for Photodynamic Therapy
2395 - B10
The AMD Telescreening Project: Breaking Down the Barriers to Access in
Ontario
A.I. Seres, A.Papp, T.Pregun, A.Szabo, N.Czumbel, Z.Kalman, A.Borbandy, J.Nemeth.
Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
A.Pirbhai, T.G. Sheidow. Ophthalmology, University of Western Ontario, London,
ON, Canada.
Purpose: From 2000 to the end of 2005, the only approved treatment for reducing
the risk of visual loss for patients with subfoveal choroideal neovascularisaton was
verteporfin photodynamic therapy (PDT). In Hungary, there is one single provider
for the treatment, situated in the capital, which is in a relative central position in this
small country. The purpose of the study was to determine the factors influencing
access to this standard-of-care treatment (PDT) in Hungary.
Methods: Files of 727 patients treated with PDT in a 5 years period were reviewed to
explore correlation between geographic home location and access to PDT treatment.
Population by age groups of the 19 counties and the capital were compared to the
number of PDT treatments performed on individuals living in the given area. PDT
coverage (no. of patients treated / 10000 older inhabitants was correlated with the
distance from the provider of the treatment.
Results: Number of treatment/ 10000 inhabitants varied from 0,02 to 1,83 in the 20
regions of the country. AMD patients living in the capital seem to have 4 times more
chance to gain access to PDT than others living elsewhere in the country. This ratio
was about 2 for younger patients with CNV in pathologic myopia. Significant negative
correlation was found between treatment coverage and distance from the provider
(r= -0,75, p < 0.01). Half of the treatments were performed on patients living in the
capital while only 17% of the population is living there. Using conservative estimate,
80% of the patients living outside the capital remained untreated.
Conclusions: For elder patients, willingness to travel for a treatment and follow-up
visits might be a problem even in a small country like Hungary. This fact may be of
importance when new treatments for AMD are introduced.
CR: A.I. Seres, Novartis, R; A. Papp, None; T. Pregun, None; A. Szabo, None; N.
Czumbel, None; Z. Kalman, None; A. Borbandy, None; J. Nemeth, None.
Support: None
Purpose: To describe the initial experience of using a teleophthalmology screening
program for AMD in Ontario. To also evaluate the effectiveness of screening patients
deemed high risk for wet AMD, and establish benchmark data for time to treatment
through the use of teleophthalmic screening over conventional referral methods in
a tertiary retinal referral practice.
Methods: This is a prospective study of patients referred to a referral practice
through a newly established teleophthalmology screening system. Data was collected
prospectively on patients screened through the AMD Telescreening Project to determine
wait times to consultation and treatment, as well as association between final clinical
diagnosis and telescreening diagnosis. An historical cohort population of all AMD
referrals to the Ivey Eye Institute within a 6 month period prior to implementation of
Telescreening was established. Wait times were compared between the retrospective
cohort and telescreening group.
Results: A total of 209 images were uploaded through the secure teleophthalmology
server for screening. 113 images were graded as Dry AMD/High Risk Dry AMD, 57
as wet AMD/query wet AMD, 3 as disciform, 23 were ungradeable and 13 were given
another diagnosis. A total of 90 patients were deemed as requiring formal evaluation
by a vitreoretinal surgeon with or without angiogram. A total of 86 patients were
evaluated clinically. Of the 52 clinically evaluated and screened as having wet AMD,
38 (73.1%) were found to actually have wet AMD. Of 18 patients screened as dry AMD
and evaluated formally, 15 (83.3%) were truly dry and 3 were found to have wet
changes. As a percentage of new referrals, non-treatable disease (dry only, disciform
or other diagnosis) comprised 43.0% of the patient referrals compared with 58.1%
according to the retrospective cohort. The mean wait time to clinical evaluation from
time of referral (ie. image upload vs. conventional fax/phone referral) was 19.98 ± 1.68
days and 51.69 ± 7.81 days, respectively showing a difference of 31.72 ± 6.78 days (p
< 0.0001). The mean wait time from telescreening referral and conventional referral
to treatment was 19.44 ± 2.38 days and 30.95 ± 4.56 days, respectively. The difference
was 11.51 ± 4.67 days (p = 0.0164).
Conclusions: Compared to conventional referral methods, telescreening for agerelated macular degeneration offers patients shorter wait times to vitreoretinal
evaluation and shorter wait times to treatment. Telescreening in AMD also streamlines
clinical practices with a higher percentage of patients for whom treatment may be
of benefit.
CR: A. Pirbhai, None; T.G. Sheidow, None.
Support: None
2396 - B11
Prevalence of Glaucomatous Risk Factors in Patients From a Managed-Care
Setting: A Pilot Evaluation
2397 - B12
Maximizing Clinic Volumes in Resident-Run Ophthalmology Clinics
J.M. Smith, G.D. Seitzman. Krieger Eye Institute, Sinai Hospital, Baltimore, MD.
E.Fang1, S.K. Law2, J.G. Walt3, T.H. Chiang4. 1Assistant Chief of Ophthalmology,
Consultative Glaucoma Service, Los Angeles, CA; 2Jules Stein Eye Institute, Los
Angeles, CA; 3Allergan, Inc, Irvine, CA; 4Allergan,Inc, Irvine, CA.
Purpose: To determine the prevalence of glaucomatous risk factors (RFs) in glaucoma
patients in a managed-care practice.
Methods: Retrospective review of medical records of 1,189 glaucoma patients.
Diagnosis and documentation information of 15 RFs reported to be associated with
glaucoma progression were collected. The 15 RFs included age > 70, family history,
African American origin, high intraocular pressure (IOP), increase cup/disc (C/D)
ratio, poor visual field score, disc hemorrhage, pseudoexfoliation sign, low central
corneal thickness (CCT), high myopia, cardiovascular disease, systemic hypertension,
diabetes mellitus (DM), migraine headache, and vasospasm. The average risk score
for the population was calculated using the predictive model based on 5 risk factors
(age, IOP, CCT, C/D ratio, VF score, and DM) derived by Medeiros et al. (2005), where
a higher score indicates greater risk.
Results: 1,182 of 1,189 patients for which medical records were available had a clear
diagnosis in the charts. Mean age (63.0 ± 11.9 years) and the average IOP (18.3 ± 4.7
mm Hg) was calculated. Average value of C/D ratio was 0.52 ± 0.18, pattern standard
deviation was 2.59 ± 1.99 dB, and CCT was 552 ± 34 microns. The glaucomatous RF
with the highest incidence was systemic hypertension (39.0%), followed by age > 70
(27.2%), DM (23.6%), African American origin (23.0%), and a family history of glaucoma
(18.2%). An average risk score was 42 for this population.
Conclusions: 3 of the 5 most prevalent glaucomatous RFs from this population were
not included in the predictive model. The prevalence of RFs and risk scores may be
compared with a non-glaucoma patient population or a population of glaucoma
patients without glaucomatous RFs to determine the relative risk difference. Existing
models for calculating glaucoma risk scores do not consider several important risk
factors, and these variables should be considered in future calculation models.
CR: E. Fang, None; S.K. Law, None; J.G. Walt, Allergan, E; T.H. Chiang, Allergan,
E.
Support: Funded by unrestricted grants
Purpose: To address the challenges of maintaining clinic volume in a resident run
ophthalmology clinic.
Methods: Retrospective tracking study monitoring patient volume, no-show rates,
and patient characteristics (age and sex) in a resident clinic over a two month period,
before and after a phone call program was instituted The call back program consisted
of calling all no-show patients on the day of the missed appointment and selecting
a new exam date.
Results:A “no-show” patient is defined as a patient who was scheduled for a clinic
appointment but does not arrive. This excludes patients who rescheduled appointments
beforehand. Over the same time period, the average no-show rate in an attending clinic
was 5.7% compared to 23.4% in the resident clinic. In 2006, we initiated a program
where every no-show patient in the resident clinic was called and rescheduled. Prior
to initiation of the program, the two month total clinic volume was 981 patients.
Daily no-show rates, Monday through Friday were 23%, 20%, 17%, 26%, 18%. After
initiation, the total number of patients seen over same time period numbered 1046
and the daily no-show rates were 29%, 25%, 21%, 18%, 22%. Older patients were not
more likely to no-show. In fact, there was a trend for the no-show population to be
younger with an average age of 45.5 years. The average age of scheduled patients
was 53.3 years. The call back program did not have an effect on the total no-show
rate but did alter the rescheduled patient’s no-show rates. Before initiation of the call
back program, 33.3% of the no-show patients rescheduled and were seen within two
months of their initial scheduled visit. In contrast, after initiation of calling, 50% of
no-show patients were seen. There was no significant trend for the no-show group
to be of a certain sex.
Conclusions: Maintaining clinic volume in a resident clinic environment poses
many challenges. Patients may have limitations in their access to health care and
may require additional assistance for clinic arrival. Adequate volume is necessary for
residency education to allow diversity of pathology and to allow residents to establish
independent relationships with their own clinic patients. With the use of a call back
program, we increased the percentage of no-show patients that were successfully
seen within two months of their initial scheduled appointment. The overall number
of no-show patients was not significantly altered by the calls, likely due to the constant
flux of new patients. The call back program is one way to increase patient volume,
improve patients’ continuity of care, and maximize educational opportunities in a
resident-run ophthalmology clinic.
CR: J.M. Smith, None; G.D. Seitzman, None.
Support: None
2394-2397
2398 - B13
Documentation of Initial Evaluation for Diabetic Retinopathy Among
Ophthalmologists: Comparison to the AAO Summary Benchmarks
2399 - B14
The Personal Costs Associated With Vision Impairment
S.-L.Chou1,2, E.L. Lamoureux1,2, J.E. Keeffe1,2. 1Ophthalmology, Centre for Eye Research
Australia, The University of Melbourne, East Melbourne, Australia; 2Vision CRC,
Sydney, Australia.
J.A. Qureshi, P.P. Lee, P.Mruthyunjaya, S.Bearelly, I.J. Suner. Ophthalmology, Duke
University Eye Center, Durham, NC.
Purpose: To evaluate documentation of initial diabetic eye evaluations (history,
physical examination, diagnosis, and patient education) for the presence of Key
Elements as defined in the AAO’s Summary Benchmarks for Preferred Practice
Patterns.
Methods: A retrospective chart review was carried out using 80 charts from 12
physician practices. Among the patients evaluated from 1/1/01 to 7/31/03 who were
diagnosed with diabetes mellitus, diabetic retinopathy, and/or macular edema, charts
from each center were selected for review using a random, stratified sample (to obtain
charts without retinopathy, with retinopathy, and with macular edema). The charts
were reviewed for documentation of the Key Elements of the initial evaluation history,
physical exam, diagnosis, and patient education as defined in the AAO’s Summary
Benchmarks. The presence or absence of each of the Key Elements was recorded. The
average number of Key Elements documented was recorded.
Results: On average, one of the four (24%) Key Elements of the history portion of the
evaluation were documented (range of 0 to 3). On average, 5.6 of the six (93%) Key
Elements of the initial physical exam were documented (range of 3 to 6). The diagnosis
of diabetic retinopathy, or lack thereof, was documented in 78% of the charts; the
severity of the disease was documented in 65% of reviewed charts. The presence or
absence of CSME was documented in 41.5% of the reviewed charts. Less than 10% of
reviewed charts documented even one of the 7 Key Elements of patient education.
Conclusions: Documentation of the Key Elements of the history, diagnosis, presence
or absence of CSME, and patient education during initial diabetic examination can be
improved significantly. Further understanding the impact of levels of conformance
to patient outcomes will be important for future inquiry.
CR: J.A. Qureshi, None; P.P. Lee, Allergan, Pfizer, Merck, F; Allergan, Alcon, Merck,
Pfizer, C; Allergan, Alcon, Pfizer, R; P. Mruthyunjaya, None; S. Bearelly, None; I.J.
Suner, Genentech, Eyetech, Pfizer, Optos, Bausch & Lomb, Carl Zeiss Meditech, R;
Genentech, Eyetech, Pfizer, Optos, Bausch & Lomb, Carl Zeiss Meditech, C.
Support: Unrestricted grant from Allergan and Research to Prevent Blindness, NEI
K12 (5K12 EY016333-02)
Purpose: To determine the personal costs associated with impaired vision in Australia
and to identify the significant independent predictors of overall expenditure.
Methods: Personal costs were collected over 12 months using diaries sent monthly to
all participants. Costs were calculated per annum. For participants who returned less
than 12 months diaries, their data were extrapolated to annual figures. Baseline and
follow-up questionnaires were administered to obtain demographic, socio-economic,
clinical and vision information, and to test the validity of the diary data.
Results: In total, 227 people consented to participate and 150 of them were deemed
eligible as they completed diaries for periods ≥3 months. The participants’ mean
age was 64.8 yr (range 10-93) and 60.7% were female. Most (44%) had severe vision
impairment in the better eye (<6/60) and the most common eye condition was AMD
(38.7%). Participants were equally located in the rural and urban areas of Australia.
102 participants completed the diaries over 12 months. In total, almost 60% of the
monthly diaries were returned indicating a good participation rate. The median annual
personal costs was AUD$2,417 (range = 7 - 18,610). The highest median expenditures
were related to costs associated with special ‘equipment’ ($202, range = 23 - 4,986),
‘personal care services’ ($280, range = 4 - 7,360), ‘home help’ ($482, range = 3 - 6,574),
‘transport assistance’ ($446, range = 8 - 5,091), and ‘taxi’ services ($260, range = 7 3,125). Six variables were univariately associated with total costs, namely residential
location, subsidy, private health cover, employment, income status and social welfare,
presenting visual acuity, and cause of vision impairment (p<0.05 for all). In the
regression model, only the variable ‘employment, income status and social welfare’
was identified as an independent significant predictor of total costs. When diary entries
were validated against specific questions in the follow-up questionnaire, there was
evidence of underreporting of costs in some cases.
Conclusions: People with impaired vision experience substantial personal costs
associated with their eye condition. Considering the evidence of underreporting,
the economic burden of personal costs associated with impaired vision may be even
greater than current estimations.
CR: S. Chou, None; E.L. Lamoureux, None; J.E. Keeffe, None.
Support: None
2400 - B15
German Eye Disease Study: Fundus Imaging Network Findings in Diabetic
Retinopathy, Age-Related Macular Degeneration, and Systemic Hypertension
2401 - B16
Assessing Behavior and Readiness for Behavior Change in Patients Taking
Ocular Hypotensive Therapy
S.Dunker1, A.U. Bayer2, J.Sebag3, German Eye Disease Study Group. 1ADC, Troisdorf,
Germany; 2ADC, Weilheim, Germany; 3VMR-Institute, Huntington Beach, CA.
G.F. Schwartz1, K.Plake2, M.A. Mychaskiw3. 1Glaucoma Consultants, Baltimore,
MD; 2Purdue University School of Pharmacy and Pharmaceutical Sciences, West
Lafayette, IN; 3Pfizer Inc, New York, NY.
Purpose: Within the German Eye Network, the Fundus Imaging Network (FIN)
provides diagnostic services to 2 million people via 10 eye diagnostic centers, all
with the same equipment, standardized testing paradigms, and centralized data
processing. Since all patients are by referral, FIN is not a health screening system. This
study evaluated the initial findings of this project to determine the frequency of major
diseases and the ability of this approach to detect undiagnosed pathology.
Methods: Dilated fundus photography using the Zeiss FF450+ digital system
generated 30° stereo central (optic disc and macula) as well as peripheral 50° digital
pictures in each eye. Images were interpreted without knowledge of the history by 3
ophthalmologist graders following a study protocol. Each lesion was digitally recorded
on each image and the totality of lesions for each eye was used to derive an ETDRS
grading for diabetic retinopathy, an AREDS level for AMD, and a precise indication
of vascular abnormalities such as focal narrowing, and arteriovenous nicking.
Results: The reproducibility was 93% for different ophtalmologists grading the
same patient. Of the first 243 patients evaluated, 31 (15.2%) had age-related macular
degeneration (AMD), but only 3 (1.2%) were exudative. Hypertensive retinopathy
was detected in 60/243 (24.7%), but only 41 (16.4%) were known to have systemic
hypertension. Of another 235 eyes in patients with diabetes, 82 (34.9%) had ETDRS
level 10, 98 (41.7%) had level 12, 31 (13.3%) level 15, and 6 (2.6%) had level 35, while 18
(7.6%) were indeterminate.
Conclusions: The reproducibility of FIN is high and the resulting data is useful for
both clinical and research applications. The FIN approach has utility in detecting
and characterizing fundus pathology that improves clinical care as in the case
of hypertensive retinopathy, where one-third of patients with retino-vascular
abnormalities were unaware that they had systemic hypertension. Due to the selection
bias FIN is not an epidemiologic population-based project, and thus the distribution
of diabetic retinopathy severities by ETDRS classification did not have the same
prevalence and incidence of other studies. But the potential to rapidly accumulate
large numbers of subjects evaluated in a standardized way and to follow them over
time with the same methodologies makes FIN a powerful tool for clinical research,
drug testing, and new diagnostic instrument development, as well as an effective
way to improve clinical care.
CR: S. Dunker, German Eye Network, C; A.U. Bayer, German Eye Network, C; J.
Sebag, German Eye Network, C.
Support: None
Purpose: Nonadherence and poor persistence with ocular hypotensive (OH)
medications are common. An instrument was developed to identify patients whose
behavior may need to be improved and who may be ready to change.
Methods: The content and face validities of the 62-item survey, which was based on
the Transtheoretical Model of Change, were confirmed by 9 glaucoma specialists.
The self-administered survey includes patient demographics, patient evaluations of
health and medications, use of and difficulties taking OH medications, and visual
function. The questionnaire was administered anonymously in a glaucoma referral
practice to consecutive patients prescribed ≥1 OH medication with no history of
trabeculectomy.
Results: In all, 102 patients were surveyed of whom 63.6% were ≥60 year old, 84.3%
had glaucoma, 63.7% were diagnosed >3 years before, 45.1% were taking 1 OH
medication, and 16.7% were taking >2 medications. The vast majority (86.6%) reported
administering eyedrops every day, 12.4% were taking action to meet this goal, and 1%
were contemplating such action; 78.6% reported administering eyedrops at the same
time every day and the remainder were taking or preparing/contemplating such action
(17.3% and 4.0%, respectively). Adherence score (23.98±1.29, possible/actual range 025/20-25) and number of adherence problems (0.92±1.08, range 0-5) were negatively
correlated (r=-0.611, P<0.0001), while number of adherence problems and number of
side effects were positively correlated (0.84±1.26, range 0-6; r=0.349, P<0.0001).
Conclusion: Identifying patients’ behaviors and barriers to medication adherence
and persistence will allow appropriate interventions to be designed.
CR: G.F. Schwartz, Santen, F; Allergan, F; Pfizer Inc, F; Pfizer Inc, C; Merck, R; Pfizer
Inc, R; K. Plake, None; M.A. Mychaskiw, Pfizer Inc, E.
Support: Research supported by Pfizer Inc.
2398-2401
2402 - B17
A Retrospective Observational Study of Resource Utilization and Costs
Associated With Combination Therapy of Glaucoma Patients in Spain Over 2
Years
2403 - B18
Assessing Opinions About Dilated Eye Exams and Knowledge About Eye
Disease in an Older, African American Population
F.Honrubia1, N.Neymark 2, P.Buchholz3, X.Badia4, G.Kobelt5. 1Hospital Do Meixoeiro,
Vigo, Spain; 2EORTC Health Economics Unit, Brussels, Belgium; 3Allergan Europe,
Ettlingen, Germany; 4Health Outcomes Research Europe, Barcelona, Spain;
5
European Health Economics SAS, Speracedes, France.
N.J. Ellish1A, R.Royak-Schaler1B, D.Scott1A. AOphthalmology and Visual Sciences,
B
Epidemiology and Preventive Medicine, 1Univ of Maryland Sch of Medicine,
Baltimore, MD.
Purpose: To determine the direct medical costs of managing glaucoma patients
using first- or second-line combination therapy over a period of 24 months. Patients
initiating a combination therapy containing an alpha-agonist were compared with
patients treated with any other type of combination therapy.
Methods: Retrospective review of patient charts for 216 patients from 21 Spanish
centers starting combination therapy in 2002/3. The follow-up period was 24 months,
and costs were determined by multiplying the recorded resource use per patient with
Spanish unit cost figures obtained from public sources.
Results: Patients initiating therapy with an alpha-agonist (N = 42) were similar with
respect to age and baseline IOP to patients started on any other combination therapy
(N = 174). There were no statistically significant differences between the two groups
with respect to treatment failure in terms of changing drug combination at least once
(42% of all patients) or not achieving an IOP ≤ 17 mm Hg at the end of the period (50%
overall). The proportion of patients needing surgery, 13% overall, was also similar
in the two groups. The mean direct medical costs over 2 years per patient were 1212
€ in the alpha-agonist group and 1152 € in the group initiated on any of the other
combinations observed. A multiple regression analysis showed that the statistically
significant determinants of mean total direct medical costs were the patient’s age, the
costs of procedures performed during control visits, surgical interventions and the fact
of changing drug combination at least once. Baseline IOP and the type of combination
drug therapy used initially had no impact on average total costs, when controlling for
the other factors. Within the alpha-agonist group, a combination with a beta-blocker
lead to significantly lower costs than for other combinations (predominantly with a
prostaglandin analog), 915 € versus 1346 €. End IOP was similar (18.6 vs 18.4 mmHg)
and the number of treatment changes was similar (46% versus 48% respectively).
Slightly fewer patients achieved target IOP, however the sample was too small to
assess whether this difference was significant.
Conclusions: Initiating combination drug therapy with an alpha-agonist containing
regimen results in costs and outcomes similar to those obtained starting with other
combinations.
CR: F. Honrubia, None; N. Neymark, None; P. Buchholz, Allergan Europe, E; X.
Badia, None; G. Kobelt, None.
Purpose: To assess intentions to get a dilated fundus examination (DFE), barriers
and benefits of DFEs, and knowledge about eye disease among older AfricanAmericans.
Methods: We recruited African-Americans 65 years of age and older who had not had
a DFE in the past two years as part of a study to increase eye examination behavior.
Participants were administered a questionnaire to determine their intention to get an
eye exam, their perceived barriers and benefits to getting a DFE, and their knowledge
about glaucoma and diabetic retinopathy.
Results: We enrolled 54 participants from senior centers, senior apartments, and
church health fairs in Baltimore city. Our study population was 59% female, with
38% having less than a h.s. education, 38% graduating from h.s., and 24% having at
least some college. Four people (7%) reported having glaucoma and 9 (17%) reported
having diabetes, with 2 diagnosed with diabetic retinopathy. Regarding intentions to
get a DFE, 44% were in the precontemplation stage, including people who had never
thought about a DFE, had not decided, or did not plan on making an appointment
in the next 6 months. 24% were planning on making an appointment in the next 6
months (contemplation), and 31% planned on making an appointment in the next
month (preparation). The most frequently cited benefit of protecting vision was being
able to live on their own (39%). Being able to read, to work or do hobbies, and perform
everyday tasks were each selected by 13-14% of the participants. Regarding barriers to
getting DFEs, 61% said they had not had a recent DFE because they were putting it off.
Other barriers reported by at least 25% of the participants was that it was hard to find
someone to go with them, they had more important problems, and they did not have
an eye doctor to go to. Many participants did not know the risk factors for glaucoma.
46% did not know that African-Americans are at increased risk, 59% did not know
that glaucoma tends to run in families, and 41% did not know that risk increases with
age. Of the 9 diabetics, 3 did not know they should have annual eye exams and 4 did
not know that diabetic retinopathy can be treated to prevent vision loss.
Conclusions: Almost 70% of the participants were not planning on making an
appointment for a DFE within the next 6 months despite the fact they were at increased
risk for glaucoma because of their age and race. Interventions to address perceived
barriers and benefits, and to increase knowledge about glaucoma and diabetic
retinopathy are needed to increase eye examination behavior.
CR: N.J. Ellish, None; R. Royak-Schaler, None; D. Scott, None.
Support: NIH Grant EY15899, Research to Prevent Blindnes Unrestricted Grant
2404 - B19
Treatment of Glaucoma in Clinical Practice: Two Year Follow-Up From an
Internet-Based Patient Registry in France
2405 - B20
Evaluation of the Comfort Level of First-Year Ophthalmology Residents With
Ophthalmology Examination Techniques
G.Kobelt1, B.Richard2, A.Bron 3, J.P. Nordmann4, J.P. Renard 5, J.F. Rouland6, P.Buchholz7.
1
European Health Economics SAS, Speracedes, France; 2European Health
Economics SAS, Forges Les Bains, France; 3University Hospital Dijon, Dijon, France;
4
CHNO des Quinze-Vingts, Paris, France; 5Hôpital Militaire du Val de Grâce,
Paris, France; 6Hôpital Claude Huriez, Lille, France; 7Allergan Europe, Ettlingen,
Germany.
H.Ansari1, J.P. Dunn, Jr. 2, S.J. Gedde1, Ophthalmology Resident Skills Acquisition
Study Group. 1Bascom Palmer Eye Institute, University of Miami Miller School of
Medicine, Miami, FL; 2Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD.
Purpose: To investigate long-term resource consumption related to the use of three
IOP-lowering topical treatments (latanoprost, travoprost, bimatoprost).
Methods: The study included 601 patients in 37 centers, that at baseline received one of
the three treatments for the first time, alone or in combination. The patients are being
followed during an ongoing, 4-year naturalistic observational study, and results at
the 2-year mark are presented. Data are collected directly on an internet-based study
site. All disease- or treatment-related consumption is recorded, as are IOP and test
results, for both eyes. Outcome is assessed based on the worse eye.
Results: Mean follow-up was 36.5 months and complete 24 months data were available
for 568 patients. Baseline distribution was 45% latanoprost, 24% travoprost, 31%
bimatoprost. Around 21% of patients were treatment naïve, while 10% started on
combination treatment. Mean age was 65 years (SD 12.3) and mean time since diagnosis
4.2 years. Total mean costs per patient were 1286 €. During the 2 first years, patients
had 3.7 visits (excluding baseline); 32.4% required a treatment change, and 7.3%
underwent surgery. Patients with a treatment change had higher around 30% costs
(1521 € compared to 1174 €). The most marked increases were due to hospitalization
and in- and outpatient surgery. The mean IOP in the worse eye was 21.3 mmHg at
baseline and 16.1 mmHg after 2 years. The proportion of patients reaching a target
level of < 15 mmHg was 42% in the bimatoprost and travoprost groups, however
treatment changes and surgery were most frequent in the travoprost group. This
proportion was significantly lower in the latanoprost group (26%), which however
contained the largest proportion of patients starting on combination after previous
prostaglandin monotherapy.
Conclusions: Overall, this interim analysis shows similar outcomes in the 3 groups,
but treatment was changed in around one fifth of patients to achieve this result. There
were no major differences in the way patients were managed.
CR: G. Kobelt, None; B. Richard, None; A. Bron, None; J.P. Nordmann, None; J.P.
Renard, None; J.F. Rouland, None; P. Buchholz, Allergan Europe, E.
Purpose: To determine the comfort level of first-year ophthalmology residents with the
ophthalmology physical exam as they progress through their first year of training.
Methods: Ophthalmology residents from thirteen U.S. ophthalmology residency
programs were surveyed prospectively during their first-year. Each resident was asked
to rate his or her comfort level with 30 ophthalmology physical exam techniques on a
Likert scale of one (not at all comfortable) to five (can perform confidently). The survey
was administered to each resident at the start of residency and at one and three months
after the start of residency. Six-, nine-, and 12-month data will also be collected.
Results: The surveys were administered to 65 first-year ophthalmology residents.
At the time of abstract submission, baseline, one month, and three month surveys
were collected from 49, 41, and 22 first-year residents, respectively. At the start of
residency, residents were extremely comfortable with distance visual acuity testing
(mean Likert score = 4.1 + 1.0), the ocular motility exam (4.0 + 0.8), confrontation visual
field testing (4.0 + 1.1), color vision testing (3.9 + 1.1), and near visual acuity testing
(3.9 + 1.0). They were most uncomfortable with indirect ophthalmoscopy with scleral
depression (1.1 + 0.4), gonioscopy (1.2 + 0.6), and retinoscopy (1.3 + 0.6). After three
months of residency, mean Likert scores for all techniques surveyed increased, but
residents remained particularly uncomfortable with indirect ophthalmoscopy with
scleral depression (2.2 + 0.9). Six and ninth month results will be collected in January
and April 2007, respectively, and presented.
Conclusions: Residents in ophthalmology receive very little ophthalmology training
prior to their residency. The results of this study indicate that first-year ophthalmology
residents rapidly become facile with ophthalmology exam techniques after the start of
residency. Determination of how quickly first-year residents become comfortable with
ophthalmology exam techniques may help residency programs tailor their curricula
to optimize the learning of these techniques by their residents.
CR: H. Ansari, None; J.P. Dunn, None; S.J. Gedde, None.
Support: Heed Ophthalmic Foundation Fellowship
2402-2405
2406 - B21
Cost-Analysis of Uveitis Patient Visits at the New York Eye and Ear Infirmary
2407 - B22
Who Attends Free Eye Screenings?
O.L. Lee, S.R. Tari, C.M. Samson. Ophthalmology, New York Eye and Ear Infirmary,
New York, NY.
H.Koenig, Y.Trigo, W.E. Sponsel. Ophthalmology, University of Texas Health Science
Center at San Antonio, San Antonio, TX.
Purpose: The purpose of this study is to examine direct costs associated with the
management of patients with ocular inflammatory diseases at a tertiary care eye
center.
Methods: A retrospective review was done of all patients seen at the New York Eye
and Ear Infirmary in 2005 with a primary diagnosis of anterior uveitis, posterior
uveitis, panuveitis, pars planitis, and scleritis.
Results: A total of 1189 patients were seen on 2966 separate visits, including 5 inpatient
stays. A total expenditure of $493k was spent on office visits, ancillary testing, inpatient
surgery and admissions. Anterior uveitis was the most common diagnosis, accounting
for 80% of all patients seen and 62% of total expenditure. While a cumulative average
of $415 worth of services was spent per patient, expenditure on panuveitis patients
averaged $791 per patient. Eleven percent of patients had laboratory workup done
at the hospital, with the most popular tests ordered being MHA-TP, CBC, ANA and
ACE. Proportionately more patients with panuveitis had laboratory investigations
than any other group. Chest X-ray accounted for the vast majority of radiological
studies performed at our institution for uveitis patients. The most common surgical
procedures performed on inpatients admitted with uveitic diagnoses were vitrectomy,
cataract extraction and intravitreal kenalog injection.
Conclusions: In conclusion, uveitis patients require a variety of resources in the
setting of a tertiary care eye center. Direct costs on average are at least four times
that of a patient seen for routine eye care, and significantly greater in patients with
panuveitis.
CR: O.L. Lee, None; S.R. Tari, None; C.M. Samson, None.
Support: None
Purpose: To determine what kinds of people take advantage of free glaucoma eye
screening opportunities in a mobile clinic stationed at multiple urban sites in South
Central Texas.
Methods: Screenings were held for 4 consecutive days each month in a 60-foot Lions
Mobile Eye Screening Unit parked outside different locations of a local grocery
chain throughout Bexar County, Texas. Informed consent documents were signed
by each participant. An IRB waiver was granted allowing for this assessment of the
demographic and health insurance status of screenees attending between September
2005 and November 2006.
Results: A total of 1881 people were screened during the 15-month period, 1030
females (55%) and 851 males (45%). The mean age of the total screened was 47.8.
Mexican-Americans comprised 56% of the total, followed by European-Americans
(24%), African-Americans (16%), Asian (2%) and Other (1%). Among all participants,
920 (49%) reported having health insurance (including Medicare, Medicaid, Veterans),
937 (50%) claimed to be uninsured, and 24 (1%) were uncertain. The EuropeanAmerican, African-American and Asian groups were all at least 50% insured (62%,
53% and 50% respectively), while Hispanics were 42% insured, and Other 33%.
Among individuals without other significant eye pathology demonstrating 20/40 or
worse pinhole visual acuity in at least one eye, 48% (340) had insurance, while 50%
(361) did not, with 1% (7) unknown. About one-third had some form of refractive
correction (236 = 34%); the remainder either admitted having no correction available
anywhere (414 = 60%) or attended without glasses (39 = 6%).
Conclusions: Just over half of the individuals who took advantage of free eye screenings
had no health insurance. More than one-third of attendees had compromised visual
acuity, with similar proportions among the insured and the non-insured. Approximately
37% of those with compromised vision and without insurance had no glasses, but,
remarkably, more than a quarter of insured individuals with visual compromise had
no glasses, either. Factors aside from access to care appear to contribute substantially
in determining whether certain individuals will take practical action to address their
own visual compromise.
CR: H. Koenig, None; Y. Trigo, None; W.E. Sponsel, None.
Support: Friends of the Congressional Glaucoma Caucus Foundation and Research
2408 - B23
Project Vision SOS (Saving Our Sight): Post-Screening Follow-Up Analysis
2409 - B24
Use of a Help-Wanted Index to Assess Demand for Ophthalmologists
S.H. Hahn1, G.Lindhorst1, S.Ferlitto2, Y.Trigo1, H.Koenig1, W.E. Sponsel1.
1
Ophthalmology, University of Texas Health Science Center, San Antonio, TX; 2San
Antonio Metropolitan Health District, San Antonio, TX.
C.C. Nwanze, R.A. Adelman. Ophthalmology, Yale School of Medicine, New Haven,
CT.
Purpose: To identify common factors that might inhibit adults, who have screened
positively and have been confirmed by a clinician as a glaucoma suspect, from seeking
clinical follow-up care.
Methods:Adults participating in standardized public glaucoma screenings at 8
centers in San Antonio, Texas, underwent frequency doubling technology C-20 (FDT)
vision screening. Those missing 2 or more FDT stimuli in either eye underwent
Heidelberg Retinal Tomograph (HRT) scanning laser optic disc/NFL tomography,
standard perimetry using Humphrey SITA 30-2 visual field (HVF) analysis, and
non-contact tonometry. Slit lamp exam and ophthalmoscopy were then performed
by an ophthalmologist who made referral arrangements with providers within the
same zip code area for follow-up.
Results: Among 1864 participants, 260 (13.94%) screened positively (57% were
female; 38% were between ages 40-59 and 36% were over 65; 152 (60%) were MexicanAmerican; 64% had some form of medical insurance). Glaucoma or suspect glaucoma
was confirmed by the ophthalmologist in 172 (9%), who were then referred to a local
provider for follow-up care. Among these 172, 106 (61%) did seek care with local
ophthalmologists, who confirmed glaucoma in 75.4% of attendees, and commenced
therapy in 63%.
Conclusions: Almost 1 in 10 screened participants were referred. Among the fewer
than 2/3 who actually attended their follow-up appointment, more than three-quarters
were confirmed as being glaucomatous. Lack of medical insurance and fear of cost
were the main reasons given for follow-up attrition. Improvements in screening
methodology now highlight our greatest ongoing challenge; to ensure that those
found to be at risk obtain follow-up care.
CR: S.H. Hahn, None; G. Lindhorst, None; S. Ferlitto, None; Y. Trigo, None; H.
Koenig, None; W.E. Sponsel, None.
Support: Friends of the Congressional Glaucoma Caucus Foundation and Research
Purpose:To develop a help-wanted index (HWI) to measure trends in marketplace
demand for ophthalmologists, then to identify the economic drivers of these trends
and the responsiveness of the ophthalmology community to marketplace demand.
Methods:Retrospective review of physician recruitment advertisements appearing in
the following journals: Ophthalmology, American Journal of Ophthalmology and Archives
of Ophthalmology from January 1980 through June 2006.
Results:Over the 26 year study period a consistent increase in the demand for academic
ophthalmologists was noted (34% of HWI in 1980 to 74% in 2005). There was also a
consistent increase in the demand for specialists (31% of HWI in 1980 to 80% in 2005),
especially demand for retina specialists. There were no consistent geographical
trends in demand. Need for academic ophthalmologists seems to be correlated with
national research expenditure and stock market gains (p = 0.00191), while demand for
private practice ophthalmologists seems to be correlated with the national economic
wellbeing, as measured by Gross Domestic Product (GDP) (p<0.001). Further analysis
indicated that training programs (p = 0.0456), residency applicants (p = 0.0128) and
fellowship applicants (p = 0.0198) respond to marketplace demand. Furthermore
salaries of academic ophthalmologists (p = 0.0226), and retina specialists (p = 0.0418)
are statistically influenced by marketplace demand.
Conclusions:Long run trends in the HWI data suggest a chronic scarcity of academic
ophthalmologists, and the emergence of need for a more specialized workforce, which
may lead to increased competition for fellowship positions. This study suggests that
the ophthalmology community is quick to respond to marketplace demand. Since
HWIs are useful tools for assessing the marketplace need for ophthalmologists, an
ongoing HWI will provide timely information about the demand for physicians in a
rapidly changing health care system.
CR: C.C. Nwanze, None; R.A. Adelman, None.
Support: None
2406-2409
2410 - B25
Domestic and International Adoption of Podcasting for Distribution of
Ophthalmology Research and Education
2411 - B26
An Online Interactive Educational Resource to Assist the Development of
Visually Impaired Students Through Online Resources
N.Ghaznawi, J.Young. Ophthalmology, New York University, New York, NY.
D.C. Gotto1, F.Abbott1, A.Clapp1, S.Eklund1, A.Fulton1, L.Mayer1, K.Miller1, T.Miller2,
A.Ross2, D.Yun1. 1Children’s Hospital Boston, Boston, MA; 2Perkins School for the
Blind, Watertown, MA.
Purpose: To determine the role of ophthalmic Podcast educational programs as a
vehicle for the international exchange of ideas. To quantify the potential of ophthalmic
Podcast technology in terms of the diversity of listenership, therefore identifying key
populations as both a target and source of future research endeavors
Methods: An ophthalmology podcast (RSS-mediated Internet audio program) was
developed, consisting of audio interviews with ophthalmologists and ophthalmic
researchers.
Apache server logs of the ophthalmology podcast “As Seen From Here” www.
AsSeenFromHere.com, were analyzed for country of origin of download request.
These data were examined for the period April 2005 through September 2006
Results: During the fourteen month study period, total listenership grew approximately
4300%. Although ophthalmologists from the United States originally accounted for the
overwhelming majority of listeners, the proportion of international subscribers has
risen dramatically. Within the last 12 months, American listenership has grown 35%
whereas international listenership has grown 304%. Ophthalmologists from outside
of the United States initially comprised fewer than 15% of listeners, but now represent
nearly half of the market. After the United States, the largest audiences came from
the United Kingdom (6.4%), China (5.0%), Canada (4.7%), Australia (3.7%) and Japan
(2.3%). More than 77,000 audio programs have been downloaded since the inception
of As Seen From Here, amounting to approximately 1.9 terabytes of data transfer to
ophthalmologists worldwide. The most recent data indicate approximately 1,300
unique computer addresses (IP addresses) download the podcast every month.
Conclusions: The ophthalmology podcast, “As Seen From Here,” is gaining increasing
acceptance as a means of dissemination of research and clinical information inside and
especially outside the United States. Therfore, Podcasting may serve as an increasingly
important means of education and information sharing.
CR: N. Ghaznawi, None; J. Young, None.
Support: None
2412 - B27
Evaluating The Benefits Of Treatments For Ophthalmic Conditions Using Cost
Utility Analysis. Which Metric To Use?
J.Kowalski1A, A.Lloyd2, J.Walt1A, A.Rentz3, J.Lee1B. AGlobal Health Outcomes Strategy &
Research, BApplied Health Outcomes, 1Allergan Inc, Irvine, CA; 2United Biosource
Corporation, London, United Kingdom; 3United Biosource Corporation, Bethesda,
MD.
Purpose: The US panel on cost-effectiveness and NICE in the UK have recommended
that health outcomes in cost utility analyses should be weighted by the preferences
of society and not patients. However, existing societal-based preference measures
either do not include items on vision loss or include a limited assessment of visual
functioning. Moreover, published info on the extent by which members of society with
good vision judge the impact of vision loss on quality of life is limited. The objective
of this research is to develop methods for capturing societal-based utility preferences
regarding the impact of ophthalmic disease.
Methods: The 25-item NEI-VFQ (VFQ) will be simplified via principal components
analysis and item response theory using data from both observational and clinical
studies. Exploratory item reduction will be stratified by peripheral versus central
vision loss and via a pooled sample. Creation of visual functioning health states from
the reduced items will include clinician review and patient interviews. Health utility
valuations based on the health states will be collected from the public in Australia,
Canada, UK, and US.
Results: The need for such a utility measure for ophthalmic conditions and the
development process will be described, and will include the pros and cons of alternative
approaches to obtaining utility data. The simplified VFQ based on analysis of >3,500
unique patients with glaucoma, DME, RVO, uveitis, or ARMD will be presented,
along with the methodology for utility elicitation from 800 members of the general
public (n=200 per country).
Conclusions: With limitations of existing utility measurement for ophthalmic
conditions, a new utility measure based on the VFQ will provide necessary information
for cost-utility analyses that are required by various health care payers and regulatory
agencies.
CR: J. Kowalski, Allergan, E; A. Lloyd, Allergan, C; J. Walt, Allergan, E; A. Rentz,
Allergan, C; J. Lee, Allergan, E.
Support: None
Purpose: Provide an online interactive educational resource to Assist the Development
of Visually Impaired Students through Online Resources (ADVISOR).
Methods: The ADVISOR project coordinated a regional group effort consisting of 13
New England agencies for children who are blind or visually impaired. Educational
multimedia teaching components, factual information sets, and interactive simulations
were developed to facilitate communication among parents, teachers and doctors.
Emerging electronic and Internet technologies were used to enhance the bi-directional
exchange of information between the information provider and the online viewer.
Ongoing patient-centered focus groups are conducted with parents to assess and
improve project information content. Web statistics software was implemented that
analyzed trends and suggested an improvement in the site’s overall design, content
and information accessibility for all parties of interest.
Results: The ADVISOR is online at http://www.e-advisor.us. The Symbol
Matching Game has been developed to assist in acuity testing for young children
by familiarizing them with LEA and HOTV symbols. The Virtual Acuity Lab, a
detailed and comprehensive module on testing techniques and demonstrations for
visual acuity has been developed. A Rich Site Summary enabled news page featuring
the latest in Accessible Technology has been developed and is updated regularly.
Accessibility standards have been updated for the entire website, including Level AAA
conformance to the W3C’s Web Accessibility Initiative Guidelines, Section 508 of the
US Rehabilitation Act validation, Cascading Style Sheets and XHTML. Real-time font
size adjustment and hi-contrast viewing modes have been built into the website to
improve the accessibility and user experience overall. A custom Content Management
System has been implemented, allowing more efficient website management.
Conclusions: The ADVISOR Project and e-Collaborative endeavors to present educated
and informed ophthalmic care by facilitating the communication among parents,
teachers and eye doctors of children with visual impairment. With the emergence of
new electronic technologies and the onset of Web 2.0, the opportunity for improved
learning methods and educational techniques through the Internet can benefit
disabled individuals. The ADVISOR is largely self-sustainable and is a quintessential
educational resource on the Internet.
CR: D.C. Gotto, None; F. Abbott, None; A. Clapp, None; S. Eklund, None; A. Fulton,
None; L. Mayer, None; K. Miller, None; T. Miller, None; A. Ross, None; D. Yun,
None.
Support: NLM Grant G08LM008108
2413 - B28
Identification of Systematic Reviews in Vision Research
T.Li1A, R.Scherer1A, C.Towse1B, B.Anton1B, K.Dickersin1A. ACochrane Eyes and Vision
Group, BWelch Library, 1Johns Hopkins University, Baltimore, MD.
Purpose: To identify and characterize published systematic reviews (SRs) relevant to eyes
and vision in major medical bibliographic databases.
Methods: Search strategy: We developed a search strategy using keywords and terms
from controlled vocabularies in the Unified Medical Language System treasure tool. We
combined topical terms with terms related to SR methodology. We searched PubMed and the
Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects,
the Health Technology Assessment Database and the NHS Economic Evaluation Database
in The Cochrane Library in November 2006. Eligibility: We included SRs, defined as full text
review articles using a systematic methodology that included a clearly formulated research
question, explicit methods to identify the primary studies, and predetermined inclusion and
exclusion criteria. We included reviews with and without meta-analyses. SRs were eligible
if they related to the etiology, epidemiology, prevention, diagnosis, intervention, practice
patterns, economic evaluation, or health care utilization of eye diseases or visual impairment
in humans. We excluded SRs that evaluated only animal or in vitro studies. Analyses: We
reviewed the citations identified, eliminated duplicates and determined final eligibility. We
classified the records by eye condition studied.
Results: Our search identified 2,707 distinct records, of which 321 were eligible. The number of
SRs increased more than 10-fold from 1992 (n = 4) to 2005 (n = 57) (see figure 1). A substantial
proportion (41.1%; 132/321) concerned common aging eye conditions: 17.1% (55/321) on
glaucoma, 11.2% (36/321) on AMD, 9.6% (31/321) on cataract, and 5.9% (19/321) on diabetic
eye disease. Other topics with 7 or more SRs were low vision (10/321), refractive surgery
(8/321) vision screening (7/321) and retinoblastoma (7/321).
Conclusions: Our results revealed an increase in the application of SR methodology to
assess the evidence in the eyes and vision literature in recent years. Enormous challenges
remain, however, with many ocular conditions areas for which an evidence-based approach
has not been used.
CR: T. Li, None; R. Scherer, None; C. Towse, None; B. Anton, None; K. Dickersin, None.
Support: NIH contract NO1-EY-2-1003, National Eye Institute, National Institutes of
Health
2410-2413
2414 - B29
Evaluating the Quality of Meta-Analyses in the Ophthalmology Literature
2415 - B30
Interactions Between Pharmaceutical Industries and Ophthalmology Trainees
R.S. Baker, M.A. Shaheen, K.C. Heslin. Ophthalmology, Drew Univ of Medicine & Sci
and UCLA School of Medicine, Los Angeles, CA.
Y.Wang, R.A. Adelman. Ophthalmology, Yale University, New Haven, CT.
Purpose: The purpose of the study was to assess the methodological quality of metaanalyses published in five leading Ophthalmology journals.
Methods: We searched the MEDLINE database electronically to identify meta-analyses
published in five leading ophthalmology journals between 2002 and 2006. The main
inclusion criterion was the reporting of pooled quantitative results of studies in
ophthalmology. All meta-analyses were retrieved and independently assessed for
quality by three reviewers using a 10-item scale from the Overview Quality Assessment
Questionnaire.
Results: Nineteen meta-analyses were identified to be included in this evaluation.
Overall agreement between the three independent reviewers was good (67%
agreement). The scientific quality of the meta-analyses, as assessed by the 10-item
scale, was generally low (mean score= 4.5 ± 2.4, maximum possible score=7). Overall,
more than half of the meta-analyses (53.3%) had major flaws (score ≤4), including poor
descriptions of statistical analyses and the omission of information on the quality of
the studies that were pooled. The agrrement between the three reviewers about the
presence of major flaws in the studies (score ≤4) was 100%.
Conclusions: This evaluation of the quality of meta-analyses published in
ophthalmology journals between 2002 and 2006 suggested major methodological
flaws. Meta-analyses with low quality may limit the validity of the reported results.
More efforts should be made to improve the quality of meta-analyses in ophthalmology
journals by following published guidelines for the conduct and reporting of metaanalyses.
CR: R.S. Baker, None; M.A. Shaheen, None; K.C. Heslin, None.
Support: AHRQ grant 1R24HS014022-01A1 & NIH/NCRR 1 R25RR019488-01 & NIH/
NCRR 1P20MD00148-01
Purpose: There has been increasing concern about the influence of pharmaceutical
promotions on physicians’ prescribing behavior. Previous studies in other specialties
have suggested that doctors in training are vulnerable to such influence although they
may be unaware of it. The purpose of the current study is to look at the behavior and
attitudes toward pharmaceutical promotions among ophthalmology trainees.
Methods: Surveys about behavior and attitudes toward interactions with
pharmaceutical representatives (Pharm Reps) were distributed to 40 ophthalmology
residency programs in the United States and the program coordinators were asked
to forward the survey to their residents and fellows.
Results: 35 responses were received. A majority (94%) of respondents report seeing
Pharm Reps visiting their program at least once every one to two months. All
respondents (100%) have accepted gifts from Pharm Reps. The most common gifts
are pens, books, lunches and dinners. While only 31% of trainees have changed
prescribing behavior based on information provided by Pharm Reps, the majority
(77%) has done so based on availability of medicine samples. Interestingly, trainees
tend to believe that they are more immune to the influence from pharmaceutical
promotions than their peers. When asked to rate the agreement to the statements with
5 meaning strongly agree and 1 meaning strongly disagree, the average agreement
score for “Pharmaceutical representatives influence my prescribing” is only 2.69,
compared to 3.40 for “pharmaceutical representatives influence other physician’s
prescribing”. The difference in the score is statistically significant (p=4.98E-07). Overall,
most respondents (86%) believe the interactions with pharmaceutical industry have
been “just right”. Although almost half of trainees (49%) admit there are guidelines
or policies in their program regarding interactions with pharmaceutical industries,
only 29% have received training in this area. There are also discrepancies among
respondents from the same program, with some stating there is such a policy while
others answered no, indicating the lack of awareness of such policies even when
they do exist.
Conclusions: There have been extensive interactions between pharmaceutical
industries and ophthalmology trainees. While most trainees believe they are not
easily influenced by pharmaceutical promotions, the majority of them have changed
behavior based on the promotion. There is currently a lack of education in this
area. Ophthalmology training programs should teach trainees regarding industry
marketing techniques, their potential influences, as well as how to critically evaluate
the information.
CR: Y. Wang, None; R.A. Adelman, None.
Support: None
2416 - B31
A Descriptive Cross-Sectional Survey Assessing the Prevalence of
Complementary and Alternative Medicine Use in Patients Visiting UPMC Eye
Center
G.A. Corrales, M.Pantcheva, M.Kahook, J.Schuman, R.Noecker. Ophthalmology,
UPMC, Pittsburgh, PA.
Purpose: To determine the prevalence, perceived benefits, and motivation for using
complementary and alternative medicine use (CAM - vitamins, herbal remedies and
dietary supplements) among patients with different eye problems.
Methods: One hundred ninety two patients were asked to participate by answering
questions and recording the responses on standard questionnaire form.
Results: Of the 192 patients surveyed 130 (67.71%) have been using CAM. Of those
using CAM 60.94% were using vitamins, 34.38 % were using dietary supplements,
and 7.81% were using herbal remedies. 6.15% were using all three types of CAM, 40%
were using two of the three different types of CAM, and 53.85% were using at least
one type of CAM. 67.69% of the patients using any type of CAM find them helpful for
their general health, 16.92% thought the CAM they were taking did not help to improve
their health, and 13.08% of patients did not know there has been any benefit for them
taking CAM. 55.38% of patients were advised by their doctor to take CAM.
Conclusions: More than half of our patients were using CAM and nearly half of them
used them for non-serious medical conditions, health promotion or disease prevention.
It is important for physicians to be aware of CAM that patients are using in order to
better advise them about the impact of these therapies on their ocular health.
CR: G.A. Corrales, None; M. Pantcheva, None; M. Kahook, None; J. Schuman,
None; R. Noecker, None.
Support: None
2414-2416
Tuesday, May 8, 11:15 AM - 1:00 PM Grand Floridian H Paper Session Program Number Range: 2882-2888
344. Gene and Gene-Environmental Interaction of Eye Diseases Organizing Section: CL Contributing Section: AP
2882 - 11:15AM
Complement Factor H, Smoking, Dietary Fish Consumption and Age-Related
Macular Degeneration: Population-Based Findings
2883 - 11:30AM
Complement Factor H, LOC387715 and Age-Related Macular Degeneration:
Population-Based Case Control Study
J.J. Wang1,2, P.Mitchell1, E.Rochtchina1, W.Smith 3, R.Klein4, B.E. K. Klein4, T.Joshi 5, T.A.
Sivakumaran 5, S.K. Iyengar5, Blue Mountains Eye Study. 1Ophthalmology (Centre
for Vision Research, Westmead Millennium Institute, Westmead Hospital),
University of Sydney, Sydney, Australia; 2Ophthalmology, Centre for Eye Research
Australia, University of Melbourne, Australia; 3Centre for Clinical Epidemiology
& Biostatistics, University of Newcastle, Newcastle, Australia; 4Department of
Ophthalmology & Visual Sciences, University of Wisconsin Medical School,
Madison, WI; 5Department of Epidemiology and Biostatistics, Case Western
Reserve University, Cleveland, OH.
W.T. Smith1, J.J. Wang2, G.Burlutsky2, C.-C.Chan 3, S.K. Iyengar4, J.Tuo3, C.Xing4,
P.Mitchell2, Blue Mountains Eye Study. 1Centre for Clinical Epidemiology and
Biostatistics, University of Newcastle, Australia, New Lambton, Australia;
2
Westmead Hospital), University of Sydney, Sydney, Australia; 3Laboratory of
Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD;
4
Department of Epidemiology and Biostatistics, Case Western Reserve University,
Cleveland, OH.
Purpose: To assess joint/ modifying effects of smoking and dietary fish consumption with
complement factor H (CFH) genotypes on the risk of age-related macular degeneration (AMD)
in an older population.
Methods: Of 3654 Blue Mountains Eye Study baseline participants aged 49+ years (1992-4),
2335 (75% of survivors) were re-examined after 5 and 1935 (75% of survivors) after 10 years.
AMD incidence was confirmed via side-by-side photographic grading. Of 2452 participants
who were followed, 1881 with DNA available were genotyped for the CFH 1061170 locus using
Taqman assays. An additive model for CFH risk stratification was used. Among participants
of first-degree family members, only the youngest member of each family was included (90
excluded). Dietary data were collected using a validated food frequency questionnaire. Fish
consumption was estimated using the Australian Tables of Food Composition.
Results: The CFH CC genotype was found in 13.6% of the population, the CT genotype
in 46.7% and TT genotype in 39.7%. After adjusting for age, sex and smoking, a gradient
pattern of increasing AMD risk associated with the CC and CT genotypes was evident (for
Early AMD, relative risk, RR 1.8, [95% confidence interval, CI 1.2-2.8] for CT and RR 2.7
[CI 1.6-4.5] for CC; for Late AMD, RR 2.7 [CI 1.2-6.4] for CT and RR 4.8 [CI 1.8-12.7] for CC,
compared to the TT genotype). There was no significant interaction (p=0.96), but a joint
effect of the CFH risk allele with smoking on Late AMD risk (for non-smokers: RR 1.7 [CI
0.6-4.6] for CT and RR 4.2 [CI 1.4-12.6] for CC; for smokers: RR 10.9 [CI 3.1-38.1] for CT and
RR 9.7 [CI 1.7-54.8] for CC). There was a significant interaction between the risk allele and
fish consumption on Late AMD risk (p=0.03). After adjusting for age, sex, smoking, white
blood cell count, weekly fish consumption was associated with a reduced risk of Late AMD
in persons with the CC (RR 0.15, CI 0.03-0.8), but not with the CT (RR 0.74, CI 0.3-2.0) or TT
genotype (RR 1.3, CI 0.2-7.1).
Conclusions: Our findings confirm the joint effects of the CFH risk allele with smoking on
Late AMD risk, and show that fish consumption appears to protect against Late AMD in
those with the CFH risk allele.
CR: J.J. Wang, None; P. Mitchell, None; E. Rochtchina, None; W. Smith, None; R. Klein,
None; B.E.K. Klein, None; T. Joshi, None; T.A. Sivakumaran, None; S.K. Iyengar, None.
Support: Australian NHMRC grants 974159 & 211069 to Mitchell and Smith, NEI grant
R01EY 015810 to Iyengar.
2884 - 11:45AM
Coding and Noncoding Variants in the CFH Gene, Including rs1410996,
Influence the Risk of Age-Related Macular Degeneration in a Japanese
Population
Purpose: Clinically based case-control studies have reported independent contributions
from the complement factor H (CFH) and LOC387715 genes to the risk of age-related macular
degeneration (AMD). We aimed to confirm this finding in a population-based case-control
study.
Methods: Cases and controls drawn from the Blue Mountains Eye Study population included
789 subjects (261 cases; 211 early and 50 late, and 528 controls matched for age, gender and
smoking). For families with multiple members, only the youngest member of each family
was analysed. Subjects were genotyped for the CFH 1061170 locus using Taqman assays and
for the LOC387715 (rs#10490924) using PCR-RFLP and Taqman assays. AMD was graded
using the Wisconsin ARM photographic grading system. Effects of the 2 gene loci on AMD
risk were assessed using logistic regression models that adjusted for age, sex and smoking.
Additive and dominant models for the gene risk alleles were used.
Results: The CFH CC genotype (risk) was found in 15.1% of the sample, CT in 49.4% and
TT genotype in 35.5%. The LOC387715 TT genotype (risk) was found in 3.5%, GT in 35.5%
and GG in 61.0%. Only two subjects (0.3%) were homozygous for risk at both CFH (CC)
and LOC387715 (TT) and were both late AMD cases. Compared to the CFH TT genotype, a
gradient pattern of increasing risk for any (early or late) AMD was evident (odds ratio, OR
1.6, 95% confidence intervals, CI 1.1-2.3 for CT and OR 3.9, CI 2.5-6.2 for CC). Compared to
LOC387715 GG genotype, corresponding risks for any AMD showed a similar pattern (OR
1.9, CI 1.4-2.7 for GT and OR 2.6, CI 1.2-5.6 for TT). Using dominant models to assess joint
effects of both gene loci, persons with any risk alleles in both CFH (CC or CT) and LOC387715
(GT or TT) had similar risks for any or late AMD as those with the homozygous CFH CC
risk alleles (any AMD: OR 3.6, CI 2.3-5.8 vs OR 3.9 for CFH CC; late AMD: OR 7.7, CI 2.5-23.3
vs OR 11.0, CI 4.2-28.8 for CFH CC).
Conclusions: Our data confirm independent effects from the CFH and the LOC387715 risk
alleles on the risk of AMD, but do not show joint effects or interaction of these two gene loci
on AMD risk using dominant models.
CR: W.T. Smith, None; J.J. Wang, None; G. Burlutsky, None; C. Chan, None; S.K. Iyengar,
None; J. Tuo, None; C. Xing, None; P. Mitchell, None.
Support: Australian NHMRC grants 974159 & 211069 to Smith and Mitchell, NEI grant
R01EY 015810 to Iyengar
2885 - 12:00PM
The Heritability of Intra-Ocular Pressure and Corneal Hysteresis: A Classical
Twin Study
K.Mori1A, P.L. Gehlbach2, S.Kabasawa1A, I.Kawasaki1A, M.Oosaki1B, H.Iizuka1C,
T.Awata1B,1C, S.Yoneya1A. ADepartment of Ophthalmology, BDivision of
Endocrinology and Diabetes, Department of Medicine, CDivision of RI Laboratory,
Biomedical Research Center, 1Saitama Medical University, Iruma, Japan;
2
Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD.
Purpose: Ethnic variation has been reported in age-related macular degeneration
(AMD)-associated Y402H polymorphism in complement factor H (CFH).This variation
is evident in the Japanese population. Recently a strong association between a
novel SNP (rs1410996) in the CFH gene and AMD has been identified in Caucasian
populations of predominantly European descent (Li M, et al. Science 2006; Maller J, et
al. Science 2006). The present study investigates whether four coding and noncoding
variants of the CFH gene, including rs1410996, are associated with AMD in native,
unrelated Japanese patients.
Methods: A total of 190 patients with AMD and 135 control subjects without AMD
were recruited for this study. Four SNPs (rs2274700, rs1410996, rs800292, rs1061170)
in the CFH gene were assessed using a TaqMan assay.
Results: The noncoding SNP (rs1410996) was associated with a significant risk of
developing AMD in a Japanese population (p=2.4x10 -5, OR(95%CI); 1.98(1.44-2.72)).
Significant association was also noted between a coding variant (rs800292, I62V) and
AMD (p=8.6x10 -6, OR(95%CI); 2.10(1.51-2.92)). In contrast, the Y402H variant showed no
significant association with AMD (p=0.10). Two common haplotypes also demonstrated
significant association with AMD (p=1.28x10 -5, 1.11x10 -3).
Conclusions: Although the Y402H variant was not significantly associated with AMD,
other coding and noncoding variants in the CFH gene including rs1410996 moderately
influenced the risk of AMD in a Japanese population.
CR: K. Mori, None; P.L. Gehlbach, None; S. Kabasawa, None; I. Kawasaki, None; M.
Oosaki, None; H. Iizuka, None; T. Awata, None; S. Yoneya, None.
Support: a grant-in-aid for scientific research (11771070) from the Ministry of Education,
Culture and Science in Japan
F.Carbonaro1, D.A. Mackey2, T.Spector1, C.J. Hammond1,3. 1Twin Research &
Epidemiology Unit, King’s College, London, United Kingdom; 2Department of
Ophthalmology, University of Tasmania, Hobart, Australia; 3West Kent Eye Centre,
Bromley Hospitals NHS Trust, Orpington, United Kingdom.
Purpose: Corneal biomechanical properties influence the results and outcomes of intraocular
pressure (IOP) measurements. Central corneal thickness (CCT) has become an important factor
in the evaluation of glaucoma. Other corneal tissue properties such as Corneal Hysteresis
(CH), the result of viscous damping in the corneal tissue, and a measure of the overall
“resistance” of the cornea, the corneal resistance factor (CRF), can be measured, and used to
calculate corneal-corrected IOP (IOPcc). This IOP, which is affected less by corneal properties
than other measuring techniques, may be more accurate in glaucoma assessment. The
purpose of this study was to assess the relative importance of genes and environment on
these corneal factors.
Methods: Monozygotic (MZ) and Dizygotic (DZ) twin pairs from the TwinsUK Adult
Twin Registry, were examined using the Reichert Ocular Response AnalyserÂ® (ORA).
Corneal Hysteresis (CH), Central Corneal Thickness (CCT), Corneal Resistance Factor (CRF),
Goldmann-correlated IOP (IOPg), and Corneal-Compensated Intraocular Pressure (IOPcc)
were recorded. Heritability of the parameters, the amount of variation explained by genetic
factors (h 2), was calculated using a structural equation modelling program (Mx).
Results: 86 pairs of twins (41 MZ, 45 DZ) were examined, with a mean age 50.5 years (range
16-76). Most were female (90%) and all were Caucasian. Mean IOPg was 15.4mmHG (SD 3.24),
and mean CH was 10.39 mmHg (SD 1.55); this was inversely related to age (r=-0.36, p<0.001).
Within-pair correlations for MZ pairs (rMZ) were higher than DZ pairs (rDZ), suggesting
genetic influences. Modeling suggested CCT was highly heritable (rMZ 0.91, rDZ 0.51, h 2 0.92),
as were IOPg (rMZ 0.80, rDZ 0.48, h 2 0.77) and CRF (rMZ 0.81, rDZ 0.49, h 2 0.82). However,
CH was less heritable, with a significant “shared environment” (c 2) effect (rMZ 0.79, rDZ
0.59, h 2 0.28, c2 0.37). This may, in part, be explained by the strong age effect, as part of the
twins’ shared environment is the sharing of age. Further modeling with larger numbers of
twins will be able to explore this.
Conclusions: Genetic factors are important in determining IOP and corneal properties
in this cohort of British twins. While central corneal thickness and the corneal resistance
factor measured by ORA are highly heritable, corneal hysteresis seems less so, which may
be explained by its strong inverse relationship with age. Further research is required to
explore this relationship, and factors influencing hysteresis.
CR: F. Carbonaro, None; D.A. Mackey, None; T. Spector, None; C.J. Hammond, None.
Support: Grant Code 2005-03e Guide Dogs for the Blind
2882-2885
Tuesday, May 8, 11:15 AM - 1:00 PM Grand Floridian H Paper Session Program Number Range: 2882-2888
344. Gene and Gene-Environmental Interaction of Eye Diseases Organizing Section: CL Contributing Section: AP
2886 - 12:15PM
High Heritability of Refractive Error, Corneal Curvature and Axial Length
in Chinese School-Aged Children: A Population-based Twin Eye Study in
Guangzhou
2887 - 12:30PM
Heritability of Myopia as a Function of Age, Near Work, and Sports Activity
M.He1,2, J.Xu1, W.Huang1, J.Zhang1, Y.Zheng1. 1Preventive Ophthalmology, Zhongshan
Ophthalmic Center, Guangzhou, China; 2School of Public Health, Sun Yat-sen
University, Guangzhou, China.
Purpose: To assess the heritability of refractive error and its related traits corneal
curvature and axial length in Chinese using a classic twin study.
Methods: Guangzhou Twin Registry was established in 2005. Twins aged 7 to 15
years living in two districts closest to the examination station were recruited from
this registry. Refractive error was measured using an autorefractor after cycloplegia.
Corneal curvature and axial length were measured using a Zeiss IOLMaster. Subjects
with retinopathy of prematurity, congenital cataract and other abnormalities were
excluded. Zygosity in all twin pairs was confirmed by genotyping with 16 polymorphic
markers. Spherical equivalent (SE), corneal curvature (CC) and axial length (AL) of the
right eye were in analysis. Heritability was assessed by structural variance component
genetic modeling using Mx software.
Results: Among 867 twin pairs who were invited and successfully contacted, 580
pairs were examined and 563 pairs were available for analysis, which included 359
monozygotic (MZ) and 204 dizygotic (DZ) twin pairs. The mean age of the subjects
was 10.8±2.6 years (range 7-15 years). Myopia (SE<-0.5D) was identified in 37.8 % twins,
increasing from 8.5% in 7 years to 69.8% in 15 years. The means CC and AL for the
cohort were 43.8 ±1.5 diopters and 23.5±1.1 mm. Intraclass correlation coefficients were
0.85 in MZ and 0.40 in DZ twins for SE (P<0.0001), 0.89 and 0.47 for CC (P<0.0001) and
0.90 and 0.45 respectively for AL(P<0.0001). An age-adjusted model identified 80.7 %
additive genetic (95%CI:77.0~83.8%) and 19.3% unique environment (95%CI:16.2~23.0%)
being best fit for SE, 87.9% additive genetic (95%CI:85.6~89.8%) and 12.1% unique
environment (95%CI:10.2~14.4%) for CC, 86.4% % additive genetic (95%CI:83.8~88.6%)
and 13.6% unique environment (95%CI:11.4~16.2%) for AL.
Conclusions: Prevalence of myopia in this twin cohort was similar to population
singleton data. Myopia is believed to be highly environmentally determined in Asians,
however, this twin study evident the high heritability of myopia in Chinese children.
More work is needed to accept or refuse the greater similarities in MZ being due to
similarities of environmental factors.
CR: M. He, None; J. Xu, None; W. Huang, None; J. Zhang, None; Y. Zheng, None.
Support: Guangzhou Science and Technology Development Fund (grant no:2006Z3E0061)
D.O. Mutti1A, J.R. Hayes1A, L.A. Jones1A, G.L. Mitchell1A, M.L. Moeschberger1B,
S.A. Cotter2, R.N. Kleinstein 3, R.E. Manny4, J.D. Twelker5, K.Zadnik1A. ACollege of
Optometry, BDivision of Epidemiology and Biometrics, College of Medicine and
Public Health, 1The Ohio State University, Columbus, OH; 2Southern California
College of Optometry, Fullerton, CA; 3School of Optometry, University of Alabama,
Birmingham, AL; 4College of Optometry, University of Houston, Houston, TX;
5
Department of Ophthalmology, University of Arizona, Tucson, AZ.
Purpose: We recently reported that sports activity in children has a protective effect on
the risk of myopia onset (Jones et al., ARVO 2006). We wanted to evaluate whether the
number of hours spent in sports activity, in addition to age and near work, affects the
estimate of heritability obtained from sibling data from the Collaborative Longitudinal
Evaluation of Ethnicity and Refractive Error (CLEERE) study.
Methods: Subjects were 796 sibling pairs 6 to 14 years of age participating in the
CLEERE study. Longitudinal data were used to compare proband data with a sibling at
an equivalent age. Heritability was computed by doubling the slope of the regression
line for refractive error (cycloplegic autorefraction) between siblings at each age.
Estimates of time spent in near work and sports activity were obtained by averaging
survey data completed each year by a parent or guardian.
Results: Heritabilities (± SE) estimated from regression slopes between siblings
increased with age from a low of 0.25 ± 0.10 at age 6 years to 0.65 ± 0.09 at age 13 years.
There was evidence of a shared environment between siblings with correlations of
0.59 (p<0.0001) for diopter-hours of near work and 0.61 (p<0.0001) for hours of sports
activities. Each factor was related to proband refractive error with correlations of 0.12 (p = 0.001) for diopter-hours of near work and 0.12 (p = 0.0006) for hours of sports
activity. Across all subjects, the unadjusted heritability was 0.77 ± 0.06. The estimate of
heritability adjusted for near work and sports activity was similar at 0.73 ± 0.06. The
increase in model R2 with the addition of both environmental variables was 0.02.
Conclusions: The heritability of myopia is related to age, increasing to higher values
at older ages when myopia is more prevalent. Environmental exposures to sports
activity and near work were shared between siblings and were related to refractive
error, but had very little effect on heritability. The results suggest a substantial
heritable component to childhood myopia with a relatively small contribution from
environmental exposure to sports activity and near work.
CR: D.O. Mutti, None; J.R. Hayes, None; L.A. Jones, None; G.L. Mitchell, None; M.
L. Moeschberger, None; S.A. Cotter, None; R.N. Kleinstein, None; R.E. Manny,
None; J.D. Twelker, None; K. Zadnik, None.
Support: NIH/NEI grants U10-EY08893 and R24-EY014792, the Ohio Lions Eye
Research Foundation, and the EF Wildermuth Foundation
2888 - 12:45PM
Association Between TGFB1 Gene and Age-Related Cortical Cataract
C.J. Hammond1,2, F.Zhang1, F.Carbonaro1, T.D. Spector1. 1Twin Research Unit, Kings
College London, London, United Kingdom; 2West Kent Eye Centre, Bromley
Hospitals NHS Trust, Orpington, United Kingdom.
Purpose:Age-related cataract, a possible biomarker of ageing, is a variable but heritable
complex trait. In order to determine the possible underlying genetic variants for
nuclear and cortical cataract, we conducted an association study of cataract and a
candidate gene for ageing related traits, TGFB1, in a female Caucasian dizygotic
twin population.
Methods:Cataract was measured objectively using Scheimpflug photography and
retroillumination camera for nuclear and cortical cataract, respectively, in a cohort
of twins aged 49-75 years (mean age 61.6 years). Six single nucleotide polymorphisms
(SNPs) were genotyped in the TGFB1 gene, and logistic regression modelling was
used to test the association between these candidates and nuclear cataract (continuous
phenotype, 293 individuals) and cortical cataract (135 cases, 158 controls), including
age as a covariate.
Results:All SNPs were in Hardy-Weinberg equilibrium (p>0.05). There was a significant
association for 3 of the 6 SNPs within the TGFB1 gene and cortical cataract (p<0.003).
No significant association was detected for individual SNPs, under either codominant
or completely dominant models (p>0.27), or two-locus haplotypes (p=0.7) with nuclear
cataract variation.
Conclusions:There was a significant association between cortical cataract and an
aging related candidate gene, TGFB1. This result suggests that this gene may play a
role in the variation of cortical, but not nuclear, cataract in our cohort. Further research
is required to examine the role of TGFB1 in cataract, in terms of replication of these
results and further understanding of its role in lens metabolism.
CR: C.J. Hammond, None; F. Zhang, None; F. Carbonaro, None; T.D. Spector,
None.
Support: Guide Dogs for the Blind Association
2886-2888
Tuesday, May 8, 11:15 AM - 1:00 PM Hall B/C Poster Session Program Number/Board # Range: 3078-3087 / B585-B594
352. Epidemiology of Retinal Vascular Diseases Organizing Section: CL
3078 - B585
Comparable Mortality in Patients With Branch Retinal Vein Occlusion and
Background Population
3079 - B586
Ocular Pigmentation Confounds the Measurements of Retinal Vessel Calibre:
The Sydney Childhood Eye Study
M.Larsen1, E.Gade2, L.Knudsen3, K.Juel4, N.Christoffersen1. 1Ophthalmology, Univ of
Copenhagen Glostrup Hospital, Glostrup, Denmark; 2Ophthalmology, Odense
University Hospital, Odense, Denmark; 3Ophthalmology, Aalborg Hospital,
Aalborg, Denmark; 4Statens Institut for Folkesundhed, Hellerup, Denmark.
E.Rochtchina1, J.J. Wang1, B.Taylor1, T.Y. Wong2, P.Mitchell1, Sydney Childhood Eye Study.
1
Westmead Hospital), University of Sydney, Sydney, Australia; 2Centre for Eye
Research Australia, University of Melbourne, Melbourne, Australia.
Purpose: To assess the relation between branch retinal vein occlusion, a condition
related to thickening of the arteriolar wall, as a prognostic marker of mortality.
Design: Long term follow up study. Participants: Patients diagnosed with branch
retinal vein occlusion.
Methods: Diagnosis of branch retinal vein occlusion, confirmed by review of color
diapositives and fluorescein angiograms. Main outcome: Observed and expected
numbers of deaths in patients and background population a recorded in comprehensive
national civic records.
Results: The study included 329 patients (173 women,156 men) born between 1902 and
1956 and aged 39-91 years when were diagnosed with branch retinal vein occlusion,
examined between 1973 and 1998. Follow-up was concluded on July 8, 2004 when
144 deaths were recorded in patients (74 women, 70 men). The expected number of
deaths, based upon the mortality of the background population was 145.5. Thus, the
standardized mortality rate was 0.99 (CI95 0.84-1.16). Stratified analyses revealed no
significant effect of age, sex, or time of diagnosis.
Conclusions: In this study of 329 patientswith branch retinal vein occlusion, we found
no significant difference in mortality between the patients with branch retinal vein
occlusion and the background population. Because an association between branch
retinal vein occlusion and markers of elevated cardiovascular/cerebrovascular risk has
been documented previously, our finding suggest the presence of effects of systemic
intervention or selective survival of the more fit patients with precursor conditions
of branch retinal vein occlusion, such as arteriovenous nicking.
CR: M. Larsen, None; E. Gade, None; L. Knudsen, None; K. Juel, None; N.
Christoffersen, None.
Support: The Danish eye health organization Værn Om Synet, Copenhagen and by
a Research Career Award from JDRF to Dr. Larsen
Purpose: To describe gender, ethnic and iris colour variability of retinal vessel calibre
measurements in a population-based study of young children.
Methods: The Sydney Childhood Eye Study (2003-4) examined 1740 6-year-old children
from 34 randomly selected schools in Sydney. Eye examination included autorefraction,
ocular biometry (Zeiss IOLMaster) and digital retinal photography. Retinal vessel
calibre was measured from retinal photographs using a standardised computerassisted method. Associations of retinal vascular calibers with gender, ethnicity and
iris colour (blue, hazel/green, tan/brown, dark brown) were analysed.
Results: Of 1740 children, 1612 had gradable retinal photographs. Mean retinal
arteriolar (CRAE) and venular (CRVE) calibre was normally distributed, with means
(standard deviation) of 163.2 (14.0) µm and 227.3 (18.3) µm, respectively. Boys had
slightly narrower retinal arteriolar and venular calibre than girls (both p<0.0001), but
the difference became non-significant after adjustment for age, ethnicity, birthweight,
height, body mass index, mean arterial blood pressure, axial length. Both arteriolar
and venular calibres, however were substantially narrower in Caucasian (mean
CRAE 160.5 µm, mean CRVE 222.4 µm) than in East Asian children (mean CRAE
171.5 µm, mean CRVE 240,5 µm), p<0.0001 for both after multivariate adjustment.
Among Caucasian children darker iris colour was associated with wider arteriolar
and venular calibres. Mean CRAE increased from 157.5 µm in blue eyes to 169.2 µm in
dark brown eyes (p for trend <0.0001). Mean CRVE increased from 218.4 µm in blue
eyes to 230.0 µm in dark brown eyes (p for trend <0.0001). In subgroup analyses of
children with dark brown eyes there was no significant difference in CRAE between
Caucasian and East Asian children, but CRVE was still approximately 10 µm wider
in East Asian than Caucasian children.
Conclusions: Darker iris colour was associated with wider measured retinal vascular
calibre. Iris colour, as a presumed surrogate measure of retinal pigmentation, appears
to be an important confounder in measuring retinal vessel calibre. This may be due
to a difference in contrast in eyes with darker retinal background. If confirmed, this
effect may need to be taken into account when assessing the calibre of retinal vessel
in subjects with different ethnic background.
CR: E. Rochtchina, None; J.J. Wang, None; B. Taylor, None; T.Y. Wong, None; P.
Mitchell, None.
Support: Australian NHMRC Grant 253732
3080 - B587
Thin Central Corneal Thickness: Risk Factor for Retinal Vein Occlusions
3081 - B588
Retinal Capillary Perfusion is Altered in Patients With Cerebrovascular
Malfunction: Predictive Value of Fundus Imaging
J.K. Lee1, E.Viriya2, A.Madu 3, U.Mian1. 1Ophthalmology, Albert Einstein/Montefiore,
Bronx, NY; 2School of Medicine, SUNY Downstate, Brooklyn, NY; 3Ophthalmology,
Bronx Lebanon Hospital, Bronx, NY.
Purpose: This study evaluated central corneal thickness (CCT) in patients with retinal
vein occlusions. The utility of CCT in the screening, diagnosis, and management of
glaucoma has been firmly established and has been incorporated into standard of
care. However, we report a new application of CCT measurements- in assessing risk
for retinal vein occlusions (RVO).
Methods: We conducted a retrospective study of patients seen at the retina service
of the Montefiore Medical Center from 2003 to 2005 who had branch retinal vein
occlusions (BRVO) or central retinal vein occlusions (CRVO). Patients’ demographics
(including age, race, sex, and pertinent medical history and ocular history) were
obtained. CCT measurements by ultrasound pachymetry were recorded for each
patient and compared to historical controls.
Results: The records for 42 eyes of 37 patients were reviewed. Mean age was 66 years
(range 53 to 82 years). There were 13 men and 24 women. In the largest survey to date
(1955 eyes), the mean CCT was 551.16 + 34.55. In comparison to this control, the mean
CCT of RVO eyes in our study was significantly less 523.25 + 37.26 (p<0.0001). The
mean CCT of the fellow unaffected eye was also thinner 526.49 + 41.34 (p<0.002). There
was no statistical difference between the mean CCT of affected and unaffected eyes
(p<0.731). 73% of the patients did not have preexisting glaucoma. This sub-group of
patients also had a lower mean CCT of 526.80 + 33.74 (p<0.001).
Conclusions: This study demonstrates a strong association between thin CCT and
retinal vein occlusions. The pathophysiology may be elucidated by recent data. Studies
have shown that thinner corneas correlate with larger and more deformable optic
discs. Large cup-to-disk ratio is a significant predictor of incident RVO (Beaver Dam
Eye Study). We hypothesize that lamina cribosa displacement (compliance) may lead
to retinal occlusive events. Ten-year incidence data from the Blue Mountains Eye
Study report that age, increasing arterial blood pressure, and atherosclerotic retinal
vessel signs are significant predictors of incident RVO. Patients who are found to have
thin CCT during routine eye exams or glaucoma workup should be warned of their
increased risk of developing retinal vein occlusions.
CR: J.K. Lee, None; E. Viriya, None; A. Madu, None; U. Mian, None.
Support: None
D.Baleanu1A, J.Harazny1A, F.E. Kruse1A, M.Ritt1B, J.Heckmann1C, R.E. Schmieder1B,
G.Michelson1A. AOphthalmology, BNephrology and Hypertension, CNeurology,
1
University Hospital Erlangen, Erlangen, Germany.
Purpose: A close correlation between cerebral and retinal arteriolar findings has been
demonstrated for patients suffering from stroke. Cerebrovascular diseases increase
the ratio of wall thickness to lumen diameter in large vessels. We evaluated retinal
capillary perfusion and wall/lumen ratio (WLR) of retinal arterioles in patients with
history of cerebrovascular event (Transitory Ischemic Attack TIA or lacunar cerebral
infarction) and in controls.
Methods: Retinal capillary flow and wall/lumen ratio of retinal arterioles were
assessed using scanning laser Doppler flowmetry at 670 nm (Heidelberg Retina
Flowmeter). The retinal vessels were scanned 2 to 3 mm temporal superior to the
optic nerve. Analyses were performed with automatic perfusion imaging analysis
(SLDF version 3.7). Arteriolar diameters (AD) were measured in reflection (DC)
images and lumen diameters (LD) in perfusion (flow) images. WLR was calculated
using the formula: WLR = (AD-LD) / LD. Study population: All patients were male.
The control group consisted of 74 healthy normotensive men without history of a
cerebrovascular event. Patients with diabetes and ocular diseases were excluded. In
the cerebrovascular event group 9 patients have had an episode of TIA and 9 patients
an acute lacunar cerebral infarction within 1-7 days prior to examination. There were
no significant differences between the control group and the cerebrovascular group
concerning age, blood pressure, heart rate and body mass index.
Results: In comparison to controls patients with a history of a cerebrovascular event
showed a significant reduction of retinal capillary perfusion (- 40%) and a significant
enhancement of wall to lumen ratio of retinal arterioles (+ 31% ) . The results are
summarized in this table:
control group n=74
Cerebrovascular event
n=18
Age
(years)
56 ±9
56 ±9
ns
Systolic blood
Diastolic blood Retinal capillary Wall to lumen
pressure (mmHg) pressure (mmHg)
perfusion
ratio
124 ±9
73 ±10
383±105
0.35±12
130 ±16
80 ±12
230±68
0.46±0.08
ns
ns
p<0.0001
p< 0.001
Conclusions: Our study indicates that alterations of cerebral vessels are reflected
by similar changes of retinal vessels. Therefore, the investigation of the retinal
vasculature may provide predictive information about cerebral vascular diseases
such as stroke .
CR: D. Baleanu, None; J. Harazny, None; F.E. Kruse, None; M. Ritt, None; J.
Heckmann, None; R.E. Schmieder, None; G. Michelson, None.
Support: None
3078-3081
3082 - B589
Thrombophilic Risk Factors in Patients With Retinal Vein Occlusion Younger
Than 45 Years of Age
3083 - B590
Seconadry Ischemic Events Following Non-Arteritic Retinal Artery Ischaemia
in Four Uk Centres
M.Rehak1A,2A, J.Rehak 2A, S.Faude1A, F.Faude1A, P.Wiedemann1A, A.Siegemund1B,
V.Krcova2B, E.Fric2A, K.Langova2C. ADepartment of Ophthalmology, BInsitute of
laboratory medicine and molecular diagnostics, 1University Leipzig, Leipzig,
Germany; ADepartment of Ophthalmology, BDepartment of haemotology and
oncology, CInstitute of medical biophysics and statistic, 2Palacky University,
Olomouc, Czech Republic.
E.Sharkawi1, J.F. Bacon2, F.H. Zaidi 3, K.Gregory-Evans3. 1Ophthalmology, Moorfields
Eye Hospital, London, United Kingdom; 2Ophthalmology, Royal Free Hospital,
London, United Kingdom; 3Ophthalmology, Imperial College London, London,
United Kingdom.
Purpose: The search for thrombophilic risk factors in patients with retinal vein
occlusion has brought very controversial data and there is no agreement if their
evaluation could offer some benefit for patients or if it is only an academic issue. The
aim of this study was to investigate the role of thrombophilic risk factors in patients
who are less than 45 years of age.
Methods: A cohort of 207 consecutive patients with first retinal vein occlusion and
a control group of 150 subjects matched for age, sex, and several risk factors were
screened from 1997 to 2005 for thrombophilic anomalies. Both cohorts were divided
into two subgroups, according to the patient’s age (less and older than 45 years). We
investigated the prevalence of positive factor V Leiden, antithrombin III plasma level,
protein C and free protein S deficiency. The prevalence of each trombophilic risk factor
in the group of patients younger than 45 years was compared with results in group
of elderly patients and also with controls for statistical significance.
Results: In patients group younger than 45 years of age the prevalence of protein C
and S deficiency (in both of factors 3 of 50 patients; 6%) were significant higher than
in controls (0 of 150; 0%). No statistical difference was found in the prevalence of
protein C and S deficiency between controls and elderly patients as well as group
of all patients. The prevalence of antithrombin III deficiency showed no difference
between patients (2 of 207; 1%) and controls (0 of 150; 0%), too. Four of 50 patients
younger than 45 years (8%) and 12 of 157 older than 45 years (7, 6%) had positive factor
V Leiden. No significant difference in prevalence of this mutation was detected in 8
of 150 controls (5, 3%).
Conclusions: Both deficiencies of protein S and free protein S seems to be associated
with retinal vein occlusion in a group of patients younger than 45 years of age.
Screening for this thrombophilic factors is therefore recommended in these patients.
In elderly patients was no association between thrombophilic risk factors and retinal
vein occlusion found.
CR: M. Rehak, None; J. Rehak, None; S. Faude, None; F. Faude, None; P. Wiedemann,
None; A. Siegemund, None; V. Krcova, None; E. Fric, None; K. Langova, None.
Support: None
Purpose: To determine the type and rate of secondary ischemic events following
acute non-arteritic retinal artery ischemia.
Methods: The medical records of a consecutive series of 163 patients with acute
retinal arterial occlusion and amaurosis fugax (AFx) were reviewed in four UK
Ophthalmology centers and data extracted
Results: The mean age of patients was 65 years, 58% were male, 20 patients (12.3%)
suffered secondary ischemic events. 14 (70.0%) of these occurred within 2 months
of the initial retinal event. These included 3 myocardial infarctions, 2 episodes of
unstable angina requiring hospitalisation, 4 cerebral TIAs, 1 cerebral stroke, 7 further
retinal artery occlusions, 2 retinal vein occlusions and 1 further episode of amaurosis
fugax. Iris neovascularisation, occurred in 12% of patients, 8 to 32 weeks following
central retinal artery occlusion.
Conclusions: The rate of secondary ischemic events following retinal arterial ischemia
was higher than expected. In contrast to previous studies, an Ophthalmologist
examined all patients diagnosed with retinal artery occlusion and AFx. The majority
of secondary events occurred in the early post retinal stroke/TIA period. These
results are consistent with cerebral stoke data and highlight the importance of urgent
treatment and rapid referral of these high-risk patients, who often first present to the
Ophthalmologist.
CR: E. Sharkawi, None; J.F. Bacon, None; F.H. Zaidi, None; K. Gregory-Evans,
None.
Support: None
3084 - B591
Influence of Diabetes, Glycemia and Retinopathy on Retinal Vascular Caliber:
The Australian Diabetes, Obesity & Lifestyle Study (AusDiab)
3085 - B592
Does Retinal Arteriolar Narrowing Precede the Long-Term Development of
Open-Angle Glaucoma: Blue Mountains Eye Study Findings
G.Tikellis1, J.E. Shaw2, R.Simpson3, P.Z. Zimmet4, S.Rogers1, J.Wang5, P.Mitchell5,
H.R. Taylor1, T.Y. Wong1. 1Ophthalmology, Centre for Eye Research Australia,
University of Melbourne, Australia; 2International Diabetes Institute, Caulfield,
Australia; 3Eastern Health Research Unit, Box Hill Hospital, Box Hill, Australia;
4
Interanational Diabetes Institute, Caulfield, Australia; 5Ophthalmology, Centre for
Vision Research, University of Sydney, Australia.
B.Taylor, J.Wang, E.Rochtchina, P.Mitchell, Blue Mountains Eye Study. Ophthalmology
(Centre for Vision Research, Westmead Millennium Institute, Westmead Hospital),
University of Sydney, Sydney, Australia.
Purpose: To examine the relationship of retinal vascular caliber to diabetes, glycemic
status and diabetic retinopathy (DR).
Methods: The Australian Diabetes, Obesity and Lifestyle Study (AusDiab, 19992000) recruited adults aged 25+ years from 42 randomly selected areas nationwide.
Diabetes was defined as fasting plasma glucose (FPG) ≥7.0 mmol/l or 2-hour plasma
glucose (2HPG) level ≥11.1 mmol/l. Impaired glucose tolerance (IGT), impaired fasting
glucose (IFG) and normal glucose tolerance (NGT) was further defined from the
FPG and 2HPG values. Non-mydriatic, digital retinal photographs were taken of
2,476 participants and graded for DR. Retinal vascular caliber was measured by
computer-assisted methods.
Results: Of the 2020 people with gradable retinal images, KDM was present in
16%, NDM in 17%, IGT in 42% and IFG in 6%. Retinal arteriolar caliber (RAC) was
significantly larger in KDM (179µm) compared to NGT (175µm) (p=0.02) after adjusting
for age, gender, systolic blood pressure, body mass index, alcohol, smoking, HDL
cholesterol and triglycerides. Each standard deviation (SD) increase in RAC was
associated with increased odds of having KDM compared to NGT (odds ratio, OR 1.24;
95%CI 1.04 - 1.47); and of having diabetes and mild-to-moderate non-proliferative DR
compared to NGT with no DR (OR 1.59 95%CI 1.21-2.07). The association of larger RAC
with KDM remained significant after further adjusting for venular caliber (p<0.05). In
similar adjusted models, retinal venular caliber (RVC) was not significantly associated
with glucose tolerance status, but was significantly associated with DR. Each SD
increase in RVC was associated with an increased likelihood of having diabetes and
mild-to-moderate non-proliferative DR (OR 1.77, 95% CI 1.34-2.32); this association
remained significant after adjusting for RAC (p<0.05).
Conclusions: Wider RAC was associated with known diabetes, and wider RVC was
independently associated with DR.
CR: G. Tikellis, None; J.E. Shaw, None; R. Simpson, None; P.Z. Zimmet, None; S.
Rogers, None; J. Wang, None; P. Mitchell, None; H.R. Taylor, None; T.Y. Wong,
None.
Support: This study was supported by the National Medical Research Council Grant
No 350448 and a Charles Viertel Charitable Foundation Grant.
Purpose: To assess whether baseline retinal arteriolar narrowing predicts incident
open angle glaucoma in an older population.
Methods: The Blue Mountains Eye Study (BMES) examined 3,654 participants aged
49+ years at baseline (1992-4). Retinal photographs were digitised and retinal arteriolar
and venular diameters measured. Open angle glaucoma (OAG) was diagnosed from
matching visual field defects and optic disc cupping, without reference to intra-ocular
pressure (IOP) level. Associations between incident OAG and arteriolar or venular
diameter were assessed after adjusting for baseline age, gender, IOP, use of glaucoma
medications, vertical disc diameter, cup-to-disc ratio and baseline disc haemorrhage.
Vessel diameter was analysed continuously and by tertile.
Results: After excluding subjects with glaucoma or optic disc abnormalities at baseline
or those with incomplete data, 2328 participants seen at the 5- and/or 10-year visits
were considered at risk of incident OAG. This developed in 99 eyes of 78 participants
(3.4%), at either the 5- or 10-year follow-up exam. After adjusting for age and sex,
narrower baseline arteriolar and venular diameter was associated with an increased
risk of incident OAG (narrowest vs widest tertile, odds ratio, OR 2.32, 95% confidence
interval, CI, 1.28- 4.20, p for trend 0.004 for arterioles and OR 1.76, CI 1.01- 3.05, p for
trend 0.04 for venules). Each standard deviation (SD) decrease in vessel diameter was
associated with an increased risk of incident OAG (OR 1.36 CI 1.07- 1.73 for arterioles
and OR 1.28 CI 1.07- 1.73 for venules). After further adjusting for IOP, use of glaucoma
medications, vertical disc diameter, cup-to-disc ratio and baseline disc haemorrhage,
the associations with arteriolar narrowing remained but became borderline nonsignificant (OR 1.86, CI 1.00- 3.61, p for trend 0.057 for the lowest vs highest tertile,
and OR 1.24, CI 0.94- 1.65 per SD decrease). The association with narrowed venular
diameter was no longer present.
Conclusions: These findings suggest that retinal arteriolar narrowing may precede the
development of OAG. This adds to previously reported BMES data which demonstrated
a strong cross-sectional association between OAG and retinal arteriolar narrowing.
CR: B. Taylor, None; J. Wang, None; E. Rochtchina, None; P. Mitchell, None.
Support: NHMRC project grants 974159 and 211069
3082-3085
3086 - B593
Retinal Vascular Caliber and the 5-Year Cumulative Prevalence of Retinopathy
Lesions in an Australian Population: The AusDiab Study
3087 - B594
Clinic vs. Reading Center Evaluation of Dense Retinal Hemorrhage at Baseline
in the SCORE Branch Retinal Vein Occlusion (BRVO) Study
S.L. Rogers1, G.Tikellis1, C.A. Harper2, J.Shaw3, P.Z. Zimmet3, P.Mitchell4, H.R. Taylor1,
J.J. Wang1,4, T.Y. Wong1. 1Retinal Vascular Imaging Centre, Centre for Eye Research
Australia, East Melbourne, Australia; 2The Royal Victorian Eye and Ear Hospital,
East Melbourne, Australia; 3The International Diabetes Institute, Caulfield,
Australia; 4Centre for Vision Research, Department of Ophthalmology, University
of Sydney, Australia.
K.Warren1, B.A. Blodi1, M.S. Ip1, I.U. Scott2, N.Oden3, P.VanVeldhuisen3, Standard Care
vs Corticosteroid for Retinal Vein Occlusion Study Group. 1Ophthalmology & Visual
Sciences, FPRC, University of Wisconsin-Madison, Madison, WI; 2Ophthalmology,
Penn State College of Medicine, Hershey, PA; 3SCORE Study Data Coordinating
Center, EMMES Corporation, Rockville, MD.
Purpose: To describe the association of retinal vessel caliber with the 5-year cumulative
prevalence of retinopathy lesions in people with and without diabetes or abnormal
glucose metabolism.
Methods: As part of the AusDiab study, retinal photography was taken at baseline and
after five years in 1,022 individuals aged 25 years and older. Retinal vessel caliber was
measured from baseline photographs using a computer-based method. Retinopathy
lesions detected at baseline and after five years were confirmed using side-by-side
grading. Logistic regression was used to calculate the odds ratios (OR) of the 5-year
cumulative prevalence of retinopathy lesions associated with baseline retinal vessel
caliber, adjusting for age, gender, glycosylated hemoglobin, glucose metabolism status
(normal, impaired fasting glucose [IFG] or impaired glucose tolerance [IGT], diabetes),
systolic blood pressure, body mass index, total cholesterol and smoking.
Results: Overall, the 5-year cumulative prevalence of retinopathy lesions was 8.2%.
Among individuals with normal, IFG/IGT, and diabetes, the cumulative prevalence
rates were 6.3%, 4.2%, and 16.4%, respectively. Larger retinal arteriolar caliber was
associated with an increased likelihood of having retinopathy lesions (OR=1.4, 95%
confidence intervals [CI] 0.7-2.6 for the middle, and OR=2.3, CI 1.1-4.5 for the widest
compared to narrowest arteriolar caliber tertile). Retinal venular caliber was not
associated with the prevalence of retinopathy lesions (OR=1.2, CI 0.6-2.2 for the middle
and OR=1.1, CI 0.5-2.2 for the widest compared to narrowest venular caliber tertile).
Conclusions: Wider retinal arteriolar caliber was related to 5-year cumulative
prevalence of isolated retinopathy lesions, independent of other risk factors.
CR: S.L. Rogers, None; G. Tikellis, None; C.A. Harper, None; J. Shaw, None; P.Z.
Zimmet, None; P. Mitchell, None; H.R. Taylor, None; J.J. Wang, None; T.Y. Wong,
None.
Support: NHMRC Grants 350448 and 233200; Charles Viertel Charitable Foundation
Grant
Purpose: To compare baseline clinic determination of presence/absence of dense macular
hemorrhage (DH) in SCORE/BRVO patients to area of retinal hemorrhage as estimated by
the UW Fundus Photograph Reading Center (FPRC).
Methods: The SCORE study consists of two multicenter trials comparing safety and efficacy
of preservative-free intravitreal triamcinolone acetonide injections vs. standard care for
macular edema associated with branch (BRVO) and central retinal vein occlusion (CRVO).
Treatment for patients assigned to standard care in the BRVO study is either immediate
grid laser treatment or deferral of laser due to dense blood in the macula. We compared
the ophthalmologist’s initial assessment of presence/absence of DH in 206 consecutive
patients enrolled in the SCORE/BRVO study to the FPRC assessment of area of retinal
hemorrhage (RH) and retinal thickening (RT). Eyes were evaluated for extent of RH and RT
by imposing the ETDRS macular grid and estimating the percent of each subfield involved.
Subfield results were combined by algorithm to yield overall areas of RH and RT within
concentric regions.
Results: In the SCORE/BRVO study, 140 patients without DH and 66 patients with DH were
available for analysis. Patients classified by clinicians with DH were determined by FPRC
to have significantly greater area of RH than those without DH.
Ret. Hem. *
with DH
(n=66)
w/o DH
(n=140)
Ret. Thick.
with DH
(n=66)
w/o DH
(n=139)
Within grid
(16 DA)
Mean (DA)
SD
Central zone
(4 DA)
Mean (DA)
SD
Central subfield
(0.44 DA)
Mean (DA)
SD
4.64
2.31
1.27
0.78
0.20
0.16
2.45
2.13
0.65
0.62
0.07
0.10
7.96
2.66
2.68
0.79
0.42
0.07
6.93
2.63
2.50
0.82
0.40
0.08
*All comparisons p<0.0002 by T-test.
Conclusion: In the SCORE/BRVO study to date, there is excellent association at baseline
between clinician determination of presence/absence of dense macular hemorrhage and
area of retinal hemorrhage as determined at the FPRC.
CR: K. Warren, None; B.A. Blodi, None; M.S. Ip, None; I.U. Scott, None; N. Oden, None; P.
VanVeldhuisen, None.
Support: National Eye Institute (National Institutes of Health, Department of Health and
Human Services) grants 5U10EY014351, 5U10EY014352, and 5U10EY014404. Investigational
drug donated by Allergan, Inc. CT: www.clinicaltrials.gov, NCT00105027
3086-3087
Tuesday, May 8, 3:00 PM - 4:45 PM Hall B/C Poster Session
376. Genetic Epidemiology Organizing Section: CL
3231 - B109
Predictive Value of Multiple Genetic Testing for Age-Related Macular
Degeneration
3232 - B110
Genotype-Phenotype and Penetrance Analysis of Mitochondrial DNA
Mutations in 36 Chinese Families With Leber’s Hereditary Optic Neuropathy
D.D. Despriet1A,2, C.C. Klaver1A,3, C.M. Van Duijn1B, A.J. Janssens1C. ADepartment of
Ophthalmology, BDepartment of Epidemiology & Biostatistics, CDepartment of
Public Health, 1ErasmusMC Rotterdam, Rotterdam, The Netherlands; 2Department
of Epidemiology & Biostatistics, Erasmus MC Rotterdam, Rotterdam, The
Netherlands; 3Molecular and Clinical Ophthalmogenetics, the Netherlands
Institute for Neuroscience, Amsterdam, The Netherlands.
M.Zhang1, H.Shi1, C.Pang1, Y.Chang1, S.Xie1, A.Mao1, J.Cao2, L.Wu 3. 1Ophthalmology,
Xingtai Eye Hospital, Xingtai , Hebei, China; 2Regeneron Pharmceuticals, Inc.,
Tarrytown, New York, NY; 3Ophthalmology, Columbia University, New York, NY.
Purpose: A recent study by Maller et al. estimated the risk of advanced Age-related
Macular Degeneration (AMD) based on five variants in the Complement Factor H
(CFH), LOC387751 and C2/FB genes in a setting comparing advanced AMD cases to
non-AMD controls. In this model, subjects who were homozygous for all risk alleles
had a 285-fold greater risk of advanced AMD than subjects who carried only lowrisk genotypes (i.e., 3% of the general population). Our aim was to determine which
genotypic profiles have an increased or decreased risk of advanced AMD compared
to the average risk in the population, and to evaluate the value of genetic screening
of these variants for the prediction of advanced AMD.
Methods: Recalculation of risks was performed with logistic regression analysis
using the observed genotype frequencies provided by Maller et al. The predictive
value of the risk alleles, or discriminative accuracy, was evaluated by the area under
the receiver-operating characteristic curve.
Results: Compared to the population-risk, subjects homozygous for all risk alleles
had a 14-fold increased risk of advanced AMD, and subjects carrying only nonrisk alleles had a 20-fold decreased risk. Absolute AMD risks were 35% and 0.17%,
respectively. The discriminative accuracy of testing all five alleles was 79.6%. When
considering only one SNP, the discriminative accuracy of Y402H of CFH was highest
(68.9%). When considering two SNPs, the discriminative accuracy was highest for
Y402H and A69S (78.8%).
Conclusions: In reference to the population-risk, subjects carrying these five highrisk alleles have a much less augmented risk of advanced AMD than as presented
by Maller et al. Nevertheless, testing these variants will help discriminate those who
will develop advanced AMD from those who will stay disease-free. To assess further
usefulness for clinical practice, these calculations should be repeated in patients with
early features of AMD.
CR: D.D. Despriet, None; C.C. Klaver, None; C.M. Van Duijn, None; A.J. Janssens,
None.
Support: Henkes Stichting Nederland
Purpose: Primary mitochondrial DNA (mtDNA) mutations at nucleotide positions
of G11778A, T14484C and G3460A are response for approximately 95% cases of
Leber hereditary optic neuropathy (LHON). In this study, we analyze the genotypephenotype correlation of these mutation hotspots in Chinese LHON families.
Methods:Thirty-six LHON pedigrees were established in Xingtai Eye Hospital. The 284
individuals (127 male, 157 female) from these families were consent to participate in this
study. The blood samples from affected and unaffected family members were collected
and processed in Department of Molecular Inheritance, Zhognshan University Eye
Center for mtDNA mutation screening. The DNAs were obtained thought phenolchloroform extraction. Heteroduplex and Single-Strand Conformational Polymorphism
(SSCP) were applied to examine mutated mtDNA sequence with specific designed
primers. Polymerase Chain Reaction (PCR) and direct automatic sequencing analyzer
were utilized for mutation detection.
Results: Among 36 LHON pedigrees, the mutations at nucleotide positions of G11778A,
T14484C and G3460A were detected in 31 families (244 members), 3 families (29
members) and 2 families (11 members), respectively. The penetrance values of three
mtDNA mutation hotspots were demonstrated 60% (77/127) in male and 38.2% (60/157)
in female. Furthermore, in 31 LHON pedigrees with G11778A mutation, 115 individuals
of 244 members (109 male, 135 female) developed typical optic neuropathy and showed
47.13% phenotype penetrance. The penetrance values were 57.8% (63/109) in male and
38.5% (52/135) in female. In 3 LHON pedigrees with T14484C mutation, 16 individuals
of 29 members (15 male, 14 female) were affected with a total of 55.17% phenotype
penetrance. In this group, the penetrance value of 77.3% (11/15) in male was double
higher than 35.7% (5/14) in female. In 2 LHON pedigrees with G3460A mutation, 6
individuals of 11 members (3 male, 8 female) were affected with phenotype of LHON
(54.55% penetrance). In this group, the penetrance values were 100% (3/3) in male,
which was almost triple higher than 37.5% (3/8) in female.
Conclusions: Three mtDNA mutation hotspots demonstrate 48.2% penetrance in
Chinese LHON families. The penetrance is 2 - 3 folds higher in male than in female. The
higher genotype-phenotype association suggests mtDNA mutation analysis provides
definitive diagnosis and predictive factor of this disease in LHON families.
CR: M. Zhang, None; H. Shi, None; C. Pang, None; Y. Chang, None; S. Xie, None; A.
Mao, None; J. Cao, None; L. Wu, None.
Support: None
3233 - B111
PAX6 and SOX2 Are Not Associated With Myopia: Findings From the 1958
British Birth Cohort
3234 - B112
Genotypic Identification of Acanthamoeba sp. Isolates Associated With an
Outbreak of Acanthamoeba Keratitis (AK)
C.L. Simpson1, P.Hysi1, S.S. Bhattacharya2, C.J. Hammond 3, A.R. Webster2, C.S.
Peckham1, P.C. Sham4, J.S. Rahi1. 1Centre for Paediatric Epidemiology and
Biostatistics, Institute of Child Health, London, United Kingdom; 2Institute of
Ophthalmology, University College London, United Kingdom; 3Twin Research
and Genetic Epidemiology Unit, Kings College London, London, United Kingdom;
4
Genome Research Center, University of Hong Kong, China.
G.C. Booton1A, C.E. Joslin2, M.Shoff 1B, E.Y. Tu2, D.J. Kelly1B, P.A. Fuerst1B. AMolecular
Genetics, BEvolution, Ecology and Organismal Biology, 1The Ohio State University,
Columbus, OH; 2Ophthalmology and Visual Sciences, University of Illinois,
Chicago, Chicago, IL.
Purpose: PAX6 and SOX2 are known to play a critical role in ocular development,
making them good candidates for refractive error. We investigated the role of PAX6
and SOX2 in physiological (primary non-syndromic) myopia, as part of a broader
association study of refractive error.
Methods: Subjects were drawn from 2494 people randomly selected from the 1958
British Birth Cohort (comprising everyone born in Great Britain in one week in March
1958), who had autorefraction undertaken at age 44. The mean spherical equivalent
of refraction of both eyes was calculated for each individual. 248 individuals were
selected at random from each of the outer tertiles of the distribution. Tagging single
nucleotide polymorphisms (SNPs) were chosen using the Tagger algorithm and
genotyped on the Illumina GoldenGate platform. Analysis was performed using the
qualitative trait (myopic vs. non-myopic) as well as the mean spherical equivalent
as a quantitative trait. Individual SNP analysis was undertaken using regression in
Stata. Single SNP and haplotype analyses performed using the likelihood ratio test
in Whap. In total for the overall study,1536 tag SNPs were chosen across 111 genes. Of
these, 25 SNPs were chosen to span a 404 Kb region that included PAX6 and putative
control regions. 3 SNPs were selected across a 10.8 Kb region that centred on SOX2
and included putative control regions. Given the sample size, this experiment has
80% power to exclude either gene contributing to more than 10% of the variance of
the refractive error in this cohort.
Results: All SNPs in PAX6 and SOX2 were in Hardy Weinberg equilibrium and the
genotyping failure rate was < 5%. After accounting for multiple testing, no statistically
significant association (p < 0.05) could be found between any of the SNPs or haplotypes
and refractive error.
Conclusions: We suggest that PAX6 and SOX2 are unlikely to be significant modifiers
of refraction. Other candidate genes and regions should therefore be prioritized in
further research into refractive error.
CR: C.L. Simpson, None; P. Hysi, None; S.S. Bhattacharya, None; C.J. Hammond,
None; A.R. Webster, None; C.S. Peckham, None; P.C. Sham, None; J.S. Rahi,
None.
Support: Medical Research Council Grant G0301009
Purpose: An increase in Acanthamoeba keratitis (AK) cases has been documented in the
Chicago, Ill. USA area from 1 June 2003 through 30 November 2005. Epidemiological
analysis indicates a significant increase in AK cases during this period when compared
to historical numbers. It was hypothesized that the increased infection rate and skewed
geographical distribution of cases may be due to changes in the type and amounts of
water treatment chemicals. Alternatively, a more pathogenic strain of Acanthamoeba
could be responsible for the increase in AK cases. In this study we use genotypic
data to test the hypothesis that a new, or a known more pathogenic genotype of
Acanthamoeba, is the cause of the recent surge in AK.
Methods: Previous sequence analysis of the 18S ribosomal RNA gene (18S rDNA)
of Acanthamoeba isolates has resulted in the placement of Acanthamoeba strains into
15 different genotypic classes. Most cases (~97%) of AK are associated with a single
genotype (designated T4) of Acanthamoeba. Rarely, AK cases are associated with
other genotypes. Other more serious infections caused by Acanthamoeba, including
granulomatous amebic encephalitis (GAE), are associated with genotype T4 and
also with additional rare genotypes not observed in AK infections. In this study we
have determined the genotypes of 11 Acanthamoeba sp. isolates from the Chicago AK
outbreak by sequencing a highly informative region of the 18S rDNA.
Results: DNA sequencing shows these isolates are predominantly genotype T4
(82%), whereas the remaining isolates were genotype T3 (18%). Both genotypes have
previously been observed in AK cases. In addition, DNA sequences are overwhelmingly
similar to previously sequenced isolates.
Conclusions: There is no support for the hypothesis that cases of AK in the Chicago
outbreak are the result of infection by a new Acanthamoeba genotype. The high sequence
similarity between these isolates and previously sequenced T3 and T4 genotype isolates
from AK cases does not support the hypothesis that they represent more pathogenic
Acanthamoeba of known genotypes. Lastly, the results lend support to the hypothesis
that increased AK cases in the Chicago area may be due to changes in water treatment,
permitting increased bacterial colonization of the water, increased Acanthamoeba
colonization, and ultimately an increase in AK cases due to an increased abundance
of Acanthamoeba in the water supply.
CR: G.C. Booton, None; C.E. Joslin, None; M. Shoff, None; E.Y. Tu, None; D.J. Kelly,
None; P.A. Fuerst, None.
3231-3234
3235 - B113
Alleles of the Y402H Variant of the Complement Factor H (CFH) Gene and
Progression of Age Related Macular Degeneration (AMD)
3236 - B114
Heritability for Known Risk Factors in Myopia - The Genes in Myopia (GEM)
Twin Study
L.Robman1, P.Baird1, A.Richardson1, P.Dimitrov1, G.Tikellis1, C.McCarty2, R.Guymer1.
1
Centre for Eye Research Australia, University of Melbourne, East Melbourne,
Australia; 2Marshfield Clinic Research Foundation, Marshfield, WI.
M.Dirani, M.Chamberlain, R.H. Guymer, P.N. Baird. Ophthalmology, Centre for Eye
Research Australia, Melbourne, Australia.
Purpose: To examine the association of CFH genotypes (in particular the C allele
of theY402H variant) with AMD progression in a cohort of older AMD-affected
Australians.
Methods: Genotyping for alleles of the CHF gene was performed for 254 individuals
aged between 51 and 89 years, who were assessed for AMD progression in the course
of the Cardiovascular Health and Age Related Maculopathy (CHARM) study. The
common allelic variants Τ and C of the CFH gene, variant Y402H, were derived using
the MassArray Platform (SEQUENOM) through the Australian Genome Research
Facility (AGRF) in Brisbane. AMD progression over an average of 7 years was assessed
using stereoscopic macular photographs.
Results: Genotype data were available on 233(92%) individuals of which 77(33%)
cases had signs of AMD progression. The T allele frequency was 61% and the C
allele frequency was 39%. AMD progression occurred in 26% of subjects with the
TT genotype, 33% with the TC genotype and 49% with the CC genotype. There was
a significant increase of risk of AMD progression in people with the CC compared
to the TT genotype (odds ratio (OR) 2.66; 95% CI 1.23-5.74) in unadjusted logistic
regression models. This association remained significant after further adjustment for
age, gender, smoking, family history of AMD, study source and duration of follow up
(OR 2.43;95% CI 1.07-5.49). The TC carriers were also at higher risk of AMD compared
to carriers with the TT genotype, but the difference was not statistically significant
(OR 1.4, 95% CI 0.72-2.71).
Conclusions: The presence of a C allele of the CFH gene was associated with a
significantly increased risk of AMD progression.
CR: L. Robman, None; P. Baird, None; A. Richardson, None; P. Dimitrov, None; G.
Tikellis, None; C. McCarty, None; R. Guymer, None.
Support: NHMRC Grant 128201
3237 - B115
Identifying Genetic Components of Visual Function - A Classical Twin Study
R.E. Hogg1A, P.Dimitrov1B, N.Hunt1B, M.Varsamidis1B, M.D. Chamberlain1B, M.Dirani1B,
A.J. Vingrys1A, R.H. Guymer1B. ADepartment of Optometry and Vision Sciences,,
B
Centre for Eye Research Australia, 1University of Melbourne, Melbourne,
Australia.
Purpose: This study sought to assess the relative genetic contribution of various
aspects of visual function using a classical twin study.
Methods: Monozygotic (MZ) and dizygotic (DZ) twin pairs without evidence of
manifest eye disease and corrected visual acuity better than 6/7.5 were recruited from
a sample of population-based volunteer twins. In each subject contrast thresholds
(luminous flicker and isoluminant Red and Blue color) were measured on a background
that produced >1100 Troland to evaluate aspects of cone visual function under steady
state conditions. Dark adaptation dynamics were determined from the rod-cone break
(RCB) returned from a tracking method following bleach of 30% photopigment.
Results: Sixteen MZ and 16 DZ twin pairs were recruited and examined in this
twin study. The mean age of subjects was 67 ± 5 years (range 53-77 years). Inter-pair
correlations [2.5% to 95% CL] for all steady state conditions were significantly greater
(p<0.05) between MZ twin pairs than they were for the DZ pairs (spatiotemporal: 4HZ
rMZ=0.81 [0.48 to 0.91] vs rDZ=0.00 [-.53 to 0.53]:14Hz rMz=0.81 [0.51 to 0.93] vs rDz=0.26 [-.68 to 0.29], Red threshold rMz=0.60 [0.12 to 0.85] vs rDZ=0.07 [-0.48 to 0.58], Blue
threshold rMZ=0.58 [0.09 to 0.84] vs rDZ=0.10 [-.45 to 0.61]). Inter-pair correlations
of the RCB were not significantly greater between MZ twin pairs than between DZ
pairs (rMZ=0.68 [.0.14 to 0.91] vs rDZ0.54 [-0.26 to 0.90]). Inter-pair variability was
significantly (p<0.05) greater between DZ observers compared with MZ pairs (F-ratio
>3.8) in all cases except for the RCB (F-ratio=0.90, p=0.58).
Conclusions: This study indicates that visual processes mediated by cones have
a genetic predisposition. However, processes underlying dark adaptation are less
dependent on genetic predisposition and more able to be influenced by environmental
factors. These findings have implications for our understanding of pathogenic
mechanisms and influences in macular diseases.
CR: R.E. Hogg, None; P. Dimitrov, None; N. Hunt, None; M. Varsamidis, None; M.D.
Chamberlain, None; M. Dirani, None; A.J. Vingrys, None; R.H. Guymer, None.
Support: NH&MRC 350224
Purpose: Education has previously been cited as a risk factor in myopia. The GEM
twin study sought to assess the genetic contribution of education using a classical
twin study.
Methods: All twins from Victoria aged 18 years or older were invited to participate in
the GEM twin study through the Australian Twin Registry. Each subject underwent
a general questionnaire comprehensive eye examination and 18ml of blood was
extracted from each participant. Categorical educational attainment data was used
with education categories 0 to 7; 0 - no education, 1 - primary education incomplete,
2 - completed primary education, 3 - secondary education incomplete, 4 - completed
secondary education, 5 - attending or completed trade school, 6 - attending tertiary
education, 7 - completion of tertiary studies.
Results: A total of 612 twin pairs (345 monozygotic and 267 dizygotic twin pairs)
with a mean age of 52.36 years (range 18- 86 years) were recruited and examined.
A total of 463(39.10%) twins had at least category 6 education and 721(60.9%) were
between education categories 3 to 5. There was no significant difference in educational
attainment between monozygotic and dizygotic twins (p>0.05). Increased education
attainment was significantly associated with spherical equivalent (r = -0.21, p<0.01).
There was a significantly higher intra-pair correlation for educational attainment in MZ
(r = 0.79) compared to DZ twin pairs (r = 0.50) (p = 0.001). The ACE model was sued to
explain the variance in education attainment, with additive genetic effects explaining
the majority of the variance in educational attainment (69%) and common and unique
environmental factors accounting for 20% and 11% of the variance, respectively.
Conclusions: A greater myopic refraction was associated with higher educational
attainment in twins. However, genetic factors explained the majority of the variance
in educational attainment and therefore this known myopic risk factor cannot be
considered solely to have an environmental component. The genetic component
identified in educational attainment suggests a role for gene-environment interactions
in myopia.
CR: M. Dirani, None; M. Chamberlain, None; R.H. Guymer, None; P.N. Baird,
None.
Support: Centre for Eye Research Australia
3238 - B116
Genomewide Scan of Ocular Refraction in African-Americans Shows Linkage
to Chromosome 7p15
R.Wojciechowski1,2, E.Ciner3, G.Ibay2, J.E. Bailey-Wilson2, D.Stambolian4. 1Genetic
Epidemiology, Johns Hopkins University, Baltimore, MD; 2NHGRI, Baltimore,
MD; 3Penn. Coll. Optom., Philadelphia, PA; 4Ophthalmology, U of Pennsylvania,
Philadelphia, PA.
Purpose: Refractive development is influenced by environmental and genetic factors.
Genetic studies have identified a number of loci linked to myopia and ocular refraction.
We performed quantitative trait locus linkage analyses in an African-American (AA)
population to identify genomic regions responsible for refraction.
Methods: We recruited 493 AA individuals in 96 families to participate in the study.
Ascertainment criteria were designed to enrich the sample for myopia. Genotyping
with 387 microsatellite markers was performed on 398 participants. The mean spherical
equivalent refractive error among genotyped individuals was -2.87 D (SD=3.58) and
myopia of at least 1 D was present in 267 (67%) participants. Multipoint, regressionbased, linkage analyses were carried-out on a logarithmic transformation of the
refraction using the statistical package MERLIN-REGRESS. Empirical significance
levels were determined by conducting 4,898 whole-genome gene-dropping simulations.
Linkage analyses were repeated after clustering families into two subgroups based on
admixture proportions as determined by the software package STRUCTURE.
Results: The maximum linkage signal was seen at 47 cM on chromosome 7 (LOD=5.87,
p=.000065). Secondary peaks (LOD>2, p<.005) were observed on chromosomes 2, 3 and
10. Only the signal on chr. 7 (genomewide p=.026) met statistical significance criterion
for genomewide significance. Stratified analyses based on admixture proportions did
not significantly alter the LOD score profile in this linked region.
Conclusions: We identified a quantitative trait locus for ocular refraction in an AfricanAmerican population on chr. 7p15. One previous study in a Caucasian sample reported
linkage to a nearby region, suggesting that this locus may contain polymorphisms that
mediate refraction across populations. The genomic region bounded by the markers
flanking our maximum linkage peak spans more than 15 megabases and contains
approximately 170 known genes.
CR: R. Wojciechowski, None; E. Ciner, None; G. Ibay, None; J.E. Bailey-Wilson,
None; D. Stambolian, None.
Support: American Optometric Foundation CIBA Vision-Ezell Fellowship (RW); NEI
grant EY12226 (DS); NHGRI(NIH) intramural program (RW, JEB-W, GI)
3235-3238
3239 - B117
The 10q26 Region and Age-Related Macular Degeneration
C.L. Thompson1A, B.E. K. Klein2, R.Klein2, J.Capriotti1A, D.Leontiev1A, K.E. Lee2, S.K.
Iyengar1B. AEpidemiology & Biostatistics, BEpidemiology & Biostatistics and
Opthamology, 1Case Western Reserve Univ, Cleveland, OH; 2Ophthalmology and
Visual Sciences, University of Wisconsin Medical School, Madison, WI.
Purpose: Age-related macular degeneration (AMD) is a leading cause of blindness
in developed nations. The 10q26 region has been linked to AMD in multiple samples
and has also been reported as most significantly coupled to AMD in a recent metaanalysis. Others have reported highly significant associations between the PLEKHA1/
LOC387715 locus and AMD.
Methods: We chose to investigate this region further with two additional independent
datasets. The first sample, the Family Age Related Maculopathy Study (FARMS)
consisted of 297 individuals in 34 families ascertained through a single individual with
severe AMD. Individuals in the FARMS sample were genotyped at 45 single nucleotide
polymorphisms (SNPs) in the 10q26 region. The second is a population-based sample,
the Beaver Dam Eye Study (BDES), consisting of 2273 individuals genotyped at four
SNPs in the PLEKHA1 and LOC387715 genes. All individuals in both studies were
assigned values for four scales representing the severity of different aspect of AMD
- 15-step AMD, 6-step pigmentary abnormality, 6-step drusen size and 4-step drusen
type scales. Associations were performed via a regression model accounting for age
and familial correlations as implemented in ASSOC (S.A.G.E. 2005).
Results: Strong evidence continues to exist for the association of this region to AMD,
with intergenic markers showing the lowest p-values in the FARMS sample (p < 10 -7 at
the rs2223089 SNP). This SNP is also highly significant for drusen size (p= 3.5 x 10 -5)
and borderline significantly associated with drusen type (p=0.01). The BDES sample
showed highly significant p-values at all four SNPs evaluated. All four scales provided
strong evidence of association of this region in the BDES sample.
Conclusions: These results support evidence of a single or multiple variations in this
region affecting AMD development. From this analysis, it appears that the intragenic
region is most significantly associated with AMD and AMD-related phenotypes.
More work will need to be done to narrow the region and explain the biological
significance.
CR: C.L. Thompson, None; B.E.K. Klein, None; R. Klein, None; J. Capriotti, None; D.
Leontiev, None; K.E. Lee, None; S.K. Iyengar, None.
3240 - B118
HTRA1 Polymorphism in Patients With Proliferative Diabetic Retinopathy in
Type 2 Diabetes
J.H. Baird1, D.Gibbs1, S.Patel1, J.Buehler1, D.J. Cameron1, E.Pearson1, R.Avery2, Z.Yang1,
J.Kaminoh1, K.Zhang1. 1Ophthalmology and Visual Sciences, University of Utah,
Moran Eye Center, Salt Lake City, UT; 2California Retinal Consultants, Santa
Barbara, CA.
Purpose: Diabetic retinopathy is one of the leading causes of blindness in the
developed world. The most severe form is proliferative diabetic retinopathy (PDR)
characterized by retinal neovascularization, vitreous hemorrhage, and tractional
retinal detachment. Recently, a single-nucleotide polymorphism (SNP) in the promoter
region of HTRA1 on chromosome 10q36 (rs11200638) was shown to be associated
with choroidal neovascularization in wet age-related macular degeneration. Since
both diseases involve neovascularization, we reason that HTRA1 may also play a
role in PDR.
Methods: A case-control study was performed. Clinical examination was performed
in all participants. Using DNA extracted from peripheral blood leukocytes, the specific
region of the HTRA1 gene containing the rs11200638 polymorphism was amplified by
using site specific primers. Rs11200638 allelic scoring was done by RFLP restriction
enzyme digestion and gel electrophoresis.
Results: The case group consisted of 151 T2DM patients with PDR and controls were
93 patients who had T2DM for at least 10 years and had no diabetic retinopathy.
Individual analysis revealed that the rs11200638 showed an association trend with
PDR, although not statistically significant (P<0.2). Post hoc analysis showed that this
risk increased additively with the presence of each A allele.
Conclusions: Allelic variability within the HTRA1 gene at rs11200638 showed a
association trend of PDR in patients with T2DM. Genotyping of a second replication
cohort is in progress. Our study may provide insight on to whether HTRA1 plays a
role in diabetic retinopathy.
CR: J.H. Baird, None; D. Gibbs, None; S. Patel, None; J. Buehler, None; D.J. Cameron,
None; E. Pearson, None; R. Avery, None; Z. Yang, None; J. Kaminoh, None; K. Zhang,
None.
Support: NIH, Foundation Fighting Blindness, the Ruth and Milton Steinbach Fund,
Ronald McDonald House Charities, the Macular Vision Research Foundation, Research
to Prevent Blindness.
3241 - B119
VEGF Polymorphisms in Japanese Patients With Age-Related Macular
Degeneration
3242 - B120
Association of VEGF Gene Polymorphisms with Proliferative Diabetic
Retinopathy in Type 2 Diabetics
S.Kabasawa1A, K.Mori1A, I.Kawasaki1B, M.Oosaki1C, H.Iizuka1D, T.Awata1C,1D, S.Yoneya1B.
A
Department of Ophthalmology, BDepartment of Ophthahlmology, CDivision of
Endocrinology and Diabetes, Department of Medicine, DDivision of RI Laboratory,
Biomedical Research Center, 1Saitama Medical University, Iruma, Japan.
V.S. Hau, Z.Tong, D.J. Cameron, D.Gibbs, L.P. Aiello, R.Avery, J.Harmon, E.Brinton,
G.Brinton, K.Zhang. Ophthalmology, University of Utah, Salt Lake City, UT.
Purpose: To determine whether vascular endothelial growth factor (VEGF) gene
polymorphisms are associated with age-related macular degeneration (AMD) in
native, unrelated Japanese patients.
Methods: A total of 190 patients with AMD (wet AMD: 170, dry AMD: 20) and 135
control subjects without AMD were recruited for this study. The C-634G, G-1154A
and C-2578A variants in the VEGF gene were assessed using a TaqMan assay. Subjects
completed health and life style questionnaire including smoking, heart diseases,
hypertension, and BMI.
Results: The genotype frequency of C-2578A in the VEGF gene differed significantly
between all AMD and control (p=4.25x10 -3, OR(95%CI); 3.75(1.41-11.4)) and wet AMD
(p=1.52x10 -3, OR(95%CI); 4.73(1.78-19.4))(Fisher’s exact test, dominant model). In
contrast, The VEGF C-2578A variant showed no significant association in dry AMD
(p=0.74). Among health and lifestyle questionnaires, smoking is an environmental
risk factor in all, wet and dry AMD (p=0.001, 0.0001, 0.02, respectively).
Conclusions: These data demonstrate a significant association of the VEGF
polymorphism with AMD in the Japanese population, especially with the wet form
of AMD.
CR: S. Kabasawa, None; K. Mori, None; I. Kawasaki, None; M. Oosaki, None; H.
Iizuka, None; T. Awata, None; S. Yoneya, None.
Support: a grant-in-aid for scientific research (11771070) from the Ministry of Education,
Culture and Science in Japan
Purpose: In the western world, type 2 diabetes is a growing epidemic known to
cause serious microvascular complications such as proliferative diabetic retinopathy
(PDR). It is thought that vascular endothelial growth factor (VEGF), a potent vascular
permeability and angiogenic factor plays an important role in microvascular
complications. Previous studies have linked specific VEGF polymorphisms with
retinopathy, and have also shown ocular levels of VEGF are raised in the neovascular
form of retinopathy.
Methods: We conducted a case-control study where 116 cases (type 2 diabetics with
PDR) and 46 controls (type 2 diabetics with 10+ years and no retinopathy) were
genotyped for 2 single nucleotide polymorphisms (SNPs, rs1413711 and rs735286) in
the promoter region of VEGF. Using DNA extracted from peripheral blood leukocytes,
the specific regions of the VEGF polymorphisms were amplified by using site specific
primers and subsequently purified. Next, a SNaPshot reaction was carried out
according to protocol (Applied Biosystems, Foster, CA). Following thermocycling, the
samples were analyzed using GeneScan Analysis on the ABI PRISM 3700. Results were
confirmed by gene sequencing. Haplotype analysis was performed using Haploview
software and analyzed by Pearson’s X2.
Results: Individual analysis revealed that the C allele at rs1413711 was significantly
associated with PDR. The C allele frequency was found to be 0.504 in cases (subjects
with PDR) and 0.372 in controls (p=0.0358). No association was shown between
rs735286 individually and PDR. However, rs1413711 and rs735286 are in fairly high
linkage disequilibrium (R=0.87). Analysis of both SNPs revealed that CC was the
risk haplotype for PDR. The frequency of CC was 0.210 in cases, and 0.108 in controls
(p=0.0328), and the frequency of TT, the protective haplotype, was 0.011 in cases and
0.048 in controls (p=0.0359).
Conclusions: These two SNPs may be important in influencing the transcription of
VEGF leading to PDR and other microvascular complications of diabetes. Further
understanding of which patients are at risk for PDR will help guide healthcare
appropriations and target those who need more aggressive diabetic management.
CR: V.S. Hau, None; Z. Tong, None; D.J. Cameron, None; D. Gibbs, None; L.P. Aiello,
None; R. Avery, None; J. Harmon, None; E. Brinton, None; G. Brinton, None; K.
Zhang, None.
Support: NIH, Foundation Fighting Blindness, Research to Prevent Blindness.
3239-3242
Wednesday, May 9, 8:30 AM - 10:15 AM Grand Floridian H Symposia Program Number Range: 3666-3670
409. Economic Impact of Eye Diseases: Methodology, Challenges, and Future Directions - Minisymposium Organizing Section: CL
3666 - 8:30AM
Epidemiology and Economics: An Overview
3667 - 8:50AM
Economic Impact of Visual Loss
E.S. West. Ophthalmology, Johns Hopkins University, Baltimore, MD.
H.R. Taylor. Centre fo Eye Research Australia, University of Melbourne, East
CR: E.S. West , None.
Support: None
Our studies have shown that vision loss cost Austalia a total of AU$9.85 billion in 2004
and ranks seventh in causes of loss of well-being. An intervention package to address
avoidable vision loss would save $5 for each $1 spent and give a lifetime savings of
AU$911 million. Although specific for Australia, these data can help guide health care
policy debate and the priority given to eye care in other developed economies.
CR: H.R. Taylor, None.
Support: None
3668 - 9:10AM
Preference-based Measures in Ocular Disease
S.Sharma. Departments of Ophthalmology and Epidemiology, Queens University,
Kingston, ON, Canada.
CR: S. Sharma, Insidermedicine, Genentech, Pfizer, Allergan, Alcon, Novartis, C.
Support: None
3669 - 9:30AM
The Basics of Decision Modeling: Why someone who is not a “wonk” should
care.
S.M. Kymes. Ophthalmology/Visual Science, Washington Univ Sch of Med, St
Louis, MO.
The purpose of economic evaluation is to determine if application of a health
intervention in a population provides benefit in excess of its cost (i.e., is a good use of
social resources). On occasion, this evaluation is conducted alongside a clinical trial.
However, for reasons of practicality and generalizability, evaluation is most frequently
conducted by using mathematical modeling techniques that allow the investigator to
evaluate he natural course off disease and the benefits and outcomes of treatment. This
method is typically referred to as “decision modeling” because the evaluation being
made is what decision the physician, patient, or average citizen would make if they
had perfect understanding of the risks, costs, and benefits of treatment. In evaluation
of the internal and external validity of such investigations, the policymaker and
clinician need to have an understanding of the assumptions upon which the model
is based, the numerical parameters in the model, and the sensitivity of results to the
model assumptions In this presentation, we will discuss how the consumer of results
of decision modeling may evaluate the validity of the model, and what the potential
consequences of failing to insist on rigorous model presentation might be.
CR: S.M. Kymes , Pfizer, F; Allergan, C; Pfizer, C.
Support: None
3666-3669
Wednesday, May 9, 8:30 AM - 10:15 AM Grand Floridian H Symposia Program Number Range: 3666-3670
409. Economic Impact of Eye Diseases: Methodology, Challenges, and Future Directions - Minisymposium Organizing Section: CL
3670 - 9:50AM
Economics of Vision Care and Policy Making: Summary
K.D. Frick. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Economic evaluation can be used to inform policy regarding medical and public health
interventions related to eye care. The quality of economic evaluation is a function of
two types of methods and data: economic and epidemiologic. An economic evaluation
is ultimately only as good as the weaker of the two types of data and methods. Even
with the best epidemiological and economic methods, economic evaluation is still
only appropriate for informing policy and not for being the only input into the policy
making process. This presentation will outline the appropriate use of economics in
policy making related to eye care and review the most critical areas in which this
type of data are needed to better inform the policy making process.
CR: K.D. Frick , None.
Support: None
3670
Wednesday, May 9, 11:15 AM - 1:00 PM Hall B/C Poster Session Program Number/Board # Range: 4281-4296 / B717-B732
442. Epidemiology of Corneal and Anterior Segment Disorders Organizing Section: CL
4281 - B717
Herpes Simplex Virus (HSV) Eye Disease and Diabetes Mellitus in Northern
California
4282 - B718
Melancytic Lesions of the Conjunctiva: A Single Center Clinical Pathological
Study
J.I. Ou1, M.Walvick 2, T.Prabriputalong3, I.Wong1, D.Gritz1,4. 1Francis I. Proctor
Foundation, Department of Ophthalmology, University of California San
Francisco, San Francisco, CA; 2Department of Ophthalmology, Kaiser Permanente
Medical Center, Oakland, CA; 3ORBIS International, New York, NY; 4Department of
Ophthalmology, Kaiser Permanente Medical Center, Oakland and Richmond, CA.
G.A. Novais, B.F. Fernandes, L.N. Santos, D.P. Cheema, L.R. de Moura, M.N. Burnier Jr.
Ocular Pathology Laboratory, McGill University, Montreal, PQ, Canada.
Purpose: A previous Israeli health maintenance organization study found an
association between HSV eye disease and diabetes mellitus. The purpose of this
study is to evaluate this relationship in a larger US population.
Methods: We performed a retrospective population-based case-control study of 9
communities consisting of 1,042,351 members of the Kaiser Permanente Health Plan
of Northern California. From this population, 172 patients with HSV eye disease were
identified in a one-year period through computerized analysis of outpatient codes
and confirmed with review of medical records. Two age- and time-matched controls
groups were chosen: (1) a community control group was randomly chosen from Kaiser
members living in the same community as the matched cases and (2) a clinic control
group was chosen randomly from members seen in the same ophthalmology clinic
for non-HSV ocular conditions within a 2 week period of the matched cases. The
electronic medical records of the cases and controls were reviewed for the diagnosis
of diabetes and diabetic retinopathy.
Results: Diabetes mellitus was present in 7.0% of patients with HSV eye disease
compared to 9.3% of community controls and 23.0% of clinic controls (p=0.45 and
p=0.0001 respectively). Diabetic retinopathy was present in 34% of the diabetics with
HSV eye disease compared to 50% of diabetics in the community control group and 67%
of diabetics in the clinic control group (p=0.50 and p=0.17 respectively). Proliferative
diabetic retinopathy was not present in diabetics with HSV eye disease and diabetics
in the community control group; 15% of the clinic controls had proliferative diabetic
retinopathy.
Conclusions: No association between HSV eye disease and diabetes mellitus in this
case control study was found. The community controls and the clinic controls were
more likely to have diabetes than patients with HSV eye disease (Odds Ratio (OR)
1.4, 95% confidence interval (CI) 0.6 to 3.0 and OR 3.9, 95% CI 2.0 to 7.8 respectively).
This study did not confirm the previously reported association between diabetes
and HSV eye disease.
CR: J.I. Ou, None; M. Walvick, None; T. Prabriputalong, None; I. Wong, None; D.
Gritz, None.
Support: None
4283 - B719
Rapid Assessment of Trachoma in a Hyperendemic Rural Area of North India
V.Jhanji1, S.Khanduja1, R.Tandon1, J.S. Titiyal1, N.Sharma1, G.Satpathy1, G.V. S. Murthy1,
S.Gupta1, P.Vashist1, R.B. Vajpayee2. 1Ophthalmology, All India Institute of Medical
Sciences, New Delhi, India; 2Ophthalmology, Centre for Eye Research Australia,
Purpose:To perform a Rapid Assessment Study of Trachoma as a public health problem
in a hyperendemic area in rural population of North India.
Methods:A rapid assessment study was done in accordance to the guidelines given
by “Program for prevention of deafness and blindness: report of global scientific
meeting on trachoma: future prospects of trachoma control” and “Rapid assessment
for blindness for trachoma” published by WHO. The assessment was done in a
health care unit in a rural district. Ten villages, each with a population of 30005000 were chosen by the method of cluster sampling. 100 children between the
ages of 1-9 years were examined from each village for signs of Trachoma Intense and
Trachoma Follicular (n=1000). Examination of both eyes for signs of trachoma and its
complications was done with the aid of binocular loupe with 2.0x or 2.5x magnification.
Conjunctival swabs from patients of active trachoma were analyzed by PCR and Direct
Immunoflourescence assay for trachoma antigen detection was performed.
Results:Forty children (males 20, females 20) had signs of active trachoma of whom,
33 had trachomatous follicles (TF) and seven had intense trachomatous inflammation
(TI). Direct Immnunoflouresence (IF) test for detection of trachoma antigen and PCR
were positive in 25% and 10% respectively.
Conclusions:The disease burden of trachoma is still high in children of rural
areas of North India and clinical examination is the most effective way of it s rapid
assessment.
CR: V. Jhanji, None; S. Khanduja, None; R. Tandon, None; J.S. Titiyal, None; N.
Sharma, None; G. Satpathy, None; G.V.S. Murthy, None; S. Gupta, None; P. Vashist,
None; R.B. Vajpayee, None.
Support: None
Purpose: : Melanocytic tumors of the conjunctiva represent approximately 50% of
all conjunctival lesions. They can be classified according to their clinicopathological
features into nevus, primary acquired melanosis (PAM) and melanoma. Although
clinical and histopathological surveys on conjunctival tumors have already been
reported, most of these studies come from tertiary centers where referral bias
is significant. Consequently, the proportion of malignant lesions is generally
overestimated. The aim of this study was to review all melanocytic conjunctival
lesions from a single center and evaluate clinico-histopathological parameters.
Methods:A retrospective analysis of all cases diagnosed as conjunctival melanocytic
lesions (nevus, melanoma or PAM) between 1993 and 2005 at The Henry C. Witelson
Ophthalmic Pathology Laboratory and Registry, McGill University, Montreal, Canada
was undertaken. Histopathological reports were reviewed in order to provide the
following patient characteristics: age at diagnosis, gender, laterality and topographic
location of the lesion. Cases that were sent as consultations from other centers were
excluded from this particular study to avoid referral bias.
Results: We received 10,675 ophthalmic specimens . Of those, 271 were conjunctival
lesions (2.5%), with 101 classified as melanocytic. Of those, 55 (49.5%) nevus, 36 (35.6%)
PAMs and 15 (17.4%) melanomas. After exclusion of referred cases, 85 lesions were
included in the study: 44 (51,7%) nevus, 33 (38,8%) PAMs, and 8 (9,4%) melanomas. The
most prevalent location was bulbar conjunctiva (81,1%), followed by caruncle (14,1%)
and tarsal conjunctiva (4,7%). The mean age + standard deviation was 40 + 16.9 years
for nevus, 41.8 +12.6 years for PAM and 70.6 + 9.5 years for melanoma. The influence
of gender on the distribution was not statistically significant (p = 0.73). However, PAM
occurred in a younger age in women than men (p = 0.01). Conjunctival nevi were:
Compound (32,9%), subepithelial (16,4%) and junctional (2,3%). PAM were further
classified into PAM with atypia (8,2%) and PAM without atypia (30,5%). PAM was the
predisposing lesion in 6 (75%) of the 8 cases of conjunctival melanoma.
Conclusions:This study revealed that nevi of the bulbar region are the most common
melanocytic lesion of the conjunctiva. The age of onset for PAM was significantly
younger for women as compared to men. Moreover PAM with atypia was the most
important predisposing lesion for conjunctival melanoma. In this particular study
the referral bias did not significantly alter the final results.
CR: G.A. Novais, None; B.F. Fernandes, None; L.N. Santos, None; D.P. Cheema,
None; L.R. de Moura, None; M.N. Burnier Jr, None.
Support: None
4284 - B720
Prevalence of Corneal Arcus and Its Association With Cardiovascular Risk
Factors in an Urban Malay Population: The Singapore Malay Eye Study (SiMES)
M.Sandar1, S.Saw1,2, W.Wong1, E.Tai 3, W.Jie Jin4,5, H.Cajucom-Uy1, M.Rosman1,
D.T. H. Tan1,2, T.Wong1,2, SIMES. 1Singapore Eye Research Institute, Singapore,
Singapore; 2Department of Ophthalmology, National University of Singapore,
Singapore, Singapore; 3Department of Endocrinology, Singapore General Hospital,
SINGAPORE, Singapore; 4Centre for Vision Research,University of Sydney, Sydney,
Australia; 5Centre for Eye Research Australia, University of Melbourne, Melbourne,
Australia.
Purpose: To describe the prevalence of corneal arcus and its association with
cardiovascular risk factors in Malay adults in Singapore.
Methods: A population-based, cross-sectional study of 3,280 (78.7% response rate)
Malays aged 40-80 years in Singapore. The population was selected based on an agestratified random sampling procedure of Malay people living in the south-western
part of Singapore. Participants had an interview, examination and ocular imaging
at a centralized study clinic. Corneal arcus was defined from a standardized clinical
examination. Non fasting blood samples were collected for measurement of serum
total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein
(LDL) cholesterol, blood glucose and glycosylated hemoglobin. Prevalence rates were
adjusted to the 2000 Singapore census population.
Results: Of the 3,271 included in this analysis, 1899 persons had corneal arcus in either
eye, giving a crude prevalence of 58.1% (95% confidence intervals [CI], 56.4, 59.8) and
age-adjusted prevalence of 52.5% (95% CI 52.4, 52.9). The prevalence increased with
age (44.0%, 57.7%, 63.3%, 68.6%, comparing age groups in decades, p<0.001) and was
higher in men than women (64.1% vs 52.4%, p<0.001). After controlling for age and
gender, corneal arcus was associated higher systolic blood pressure (odds ratio [OR]
1.4, 95% CI 1.1, 1.7, comparing 4th vs 1st quartile), higher diastolic blood pressure (OR 1.4,
95% CI 1.2, 1.7), higher glycosylated hemoglobin (OR 1.2, 95% CI, 1.0, 1.4) and higher
HDL-cholesterol (OR 3.5, 95% CI 1.1, 1.6). Corneal arcus was not significantly associated
with diabetes, hypertension and cigarette smoking status, and total cholesterol, LDL
cholesterol and blood glucose levels.
Conclusions: This study shows a high prevalence of corneal arcus in an adult Malay
population. Corneal arcus was associated with older age, male gender, and higher
blood pressure, but not with diabetes, hypercholesterolemia and cigarette smoking.
CR: M. Sandar, None; S. Saw, None; W. Wong, None; E. Tai, None; W. Jie Jin, None; H.
Cajucom-Uy, None; M. Rosman, None; D.T.H. Tan, None; T. Wong, None.
4281-4284
4285 - B721
The Prevalence of and Risk Factors for Pterygium in a Malay Population: The
Singapore Malay Eye Study (SiMES)
4286 - B722
Corneal Endothelial Cell Sample Profile on Specular Microscopy With
Reliability and Reproducibility
H.Y. Cajucom-Uy1,2, S.M. Saw1,3, W.L. Wong1, M.Rosman1,2, J.L. Loo1,2, S.C. Loon1,2, S.Y.
Shen1,2, D.T. H. Tan1,2, T.Y. Wong1,2. 1Singapore Eye Research Institute, Singapore,
Singapore; 2Singapore National Eye Centre, Singapore, Singapore; 3Department
of Ophthalmology, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore.
F.C. Abib1, A.R. C. Schaefer2, T.M. C. Schaefer3, R.Godois4, R.A. Laing5.
1
Ophthalmology, Federal University of Parana, Curitiba, Brazil; 2Ophthalmology,
University of São Paulo, São Paulo, Brazil; 3Ophthalmology, University of São
Paulo, Curitiba, Brazil; 4Biology, Playmed, Cianorte, Brazil; 5Bio-Optics, Inc.,
Sarasota, FL.
Purpose: To describe the prevalence of pterygium and its risk factors in the urban
Malay population of Singapore
Methods: A population-based cross-sectional study of 3,280 (78.7% response rate)
Malays aged 40-80 years in Singapore. The population was selected based on an agestratified random sampling procedure of Malay people living in the south-western
part of Singapore. Participants had a standardized interview, examination and ocular
imaging at a centralized study clinic. Pterygium was diagnosed and graded clinically
by slit-lamp examination as Grade 1 (atrophic), Grade 2 ( intermediate) and Grade 3 (
fleshy), and also classified as either unilateral or bilateral pterygia.
Results: Data were available on 3266 participants. There were 508 people with any
pterygia, 289 with unilateral and 219 with bilateral pterygia. The overall prevalence
was 15.6% (95% confidence intervals, 14.3, 16.8). The prevalence increased with age
(7.1%,15.0%, 19.0% and 22.0% among participants aged 40-49, 50-59, 60-69 and 70-79
years, respectively (p for trend <0.001) and was higher in men than women (20.4% vs
11.1%, p<0.001). After adjusting for age and gender, pterygium was more common in
subjects with elementary education or lower (odds ratio[OR] 2.24, 95%CI, 1.33, 3.77),
among subjects with a history of smoking(OR: 1.52, 95%CI, 1.15, 2.01), hypertension
( OR: 1.56, 95%CI, 1.25, 1.94) and previous myocardial infarction (OR: 1.43, 95%CI,
1.01, 2.03) and among service workers and cleaners (OR: 1.76,95%CI, 1.13, 2.75) and
production workers (OR: 2.27, 95%CI,1.41,3.65) as compared to professionals and office
workers. Grade 3 (n=92) pterygium was independently associated with male gender
but not related to age. Grade 3 pterygium was more common in subjects with lower
educational attainment and in those who were unemployed.
Conclusions: The prevalence of pterygium in Singapore is 15.6% among Malays aged
40 years and older. This rate is higher than most other population-based studies.
Independent associations with male gender, older age, certain occupations as well as
systemic and medical factors suggest a multi-factorial etiology for this condition.
CR: H.Y. Cajucom-Uy, None; S.M. Saw, None; W.L. Wong, None; M. Rosman,
None; J.L. Loo, None; S.C. Loon, None; S.Y. Shen, None; D.T.H. Tan, None; T.Y.
Wong, None.
Purpose: To determine the corneal endothelial sample profile in specular microscopy
with reliability and reproducibility.
Methods: A retrospective study was performed of 100 right eyes of patients who had
undergone corneal specular microscopy, with different clinical situations, in March
2006 in a private clinic. The Bio-Optics specular microscopy was used with the Bambi
2000 Plus software. To compute the sample size we used the software package, CELLS
ANALYZER - Corneal Endothelial Statistical LabPat Rec with planned reliability degree
(RD) 95%. The sampling process of acquiring endothelial images and counting those
cell images were stoped when the calculated relative error (RE) < 0.05. Endothelial
samples were evaluated in relation to calculated sample size, considered number of
endothelial images, and cell number of the specular microscopy exams.
Results: The sex distribution was 64 (64%) of the eyes of female patients and 36(36%)
of male patients. The minimum age was 16 years, the maximum 96 years and the
average 51±19 years. The smallest computed sample size was 57 cells, the largest 315
cells and the average was 138±45 cells; The smallest endothelial sampling had 1 image,
the largest 7 images and the average 2.35±1.05 images.
Conclusions: To make corneal specular microscopy with reliability and reproducibility
(RD 95% and RE<0.05) the sampling process needed 1 to 7 (2.35±1) different images and
a large number of endothelial cells counted in different areas of corneal endothelial
mosaics.
CR: F.C. Abib, P, P; A.R.C. Schaefer, None; T.M.C. Schaefer, None; R. Godois, P,
P; R.A. Laing, P, P.
Support: None CT: BANPESQ - UFPR - BRAZIL
4287 - B723
Detection of Herpes Simplex Virus DNA by PCR in Corneal Specimens With
Different Types of Keratitis
4288 - B724
Hansen’s Disease: The Northeastern Experience
A.D. Baryluk1A, B.Rymgayllo- Jankowska1A, E.Rakowska1A, D.Haszcz1A, E.Suchodola1A,
M.Ziaja1B, M.Polz- Dacewicz1B, Z.F. Zagorski1A. A1st Dept of Ophthalmology, BDept of
Virology, 1Medical University Lublin, Lublin, Poland.
Purpose: 1). Detection and comparison of HSV DNA frequency in corneal
specimens obtained from patients with the history of herpetic keratitis, keratitis
caused by other factors than HSV and in corneas with noninflammatory disorders.
2). Analysis of factors likely to be associated with the frequency of HSV DNA presence
in corneas: age, gender, place of living, systemic diseases, eye disorders other than
keratitis, and number of recurrences.
Methods: The history of 47 patients with active keratitis or postinflammatory and
dystrophic corneal disorders were analyzed. The patients were treated at the 1st Dept.
of Ophthalmology, Medical University of Lublin, from September 2003 to December
2005. 33 full thickness corneal buttons, obtained from 31 patients after PKP, and corneal
scrapings obtained from16 patients with active keratitis were examined. On the basis
of the history and clinical appearance corneal buttons were divided into 3 groups and
scrapings into 2 groups.HSV DNA was detected using PCR method.
Results: In the I group of 14 corneal buttons with the history of herpetic
keratitis, HSV DNA was detected in 78,6%. In the II group of 11 corneal buttons
with another form of keratitis, HSV DNA was detected in one case. HSV DNA
was not detected in corneal buttons with noninflammatory opacities present.
In corneal scrapings obtained from areas with clinical features of HSV infection (group I),
DNA HSV was detected in 8 out of 11 samples (72,7%). In the II group - scrapings obtained
from patients with keratitis of other than HSV infection, HSV DNA was not detected.
The investigation found no statistical correlation between the presence of HSV DNA in cornea
and: age, gender, place of living, other concomitant eye diseases, and systemic disorders.
No correlation was found between postkeratoplasty inflammatory manifestations
and HSV DNA presence in corneal buttons.
Conclusions: 1). Statistically increased frequency of HSV DNA was detected
in corneas with history or with clinical manifestations of herpetic keratitis.
2). No statistical correlation were found between HSV DNA presence in the corneal
buttons and age, gender, place of living, eye disorders other than keratitis, or systemic
diseases. 3). No correlation was found between postkeratoplasty inflammatory
manifestations and HSV DNA presence in corneal buttons. 4). PCR seems to be a
very good method of HSV DNA detection in corneal specimens.
CR: A.D. Baryluk, None; B. Rymgayllo- Jankowska, None; E. Rakowska, None; D.
Haszcz, None; E. Suchodola, None; M. Ziaja, None; M. Polz- Dacewicz, None; Z.F.
Zagorski, None.
Support: None
I.M. Balderas1, S.H. Soukiasian2. 1Ophthalmology, Tufts- New England Eye Center,
Boston, MA; 2Ophthalmology, Lahey Clinic, Burlington, MA.
Purpose: To describe the demographics, ophthalmic pathology and natural history
of ocular lepromatous disease in patients cared for at the Lahey Clinic Hansen’s
Disease Center.
Methods: The Lahey Clinic maintains one of only 11 National Public Health Service
sponsored Hansen’s Disease Centers. The Hansen’s Disease Center at the Lahey
Clinic is administered by the Departments of Infectious Diseases and Dermatology.
Hansen’s patients are referred to the Ophthalmology Department routinely for baseline
evaluation and treatment of disease-related conditions. A review of patient charts and
computer records for 61 individuals currently enrolled in the Hansen’s Disease Center
was performed. A database was then created to catalogue demographic information
such as gender, country of origin and patient identification information. In addition,
disease classification, ocular findings, treatments employed and outcomes of treatment
were recorded. Where appropriate, photography was employed to record facial, anteior
segment and posterior segment pathology.
Results: There are 61 patients enrolled in the Hansen’s Disease Center at the Lahey
Clinic. Forty-eight of the 61 patients have been evaluated by the Lahey Clinic
Department of Ophthalmology. Of the 61 patients, 21 are female versus 40 males
(34.4% vs 65.6%). This patient population represents over 17 countries, but most patients
are from Brazil (21 patients, 34.4%), Cape Verde (7 patients, 11.5%), and Vietnam (4
patients, 6.6%). Forty-nine of the 61 patients have been evaluated by the ophthalmology
department for dry eye symptoms (11 patients, 18.0%), pterygium (11 patients, 18.0%),
lid disorders (7 patients, 11.5%), exposure keratopathy or corneal scarring (6 patients,
9.8%), and chronic uveitis (5 patients, 8.2%).
Conclusions: There are approximately 6,500 people living in the United States that
are registered in the Hansen’s Disease registry. It is estimated that 96 new cases were
reported in the United States in 2002, and nearly 800,000 cases worldwide are reported.
It is estimated that between 30 and 57% of people with Hansen’s disease have some
degree of ocular involvement. Hansen’s disease has extensive effects on the eyes, and
left untreated, can have devastating and permanent negative effects on vision and
patient quality-of-life. It is our hope that this database will allow for earlier and more
extensive screening in our Hansen’s population, thus allowing earlier intervention
and better visual and quality-of-life outcomes.
CR: I.M. Balderas, None; S.H. Soukiasian, None.
Support: None
4285-4288
4289 - B725
Etiology of Microbial Keratitis at Two Tertiary Eye Care Centers in Hyderabad
(Sindh) Pakistan
4290 - B726
Surveillance of Contact Lens Related Microbial Keratitis in Australia and New
Zealand: Multi-Source Case-Capture and Cost-Effectiveness
A.A. Kazi1,2, N.A. Khan2, J.Khan2, S.Afzal2, N.Laghari2, I.Parekh1. 1Ophthalmology,
Isra University, Hyderabad, Pakistan; 2Ophthalmology, Liaquat University Eye
Hospital, Hyderabad, Pakistan.
L.J. Keay1,2, K.Edwards3,2, G.Brian4, F.Stapleton2,1. 1Vision Cooperative Research
Centre, Sydney, Australia; 2School of Optometry and Vision Science, University
of New South Wales, Sydney, Australia; 3Vision Cooperative Research Centre,
Kensington, Australia; 4International Centre for Eyecare Education, Kensington,
Australia.
Objective: To determine the risk factors and etiological agents responsible for microbial
keratitis at 2 tertiary centers in Hyderabad, Southern Sindh Province, Pakistan.
Materials and Methods: Ninety patients diagnosed with infective keratitis presenting
at either Liaquat University Eye Hospital or the Isra University Hospital, Hyderabad,
Pakistan between February and June 2006 were enrolled in the study. A performa
was used to identify patient name, age, eye involved, sex, demographics, risk factors,
visual acuity at presentation, size and location of infiltrate, presence or absence of
hypopyon, and prior use medications or antibiotics. Corneal scrapings were obtained
in all eyes and sent for gram staining and KOH smears. The corneal scrapings were
also cultured in sheep’s blood agar, and sabouraud’s agar. The eyes were treated
empirically with broad spectrum antibiotics and antifungal topical agents with or
without atropine.
Results: The average age of our patients presenting with infective keratitis was 41
years, with males: female ratio of 2:1. The majority of the patients presented from rural
sindh (65%) as compared urban city dwellers. Fifty percent of the patients presented
with hypopyon. Seventy seven (85.5 %) of the ninety patients in the study were using
topical antibiotics, steroids and or antifungal drops at presentation. Gram staining
was positive in 9 of the 90 (10 %) eyes cultured. The KOH prep was positive in 28 of
the 90 (31.1%) eyes cultured. Eight patients had bacterial growth on the sheep’s blood
agar and twenty four had fungal growth on the sabouraud’s agar.
Conclusion: The prevalence of fungal keratitis is extremely high as compared to other
epidemiological studies undertaken in other countries. This is probably due to the
majority of patients presenting from rural areas (with vegetation trauma) and also
due to poor selection of topical antibiotics and misuse steroids prior to presentation
at the tertiary eye care centers.
CR: A.A. Kazi, None; N.A. Khan, None; J. Khan, None; S. Afzal, None; N. Laghari,
None; I. Parekh, None.
Support: None
4291 - B727
Gender Differences of Anterior Segment Morphology in Japanese Normal
Subjects Evaluated by a Rotating Scheimpflug Camera
Purpose: To evaluate a multi-source surveillance system used in a 12-month study of
contact lens related microbial keratitis in Australia and New Zealand.
Methods: All practising ophthalmologists and optometrists were surveyed on 6
occasions over 12-months via post or the Internet. Participation was defined as
reporting at least once during the study period and the response rates represented
those who responded on all six occasions. Cases were also detected through hospital
audit. All ophthalmologists and a sub-group of optometrists were contacted by phone
to elicit a response (active surveillance). The utilisation and cost-effectiveness of
active surveillance were compared to reports received via the post or the Internet.
Case ascertainment and cost-effectiveness were compared for different sources of
case capture.
Results: The rate of participation for ophthalmologists was 95.8% (711/742) and 88.5%
(657/742) responded for all reporting periods. Active surveillance was required for
63% (416/661) of responses in New Zealand (NZ) and 73% (59/81) in Australia (AU) at
AUD23.14 per practitioner. Internet reporting was more widely used in New Zealand
(NZ: 31% vs AU:17%, p=0.006) and was the most cost effective mode of reporting
(AUD1.43 per practitioner). Postal reporting (AUD; AU:3.54,NZ:9.84 per practitioner)
was under-utilised (3% of responses). Average start up costs comprised 50% of study
costs followed by active follow-up (42%), postal (6%) and Internet reporting (2%).
Ophthalmologists (50.4%, 144/286 of cases) were the most cost-effective source of cases,
followed by hospital audit (24.5%, 70/286) and optometry (25.1%, 72/286). Duplicate
reporting occurred in 13% (37/286) of cases.
Conclusions: High response rates were obtained by substantial resource commitment
to active follow-up. Internet reporting was widely used and was cost-effective.
Hospital audit and supplementary reporting by optometry were used for the first
time in a surveillance study of contact lens related microbial keratitis, and contributed
significantly to case capture.
CR: L.J. Keay, None; K. Edwards, None; G. Brian, None; F. Stapleton, None.
Support: NHMRC Post-Graduate Scholarship, Australian Government via the
Cooperative Research Centres Program, Institute for Eye Research and CIBA Vision
4292 - B728
Microbial Keratitis in Central Florida: Epidemiology, Treatment, and Outcomes
Y.Ikeda, K.Mori, T.Ikushima, L.Kobayashi, K.Imai, S.Kinoshita. Ophthalmology, Kyoto
Prefectural Univ of Med, Kawaramachi-dori Kamigyo-ku, Japan.
Purpose: To evaluate the gender differences in the anterior segment morphology in
Japanese normal subjects measured by a rotating Scheimpflug camera (Pentacam;
Oculus Inc., Lynnwood, WA, USA)
Methods: A total of 501 normal subjects (222 females and 279 males; mean age: 47.9
± 14.3 years) who visited Kyoto Prefectural University of Medicine from March 2005
to October 2006 were enrolled. All the subjects were confirmed to be normal by
glaucoma specialists, using FDT screening N-30 (Carl Zeiss Meditec, Inc.) and nonmydriatic optic disc photographs. After measuring with the Pentacam, the right eyes
were chosen for the further statistical analysis (Mann-Whitney U test, Spearman’s
correlation coefficient by rank test). Mean central corneal thickness (CCT), anterior
chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle
(ACA) were calculated and compared between females and males. The relationship
between the age and each value obtained by the Pentacam was also evaluated by
linear regression analysis.
Results: There were no significant differences in age between the two groups. Mean
CCT, ACV, ACD, and ACA in female vs. male group were 542.1 ± 32.1 vs. 550.0±32.6
micrometer, 157.8±52.8 vs. 181.5±50.2 mm 2, 2.8±0.4 vs. 3.1±0.6 mm, 34.8±7.4 vs. 37.8±6.4
degree, respectively. All the measured values (CCT, ACV, ACD, and ACA) showed a
significant difference between the female and male groups, showing that the female
group displays much thinner corneas and narrower angles than the male group. CCT
showed no changes with age in both groups. Anterior segments of the female eyes
showed much larger changes with age than those of the male eyes.
Conclusions: There were significant differences between genders in relation to anterior
segment morphology in Japanese normal subjects.
CR: Y. Ikeda, None; K. Mori, None; T. Ikushima, None; L. Kobayashi, None; K.
Imai, None; S. Kinoshita, None.
Support: None
T.K. Ramjattan, S.Tuli. Ophthalmology, University of Florida, Gainesville, FL.
Purpose: To study the clinical features, treatment, and outcomes of bacterial, fungal,
and viral keratitis.
Methods: Retrospective chart review of 502 consecutive patients treated for microbial
keratitis at the University of Florida between July 2001 to June 2006. Data includes
patient demographics, prior treatment, visual acuity at presentation, risk factors,
presenting symptoms, clinical exam, culture results, treatment modality, and final
visual acuity.
Results: The average age of patients was 45.3 years. The most common symptoms
at presentation were pain (81%) and photophobia (46%). Contact lens wear was the
most common risk factor (35%), followed by trauma (24%). 6% were located at the
graft margin of a previous penetrating keratoplasty. Most corneal infiltrates (80%)
were smaller than 3 mm. 46% had associated anterior chamber inflammation and 14%
had a hypopyon at presentation. 1% presented with corneal perforation. The average
presenting visual acuity was 20/125 and the average final visual acuity was 20/70.
Although 66% of patients were on antibiotics at presentation, 56% of bacterial cultures
were positive. Gram positive cocci were the most common isolated organism (85%),
while gram negative rods were present in 22%. 29% had more than one organism
isolated. 11% of Fungal cultures were positive, one third of which grew Fusarium.
5% of viral cultures and 7.6% of Acanthamoeba cultures were positive. 20% had
positive Gram Stains and 17% had positive Gomori methenamine silver stains. 14
patients had Confocal Microscopy at an outside institution; 10 (73%) were positive
for Acanthamoeba. Most patients received only medical treatment (88%). Surgical
interventions (12%) included corneal glue (52%), therapeutic penetrating keratoplasty
(33%), tarsorraphy (26%), and enucleation (15%).
Conclusions: Microbial keratitis is commonly seen at the University of Florida. Contact
lens use is the most common risk factor. Corneal cultures to guide medical therapy
are useful even if patients are on topical antibiotics at presentation. Good outcomes
can be achieved with appropriate therapy.
CR: T.K. Ramjattan, None; S. Tuli, None.
Support: None
4289-4292
4293 - B729
Prevalence and Risk Factors for Dry Eye Syndrome Among Older Men in the
United States
4294 - B730
Granulomatous Inflammation in Juvenile Idiopathic Arthritis
B.M. Miljanovic1, R.Dana2, D.Sullivan2, D.A. Schaumberg1,2. 1Brigham & Women’s
Hospital, Harvard Medical School, Boston, MA; 2Schepens Eye Research Institute,
Harvard Medical School, Boston, MA.
Purpose: Dry eye syndrome (DES) is one of the most frequent reasons for seeking eye
care in the US, but its frequency and risk factors have not been extensively studied
among men.
Methods: We conducted a cross-sectional survey of 25,444 US male physicians, all
participants in the Physicians’ Health Study, to study their history of diagnosed DES
and symptoms of DES. We defined DES as the presence of clinically diagnosed DES
or severe symptoms (both dryness and irritation constantly or often). We calculated
the age-specific prevalence of DES and adjusted the overall prevalence to the age
distribution of men in the US population in 2004 to estimate the number of men affected
presently, and then projected estimates forward to the expected population in the
year 2030. We used logistic regression to examine associations between demographic
and other risk factors and DES.
Results: The prevalence of DES increased with age, from 3.9% among men 50-54 years
old to 7.67% among men 80 years and older. Compared with men 50-54 years old,
being 75 years or older was a significant risk factor for DES (odds ratio [OR]=1.51; 95%
confidence interval [CI]=1.15-1.97) for 75-79y old; (OR=1.76; CI=1.34-2.32) for 80 years
and older (P for trend<0.0001). History of high blood pressure, (OR=1.28; CI=1.12-1.45),
and benign prostatic hypertrophy (OR=1.25; CI=1.09-1.44) were also significantly
associated with a higher risk of DES in the study population. The age-standardized
prevalence of DES was 4.34%, or 1.68 million men aged 50 years or older in the US.
Assuming age-specific risks remain constant, DES can be expected to affect over 2.79
million men aged 50 years or older in the US by 2030.
Conclusions: Dry eye syndrome leading to a clinical diagnosis or severe symptoms
is prevalent in older men. The findings of higher risks among men with hypertension
or benign prostatic hypertrophy point to the need for further research on the impact
of comorbid conditions and their treatments on DES. The aging of the population is
predicted to result in a growth to more than 2.7 million American men aged 50 years
and older with DES by 2030. A better understanding DES and its impact on public
health and quality of life is an important goal.
CR: B.M. Miljanovic, None; R. Dana, None; D. Sullivan, None; D.A. Schaumberg,
None.
Support: NIH grants EY00365,CA47988, HL43851; Pfizer Consumer Health Care ;
The Joint Clinical Research Center, Harvard Dept of Ophthalmology ; and Allergan,
Inc.
4295 - B731
Domestic Water Quality and Contact Lens-Related Microbial Keratitis
Purpose: Environmental bacteria are frequently associated with contact lens (CL)related microbial keratitis. Since one attribute of domestic water quality is the total
(environmental and enteric) coliform count, we hypothesised that poor water quality
may be associated with CL-related microbial keratitis. This study examined the
relationship between water quality and CL-related microbial keratitis in a populationbased study.
Methods: New cases of CL-related microbial keratitis (n=287) were detected via a
national surveillance study conducted in Australia from October 2003 to September
2004. Controls (n=1,373) were identified using a national telephone survey of 35,914
individuals aged 15-64 years in randomly selected households. Postcode data were used
to establish domestic water supply regions and water quality data were obtained from
the respective water supplier or local government compliance reports. Water quality
was categorised according to the percentage of samples with zero total coliforms;
greater than 98% of samples with total coliform count compliance denotes high water
quality zones; those with 95-98% compliance are moderate quality zones and below
95%, poor quality zones. Water supply data were available for 156 cases and 937
controls. A Chi-squared test was used to compare the distribution of water quality
between cases and controls.
Results: See Table 1. There was no statistical significance in association between water
quality and CL-related microbial keratitis.
Conclusions: Water quality, as reported by the publicly available monitoring data,
and using total coliform count as the criterion, was not associated with CL-related
microbial keratitis. Causative organisms may be derived from other environmental
sources.
Case
Control
Poor
< 95
16.0%
11.8%
Water Quality
Medium
95 - 98
13.6%
17.0%
Purpose: The uveitis associated with juvenile idiopathic arthritis (JIA) has typically
been described as non-granulomatous. Few previous reports have commented on
granulomatous disease in JIA-associated uveitis. This study reports the prevalence
of granulomatous disease in a population with JIA-associated uveitis.
Methods: Medical records of the Illinois Eye and Ear Infirmary Uveitis Service from
1973 until 2006 were reviewed to identify patients with JIA-associated uveitis. Patients
were included if they were diagnosed with JIA by a rheumatologist, and experienced
at least 6 weeks of arthritis starting before age 16. Granulomatous disease was defined
by the presence of mutton-fat keratic precipitates (KP), Busacca nodules, or “ghost”
KP. Student’s t-test and chi square testing were performed to examine associations
with demographic variables. Statistical significance was set at p=0.1.
Results: 102 patients with JIA-associated uveitis were identified, of which 73 had
retrievable medical records. Baseline demographic characteristics revealed that 85%
of patients were female, 88% were White, 8% were Black, and 5% were Hispanic.
85% of patients had pauciarticular disease, and the remainder had polyarticular
disease. 64% were ANA positive. Granulomatous uveitis was observed in 27% of
the population, with 7% exhibiting mutton fat KP, and 20% ghost KP. There was no
association between the presence of granulomatous disease and age of uveitis onset
(p=0.6), gender (p=0.5), or whether the arthritis was pauciarticular or polyarticular
(p=0.6). There was an association between granulomatous disease and ANA status
(p=0.09), with 44% of ANA positive patients having granulomatous disease compared
to 15% of ANA negative patients. There was an association between granulomatous
disease and race, with 67% of Blacks having granulomatous disease compared to 24%
of non-Blacks (p=0.02), and 23% of Whites showing granulomatous disease, compared
to 56% of non-Whites (p<0.05).
Conclusions: Granulomatous disease was more common in this series of JIA-associated
uveitis than previously reported. Granulomatous disease was less common in Whites,
more common in Blacks, and more common in ANA positive patients. It is possible that
some patients with arthritis and positive ANA titers were categorized as having JIA,
when in actuality they had a different disease more consistent with granulomatous
uveitis, such as sarcoidosis. However, if sarcoidosis is excluded, the presence of
granulomatous disease is not inconsistent with a diagnosis of JIA uveitis.
CR: J.D. Keenan, None; D.A. Goldstein, None; H.H. Tessler, None.
Support: None
4296 - B732
Prevalence of Helicobacter Pylori Infection in Patients With Posner-Schlossman
Syndrome
F.Stapleton1,2, P.Xu1, L.Keay1,2, K.Edwards1,3, A.Ho1,2. 1School of Optometry & Vision
Science, University of New South Wales, UNSW Kensington Sydney, Australia;
2
Institute for Eye Research and Vision CRC, Sydney, Australia; 3Vision CRC,
Sydney, Australia.
Table 1
J.D. Keenan, D.A. Goldstein, H.H. Tessler. Department of Ophthalmology, University
of Illinois Eye and Ear Infirmary, Chicago, IL.
S.Park1, J.M. Kim1, K.H. Park 2,3, T.W. Kim2,3, D.M. Kim2,3, C.Y. Choi1, H.R. Chang1, J.W.
Koh4. 1Kangbuk Samsung hospital, Seoul, Republic of Korea; 2Ophthalmology,
Seoul National University college of Medicine, Seoul, Republic of Korea; 3Seoul
Artificial Eye Center, Seoul, Republic of Korea; 4Ophthalmology, chosun university
hospital, Gwangju, Republic of Korea.
Purpose: This study was conducted to investigate a possible association between
Helicobacter pylori infection, which may have inflammatory nature, and PosnerSchlossman syndrome. 21 patients with Posner-Schlossman syndrome were
evaluated.
Methods: This study included 21 eyes of 21 patients with Posner-Schlossman
syndrome.Posner-Schlossman syndrome was diagnosed on the basis of findings in
ophthalmic and laboratory examinations. All patients performed serologic test of H.
pylori IgG Ab to detect H. pylori infection
Results: Among 21 patients, there were 16 males (76.2%) and 5 females (23.8%), with
a mean age of 49.9±15.9 years. The Posner-Schlossman syndrome showed an H. pylori
infection prevalence of approximately 85.7% (H. pylori IgG Ab (+): n=18 patients). In
H. pylori IgG Ab (+) group, glaucoma was 50%(n=9 patient). Recurrent attacks were
in 6 patients(in H. pylori IgG Ab (+) group, 33%, n=6).
Conclusions: In our study, H. pylori infection was more frequent in Posner-Schlossman
syndrome patients. We think, H. pylori may be either a common factor that causes
susceptibilities to Posner-Schlossman syndrome or one of causal factors for developing
Posner-Schlossman syndrome.
CR: S. Park, None; J.M. Kim, None; K.H. Park, None; T.W. Kim, None; D.M. Kim,
None; C.Y. Choi, None; H.R. Chang, None; J.W. Koh, None.
Support: None
High
>98
70.4%
71.2%
CR: F. Stapleton, None; P. Xu, None; L. Keay, None; K. Edwards, None; A. Ho,
None.
Support: None
4293-4296
Wednesday, May 9, 11:15 AM - 1:00 PM Hall B/C Poster Session Program Number/Board # Range: 4327-4351, 6044 / B908–B932, B910A
444. Epidemiology and Risk Factors for Glaucoma Organizing Section: CL Contributing Section: AP, VI
4327 - B908
Ultrasound Biomicroscopy in Iridocorneal Endothelial Syndrome
4328 - B909
Concurrent Open-Angle Glaucoma and Age-Related Macular Degeneration in
the White and Hispanic Populations in the United States
A.H. The1, M.Kurli1, S.Dorairaj1, P.A. Sidoti1,2, C.Tello1,2, R.Ritch1,2. 1Einhorn Clinical
Research Center, New York Eye & Ear Infirmary, New York, NY; 2New York
Medical College, Valhalla, NY.
Purpose: To describe the ultrasound biomicroscopic (UBM) features in eyes with
iridocorneal endothelial (ICE) syndrome.
Methods: UBM was performed on 10 patients with ICE and on 10 normal subjects. Seven
patients had essential iris atrophy (EIA) and 3 patients had Chandler’s syndrome (CS)
(Table 1). Analysis of anterior chamber depth (ACD) and angle recess area (ARA) was
performed with UBM Pro2000 Software. ARA was defined by the anterior iris surface,
corneal endothelium, and a line drawn 750μm anterior to the scleral spur. Central corneal
thickness (CCT) was determined by UBM.
Results: Central ACD was lower in patients with ICE (mean 2.41 mm ± SD 0.31 mm) as
compared to normal subjects (mean 2.62 mm). Peripheral anterior synechiae (PAS) were
observed in all patients with ICE syndrome. ARA in the quadrant of maximum PAS
was 0 in all patients with ICE. CCT was elevated in patients with CS. A membranous
mound was observed in 2 patients with CS in the anterior chamber angle (Figure 1).
PAS and a narrow angle were identified in the fellow eye of one patient with CS. Two
patients with EIA revealed PAS characterized by a focal central adherence of the iris
to the cornea and an open iridocorneal angle. One patient with EIA demonstrated a
discrete separation of the iris lamellae with PAS. A solitary cyst was identified in the
fellow eye of the same patient.
Conclusions: UBM serves as a valuable tool in the assessment of anterior segment
characteristics in patients with ICE syndrome. UBM is effective in identifying PAS and
iris atrophy in patients with corneal edema.
L.Racette1A, S.Jain1B, B.E. K. Klein2, R.Klein2, R.Varma 3, R.N. Weinreb1A. AHamilton
Glaucoma Center, BDivision of Biostatistics and Bioinformatics, 1University of
California at San Diego, La Jolla, CA; 2School of Medicine and Public Health,
University of Wisconsin-Madison, Madison, WI; 3Department of Ophthalmology
and Preventive Medicine, University of Southern California, Los Angeles, CA.
Purpose: To estimate the co-prevalence of concurrent open-angle glaucoma (OAG) and age-related macular
degeneration (ARMD) in the United States. To determine the current number of people who are affected by
these two diseases concurrently and to estimate how many might be affected in the year 2030.
Methods: Co-prevalence estimates for OAG (definite and probable combined) and both early and late ARMD
were calculated for Whites (Beaver Dam Eye Study) and Hispanics (Los Angeles Latino Eye Study), by dividing
the number of affected individuals by the total number of people included in each of the population-based
studies. OAG and ARMD could be observed in either eye. Population aging trends were obtained from the
United States Census Bureau based on the middle series of the 1990 census for the White non-Hispanic (Whites)
and Hispanic (Hispanics) projections. Co-prevalence estimates and number of affected people were derived
globally (people aged between 40 and 100 years), and by 10-year age stratification.
Results: The table presents the prevalence of OAG and both early and late ARMD for Whites and Hispanics.
The current and projected number of people affected concurrently by OAG and early and late ARMD is also
presented. Co-prevalence estimates of both conditions increase with age and appear comparable in Whites
and Hispanics for early, but not late ARMD.
Prevalence (%)
Population
Co-prevalence (%)
Age
(years)
OAG
Early
ARMD
Late
ARMD
40-100
40-49
50-59
60-69
70-79
80+
40-100
40-49
50-59
60-69
70-79
80+
4.06
1.34
1.56
3.96
7.91
12.70
4.65
1.25
2.96
7.20
14.43
22.06
18.06
8.30
11.44
19.32
29.06
38.52
9.13
6.16
8.16
10.93
16.52
25.74
1.32
0
0.16
0.85
3.45
6.56
0.41
0
0.22
0.25
1.39
7.35
Whites
Hispanics
OAG &
Early
ARMD
0.93
0
0.16
0.78
1.78
5.74
0.70
0.22
0.27
1.02
2.09
5.88
OAG
& Late
ARMD
0.20
0
0
0.16
0.33
1.64
0.07
0
0
0
0.17
2.21
Concurrent OAG & Early Concurrent OAG & Late
ARMD (# of affected
ARMD (# of affected
people)
people)
2007
2030
2007
2030
941,858
0
45,294
152,238
226,314
524,474
89,860
11,645
9,705
20,667
25,798
43,888
1,055,137
0
36,658
204,348
420,476
820,094
174,645
16,795
17,574
55,617
75,054
124,649
201,827
0
0
30,448
42,434
149,850
8,558
0
0
0
2,150
16,458
226,101
0
0
40,870
78,839
234,312
16,633
0
0
0
6,255
46,743
Conclusions: People over 70 years of age are the most affected by concurrent OAG and ARMD, with higher
co-prevalence estimates and the largest relative increase in the number of offected people in 2030. The imminent
aging of the population will result in an increased number of people affected concurrently by OAG and ARMD,
placing a potential burden on the health care system for people this age.
CR: L. Racette, None; S. Jain, None; B.E.K. Klein, None; R. Klein, None; R. Varma, None; R.N. Weinreb,
None.
Support: NIH Grant EY06594 (RK; BEKK); NIH Grant EY11753 and Research to Prevent Blindness (RV)
CR: A.H. The, None; M. Kurli, None; S. Dorairaj, None; P.A. Sidoti, None; C. Tello,
None; R. Ritch, None.
Support: Matt and Lee Sabatine Research Fund of the New York Glaucoma Research
Institute, New York, NY
4329 - B910
Visual Field Loss and Health Related Quality of Life
4330 - B911
Dallas Glaucoma Registry: Prevalence of Surgical Intervention in Glaucoma
E.Aghaian1, J.Wu2, R.McKean-Cowdin 3, S.Azen 3, C.Johnson4, R.Varma1, Los Angeles
Latino Eye Study Group. 1Department of Ophthalmology, Doheny Eye Institute, Los
Angeles, CA; 2Department of Pharmaceutical Economics and Policy, USC School of
Pharmacy, Los Angeles, CA; 3Department of Preventive Medicine, Keck School of
Medicine, Los Angeles, CA; 4Devers Eye Institute, Portland, OR.
K.S. Kooner, B.J. Cho, E.Uchiyama, K.Kerr, B.L. Willis, A.Mughal. Department of
Ophthalmology, Univ Texas Southwestern Medical Center, Dallas, TX.
Associations Between Binocular Visual Field Measures and Vision Related Quality of Life.
The Los Angeles Latino Eye Study (LALES)
Purpose:To assess the association between simulated binocular visual field (BVF) scores
and self-reported vision-related quality of life (QOL).
Methods:Participants in LALES - a population-based prevalence study of eye disease in
Latinos age 40 years and older - underwent interviews and a comprehensive ophthalmic
examination including visual field testing using the Humphrey Automated Field Analyzer
(SITA Standard 24-2). Mean Deviation (MD) scores from each eye were recorded. Monocular
visual field (MVF) test results were then used to calculate three simulated BVF scores (best
location, and two probability summation scores) based on published algorithms. QOL was
assessed by the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Pearson
correlation was used to determine correlation between MVF MD and BVF scores as well as
the correlation between visional related QOL scores and BVF scores. Linear regression was
used to assess the association between QOL and binocular summation score^2. The model
was adjusted for covariates that have previously been shown to impact QOL.
Results:3312 participants were included in the analyses. The average age of the participants
was 55 years and 57% were females. Three binocular VF scores (best location, and two
probability summation scores) had a high correlation with VF MD at better seeing eye (r=0.94)
and a slightly lower correlation with VF MD in the worse eye (r=0.86). The BVF scores also
significantly correlated with vision related QOL subscales and composite scale, correlation
coefficient ranged from 0.19 (ocular pain) to 0.39 (composite). The correlation coefficients are
similar for all three BVF scores. Linear regression analyses indicated decreased binocular
probability summation score ^2 were significantly associated with decreased in QOL score.
VF loss as assessed by the binocular probability summation score^2 had the greatest impact
on driving difficulty (slope (ß=1.48)), vision-related mental health (ß=1.11), and vision-related
dependency (ß=1.10) sub-scale scores.
Conclusion:The binocular best location, summation^2, and summation^4 had similar
correlation with QOL. The simulated BVF provides us a tool to measure vision, which may
be used for vision related disability measure.
CR: E. Aghaian, None; J. Wu, None; R. McKean-Cowdin, None; S. Azen, None; C. Johnson,
None; R. Varma, None.
Support: Grants EY11753 and EY03040, the National Eye Institute and the National Center
on Minority Healthy and Health Disparities. Unrestricted grant from Research to Prevent
Blindness, NY, NY
Purpose: To determine prevalence of surgical intervention in patients with glaucoma
in the Dallas Glaucoma Registry (DGR) and the influence of degree of visual field (VF)
damage, central corneal thickness (CCT) and cup/disk (C/D) ratio in the decision to
intervene surgically.
Methods:. Various variables collected on each patient were: age, gender, race, type of
glaucoma, vision, degree of damage, medications, surgeries, intraocular pressure.For
this study, surgical intervention included both laser and other interventional glaucoma
procedures. VF was graded from 0-3 depending on the severity of loss.
Results: The surgical intervention in 3713 eyes (1972 patients) is shown below.
Diagnosis
Primary Open Angle
P Value
Normal Tension
P Value
Glaucoma Suspect
P Value
Secondary
P Value
Narrow Angle
P Value
Childhood
P Value
Surgery
Status
YES
NO
649 (34.4)
1236 (65.6)
YES
NO
9 (15.3)
50 (84.7)
YES
NO
37 (3.1)
1170 (96.9)
YES
NO
114 (41.5)
161 (58.5)
YES
NO
183 (72.6)
69 (27.4)
YES
NO
16 (45.7)
19 (54.3)
N (%)
Mean VF
± SD
1.99 ±1.08
1.73 ±1.11
<0.001
2.00 ± 0.866
1.56 ± 1.04
0.204
0.420 ± 0.906
0.460 ± 0.825
0.744
1.87 ± 1.20
1.81 ± 1.21
0.736
1.02 ± 1.09
1.38 ± 1.31
0.044
2.56 ± 0.73
1.00 ± 1.34
0.001
Mean CCT
± SD
542.5 ± 38.7
541.3 ± 44.4
0.627
529.4 ± 37.3
539.9 ± 38.0
0.957
554.5 ± 27.1
550.2 ± 37.3
0.597
579.1 ± 76.6
556.9 ± 68.4
0.073
556.6 ± 46.8
551.5 ± 37.8
0.446
527.2 ± 68.8
595.8 ± 58.0
0.011
Mean C/D ratio ± SD
0.781 ± 0.193
0.729 ± 0.201
<0.001
0.833 ± 0.190
0.680 ± 0.219
0.053
0.462 ± 0.187
0.535 ± 0.192
0.022
0.660 ± 0.259
0.614 ± 0.258
0.181
0.486 ± 0.224
0.621 ± 0.262
<0.001
0.847 ± 0.195
0.682 ± 0.284
0.064
Conclusions: In this study, both VF and C/D statuses were instrumental in the decision
to intervene surgically. DGR may provide an estimate of epidemiology and outcome
of glaucoma in racially mixed population of North Texas.
CR: K.S. Kooner, None; B.J. Cho, None; E. Uchiyama, None; K. Kerr, None; B.L.
Willis, None; A. Mughal, None.
Support: An unrestricted grant from Research to Prevent Blindness, New York.
4327-4330
4331 - B912
Glaucoma Screening is Affected by Length Bias
4332 - B913
Central Corneal Thickness (CCT) Decreases With Age
R.Stoutenbeek, II1,2A, S.de Voogd2A, R.C. W. Wolfs2A,2B, A.Hofman2A, P.T. V. M. de
Jong2A,3, N.M. Jansonius1,2A. 1Ophthalmology, University Medical Center Groningen,
University of Groningen, Groningen, The Netherlands; AEpidemiology &
Biostatistics, BOphthalmology, 2Erasmus Medical Center, Rotterdam, The
Netherlands; 3Ophthalmogenetics, Netherlands Institute for Neuroscience, Royal
Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
N.Lin. Eye and Vision Central California, Fresno, CA.
Purpose: Patients detected by a periodic screening programme tend to have less
severe and less progressive disease as compared to patients detected in another way.
This phenomenon has been named “length bias”. Aim of the present study was to
investigate whether there exists a length bias in glaucoma screening.
Methods: Participants aged >=55 years from the prospective population-based
Rotterdam Study underwent at baseline (1991-1993) and at follow-up (1997-1999) the
same ophthalmic examination, including visual field testing and simultaneous stereo
optic disc photography. 87 out of 3842 participants developed glaucoma during a
mean follow-up time of 6.5 years. Six out of these 87 incident glaucoma cases had to be
excluded. We compared glaucoma cases diagnosed before the follow-up examination
to those who remained undetected until the follow-up examination.
Results: Of the 81 incident glaucoma cases, 23 were detected before the followup examination, whereas 58 patients remained undetected until the follow-up
examination. The undetected cases showed more often glaucomatous optic neuropathy
without glaucomatous visual field loss (31 of 58) as compared to the detected cases
(4 of 23; P=0.001). Of the 27 (58-31) undetected cases with visual field loss, only 4 had
developed significant loss in their better eye.
Conclusions: Glaucoma screening is affected by a length bias. Expected benefits of
a screening programme in addition to case finding as performed currently should
be tempered accordingly.
CR: R. Stoutenbeek, None; S. de Voogd, None; R.C.W. Wolfs, None; A. Hofman,
None; P.T.V.M. de Jong, None; N.M. Jansonius, None.
Support: None
Purpose: To evaluate the relationship between central corneal thickness (CCT) and
age of patients in a general ophthalmology clinic.
Methods: Total of 908 patients (mean age 34.8 yrs, range 6 mos - 90 yrs) attending a
general ophthalmology clinic from April 2006 through October 2006 were included
in the study. Patient population consisted of 64.1% Hispanic, 20.1% Caucasian, 12.3%
Asian, and 3.5% African American; 45.7% was male and 54.3% female. Eyes with
corneal diseases were excluded from the study. CCT was measured in 1813 eyes
with ultrasound pachymeter (Pocket II, Quantel Medical SA, Bozeman, MT). Five
readings were obtained, and the average was recorded. Unpaired T-tests were used
to make the various comparisons. Correlation of mean CCT with different age groups
was measured.
Results: The mean CCT of all patients was 562.0 ± 42.6 µm. The difference between
the left eye and right eye was not statistically significant (P = 0.657). CCT in males
(564.5 ± 43.5 µm) was thicker than that (559.9 ± 43.1 µm) in females (P = 0.026). CCT in
patients aged < 10 yrs was 578.7 ± 42.2 µm, 10-19 yrs 573.6 ± 40.9 µm, 20-29 yrs 560.1 ±
41.7 µm, 30 - 39 yrs 560.8 ± 43.5 µm, 40 - 49 yrs 553.9 ± 41.4 µm, 50 - 59 yrs 552.8 ± 36.7
µm, 60 - 69 yrs 544.1 ± 37.9 µm, and > 70 yrs 542.4 ± 36.7µm. The differences among age
groups were significant (P<0.01) except in the groups between < 10 yrs and 10 -19 yrs;
20 - 29yrs and 30 -39 yrs; 20 - 29 yrs and 40 - 49 yrs; 20 - 29 yrs and 50 - 59 yrs; 30 - 39
yrs and 40 - 59 yrs; 30 - 39 yrs and 50 - 59 yrs; 40 - 49 yrs and 50 - 59 yrs; and 60 - 69 yrs
and > 70yrs. CCT in patients aged < 40 yrs (572.3 ± 42.4 µm) was significantly thicker
(P<0.00001) than that in patients aged > 40yrs (547.8 ± 38.5 µm). CCT was inversely
correlated with age (r = -0.3187, P < 0.0001). The same findings were observed in both
male (r = -0.3045, P < 0.0001) and female groups (r = -0.3011, P < 0.0001).
Conclusions: CCT is inversely correlated with age. The CCT measurement is important
in glaucoma assessment and management. Measuring CCT in patients older than 40
years is more important because older patients have thinner corneas. The findings have
significant clinical implications in the diagnosis and management of glaucoma.
CR: N. Lin, None.
Support: None
4333 - B914
Primary Angle Closure Glaucoma: A Descriptive Study in a Scottish Caucasian
Population
4334 - B915
Distribution and Factors Associated With Central Corneal Thickness in Malays:
The Singapore Malay Eye Study (SiMES)
W.Ng1A, G.S. Ang1B, A.Azuara-Blanco1B. 1Aberdeen Royal Infirmary, Aberdeen,
United Kingdom; BOphthalmology, 1Aberdeen Royal Infirmary, Aberdeen, United
Kingdom.
1
Demographics of cohort
Variables
* mean(±s.d)
Gender [no. of patients (%)]Female
Age [years]
Hypermetropia
[no of patients(%)]
PACG
(n=50)
27 (54.0%)
69.7 (±9.68)*
PAC
(n=30)
20 (66.7%)
66.0 (±11.4)*
NA
(n=24)
17 (70.8%)
66.3 (±11.6)*
32 (59.3%)
24 (80.0%)
18(75.0%)
Purpose: To describe the frequency, and the ocular and demographic variables among
Caucasian patients with Narrow Angles (NA), Primary Angle Closure (PAC) and Primary
Angle Closure Glaucoma (PACG) in the North East of Scotland newly referred to the glaucoma
clinic.
Methods: A retrospective review on all newly diagnosed Caucasian patients with
NA, PAC and PACG who were seen in an Academic Department (Aberdeen Royal
Infirmary) over a 2 year period. Secondary angle closures were excluded. Frequency
of PACG and Acute Angle-Closure attacks was compared with the number of new
referrals to the glaucoma clinic and estimated population for North East of Scotland.
Definitions: NA: Narrow anterior chamber angle on gonioscopy (i.e. trabecular meshwork
appositionally closed without indentation in at least 3 quadrants) and IOP< 21 mmHg
PAC: NA and IOP(Intraocular Pressure) > 21mmHg, or presence of peripheral anterior
synechiae
PACG: PAC with evidence of glaucomatous damage (reproducible visual field defects or
glaucomatous optic disc damage)
Results: 104 patients were analysed. PACG patients made up nearly 50% of the
cohort. 13 had bilateral PACG. 12 patients had Acute Angle-Closure attacks. PACG
makes up 0.015% of North East of Scotland population estimates. The yearly
frequency of Acute Angle-Closure attacks in the North East of Scotland is 0.003%.
The total number of patients referred to the glaucoma unit in 1 year was 318 of which 109
had glaucoma regardless of aetiology. 23% of these glaucoma referrals had Primary Angle
Closure Glaucoma.
Conclusions: PACG and Acute Angle-Closure attacks are uncommon in Caucasians. However,
PACG represents more than 20% of new glaucoma referrals which makes up a fair proportion
of glaucoma work load in Aberdeen Royal Infirmary. The age of PACG presentation was nearly
70 which suggests that in Caucasians it may present at a later age. An inversed pyramid
was observed with regards to the frequency of NA, PAC and PACG . The reason for more
patients with glaucomatous damage is debatable. Whether this is due to poor detection or
a faster disease progression in Caucasians remains uncertain.
CR: W. Ng, None; G.S. Ang, None; A. Azuara-Blanco, None.
Support: None
W.Wong1, T.Wong2,1, S.-M.Saw1,3, P.Foster4, P.Mitchell5, S.Shen1,3, S.Mya1, T.Aung1,3.
Singapore Eye Research Institute, Singapore, Singapore; 2Centre for Eye Research
Australia, University of Melbourne, Melbourne, Australia; 3Department of
Ophthalmology, Yong Loo Lin School of Medicine, National University of
Singapore, Singapore, Singapore; 4Institute of Ophthalmology, University College
London, London, United Kingdom; 5Centre for Vision Research, University of
Sydney, Sydney, Australia.
Purpose: To describe the distribution and correlation of central cornea thickness
(CCT) in Malay adults in Singapore
Malay persons aged 40-80 years residing in the south-western part of Singapore was
conducted in 2004-6. Participants had a standardized interview, examination, ocular
imaging, laboratory tests at a centralized clinic. CCT measurements were performed
with an ultrasound pachymeter.
Results: CCT was recorded for 3240 right eyes and for 3233 left eyes. CCT was normally
distributed with mean of 541.3 μm (95% confidence interval [CI], 540.1 to 542.4) in right
eyes and mean of 540.6 μm (95% CI, 539.4 to 541.4) in left eyes. CCT decreased with
increasing age (547.7 in 40-49 years, 543.5 in 50-59 years, 540.2 in 60-69 years, and 532.3
in 70-80 years, P<0.001) but was not associated with gender. After controlling for age
and gender, CCT was significantly and positive correlated with higher intraocular
pressure (Pearson’s correlation coefficient 0.19, P<0.001), axial length (0.05, P=0.007),
weight (0.06, P=0.001), and serum glucose (0.06, P=0.001) and glycosylated hemoglobin
(0.07, P<0.001) levels. After controlling for age and gender, CCT was not associated
with spherical equivalent refraction, anterior chamber depth, systolic and diastolic
blood pressure and height.
Conclusions: In Malay adults, CCT decreased with age and was associated with
higher intraocular pressure and hyperglycemia.
CR: W. Wong, None; T. Wong, None; S. Saw, None; P. Foster, None; P. Mitchell,
None; S. Shen, None; S. Mya, None; T. Aung, None.
4331-4334
4335 - B916
Non-Compliance, the Blind Spot in Glaucoma Treatment: Results From the
Belgian Compliance Study in Ophthalmology
4336 - B917
Self-Reported Barriers and Strategies to Better Follow-Up Among Glaucoma
Patients in South India
S.Vandenbroeck1, F.Dobbels1, I.Stalmans2, S.De Geest1,3, T.G. Zeyen2. 1Centre for
Health Services and Nursing Research, Catholic University of Leuven, Belgium;
2
Ophthalmology, University Hospitals of Leuven, Belgium; 3Institute of Nursing
Science, University of Basel, Switzerland.
B.W. Lee1, S.Parthasarathi2, K.Singh1, R.K. John 3, A.L. Robin4. 1Ophthalmology,
Stanford University, Stanford, CA; 2Glaucoma Service, Aravind Eye Hospital,
Coimbatore, India; 3Delve Data Systems, Coimbatore, India; 4Ophthalmology, Johns
Hopkins University, Baltimore, MD.
Purpose: Favorable outcomes of glaucoma are largely dependent on the patient’s
ability to comply with prescribed eye drop treatment. Yet, compliance studies are
usually single-center studies, including a small number of patients. The goal of the
multi-center Belgian Compliance Study in Ophthalmology (BSCO) was to substantiate
the magnitude of non-compliance (NC) with eye drop treatment in a large sample of
glaucoma patients and to determine a possible association between NC and selected
demographic & treatment characteristics.
Methods: A cross-sectional survey was performed in 876 glaucoma patients treated
in 60 different ophthalmologic centers in Belgium. NC with eye drop treatment was
assessed anonymously using a written self-report questionnaire developed for the
purpose of this study. More specifically, patients were asked how many times they
had forgotten to administer eye drops during the past 2 weeks. Patients had 4 answer
options: never, seldom, once a week or daily. Two definitions of NC were explored: (1)
missing one or more doses; (2) missing two or more doses in the past 2 weeks.
Results: 731 out of 876 (83.5%) questionnaires were available for data analyses. 39.7%
and 12.3% of the patients admitted not being compliant to their treatment regimen in
the last 2 weeks for resp. chosen definitions. Correlates of NC were robust as similar
correlates were found for the 2 definitions. Significantly more male patients ((1)
χ2=10.46; p=0.001; (2) χ2=9.15; p=0.002) and younger patients ((1) Mann-Whitney U=
54296; p<0.001; (2) Mann-Whitney U= 25669; p=0.073) were NC. Moreover, a higher
number of daily doses was also positively associated with NC ((1) Mann-Whitney
U=56580; p=0.013; (2) Mann-Whitney-U=22386; p<0.001). Within the group of NC
patients, the evening doses were mentioned to be most frequently missed in 59.6%
(1) and 56.7% (2) of the patients respectively. 47% (1) and 31.1% (2) suggested fewer
doses per day as a valuable compliance enhancing intervention.
Conclusion: A substantial proportion of patients had problems with complying with
eye drop treatment similar to previous evidence in smaller samples. Correlates of
NC, male gender, younger patients and fewer doses, seemed quite robust. Clinicians
should regularly screen for NC during routine follow-up. Patients at risk should be
referred for compliance enhancing interventions. A possible pathway to improve
compliance may be the reduction of daily doses.
CR: S. Vandenbroeck, None; F. Dobbels, None; I. Stalmans, None; S. De Geest,
None; T.G. Zeyen, None.
Support: Phizer Grant
Purpose: To identify barriers against and develop strategies to improve attendance
of follow-up glaucoma examinations (FGEs) in South India.
Methods: A prospective case-control study enrolled 300 established patients with
primary glaucoma, including 150 who did and 150 who did not attend FGEs as advised
in the past year at Aravind Eye Hospital. A medical record review was performed and
identified 226 (75.3%) patients who failed to attend at least one FGE over the past year.
These patients were asked to identify the cause(s) of non-attendance. All 300 patients
were asked about various strategies to facilitate FGE attendance.
Results: Among the 226, 43.8% reported “My eyes were okay” as a reason for not
attending follow-up. The following were cited as the most important reason for
non-attendance: “My eyes were okay” (25.7%), “Lack of Escort” (15.0%), and “Unable
to leave work responsibilities” (7.5%). Providing a mobile glaucoma van (64.0%) or
satellite vision station (44.3%) at which ocular examinations could be performed were
identified as the best strategies to facilitate FGE attendance, followed by providing
reminders a week before appointment dates (33.0%).
Conclusions: Widespread lack of awareness on the importance and rationale for
attending FGEs is still the most important reason why patients fail to attend FGEs,
whereas medical fees, lost wages, and transportation difficulties appear to be far
less important factors. Strategies to improve attendance of FGEs should focus on
providing more effective patient education and counseling on the importance of
FGEs in managing glaucoma and reducing vision loss. Since patients themselves
favor strategies that would decrease transportation time and overall time required
to attend FGEs, various adjunctive strategies that would help in rescheduling missed
appointments, decreasing patient waiting time, or facilitating follow-up through novel
means should not be overlooked.
4337 - B918
The Relation of Central Corneal Thickness and Intraocular Pressure in a
Glaucoma Screening Population Based Study in Brooklyn, NY
4338 - B919
Prevalence of Exfoliation Syndrome and Exfoliative Glaucoma in Buenos Aires,
Argentina
A.Michael, M.Singh, P.Chamnongvongse, D.Steffy, S.Rastogi, T.L. Brevetti, D.R. Lazzaro.
Ophthalmology, SUNY Downstate Med Ctr, Brooklyn, NY.
S.Lerner1,2, C.Picotti 3, D.Scaricaciottoli 3, S.Basualdo3. 1Ophthalmology, University
Favaloro and University of Buenos Aires, Buenos Aires, Argentina; 2Hospital
Malvinas Argentinas. Fundacion para el Estudio del Glaucoma, Buenos Aires,
Argentina; 3Ophthalmology, Hospital Malvinas Argentinas, Buenos Aires,
Argentina.
Purpose: We set out to confirm if the relationship between central corneal thickness
(CCT) and intraocular pressure (IOP) matched previous findings in a population
based epidemiologic study conducted in Brooklyn, New York.
Methods: 274 eyes of 369 participants from 13 community health fairs in Brooklyn, NY
participated in our glaucoma screening project (January to October 2006). Volunteers
filled out questionnaires that assessed various demographic data and self-reported
glaucoma risk factors. Any participants currently on IOP lowering medications or any
participants with a history of prior glaucoma surgery were excluded from the study.
The participants also underwent a C20-1 frequency doubling technology visual field
test, IOP measurements using tonopens, and CCT using corneal pachymeters.
Results: Of the 369 participants, a majority (62%) were of African-American decent.
The average age was 54 years old (range: 21 - 99). We found the average CCT and
average IOP in our population were 541 and 17 respectively. In corroboration with
previous studies, we found a linear relationship between central corneal thickness
and intraocular pressure. Using Pearson’s statistical analysis, we found that thicker
pachymetry readings were associated with increased intraocular pressures (r =
0.185, p = 0.002).
Conclusions: The present study revealed a statistically significant correlation between
thicker corneal pachymetry readings and intraocular pressures in a largely AfricanAmerican population in Brooklyn, NY.
CR: A. Michael, None; M. Singh, None; P. Chamnongvongse, None; D. Steffy,
None; S. Rastogi, None; T.L. Brevetti, None; D.R. Lazzaro, None.
Support: Friends of the Congressional Glaucoma Caucus
CR: B.W. Lee, None; S. Parthasarathi, None; K. Singh, None; R.K. John, None; A.
L. Robin, None.
Support: Stanford Medical Scholars Research Program
Purpose: The prevalence of exfoliation síndrome (XFS) varies widely in different
parts of the world. Little is known about prevalence in Latin America. To report the
prevalence of XFS and exfoliative glaucoma (XFG) in a population attending a public
hospital in Malvinas Argentinas, Buenos Aires, Argentina.
Methods: Consecutive phakic patients older than 60 years-old, without personal
history of glaucoma were examined. A complete ophthalmic examination was
performed.
Results: 49 out of 337 patients (14.5%) had XFS. Mean age was 72.9 (+ 6.6) years-old.
69.4% were male; and in 63.2% was bilateral. The prevalence increased with age:
from 9.5% in individuals between 60-69 years-old to 27.2% in individuals > 80 y/o.
Cataract was observed in 59%, glaucomatous optic neuropathy in 34.6%, and IOP
>21 mmHg in 30.5% of the individuals with XFS. 46.9% of the patients with XFS had
blood hypertension and 16.3% had diabetes.
Conclusions: XFS was frequent in the studied population. A very important percentage
of these individuals had glaucoma, and elevated IOP was also frequent in this study.
Almost half of the subjects had blood hypertension and one out of six had diabetes.
XFS and XFG may be highly prevalent in Argentina. Blood hypertension and diabetes
should be investigated in patients with XFS.
CR: S. Lerner, None; C. Picotti, None; D. Scaricaciottoli, None; S. Basualdo,
None.
Support: None
4335-4338
4339 - B920
Socioeconomic Status and Extent of Visual Field Loss in Glaucoma Patients at
First Presentation to Manchester Royal Eye Hospital
4340 - B921
Association of Diabetes and Glaucoma in a Predominantly Hispanic Screening
Population
S.Sukumar, R.Harper, C.Fenerty, D.B. Henson. Dept of Ophthalmology, MREH,
School of Medicine, University of Manchester, Manchester, United Kingdom.
Y.Trigo, H.Koenig, W.E. Sponsel. Ophthalmology, Univ of Texas Hlth Sci Ctr SA, San
Antonio, TX.
Purpose: To investigate the relationship between socioeconomic status and the extent
of visual field loss in glaucoma patients at their first presentation to Manchester Royal
Eye Hospital, (MREH).
Methods: Ninety patients attending MREH between the years 1995 and 2005 were
selected from a visual field database of patients with primary open angle glaucoma.
Using the first visual field record of the worse eye, selection assured that ~30 patients
fell into each of 3 Mean Deviation bands (>-5dB, -5 to >-15, <-15dB). A guide as to the
socioeconomic status of each patient was obtained from the ACORN registry using
the patient’s postcode address. Postcode addresses in the UK geographically locate
regions of approx. 15 households and the ACORN registry uses a variety of databases
to classify those living within each postcode area into one of 5 socioeconomic bands
(Wealthy achievers, Urban prosperity, Comfortably off, Moderate means and Hard pressed).
For the purposes of our analysis we placed the first 3 bands in to Group 1 and the last
2 in to Group 2. Data on IOP, vertical CD ratio and family history of glaucoma were
extracted from the patient’s notes.
Results: 41 patients were classified into Group 1 (Mean age 69.05years, Male 42%)and
49 patients into Group 2 (mean age 68.97 years, Male 48%). There was no significant
difference in IOP (p=0.089) or vertical CD ratio (p=0.776) between the two groups
although more people in Group 1 had a family history of Glaucoma (27% vs 14%). The
distribution of visual field loss by Group is given in Figure 1.
Figure 1.
Purpose: To find whether there is an association between a known diagnosis of diabetes and
clinically confirmed glaucoma, detected at mobile eye screenings in San Antonio, Texas.
Methods: Four-day screenings for glaucoma were held monthly at different sites using a 60foot Lions Mobile Eye Screening Unit. Those screening positively, with at least 2 reproducible
FDT misses in either eye, underwent HVF SITA 30-2 perimetry, HRT II scanning laser
tomography, tonometry, and a full examination by an ophthalmologist. A glaucoma specialist
reviewed all examination findings and rated the results as suspect, mild, moderate, or severe
glaucoma. All participants underwent a pre-screening interview that specifically asked
whether they had diabetes.
Results: Among >6000 individuals (mean age 62) screened during the past 34 months in
Bexar County, 657 (11%) reported having diabetes. Glaucoma was confirmed or suspected
after clinical exam in 212 (4%) of all screenees (mean age 59). Among these 212 induviduals
with confirmed/suspect glaucoma, 159 (75%) were Mexican-American, 64 (30%) of whom
reported having diabetes. Diabetes was more prevalent among Mexican-American females
(256; 39%) than males (197; 30%). Among each of the other ethnic groups screened, fewer than
7% of participants of either gender reported having diabetes. Among positively screened male
Mexican-Americans with diabetes who were ultimately confirmed to have severe glaucoma,
a very high proportion (39%) demonstrated severe glaucomatous pathology on clinical
examination. Diabetic Mexican-American females screening positively for glaucoma more
frequently displayed less severe pathology, with 32% being categorized as being glaucoma
suspects only. Among the male African-Americans with confirmed/suspected glaucoma 9%
reported being diabetic, and the proportion among African-American females was similar
(8%). In no other ethnic group was diabetes reported among more than 4% of those whose
positive screening exam resulted in confirmed or suspected glaucoma.
Conclusions: The overall proportion of Mexican-Americans among the positive and negative
screening cohorts was comparable, but there was a nearly three-fold difference observed in
the proportion reporting diabetes among individuals with suspected or confirmed glaucoma
versus adults who passed the eye screening (ie. Pinhole VA >20/40 and normal FDT OU).
These findings suggest that diabetes, which is highly prevalent among Mexican-Americans,
may be a risk factor for glaucoma among individuals of that heritage in Bexar County, where
at least 95% of adult diabetes is Type II.
CR: Y. Trigo, None; H. Koenig, None; W.E. Sponsel, None.
Support: Friends of the Congressional Glaucoma Caucus Foundation and Research to
Prevent Blindness
Ordinal logistic regression of this data showed that patients with severe visual field
loss are more likely to be in Group 2 than in Group 1 (OR 3.6, 95% C.I. 1.14 -11.1).
Conclusions: The extent of visual field loss in glaucoma patients at first presentation
to MREH is related to the socioeconomic status. Patients from poorer socioeconomic
groupings are more likely to present with advanced visual field loss.
CR: S. Sukumar, None; R. Harper, None; C. Fenerty, None; D.B. Henson, None.
Support: BUPA Foundation
4341 - B922
The Relation Between Caffeine Consumption and Primary Open Angle
Glaucoma: Result From Two Prospective United States Cohorts
4342 - B923
The Prevalence of Glaucoma in a Malay Population in Asia: The Singapore
L.R. Pasquale1, S.E. Hankinson2,3A, B.A. Rosner2,3B, W.C. Willett2,3A, J.Kang2.
1
Ophthalmology, Harvard Medical School/Mass Eye & Ear Infirmary, Boston, MA;
2
Medicine, Channing Laboratory/Brigham and Women’s Hospital, Boston, MA;
A
Epidemiology, BBiostatistics, 3Harvard School of Public Health, Boston, MA.
S.Y. Shen1, T.Y. Wong1, P.Foster2, J.L. Loo1, S.C. Loon1, M.Rosman1, N.Ishak1, A.Foong1,
S.M. Saw3,4A, T.Aung1,4B. 1Singapore Eye Research Institute, Singapore National Eye
Center, Singapore, Singapore; 2Institute of Ophthalmology, University College
London, London, United Kingdom; 3Centre for Eye Research Australia, University
of Melbourne, Melbourne, Australia; ADepartment of Community, Occupational
and Family Medicine, BDepartment of Ophthalmology, 4Yong Loo Lin School of
Medicine, National University of Singapore, Singapore, Singapore.
Purpose: Caffeine consumption is positively associated with elevated intraocular
pressure (IOP) in open-angle glaucoma patients. In this study, we investigated whether
caffeine consumption was associated with an increased risk of primary open-angle
glaucoma (POAG).
Methods: We used 2 large US-based cohorts of women and men respectively, the
Nurses’ Health Study and Health Professionals Follow-up Study, to form a cohort
at risk for POAG. Eligible participants were 40+ years old, did not have POAG at
baseline, and reported receiving eye examinations during follow-up. Ultimately
78,712 female nurses and 41,667 male health professionals contributed person-time
from 1980-2002 and 1986-2002 respectively. Information on caffeine consumption,
potential confounders including smoking history and POAG diagnoses was updated
using biennial questionnaires. During follow-up, we identified 856 self-reported POAG
cases that were confirmed with medical record review. Cohort-specific and pooled
analyses across cohorts were conducted to calculate multivariable rate ratios (RR) of
POAG and their 95% confidence intervals [95% CI].
Results: Although overall, caffeine consumption was not associated with risk of POAG,
very high consumption increased risk. Compared with those consuming < 150 mg/day,
(about 1 cup of coffee), the pooled RRs were 1.09 [ 0.89-1.34] for consuming 150-299
mg/day, 0.94 [0.75-1.18] for 300-449 mg/day, 1.31 [1.05-1.64] for 450-559 mg/day and
1.16 [0.94, 1.45] for 600 mg+/day [p for linear trend = 0.11]. However, those consuming
the most caffeinated coffee (6 or more cups/day) were at 1.71 fold increased risk [95%
CI: 1.15-2.55] compared to those not consuming any coffee [p for linear trend = 0.03].
We did not observe associations with tea intake. Associations were more adverse in
relation to POAG with elevated IOP.
Conclusions: Six or more cups of coffee daily were associated with increased risk of
POAG; however, lower doses did not appear to influence the risk of POAG.
CR: L.R. Pasquale, None; S.E. Hankinson, None; B.A. Rosner, None; W.C. Willett,
None; J. Kang, None.
Support: NIH Grant EY015473, EY09611 and CA 87969
Purpose: To describe the prevalence and type of glaucoma in an urban Malay
population.
Methods: A population-based, cross-sectional study of Malays aged 40-80 years
residing in Singapore. An age-stratified random sampling procedure selected 5,600
Malay names residing in south-western Singapore from the national database. Selected
individuals were contacted by telephone and home visits to determine study eligibility.
Eligible individuals were invited to a centralized clinic for a standardized interview,
ophthalmic imaging and clinical assessment. Clinical assessment included presenting
and best-corrected visual acuity, refraction, slit-lamp bio-microscopy, assessment
of intraocular pressure (IOP) by Goldman applanation tonometry and optic disc
examination. Participants who were categorized as ‘glaucoma suspect’ received visual
field examination (24-2 SITA static, threshold-related) and gonioscopy in addition to the
standardized clinical assessment. Glaucoma was defined according to the International
Society for Geographical and Epidemiological Ophthalmology classification.
Results: Off the 5,600 names selected, 4,168 (74.4%) were eligible for the study and a
total of 3,280 had attended the centralized clinic (78.7% response rate). Of these, 363
(11.07%) were categorized as ‘glaucoma suspect’. There were 157 people diagnosed
to have glaucoma, resulting in a crude prevalence of 4.79% and the age-standardized
prevalence of 3.6% (95% confidence intervals [CI] 3.5 to 3.6). Of all the glaucoma cases,
142 (3.26%; 95% CI, 3.17 to 3.36) were primary open angle glaucoma; (POAG), 12 (0.18%;
95% CI, 0.16 to 0.20) were primary angle closure glaucoma (PACG), 2 (0.05%; 95% CI
0.03 to 0.06) were secondary glaucoma and 1 (0.06%; 95% CI 0.05 to 0.08) was congenital
glaucoma. There were altogether 198 (6.04%) glaucoma suspects.
Conclusions: This study shows that the prevalence of glaucoma among Malays in
Singapore aged 40-80 years old is 4.79% and the age-standardized prevalence is
3.6%.
CR: S.Y. Shen, None; T.Y. Wong, None; P. Foster, None; J.L. Loo, None; S.C. Loon,
None; M. Rosman, None; N. Ishak, None; A. Foong, None; S.M. Saw, None; T. Aung,
None.
Support: Singapore National Medical Research Council Grants No 0796/2003 and
Singapore Biomedical Research Council Grant No 501/1/25-5
4339-4342
4343 - B924
Prevalence of Disc Hemorrhage in a Population-Based Study of Japan
4344 - B925
Prevalence of Primary Open-Angle Glaucoma and Pseudoexfoliative Glaucoma
(PEXG) by IOP Level in a Population-Based Study. Thessaloniki Eye Study
A.Iwase1, M.Araie2, A.Tomidokoro2, A.Hashizume2, Y.Kitazawa 3, Tajimi Study Group.
1
Ophthalmology, Tajimi Municipal Hospital, Tajimi, Japan; 2Ophthalmology,
University of Tokyo Graduate School of Medicine, Tokyo, Japan; 3Akasaka
Kitazawa Clinic, Tokyo, Japan.
Purpose:Optic disc hemorrhage (DH) is one of the most important risk factors for
progression of glaucoma. DH is reportedly observed more frequently in normaltension glaucoma (NTG) than in primary open angle glaucoma, and prevalence of
NTG is as high as 3.6% in Japan.1 We investigated prevalence of DH and its relating
systemic and ocular factors in participants of the Tajimi Study, a population-based
glaucoma survey in Japan.1
Methods: 3021 out of eligible residents (78.1%) underwent the screening examinations
including non-mydriatic fundus photographs. All fundus photographs were reviewed
by one experienced examiner (IA) to determine the presence of DH. To decide factors
associating with DH other than glaucoma in non-glaucoma subjects, the relating
factors were studied using logistic analysis with stepwise selection in which the
independent variable was the presence of DH and the dependent ones were sex, age,
mean blood pressure, height, weight, refractive error, intraocular pressure, central
corneal thickness, optic disc area, presence of parapapillary atrophy (PPA) -alpha,
and area of PPA-beta. A DH-positive eye in each subject with DH and a randomly
chosen eye in each subject without DH were analyzed.
Results: Fundus photographs with sufficient quality were available in 2911 subjects.
DH was found in at least one eye in 36 subjects (prevalence = 1.2%, 95% confidence
interval 0.9 - 1.6%), including 19 of 145 subjects with definitive glaucoma (prevalence
13.1%), 7 of 74 with glaucoma suspect (9.5%), and 10 of 2692 non-glaucoma subjects
(0.4%). Prevalence of DH was significantly different among the 3 groups (P<0.001,
chi-square test). The logistic analysis revealed that higher age (P<0.001) and larger
area of PPA-beta (P=0.040) were significantly associated with the presence of DH in
non-glaucoma subjects.
Conclusions: Prevalence of DH in a Japanese population aged 40 or older in Tajimi
was 1.2%. DH was found approximately 30 times more frequently in subjects
with definitive glaucoma than in non-glaucoma subjects. Other than glaucoma,
higher age and greater area of PPA-beta were significantly associated with DH.
1, Iwase et al. Ophthalmology 2004;111:1641-1648
CR: A. Iwase, None; M. Araie, None; A. Tomidokoro, None; A. Hashizume, None; Y.
Kitazawa, None.
Support: the Japan National Society for the prevention of Blindness
4345 - B926
The Impact of Hyperemia on Glaucoma Treatment
T.J. Zimmerman1, S.Hahn2, L.Gelb3, H.Tan 3, E.E. Kim4, S.N. Shah4. 1Ophthalmology,
University of Louisville, Louisville, KY; 2Albert Einstein School of Medicine, New
York, NY; 3HealthCore Inc., Wilmington, DE; 4Pfizer Inc, New York, NY.
Purpose: Because many open-angle glaucoma (OAG) patients prescribed topical
glaucoma medications may be switched (discontinued) from their initial medication,
we studied the impact of ocular adverse events (AEs; hyperemia) on continuation of
treatment with prostaglandin analogs (PGs).
Methods: Medical and pharmacy claims of a private US health network identified
patients filling initial topical ocular hypotensive prescriptions from 2001-2004. In all,
300 OAG patients prescribed a PG and 103 ophthalmologists were selected by algorithm
(maximized likelihood of linkage) for telephone interviews. Medical charts for 225/300
interviewed patients cross-validated claims and survey data. Patient and physician
reports of PG-related AEs and reasons for PG discontinuations were correlated with
chart data of the frequency and impact of ocular AEs. The medication possession ratio,
an indicator of patient adherence, was correlated to ocular AEs.
Results: Initial claims for 13,977 patients were latanoprost (41%), timolol (23%),
alpha adrenergics (12%), bimatoprost (12%), travoprost (10%), and CAIs (3%). The
discontinuation rate of index medication in the first 90 days was 55.4%. For the 65%
of charts of patients receiving PGs that noted an AE, hyperemia was the most cited
(70%); hyperemia was noted beyond the first visit in 57% of these charts, and 27.4%
of patients with hyperemia were discontinued from their medication. PG-treated
patients reporting AEs as a “significant problem” had poorer adherence (p=.04). Only
69% of patients reporting hyperemia recalled mentioning the problem to a physician,
and 10% acknowledged skipping doses due to hyperemia (likely underreported).
AEs were seen as an adherence barrier by 97% of physicians; 94% used AE reports to
detect nonadherence. Physicians cited hyperemia as the AE most affecting adherence
(mean=18%), and 72% felt that adherence differs across PG due to AEs.
Conclusions: With PGs, hyperemia accounts for the majority of discontinuations
attributable to ocular AEs. Hyperemia may limit adherence and frequently is cited by
ophthalmologists as a differentiating factor in cooperation with PG therapy.
CR: T.J. Zimmerman, Pfizer Inc, C; S. Hahn, None; L. Gelb, HealthCore Inc., F; H.
Tan, HealthCore Inc., F; E.E. Kim, Pfizer Inc, E; S.N. Shah, Pfizer Inc, E.
Support: Research supported by Pfizer Inc.
F.Topouzis1, M.R. Wilson2, A.Harris3, E.Anastasopoulos1, F.Yu4, T.Pappas1, A.Koskosas1,
P.Founti1, A.L. Coleman4. 1II Department of Ophthalmology, Aristotle University of
Thessaloniki, Thessaloniki, Greece; 2School of Medicine, University of Colorado
Denver and Health Science Center, Denver, CO; 3Department of Ophthalmology,
Indiana University, Indianapolis, IN; 4Center for Eye Epidemiology, Jules Stein Eye
Institute, UCLA, Los Angeles, CA.
Purpose: To evaluate the association of primary open angle glaucoma (POAG) and
pseudoexfoliative glaucoma (PEXG) and screening intraocular pressures (IOPs) in
the Thessaloniki Eye Study (TES).
Methods: TES is a cross-sectional, population-based of 2554 individuals in Thessaloniki,
Greece. Subjects were diagnosed with POAG if they had glaucomatous optic nerve
damage and open, normal-appearing anterior chamber angles in absence of secondary
causes in either eye. Subjects were diagnosed with PEXG if they had glaucomatous
optic nerve damage and pseudoexfoliative material in either eye.
Results: Among the clinic-visit participants (n=2261), 94 subjects had POAG (4.2%)
and 41 had PEXG (1.8%). 270 (12%) subjects had pseudoexfoliation. The prevalence of
PEXG among subjects with pseudoexfoliation was 15.2% and the prevalence of POAG
among subjects without pseudoexfoliation was 4.7%. Mean IOPs were 19.2 mmHg and
21.3 mmHg for the POAG and PEXG, respectively. 39 POAG and 26 PEXG subjects were
receiving treatment (medications or prior surgery) and had mean IOPs of 18.6 mmHg
and 19.3, respectively. In subjects without treatment the mean IOP was 19.6 mmHg
and 24.6 for POAG and PEXG, respectively. PEXG presented with greater prevalence
among subjects with pseudoexfoliation compared to POAG prevalence among subjects
without pseudoexfoliation for the same IOP level throughout the whole IOP range.
The risk of being diagnosed with glaucoma increased exponentially for IOPs greater
than 21 mmHg for both POAG and PEXG.
Conclusions: Greater prevalence of PEXG compared to POAG for the same
IOP level was observed in TES. This may be due to higher IOP fluctuations
in eyes with pseudoexfoliation or to more susceptible optic nerves in eyes with
pseudoexfoliation.
CR: F. Topouzis, None; M.R. Wilson, None; A. Harris, None; E. Anastasopoulos,
None; F. Yu, None; T. Pappas, None; A. Koskosas, None; P. Founti, None; A.L.
Coleman, None.
Support: International Glaucoma Association London UK, UCLA Center for Eye
Epidemiology CA, Health Future Foundation Creighton Univ. NE, Texas Tech Univ.
Health Sciences Center TX, Pfizer Inc., Merck & CO Inc
4346 - B927
A Preliminary Study: How Real Is the Risk for Developing Drug Induced Angle
Closure Glaucoma?
S.R. Shareef 1, S.S. Awadalla2. 1Ophthalmology, Univ of Rochester Eye Institute,
Rochester, NY; 2Biostatistics and Computational Biology, University of Rochester
School of Medicine and Dentistry, Rochester, NY.
Purpose: (1) To determine prevalence of drug induced secondary angle closure
glaucoma (sACG) from public consumption. (2) To assess statistical significance of
risk for developing sACG by taking such medications.
Methods: Literature Search using PubMed (1966 to present) conducted to identify all
sACG publications. Drug warning label using the term ‘glaucoma’ was ascertained for
each drug using UpToDate Online Search Engine at http://www.utdol.com/utd/index.
do. Reports were divided into 3 categories: Chemically induced ACG among the public
(Group A; n=126); General anesthesia induced ACG (Group B; n =10); non-drug induced
ACG (Group C; n=57). Intra-ocular surgical (iatrogenic) ACG reports were excluded. In
Groups A and B, drugs were categorized by class; Group C, by etiology. In Group A, the
proportions of the most prevalent drug classes were compared to overall population
proportions of written prescriptions of the top 200 drugs in 2003.
Results: The prevalence of drug-induced ACG (Group A) was 65.3% [CI = (58.1%,
72.0%)], general anesthesia (Group B) (5.2%) [CI = (2.5%, 9.3%)], and non-drug induced
(Group C) (29.5%) [CI = 23.2%, 36.5%]. Within Group A, the most frequent drug classes
were Anti-seizure (73.8%) [CI = (65.2%, 81.2%)], Anti-depressant (10.3%) [CI = (5.6%,
17.0%)] and Bronchodilators (6.3%) [CI = (2.8%; 12.1%)]. In Group C, vascular etiology
(56.1%) [CI = (42.4%, 69.3%)] was most common. Drug-induced [Groups A, B] had a
female preponderance and bilateral ACG. A two-proportion test for the top 3 drugs
for each class showed that only the Anti-seizure drug Topamax had an increased
proportion of 64% [CI = (56.8%, 72.1%)] as compared to Anti-depressant drug Paxil
and Bronchodilator drug Albuterol.
Conclusions: In 4 decades, the most prevalent published risk factor for sACG was
drug-induced [Group A (65.3%)] among the public that consumes such medications.
Anti-seizure, Anti-depressant and Bronchodilators respectively were the most frequent
drug class reported. However, within this class, only Topamax showed a significantly
high proportion of risk for sACG compared to the overall population proportions
of written prescriptions in 2003. A bilateral presentation of ACG should prompt
physicians to take a good medical history to rule out a drug-induced etiology and to
warn patients of this risk prior to prescribing topiramate.
CR: S.R. Shareef, None; S.S. Awadalla, None.
Support: None
4343-4346
4347 - B928
Prevalence of Glaucoma in the Afrocolombian Population of Quibdó Colombia
S.Belalcazar1A, M.F. Delgado1A, H.Posso1B, G.Figueroa1A, A.Gutiérrez1A, A.Rico1B,
M.Gómez2, M.Herrera2. AGlaucoma, BEpidemiology, 1Fundacion Oftalmologica
Nacional, Bogota, Colombia; 2Investigation Department, Instituto Nacional para
Ciegos, Bogota, Colombia.
4348 - B929
Ultrasound Biomicroscopic Prevalence of Plateau Iris Among Hispanic and
Black Angle Closure Suspects
A.A. Madu1, A.E. Fleury1, P.Channa1, U.Mian2. 1Glaucoma Services, Bronx Lebanon
Hospital Center, Bronx, NY; 2Ophthalmology, Montefiore Medical Center, Bronx,
NY.
Purpose: To estimate glaucoma prevalence in a native AfroColombian population.
Methods: The study was divided in two phases. The first phase was developed by two
optometrists who screened 977 individuals, in the AfroColombian community. Quibdo
is located in the Pacific Colombian region; it is underdeveloped with high indices of
illiteracy. The authors traveled to Quibdo and transported the equipment. Individuals
were recruited as volunteers. Evaluation included measuring the intraocular pressure
(IOP) and optic disc examination. Past medical, ocular and family history of glaucoma
was taken. Analysis of the first phase resulted in 320 glaucoma suspects (IOP above
21 mmHg, and/or optic disc with suspicious cupping) who were included in the
second phase. This was developed by two glaucoma specialists and two second year
ophthalmology residents. Evaluation included slit lamp exam, IOP measurement,
gonioscopy, optic disc evaluation, and ultrasound pachymetry. Frequency doubling
technology perimetry was performed in ocular hypertensives and, or individuals
with cupping ≥ 0.5. Results were analyzed with Excel and SPSS.
Results: Prevalence of glaucoma was estimated in 5.3%. Of the 320 individuals
evaluated in the second phase, demographics showed 66.6% females, and mean age
of 55 years. 16.3% were confirmed to be glaucomatous, 21.6% were glaucoma suspects
and 62.1% were non glaucomatous. The glaucoma suspects were classified as ocular
hypertensives 2.8%, and suspicious cupping 18.8%. The confirmed glaucoma group
had mean IOP of 25.3 mmHg (sd ± 10), mean pachymetry ± 505 μ (sd 34.5), and mean
optic disc cupping of 0.7 (sd ± 0.2). The ocular hypertensives had mean IOP of 27.2
(sd ±4.2), mean pachymetry 523.7µ (sd ± 33.6) and mean optic disc cupping of 0.3 (sd
±0.1). The suspicious cupping group had mean IOP of 15.1 mmHg (sd ± 15.5), mean
pachymetry 500.6µ (sd ± 38.6) and mean optic disc cupping of 0.6 (sd ± 0.1). Of the
320 individuals (640 eyes), gonioscopy was performed in 635 eyes, revealing open
angles (Shaffer grade II to IV) in 602 eyes (94.8%), anatomic narrow angle (appositional
angle closure) in 16 eyes (2.5%) and closed angles (synechial closure and or obstructed
chamber angle) in 33 eyes (5.2%).
Conclusions: Glaucoma has 5.3% prevalence in the afrocolombian population.
Blindness from glaucoma was found in 7 eyes (n=104, 6.7%) and 42 individuals (13.1%)
reported positive family history of glaucoma. The lack of health coverage makes it a
major public health concern in the country.
CR: S. Belalcazar, None; M.F. Delgado, None; H. Posso, None; G. Figueroa, None; A.
Gutiérrez, None; A. Rico, None; M. Gómez, None; M. Herrera, None.
Support: None
Purpose: The diagnosis of plateau iris is often reserved for young female patients
ages 30-50 years (Wang et al eMedicine 2005). Recently Kumar et al (AAO 2006)
presented a high prevalence of plateau iris among Asian primary angle closure
suspects. The purpose of this study is to determine the ultrasound biomicroscopic
prevalence of plateau iris configuration among Black and Hispanic primary angle
closure suspects.
Methods: Two glaucoma specialists, independently reviewed 120 sequential high
frequency anterior segment ultrasounds of angle closure suspects over 2 six month
periods. The observers were masked to the gonioscopic and clinical findings. Each
patient had one eye study consisting of a minimum of 8 quadrants performed in the
light and dark. Patients with a history of trauma were excluded. A total of 105 patients
were included in the analysis.
Results: In order to have plateau iris configuration, the observers had to agree on at
least 2 quadrants of anteriorization of the ciliary processes. Fifty eight of 105 (55.2%)
patients were noted to have plateau iris configuration. There were 81/105 (77.14% )
females. There were 66 Hispanics, 52 females and 14 males. Fifty five percent of the
Hispanic females (29/52) and 7/14 (50%) Hispanic males had plataeau iris configuration.
Of the Black patients, 24/33 (72.7) were female and 11/24 (45.8%) females and 6/9 (66%)
males had plateau iris configuration.
Conclusions: There is a high prevalence of plateau iris configuration among Black and
Hispanic angle closure suspects. The majority of these patients are female. Pupillary
block is generally a minimal component of plateau iris and iridotomy is not entirely
effective in relieving the closed angle configuration predisposing the patient to possible
angle closure glaucoma. Anterior segment ultrasound is useful in the identification
and diagnosis of plateau iris configuration. Identification of these patients necessitates
the addition of argon laser iridoplasty to iridotomy thereby minimizing the possibility
of angle closure glaucoma.
CR: A.A. Madu, None; A.E. Fleury, None; P. Channa, None; U. Mian, None.
Support: None
4349 - B930
Factors Associated With Poor Follow-Up Among Glaucoma Patients in South
India
4350 - B931
Pupillary Block in Peters’ Anomaly
T.Sagara1A, M.Kozawa1B, K.Ota1B, Y.Fujitsu1B, K.Suzuki1B, T.Nishida1B. AOcular
Pathophysiology, BOphthalmology, 1Yamaguchi University Graduate School of
Medicine, Ube City, Japan.
S.Parthasarathi1, B.W. Lee2, K.Singh2, R.K. John 3, A.L. Robin4. 1Glaucoma Service,
Aravind Eye Hospital, Coimbatore, India; 2Ophthalmology, Stanford University,
Stanford, CA; 3Delve Data Systems, Coimbatore, India; 4Ophthalmology, Johns
Hopkins University, Baltimore, MD.
Purpose: To determine the factors associated with poor follow-up among glaucoma patients
in South India.
Methods: This prospective case-control study enrolled 300 established patients with
primary glaucoma, including 150 who did and 150 who did not attend follow-up glaucoma
examinations (FGEs) as advised in the past year at Aravind Eye Hospital. Responses regarding
various factors hypothesized to be associated with follow-up compliance were collected by
oral questionnaire.
Results: The factors most associated with poor FGE attendance included: means-tested
waiving of clinic fees for low-income patients [Adj. OR--3.10, 0.91-10.50], lower perceived
importance of attending FGEs [Adj. OR--10.80, 4.40-26.50], and non-use of glaucoma
medications [Adj. OR--2.10, 1.10-4.00]. Notable factors not significantly associated with FGE
attendance included: severity of disease, convenience of travel, direct and indirect costs
associated with attending FGEs, and self-reported difficulty attending FGEs.
Conclusions: Despite the waiving of clinic fees, low-income status is still associated with
poor follow-up. Many factors traditionally believed to influence follow-up, such as travel to
clinic and severity of disease, were found to have little to no effect in this study. This research
suggests that efforts to improve patient attendance of FGEs should focus on improving
patients’ knowledge and perceptions about the importance of attending regular FGEs,
since even marginal differences in patients’ perceived importance of follow-up (“somewhat
important” vs. “very important”) were associated with significant differences in FGE
attendance. Administering short questionnaires that elicit factors associated with poor
follow-up may be a valuable means of identifying patients at greater risk for poor followup. These patients can then be counseled, educated, and treated appropriately in order to
minimize disease progression and unnecessary glaucoma-induced vision loss.
Purpose: In Peters’ anomaly, the anterior chamber angle is usually grossly normal
even if the adhesion of the central corneal defect to the iris is severe. We now present
a rare case of Peters’ anomaly with a flattened anterior chamber caused by pupillary
block.
Methods/Results: A 2-month-old infant presented with corneal leukoma in his right
eye. Synechiae extending from the central iris to the periphery of the corneal opacity
were apparent and the anterior chamber was flat. No abnormalities of the vitreous
cavity or retina were detected by ultrasonography in the B-scan mode. The patient
was thus diagnosed with unilateral Peters’ anomaly. Intraocular pressure (IOP) of his
right eye was 31 mmHg under general anesthesia. We attempted to form the anterior
chamber by injection of balanced salt solution and trabeculotomy. Minimal formation
of the anterior chamber was achieved and the iris root unexpectedly prolapsed through
the ruptured trabeculum. The prolapsed iris was excised. Five days after surgery, IOP
was 10 mmHg and a shallow anterior chamber was detected in the inferior portion
of the right eye. After 2 months, IOP was 11 mmHg and the anterior chamber was
deepening in all quadrants.
Conclusions: Given that the anterior chamber formed after peripheral iridectomy,
pupillary block was the likely cause of the flat chamber in the patient. As far as we
are aware, this is the first report of Peters’ anomaly with pupillary block.
CR: T. Sagara, None; M. Kozawa, None; K. Ota, None; Y. Fujitsu, None; K. Suzuki,
None; T. Nishida, None.
Support: None
Factors Associated with Poor Attendance of FGEs
Variable
Payment Status (Non-Paying vs.
Paying)
Education Level (Illiterate vs.
Literate)
Perceived Importance of Attending
FGEs (Somewhat Important vs. Very
Important)
Use of Glaucoma Medications (Nonuse vs. Use)
Adjusted OR for Poor FGE Attendance
Unadjusted OR for Poor
(95% CI) *Multivariate Logistic Regression,
FGE Attendance (95% CI)
Stepwise Method
4.67 (1.53-14.22)
3.10 (0.91-10.50)
3.50 (1.64-7.45)
2.40 (1.00-5.50)
13.11 (5.43-31.70)
10.80 (4.40-26.50)
2.61 (1.45-4.71)
2.10 (1.10-4.00)
CR: S. Parthasarathi, None; B.W. Lee, None; K. Singh, None; R.K. John, None; A.L. Robin,
None.
Support: Stanford Medical Scholars Research Program
4347-4350
4351 - B932
Comparative Study of Pneumotonometer, Goldmann Tonometer, and I-Care
Tonometer After PRK
6044 - B910A
Prevalence and Risk Factors of Pseudoexfoliation in Latinos: The Los Angeles
Latino Eye Study (LALES)
M.Malloci, G.Cappai, I.Zucca, M.Galantuomo, M.Lepuri, M.Fossarello. University Eye
Clinic of Cagliari, Cagliari, Italy.
E.Aghaian, M.-Y.Lai, S.Azen, R.Varma, Los Angeles Latino Eye Study Group.
Ophthalmology, Doheny Eye Institute, Los Angeles, CA.
Purpose: To compare intraocular pressure (IOP) measurements with noncontact
pneumotonometer, Goldmann applanation tonometer, and I-care tonometer in myopic
eyes treated with excimer laser Photorefractive Keratectomy (PRK).
Methods: IOP was measured with noncontact pneumotonometer, Goldmann tonometer
and I-care tonometer in random order in 23 eyes before and after PRK surgery. Central
corneal thickness (CCT) was measured using an ultrasonic pachymeter after all IOP
determinations had been made. Right and left eyes were analyzed separately for
statistical purposes.
Results: IOP values obtained before surgery were significantly similar with all 3
instruments. After surgery, IOP values resulted significantly lower,, and appeared
related to changes in CCT values. A mean decrease in IOP of 0.4 mm Hg/10 µm of
CCT was observed with the pneumotonometer, a mean decraseof 0.6 mm Hg/10 µm
of CCT with the Goldmann tonometer, and of 0.10 mm Hg/10 µm of CCT with the
I- care tonometer.
Conclusions: Corneal changes after myopic PRK may induce an underestimation of
the IOP imeasurements. The tonometry with I-care was least affected by PRK corneal
changes. Stromal thinning after refractive surgery may represent one possible factor
among others. The ablation of Bowman’s layer may modify corneal elastic properties,
independently from CCT.
CR: M. Malloci, None; G. Cappai, None; I. Zucca, None; M. Galantuomo, None; M.
Lepuri, None; M. Fossarello, None.
Support: None
Purpose: To determine the prevalence and risk factors for Pseudoexfoliation (PXF)
in a population-based sample of Latinos 40 years and older.
Methods: The study cohort consisted of all self-identified Latinos of primarily Mexican
ancestry 40 years and older residing in 6 census tracts in La Puente, California. From
the total of 6357 participants, 5922 subjects underwent a complete ophthalmologic
examination, including visual acuity testing, slit lamp examination, applanation
tonometry, gonioscopy, and dilated examination of the lens, fundus, and optic disc.
A participant was diagnosed with PXF if s/he had typical white deposits on the
anterior lens surface, pupillary margin of the iris, corneal endothelium, and trabecular
meshwork in at least one eye. Frequency distributions and multiple linear regression
models were used to determine prevalence and risk factors associated with PXF.
Results: Of the 5922 participants, 26 persons (0.44%) had PXF. There was a significant
increase in prevalence with age (0% in 40-49 yr, 0.11% in 50-59yr., 0.52% in 60-69yr.,
2.89% in 70+ yr. old age groups; P<.0001). The prevalence was similar in men (0.45%)
and women (0.43%) (p=0.95). 61.5% of the participants with PXF had unilateral signs
of PXF. Compared to participants without PXF, those with PXF had a significantly
higher prevalence of ocular hypertension (intraocular pressure - IOP >21 mmHg)
(15.4% vs. 3.2%), and mean IOP was higher in participants with PXF than those without
PXF (16.8 mmHg vs. 14.5 mmHg). The Odds Ratios (OR, 95% confidence interval) for
having ocular hypertension after adjusting for age was 3.77 (1.23-11.51, p=0.02). 19%
(5/26) of persons with PXF had glaucomatous optic nerve damage (GOND). While the
unadjusted OR for having GOND was significant (6.34, 2.32-17.32), after adjusting for
age, this was no longer significant (2.02, 0.72-5.69).
Conclusions: The prevalence of PXF varies in different populations ranging from
0% in Eskimos to 38% in Navajo Indians. This is the first study conducted in a Latino
population to examine the prevalence of PXF. Despite a low overall prevalence, the
prevalence of PXF markedly increases with age. Given the higher prevalence of
ocular hypertension and higher mean IOPs, it is likely that Latinos with PXF are
at a higher risk of developing GOND compared to those without PXF. However
our data were unable to substantiate this possibly due to the small sample size of
participants with PXF.
CR: E. Aghaian, None; M. Lai, None; S. Azen, None; R. Varma, None.
Support: NEI EY 11753, RPB
4351, 6044
Wednesday, May 9, 3:00 PM - 4:45 PM Hall B/C Poster Session Program Number/Board # Range: 4826-4853 / B1039-B1066
479. Epidemiology of Pediatric Eye Diseases II Organizing Section: CL Contributing Section: EY, PH
4826 - B1039
Retinal Changes in Amblyopia. An OCT Study
S.C. Huynh1A, X.Y. Wang2, F.Martin1B, E.Rochtchina1A, P.Mitchell1A, Sydney Myopia
Study, Sydney Childhood Eye Study. AOphthalmology (Centre for Vision Research,
Westmead Millenium Institute, Westmead Hospital), BOphthalmology (The
Children’s Hospital at Westmead), 1University of Sydney, Sydney, Australia; 2School
of Optometry (Vision Cooperative Research Centre), University of New South
Wales, Sydney, Australia.
Purpose: To examine macular and peripapillary nerve fiber layer (NFL) thickness in
amblyopia.
Methods: The Sydney Childhood Eye Study is a population-based study of children’s
eye health. Participants included 4118 (76.5%) of 5382 eligible children recruited from a
random cluster sample of 34 primary schools and 21 high schools in the metropolitan area
of Sydney, Australia, respectively. Examinations were conducted during 2003-05. Among
the 3529 children (85.7%) in this report, the median ages of the two cohorts were 6 years
(n=1395) and 12 years (n=2134). Comprehensive examinations included determination of
best visual acuity (BVA), cycloplegic autorefraction, cover testing to identify strabismus
and optical coherence tomography (StratusOCT, Carl Zeiss). Amblyopia was defined as
BVA<0.3 logarithm of the minimum angle of resolution units not explained by underlying
eye or visual pathway abnormalities. Analyses compared macular and peripapillary
NFL thickness in amblyopic and non-amblyopic eyes, adjusting for confounders where
appropriate.
Results: The foveal minimum thickness was greater (by 5.0µm, p<0.05) in amblyopic eyes
compared to the normal fellow eye and compared to right eyes of non-amblyopic children
(by 12.1µm, p<0.05), adjusted for age, gender, height, ethnicity, axial length and cluster
sampling. Amblyopic eyes also had thicker central maculae (1-mm diameter region) in
both comparisons, although these differences were not statistically significant. The inner
macular ring (outer radius 1.5mm) was thinner in amblyopic than in normal fellow eyes.
Children who had untreated unilateral amblyopia had a significantly increased (p<0.05)
inter-ocular difference in central macular thickness than those who previously received
treatment. Peripapillary NFL thickness was not significantly different between amblyopic
and normal fellow eyes or normal eyes of non-amblyopic children.
Conclusions: Central macular thickness may be increased in amblyopia and this outcome
may be reversed with treatment. It is not certain, however, if the observed increase in
macular thickness precedes or follows the development of amblyopia. Further studies are
needed, given the previous postulate of a cortical or lateral geniculate site for amblyopia
No differences in peripapillary NFL thickness were found in amblyoipic compared to
normal eyes.
CR: S.C. Huynh, None; X.Y. Wang, None; F. Martin, None; E. Rochtchina, None; P.
Mitchell, None.
Support: Australian NH&MRC Grant 253732
4827 - B1040
ATS HOTV Visual Acuity Test Results in African-American and Hispanic
Children: The Multi-Ethnic Pediatric Eye Disease Study
K.Tarczy-Hornoch, Y.Wang, S.A. Cotter, M.S. Borchert, S.P. Azen, R.Varma, MultiEthnic Pediatric Eye Disease Study Group. Ophthalmology, University of Southern
California, Los Angeles, CA.
Purpose: To describe age-, gender- and ehtnicity-specific Amblyopia Treatment Study
(ATS) HOTV test results using the Electronic Visual Acuity (VA) Tester in AfricanAmerican and Hispanic children 30 to 72 months of age without visually significant
clinical abnormalities or refractive error.
Methods: A population-based cohort of children 30-72 mos. of age underwent ATS
HOTV testing, right eye (RE) first. All children had a full clinical examination with
refraction (cycloplegic in >97% of children). We report presenting RE VA in children
without glasses (>99% of children), and without ≥3D RE spherical equivalent (SE)
hyperopia, ≥0.5D RE SE myopia, ≥1D RE astigmatism, ≥1D SE anisohyperopia, ≥3D SE
anisomyopia, ≥1.5D anisoastigmatism, strabismus, visual axis occlusion, nystagmus,
or anterior segment or fundus abnormalities affecting vision. Proportions of children
with VA 20/40 or better, and mean logMAR VA for different age groups, genders and
ethnicities were evaluated using chi-square analysis and the t-test.
Results: 1210 Hispanic and 1087 African-American children had HOTV testing (86%
successful). VA was 20/40 or better in 77%, 93%, >99% and >99% of testable children
30-36 mos., 37-48 mos., 49-60 mos., and 61-72 mos. of age, respectively. There was
significant improvement in test results with age (p<0.0001, trend test). There were
no gender- or ethnicity-related differences in the proportion of children with VA
20/40 or better at any age, or overall after adjusting for age (p=0.86 for gender; p=0.55
for ethnicity). Mean (s.d.) logMAR VA values were 0.25 (0.15), 0.17 (0.14), 0.08 (0.10)
and 0.02 (0.09) for children 30-36 mos., 37-48 mos., 49-60 mos. and 61-72 mos. of age,
respectively. Mean VA did not differ between ethnicities in any age group (p≥0.12).
Mean VA was better in males (0.07) than females (0.09) at 49-60 mos. of age (p=0.004),
but not at other ages (p≥0.35).
Conclusions: Preschool ATS HOTV test results are better in older children than
younger children. This is likely to be related to cognitive maturation. By 4 years of
age, virtually all children without clinical abnormalities or refractive error likely to
affect vision, achieve 20/40 or better when first tested.
CR: K. Tarczy-Hornoch, None; Y. Wang, None; S.A. Cotter, None; M.S. Borchert,
None; S.P. Azen, None; R. Varma, None.
Support: EY014472
4828 - B1041
Randot Preschool Stereoacuity Test Results in African-American and Hispanic
4829 - B1042
Longitudinal Measures of Intraocular Pressure and Axial Length in a Subgroup
of Children in the Correction of Myopia Evaluation Trial (COMET)
M.S. Borchert, K.Tarczy-Hornoch, Y.Wang, S.A. Cotter, S.P. Azen, R.Varma, MultiEthnic Pediatric Eye Disease Study. Department of Ophthalmology, USC School of
Medicine, Los Angeles, CA.
L.Deng1, R.Manny2, C.Crossnoe3, J.Gwiazda1. 1Vision Science, New England College
of Optometry, Boston, MA; 2University of Houston College of Optometry, Houston,
TX; 3No Affiliation, Lubbock, TX.
Purpose: To describe age-specific Randot Preschool Stereoacuity test performance in
African-American and Hispanic children 30 to 72 months of age.
Methods: A population-based cohort of children 30-72 mos. of age underwent Randot
Preschool Stereoacuity testing prior to any cover testing or visual acuity testing. All
children had a full clinical examination including determination of refractive error,
strabismus and amblyopia. Proportions of children with stereoacuity 60 arc-seconds
or better for different age groups, genders and ethnicities were evaluated using chisquare analysis.
Results: Of 3363 Hispanic and African-American children, 80% were able to perform
stereoacuity testing, and received a score between 800 and 40 arc-seconds, or “no
stereopsis”. Scores of “no stereopsis” were obtained in 11%, 11%, 5% and 3% of testable
children 30-36 mos., 37-48 mos., 49-60 mos., and 61-72 mos. of age, respectively. The
modal scores were 200 arc-seconds, 60 arc-seconds, 60 arc-seconds, and 40 arcseconds in testable children 30-36 mos., 37-48 mos., 49-60 mos., and 61-72 mos. of age,
respectively. Stereoacuity was 60 arc-seconds or better in 15%, 31%, 50% and 66% of
testable children 30-36 mos., 37-48 mos., 49-60 mos., and 61-72 mos. of age, respectively.
There was significant improvement in performance with age (p<0.0001, trend test).
The proportion of African-American children 30-36 mos. of age with 60 arc-seconds or
better (21%) was higher than that for Hispanic children (9%) (p=0.02), but there were
no ethnicity-related differences in any other age category (p>=0.35), or overall after
adjusting for age (p=0.47). There were no gender related differences after adjusting
for age (p=0.06). There were no significant changes in the stereopsis scores for any
age group after excluding 150 children with strabismus or amblyopia.
Conclusions: Randot Preschool Stereoacuity test performance improves with age.
By 5 years of age, two thirds of testable children demonstrate stereoacuity of 60
arc-seconds or better. There are no consistent gender or ethnicity related differences
in stereoacuity measurements in this age group. Poor stereoacuity scores in young
children are not necessarily indicative of subnormal binocular vision.
CR: M.S. Borchert, None; K. Tarczy-Hornoch, None; Y. Wang, None; S.A. Cotter,
None; S.P. Azen, None; R. Varma, None.
Purpose: To investigate the association between intraocular pressure (IOP) and axial
length (AL) over five years in a subgroup of children enrolled in COMET.
Methods: IOP (Tonopen), AL by A-scan ultrasonography (Sonomed) and refractive
error by cycloplegic autorefraction (Nidak) in the right eye were measured at baseline
and over the next 5 years in 104/118 myopic children in COMET at the Houston site.
ANOVA was used to compare AL change over 5 years across 4 ethnicity groups.
Regression analyses studied the association between IOP and AL change over the
5-year follow-up.
Results: At baseline mean AL was 24.1mm+/-0.643 and mean refractive error was
-2.34D +/- 0.88. Mean AL increased 0.99mm+/-0.50 over five years. African-Americans
had significantly less increase in AL (n=17, 0.78 mm+/-0.43) than Whites (n=25,
1.10mm+/-0.52, p-value<0.05) but not Asians (n=7, 0.94mm +/-0.52) or Hispanics
(n=50, 1.00mm +/-0.51). Baseline IOP was 15.918mmHg and it decreased 0.149mmHg
over 5 years. IOP, averaged over the 6 visits, was 15.787 mmHg +/-2.82. The average
IOP of African-Americans (17.88 mmHg) was higher than that of Hispanics (15.77
mmHg, p = 0.006) and Whites (14.51 mmHg, p = 0.001), but not Asians (16.26 mmHg).
There was no significant association between IOP at baseline and AL change, and
no significant association between IOP change and AL change over five years when
examined either as continuous or categorical variables. There was a strong correlation
between axial elongation and myopia progression over five years (r=-0.89). Because
of this high correlation there was also no significant association between IOP and
refractive error change.
Conclusions: Small but significant ethnic differences were noted in the IOP of myopic
children. Small but significant ethnic differences were also found in axial elongation.
With the highest IOP, African-Americans had the least AL change over 5 years. The
absence of an association between IOP and myopia progression does not support
theories linking these two factors.
CR: L. Deng, None; R. Manny, None; C. Crossnoe, None; J. Gwiazda, None.
Support: National Eye Institute Grants: 5U10 EY11740, EY11756, EY11805,
EY014817 CT: www.clinicaltrials.gov, NCT00000113
4826-4829
4830 - B1043
The Accuracy of Pediatric Intraocular Lens Calculations Using the SRK II
Formula
4831 - B1044
Age-, Gender- and Ethnicity-Related Differences in Axial Length in Preschool
A.M. Cottrell, L.Levine. Ophthalmology, University of Florida, Gainesville, FL.
A.W. Foong, A.DiLauro, Y.Wang, S.A. Cotter, K.Tarczy-Hornoch, M.S. Borchert, S.P.
Azen, R.Varma, MEPEDS Group. Ophthalmology, University of Southern California,
Los Angeles, CA.
Purpose To determine the the accuracy of the SRK II formula in pediatric
cataract surgery at our institution, and identify methods to improve
refractive outcomes in pediatric patients. Current data indicates that a wide
range of predictive error is possible regardless of which formula is used.
Methods The measured outcome is the absolute difference between the predicted and the
actual postoperative spherical equivalent (prediction error). The strength of this association
is measured by the Pearson correlation coefficient. All measurements and surgeries
were performed by one surgeon from 1998-present and include patients ages 1-15 (n=21).
Results The SRK II formula tends to predict a more hyperopic spherical equivalent with
a Pearson correlation coefficient of 0.73 (p = 0.0001). The mean prediction error is 1.14D.
There is no significant correlation between prediction error and axial length (-0.057, p =
0.806), or between patients under and over age 5 (prediction error 1.35 vs. 1.01, p = 0.40)
Conclusions According to the major published studies to date, no formula demonstrates
accuracy in children comparable to that seen in adults. Our data shows that the SRK II
formula provides predictable postoperative outcomes, and the prediction error is not
solely dependent on axial length or age alone. There are multiple factors leading to
prediction error in children, including a smaller anterior chamber depth and a larger
lens relative to intraocular volume. The use of the SRK II formula at our institution is
justified based on low overall prediction error. Refractive outcomes can be improved
for many patients by adjusting intraocular lens power to account for this hyperopic
prediction error.
CR: A.M. Cottrell, None; L. Levine, None.
Support: None
4832 - B1045
Reproducibility and Effects of Refraction on Optical Coherence Tomography
Measurements in Children
Purpose: To characterize age-, gender-, and ethnicity-related differences in axial length
(AL) in African-American and Hispanic children 30 to 72 months of age.
Methods: The Multi-Ethnic Pediatric Eye Disease Study (MEPEDS) is a populationbased study of eye disease in children aged 6-72 months. Participants 30-72 months old
undergo AL testing with the Zeiss IOLMaster as part of their clinical examination. A
minimum of two measurements is obtained for each eye and the mean AL is recorded.
Right and left eye correlation was determined using the Pearson correlation coefficient.
Differences in AL between groups of age, gender, and ethnicity were examined using
the two-sample t-test and the ANOVA procedure. AL values adjusted for age, gender,
and ethnicity were evaluated using the general linear model.
Results: AL measurements in both eyes were obtained from 3065 children (53%
Hispanic and 47% African American; 49% males and 51% females) aged 30-72 months.
There were 460, 831, 922, and 852 children in age groups of 30-36, 37-48, 49-60, and
61-72 months, respectively. There was no significant difference in AL between right
and left eyes (R=0.97, p<0.0001), hence analysis was performed using right eye data
only. The mean ± SD AL measurements increased with age: 30-36 months (21.63 ±
0.70mm), 37-48 months (21.85 ± 0.74 mm), 49-60 months (22.11 ± 0.73 mm), and 61-72
months (22.35 ± 0.78 mm). AL differed significantly by gender (males, 22.28 ± 0.76 mm;
females, 21.80 ± 0.74 mm; p<0.001) and ethnicity (Hispanic, 22.07 ± 0.77 mm; AfricanAmericans, 22.00 ± 0.80 mm; p=0.03). AL also differed significant between all groups
(p<0.0001, one-way ANOVA). Male gender was associated with a 0.48 mm increase
in AL (p<0.0001, adjusting for age and ethnicity). Also, AL increased by 0.27 mm for
every 12 month increase in age (p<0.0001, adjusting for gender and ethnicity).
Conclusions: Our data show that AL increases steadily with age from 30-72 months.
Gender- and ethnicity-related differences in AL deserve further exploration to
determine the underlying mechanisms and the clinical significance of differing AL
within these groups.
CR: A.W. Foong, None; A. DiLauro, None; Y. Wang, None; S.A. Cotter, None; K.
Tarczy-Hornoch, None; M.S. Borchert, None; S.P. Azen, None; R. Varma, None.
4833 - B1046
Eye Care in a Large Population of Children Aged 3-7 Years
X.Wang1,2, S.Huynh1, G.Burlutsky1, F.Stapleton2, P.Mitchell1, Sydney Childhood Eye
Study. 1Ophthalmology (Centre for Vision Research, Westmead Millennium
Institute, Westmead Hospital), University of Sydney, Sydney, Australia; 2Vision
Cooperative Research Centre, University of New South Wales, Sydney, Australia.
Purpose: To determine the reproducibility of optical coherence tomography (OCT)
measurements of macular, nerve fiber layer (NFL) and optic disc parameters, and to
investigate the influences of axial length and refraction on these measurements in
children with healthy eyes.
Methods: The Sydney Childhood Eye Study is a population-based survey of 2353 Year
7 students (75.3% response) from a random cluster-sample of 21 secondary schools
across Sydney. A consecutive sub-sample of 120 children had OCT (StratusOCT, Carl
Zeiss, CA) performed by a single operator, which was repeated with a brief rest between
the two sessions. Scans of the macula, NFL and optic disc were performed.
Results: The mean age, refractive error and axial length of the children was 13.3 yrs,
-0.06D and 23.36 mm, respectively. The inter-session intra-class correlation coefficients
(ICC) for measurements of macular, NFL and disc parameters were small. Among all
macular parameters, foveal minimum thickness was the least reproducible measure
and also had the highest intra-session variability (ICC 14.4%) and coefficient of
variation (CoV, 4.1% & 3.4%). Among NFL parameters, nasal quadrant measures
were the least reproducible with relatively high intra-session ICC & CoV (5.9% &
7.2%). The reproducibility of optic disc measures was similar to NFL measures except
for horizontal & vertical disc diameters, which showed low inter-subject ICC (48.4%
& 38.6%, respectively) and high CoV (7.6% & 10.1%, respectively). There was strong
agreement (correlation coefficients >0.7, p<0.0001) between measurements performed
either with or without axial length and refraction data entered for all 3 comparisons.
Absolute differences in measurements of macular parameters were not significantly
different between scans performed with or without ocular biometric data entered.
For NFL thickness measurements, mean differences in nasal and temporal quadrants
were significant when the refractive error was entered into the instrument. There
was no significant difference whether either axial length or both axial length and
refraction were entered.
Conclusions: The StratusOCT demonstrated quite reproducible measurements
of macular and NFL thickness. Optic disc parameters, however, showed lower
repeatability. Magnification due to axial length and refractive error had minimal
impact on the measurements of macular and NFL thickness.
CR: X. Wang, None; S. Huynh, None; G. Burlutsky, None; F. Stapleton, None; P.
Mitchell, None.
Support: None
W.L. Marsh-Tootle1A, J.S. Tootle1A, T.C. Wall1B, R.Kristofco1C, S.Person1D. ASchool
of Optometry, BSchool of Medicine Department of Pediatrics, CDepartment of
Continuing Medical Education, DDepartment of Medicine, 1UAB, Birmingham, AL.
Purpose: To evaluate delivery of eye care services in a population of low-income
children aged 3-7 years who have insurance for eye care and glasses.
Methods: Using claims filed with Alabama Medicaid during fiscal year 2003, we
determined rates of well-child checks (WCCs) and receipt of services from eye
specialists. We also determined the percentage of children at each age studied with
a diagnosis of strabismus or amblyopia, or with a claim for glasses.
Results: Of 134,568 enrolled children aged 3-7 years, 55,706 had a WCC. The proportion
of children seeing an eye specialist was 15% in the group with a WCC and 11% in
the group without (p< 0.001). The percentage of enrolled children examined by eye
specialists increased steadily with age from 7% at age 3 years to 20% at age 7 years.
Claims for glasses were filed for 2% of enrolled children aged 3 years, 3% aged 4 yrs,
6% aged 5 yrs, 10% aged 6 yrs, and 13% aged 7 yrs. Of children with claims for eye
services, the proportion examined by optometrists increased with each year of age
from 49% at age 3 years, 58% at age 4 years, 70% at age 5 years, 75% at age 6 years, and
78% at age 7 years. The percentage of enrolled children with a diagnosis of strabismus
or amblyopia was 1.2% at age 3 and 4 years, 1.6% at age 5 and 6 years, and 1.4% at age
7 years. Refractive diagnoses were most common (48% of all codes filed).
Conclusions: After age 3 years, optometrists provide the majority of services to
children in the population we studied. Rates of reporting diagnoses of strabismus or
amblyopia are less then the expected prevalence.
CR: W.L. Marsh-Tootle, None; J.S. Tootle, None; T.C. Wall, None; R. Kristofco,
None; S. Person, None.
Support: NIH Grant R01 EY015893
4830-4833
4834 - B1047
Assessment of Pediatric Residents: Beyond Simply Looking for a Red Reflex
J.A. Sokol, M.E. Keshet, M.B. Hymowitz, H.M. Engel. Ophthalmology, Albert Einstein
College of Medicine (AECOM)/Montefiore Medical Center (MMC), Bronx, NY.
Purpose: To assess the ophthalmic knowledge and skills among pediatric residents.
Published studies have shown there is lack of ophthalmology education in medical
school curricula which has led to a gap in the knowledge base and skills among
medical graduates. Currently, the managed healthcare system now places a larger
responsibility on primary care physicians to diagnose and treat medical conditions
that would otherwise be treated by specialists. Our goal was to identify weaknesses
among pediatric residents and to create a customized curriculum to enhance their
ophthalmic education and strengthen their skills and confidence.
Methods: A survey was administered to 69 pediatric residents (Postgraduate Year
1 - 3) at The Children’s Hospital at Montefiore (CHAM), Bronx NY, to evaluate their
fund of knowledge and examination skills. There were 13 knowledge questions,
covering pediatric topics such as nasal lacrimal duct obstruction (NLD), amblyopia,
eye turn, and cataracts. There were 5 skills questions evaluating pediatric residents’
comfort with the basic eye examination including using the direct ophthalmoscope,
performing the cover/uncover test, reading CT scans and MRIs, and identifying
various eye conditions. The survey was administered during the weekly pediatric
conferences at CHAM with the understanding that a curriculum would be created
to further CHAM pediatric residents education. Individuals were excluded if they
were not CHAM pediatric residents.
Results: When evaluating all residents’ ability to identify features of certain eye
conditions, the following were answered correctly: amblyopia (64%), congenital
cataracts (55%), congenital glaucoma (79%), infectious conjunctivitis (91%), corneal
abrasion (45%), neonatal conjunctivitis (52%), NLD (76%), orbital cellulitis (76%),
orbital neoplasm (91%), red reflex (76%), retinopathy of prematurity (88%), shaken
baby syndrome (39%), strabismus (52%). When assessing residents comfort level
with the ophthalmic exam skills, they were not very or not comfortable at all in the
following categories: cover/uncover test (42%), reviewing orbital CT/MRI (82%), fundus
exam (57%), direct ophthalmoscopy (48%). All residents surveyed were somewhat or
very comfortable with the red reflex exam. There was insufficient data to compare
knowledge and skills between postgraduate levels.
Conclusions: CHAM pediatric residents demonstrate deficiencies in both ophthalmic
knowledge and comfort in clinical skills. Further steps need to be taken to improve
the education of these primary care physicians.
CR: J.A. Sokol, None; M.E. Keshet, None; M.B. Hymowitz, None; H.M. Engel,
None.
Support: None
4836 - B1049
Evaluation of a Pilot Project to Screen Children’s Vision in Nicaragua
M.Frazier1, P.S. W. Fuhr1,2, W.L. Marsh-Tootle1. 1Optometry, University of Alabama at
Birmingham, Birmingham, AL; 2Optometry, Birmingham Dept. of Veterans Affairs
Medical Center, Birmigham, AL.
Purpose: The purpose of this study was to evaluate visual acuity screening
administered by local teachers and nurses in Nicaragua.
Methods: Local teachers and nurses were trained by experts to screen young children
using a standard protocol and testing at 5 feet with a booklet containing 12 Lea
symbols. Each page had a single, 20/40 symbol surrounded by bars separated by one
half the target width. Fail criterion was two or more incorrect answers per binocular
or monocular assessment. Optometrists, who were masked to the screening result,
performed a standardized examination with cycloplegia on a selected sample of
365 children that included both screening passes and fails. Diagnostic fails were
determined by the doctor’s decision to treat or monitor the child’s condition.
Results: Children were in pre-school to second grade (aged 3 to 9 years). Of the
5,673 children who were screened, 350 (6.17%) failed the screening. The sample of
children examined included 211 screening passes and 154 fails. Sensitivity was 77%,
and specificity was 66%. Specificity was reduced by a high false positive rate (28%)
consistent with a low positive predictive value (34%). The false negative rate (4%) was
consistent with a high negative predictive value (94%).
Conclusions: The false positive rate of this protocol, as implemented by local teachers
and nurses, was unexpectedly high and unacceptable. Efforts to decrease over-referrals
may include further training and evaluation of screeners and /or implementing
a second screening by a supervisor prior to recommending eye examinations. On
the other hand, the false negative rate was low, and continued efforts to improve
this program are essential to provide necessary eye care to children in this poverty
stricken nation with limited manpower and resources. Other, more costly screening
methods would not be feasible.
CR: M. Frazier, None; P.S.W. Fuhr, None; W.L. Marsh-Tootle, None.
Support: None
4835 - B1048
The Economics of Pediatric Eye/Vision Screening: Calculating the CostEffectiveness of a Large-Scale Preschool Vision Screening Program
R.J. Adams1, J.R. Drover2, P.G. Kean3, M.L. Courage1. 1Psychology/Pediatrics, Science/
Medicine, Memorial University, St John’’s, NF, Canada; 2Retina Foundation of the
Southwest, Dallas, TX; 3Private Practice Optometrist, St John’s, NF, Canada.
Purpose: Because of the plasticity of the developing visual system, early eye and
vision screening has been advocated for preventing long term visual pathology,
notably amblyopia. However, there is substantial debate over the effectiveness and
the economics of vision screening in preschool children. Many screening tools are
ineffective, and/or it is perceived that the cost of screening exceeds the expected
benefits of early treatment. Here, we report on the development of a new comprehensive
battery of screening tests and provide an economic analysis of the effectiveness of
various test combinations
Methods: 946 Canadian preschool children (n = 946) were screened with an extensive
battery of the latest pediatric tests of visual acuity, refractive error (Welch Allyn
SureSight), contrast sensitivity, stereoacuity, and ocular alignment/motility. A child
who failed any test was reexamined with the entire battery, and if s/he again failed
any test, was then referred (n = 152) for a gold standard optometric exam. Based on the
exam, we calculated measures of clinical effectiveness/validity (sensitivity, specificity
positive/negative predictive value) for each possible combination of tests. The 10
most accurate combinations (validity > 85%) were then submitted for analysis of cost
effectiveness. Included in this analysis were the “real” monetary amounts required
to fund all components of the screening program, including labor, transportation,
equipment, materials, and professional fees.
Results: Based on the model of Konig et al (Strabismus, 2000), cost effectiveness
ratios (CER) were calculated for each combination’s ability to identify a child with
a previously undetected vision disorder. For the 10 combinations, CER ranged from
$ 175 to $ 313 (CAN) per detected child (2006: $1 CAN = $0.88 US). In general, 3-test
combinations were most cost effective ($205 CAN per detected child). Autorefraction
and ocular alignment/motility were always included in the most accurate and the
most economical combinations
Conclusions: Our data suggest that given the significant medical, social, educational,
and rehabilitative costs of failing to detect early visual pathology, the cost ($250
CAN) per previously undiagnosed child is relatively inexpensive. However, it must
be emphasized that cost effectiveness depends critically upon the inclusion of valid
pediatric tests which evaluate different dimensions of vision.
CR: R.J. Adams, None; J.R. Drover, None; P.G. Kean, None; M.L. Courage, None.
Support: NSERC (Canada), Janeway Hospital Research Foundation
4837 - B1050
Correlation of Visual Disorders and Brain MRI Findings in Premature Cerebral
Palsied Children
D.Kokkinou1, A.Vardarinos1, N.Kozeis1, A.Felekidis1, S.Lake2A, N.Georgiadis2B. 1Eye
Department, Ippokration General Hospital, Thessaloniki, Greece; A3rd University
Eye Department, B1st University Eye Department, 2AHEPA University Hospital,
Thessaloniki, Greece.
Purpose: A high percentage of very premature babies suffer from cerebral palsy.
Many of them suffer multiple disabilities. In order to investigate a possible correlation
of visual disorders and certain types of brain damage in premature cerebral palsied
(CP) children, this study was set up.
Methods: 51 premature CP children (GA<32 weeks, BW<1500 g) participated in
this study. Gross motor functional classification system (GMFCS), brain magnetic
resonance imaging (MRI) and visual resolution assessment using the visual functional
assessment - K test was performed. Babies with epilepsy and severe eye operations
were excluded.
Results: The brain MRI showed that the majority of the children (40) appeared with
mild to severe periventricular leukomalacia (PVL); GMFCS showed variability in
kinetic severity, while the visual testing showed that only 14 children appeared with
visual resolution within normal limits.
Conclusions: Children with mild to moderate disability appeared with better visual
level, instead of those with severe to very severe disability whose visual level was
significantly reduced. It was also found that children with moderate PVL scored better
than those with either severe PVL or combined PVL and cortical atrophy.
CR: D. Kokkinou, None; A. Vardarinos, None; N. Kozeis, None; A. Felekidis,
None; S. Lake, None; N. Georgiadis, None.
Support: None
4834-4837
4838 - B1051
Brain MRI Findings vs. Visual Disorders in Full Term Babies With Perinatal
Asphyxia
4839 - B1052
Ocular Findings in Arthrogryposis Congenita
E.E. Obi, P.Watts. Ophthalmology, University Hospital of Wales, Cardiff, United
Kingdom.
A.Felekidis1, N.Kozeis1, P.Stergiopoulos1, S.Lake2, D.Kokkinou1. 1Eye Department,
Ippokration General Hospital, Thessaloniki, Greece; 23rd University Eye
Department, AHEPA University Hospital, Thessaloniki, Greece.
Purpose: Visual function is commonly affected in cerebral palsied children. Various
visual parameters have been investigated already. This study was organized in order
to investigate the visual disorders in full term cerebral palsied (CP) children, who
suffered perinatal asphyxia and their correlation to certain types of brain damage.
Methods: 29 children were included in this study. Gross Motor Functional classification
System (GMFCS), brain magnetic resonance imaging (MRI) and an eye testing by
Visual Functional Assessment - K test were performed. Children with epilepsy or
severe previous eye operations were excluded.
Results: The brain MRI showed that the majority of the children suffered moderate
to severe periventricular leucomalacia (PVL) and combined PVL with atrophy;
GMFCS showed that the majority suffered moderate to very severe kinetic disability.
Interestingly, 50% of the children appeared with visual resolution within normal
limits.
Conclusions: Children with mild to moderate disability appeared with better visual
level, compared to those with severe to very severe disability whose visual level was
significantly reduced. Children with moderate PVL scored visually better than those
with either severe PVL or combined PVL with cortical atrophy.
CR: A. Felekidis, None; N. Kozeis, None; P. Stergiopoulos, None; S. Lake, None; D.
Kokkinou, None.
Support: None
Purpose: Arthrogryposis, or arthrogryposis multiplex congenita, comprises non
progressive conditions characterized by multiple joint contractures found throughout
the body at birth. The incidence is 1 in 3000. The major cause of arthrogryposis is fetal
akinesia (ie, decreased fetal movements) due to fetal abnormalities (eg, neurogenic,
muscle, or connective tissue abnormalities; mechanical limitations to movement)
or maternal disorders (eg, infection, drugs, trauma, other maternal illnesses).
Generalized fetal akinesia also can lead to polyhydramnios, pulmonary hypoplasia,
micrognathia, ocular hypertelorism, and short umbilical cord. While the preponderance
of musculoskeletal disorders are largely known, the ocular anomalies are not.
The aim of the study, was to ascertain the range of ocular anomalies in arthrogryposis
congenita, particularly the most predominant ones.
Methods: An observational survey was carried out through the Arthrogryposis TAG
society using a designed questionnaire. distributed to its members.
Results: 35 questionnaires were returned, 33 out of 35 responses were complete. A
significant range of ocular diseases were found in 66% (23) of cases, ranging from
astigmatism, keratoconus, ptosis, strabismus, glaucoma to cortical blindness.
Conclusions: In this group of patients, despite severe musculoskeletal manifestations,
there is unfortunately a preponderance of refractive errors and strabismus, which
could give rise to further limitations in their mobility. Since a diagnosis is usually
made at birth or early childhood, it is recommended that in this group of patients,
an ophthalmology review forms part of their multidisciplinary care to prevent
ambylopia.
CR: E.E. Obi, None; P. Watts, None.
Support: None
4840 - B1053
Prevalence and Etiology of Visually Significant Pediatric Cataracts
4841 - B1054
Prevalence of Heterophoria and Its Association With Refractive Error in
Australian School Children
R.Krishnamurthy, D.K. VanderVeen. Ophthalmology, Childrens Hospital Boston,
Boston, MA.
Purpose:Pediatric cataracts are the most common cause of treatable childhood vision
impairment, accounting for 5-20% of blindness in children worldwide. Previous
epidemiologic studies have focused on types of cataracts within a patient population
without distinguishing their visual significance and need for cataract extraction.
Additionally, the majority of these studies were conducted in foreign countries such as
India and Denmark, whose populations differ substantially from ours. For comparison,
we surveyed the etiologies of pediatric cataract that required surgical intervention
in our U.S. tertiary care institution.
Methods:A retrospective chart review of all patients who underwent cataract
surgery at Children’s Hospital, Boston from 2000-2005 was conducted. Age of patient,
etiology of cataract, and the date of surgery were recorded for each patient. Etiological
classification of the cataracts was based on information from the medical records.
Results:There were 159 patients <18 years at the time of surgery (80 females, 79 males);
overall 96 patients had bilateral cataracts. Heritable cataracts accounted for 22% of
patients with bilateral cataracts and none of the unilateral cataracts. Secondary causes
for cataracts accounted for 25% of patients. Radiation treatment was the etiology
of cataracts in 14% patients, trauma in 8%, uveitis in 2 and diabetes in 1%. Ocular
dysmorphology (Leber’s congenital amaurosis, optic atrophy) and systemic anomalies
(Down’s syndrome, CHARGE association, Lowe syndrome and developmental delay)
accounted for 9% patients requiring cataract surgery. 74 patients (46%) had cataracts
of unknown etiology.
Conclusions:Even amongst visually significant cataracts undergoing cataract
extraction, the proportion of idiopathic cataracts is similar to other reported studies, at
approximately 40%. Familial cataracts were much less prevalent than expected amongst
patients with bilateral cataracts, accounting for less than one-quarter of the patients.
This is likely because many hereditary cataracts may not be visually significant
immediately and therefore do not require surgery. It is important to recognize that
the majority of the visually significant bilateral cataracts were not attributed to either
genetic or infectious etiologies and other causes should be explored. Secondary causes
were responsible for a larger percentage of cataracts than previously published and
parents should be made aware of the high risk of cataract development in patients
with these underlying risk factors.
CR: R. Krishnamurthy, None; D.K. VanderVeen, None.
Support: None
J.F. Leone1, K.A. Rose1, A.Kifley2, M.Cosstick 2, P.Mitchell2, Sydney Childhood Eye Study,
Sydney Myopia Study. 1School of Applied Vision Sciences, The University of Sydney,
Lidcombe, Australia; 2Ophthalmology (Centre for Vision Research, Westmead
Australia.
Purpose: To examine the prevalence of heterophoria and its relationship with refractive
error in population-based random samples of 6- and 12-year old school children.
Methods: The Sydney Myopia Study randomly selected 55 primary and secondary
schools, stratified by socio-economic status. All Year 1 and Year 7 students were invited
to participate. Cycloplegic autorefraction, cover/uncover, alternate cover test and prism
bar cover tests at near (33cm) and distance (6m) fixation were performed. Myopia was
defined as spherical equivalent ≤-0.5D; emmetropia >-0.5 to <+0.5; mild hypermetropia
≥+0.5 to <+2.00; and significant hypermetropia as ≥+2.00 in at least one eye.
Results: Of the 4107 students who participated, 1692 (mean age 6.7 years) and 2289
(mean age 12.7 years) who had no strabismus or vertical phoria were included in
this analysis. For near, exophoria was highly prevalent (Year 1: 58.3% vs. 9.2% for
esophoria; Year 7: 52.2% vs. 10.4% for esophoria). For distance, there was a trend of
reducing exophoria prevalence with increasing age (Year 1: 13.5%, CI 10.8-16.2%; Year
7: 7.8%, CI 4.3-11.2%) with very low rates of esophoria (Year 1: 1.0%; Year 7: 1.3%) and
orthophoria the norm (Year 1: 85.4%; Year 7: 90.9%). There was a significant association
between near phoria and refractive error in both the Year 1 (p=0.0296) and Year 7
students (p<0.0001). Children with hyperopia were more likely than children without
significant refractive error to be esophoric at near (Year 1: OR 1.7, CI 1.1-2.8; Year 7:
OR 2.9, CI 1.7-4.8). At age 12, children with myopia were more likely than children
without significant refractive error to be exophoric (near: OR 2.1, CI 1.5-2.7; distance:
OR 3.1, CI 2.1-4.4). It was rare for children to have both myopia and esophoria at near
(Year 1: 0.06%; Year 7: 0.6%).
Conclusions: Consistent with other studies, we found that esophoria for near
was rare. This finding has implications for anti-myopia therapy using progressive
addition lenses. While orthophoria has more typically been found at near in studies
of comparable samples (aged 5-13 years), we found a high prevalence of exophoria at
near. Differences in detailed methodology may provide a partial explanation.
CR: J.F. Leone, None; K.A. Rose, None; A. Kifley, None; M. Cosstick, None; P.
Mitchell, None.
Support: NHMRC 253732, 2003-5
4838-4841
4842 - B1055
Mechanism of Canalicular Lacerations in Children: An 18 Year Experience
K.Parbhu1, D.Jordan2, L.Mawn1. 1Ophthalmology, Vanderbilt University, Nashville,
TN; 2Ophthalmology, University of Ottawa, Ottawa, ON, Canada.
Purpose: To evaluate the mechanism of canalicular lacerations in children.
Methods: The records of all patients referred to the oculoplastics service at both
Vanderbilt Eye Institute and University of Ottawa Eye Institute with a diagnosis of
canalicular laceration between October 1988 and September 2006 were reviewed.
Variables assessed included mechanism of injury, canalicular involvement, surgical
repair, age, sex, associated injuries, and season of injury.
Results: A total of 90 children who sustained a laceration to the canalicular system were
identified. Dog bites were the causative factor in the greatest number of canalicular
injuries, occurring in 25 (28%) children. Falls were the second largest cause, occurring
in 19 (21%). Other mechanisms of injury included: toys (9), wires (8), motor vehicle
accidents (MVA) (7), tree branches (7), assault (7), door handles (6), horse hoof (1), and
kitchen utensil (1). The inferior system in isolation (50) was involved more frequently
than the superior system in isolation (35) or both systems simultaneously. Canalicular
repair was carried out with silicone tube intubation in all patients with 83 (92%)
undergoing placement of the tube using the pigtail probe technique and 7 (8%) having
Crawford stents passed through the canalicular system. The mean age at the time of
injury was 7.8 years (range 10 month - 18 years). Canalicular laceration was found to
occur significantly in younger children only when secondary to penetration by wire
objects (mean age= 3.7 years, p=0.02) and significantly in older children when it was
secondary to assault (mean age= 14.4 years, p=0.0006) and MVAs (mean age= 13.3,
p=0.005). Males accounted for 77 percent of patients with canalicular lacerations.
28 of the 90 canalicular lacerations occurred in association with another injury. .
Canalicular lacerations sustained secondary to a MVA were significantly associated
with having another injury (p=0.002).
Conclusions: To our knowledge, we present the largest series to date of canalicular
lacerations in children. In our series, we found that canalicular lacerations result
most often from dog bites and falls in children. The inferior canalicular system in
isolation tends to be involved more frequently. Injury to the canalicular system occurs
significantly in younger children when secondary to penetrating injury by wire
objects and in older children when secondary to assaults or MVAs. We also found
that the majority of canalicular lacerations occur in isolation. The only mechanism
significantly associated with other injuries was found to be MVAs.
CR: K. Parbhu, None; D. Jordan, None; L. Mawn, None.
Support: None
4844 - B1057
Ophthalmologic Findings in Children and Young Adults With Mitochondrial
Encephalomyopathies With Known DNA Mutation
M.A. Gronlund1, A.Seyedi-Honarvar1, E.Rudholm2, N.Darin 3, M.Tulinius3, S.Andersson1.
1
Dept of Pediatric Ophthalmology, Institute of Physiology and Neuroscience/
Ophthalmology, Goteborg, Sweden; 2The Sahlgrenska University Hospital,
Department of Pediatric Ophthalmology, Goteborg, Sweden; 3The Sahlgrenska
University Hospital, Department of Pediatrics, Goteborg, Sweden.
Purpose: Mitochondrial encephalomyopathies constitute a relatively common
group of neurometabolic diseases in childhood. They are caused by defects in the
oxidative phosphorylation due to mutations in either the nuclear or the mitochondrial
DNA (mtDNA). Since 1988, more than 100 mutations of mtDNA have been reported,
including large-scale rearrangements, as well as point mutations. Different
ophthalmologic findings, such as external ophthalmoplegia, optic disc atrophy and
retinal degeneration have previously been reported. The purpose of this study was
to describe ophthalmologic findings in patients with mitochondrial diseases with
known genotypes.
Methods: A retrospective study was performed in 52 patients (26 males; 26 females) born
between 1967-2002, having genetically verified mitochondrial encephalomyopathies.
51 of these subjects had undergone a detailed ophthalmologic examination including
visual acuity (VA), eye motility, refraction, slit-lamp examination, ophthalmoscopy
and in several cases also electroretinogram (ERG) and pachymetry.
Results: 43/51 (84%) of the patients had one or more ophthalmologic findings such
as ptosis (n=16), reduced eye motility (n=14), severe external ophthalmoplegia (n=5),
strabismus (n=6), nystagmus (n=4), low VA (n=19), refractive errors (n=14), increased
corneal thickness (n=10), photophobia (n=3), optic atrophy (n=15), pigmentation in
the macula and/or periphery (n=11), and ERG-verified retinal dystrophy (n=7). Some
genotypes (i.e. mtDNA deletion) have a more severe ophthalmologic phenotype
than others
Conclusions: The results show that a majority of patients with mitochondrial
encephalomyopathies has ophthalmologic abnormalities. We recommend that an
ophthalmologic examination, including ERG, should be performed in all children
and adolescents who are suspected to have a mitochondrial disease.
CR: M.A. Gronlund, None; A. Seyedi-Honarvar, None; E. Rudholm, None; N. Darin,
None; M. Tulinius, None; S. Andersson, None.
Support: Gothenburg Medical Society, Sweden
4843 - B1056
The Impact of Vision Impairment for Children (IVI_C): Validation of a Quality
of Life Questionnaire
G.M. Cochrane, E.L. Lamoureux, J.E. Keeffe. Centre for Eye Research Australia, East
Purpose: To describe the psychometric properties of the Impact of Vision Impairment
for Children (IVI_C) questionnaire and appraise its validity and reliability.
Methods: The 28-item IVI_C questionnaire, developed from focus groups without
a priori domains, was designed to measure the impact of vision impairment on
participation in school and daily activities for students aged 8 to 18 years. Each item
is rated on a 5-point Likhert scale ranging from always (1) to never (5). The IVI_C
was administered to 126 low vision students (<0.3LogMAR) and 36 age-matched,
sighted students. Distance and near visual acuity (VA), contrast sensitivity, sociodemographic, service support and school activity data were also collected. 3 sub-sets
of students completed the IVI_C twice, 3 to 6 weeks apart or by different forms of
administration (face or telephone).
Results: The mean age and distance VA values for the low vision group (63% male) were
12.8 years (±2.9) and 1.1LogMAR (SD=0.80). 24 items (86%) were considered relevant
by 90% or more of the respondents and 25 items (89%) recorded responses across the
full range. 2 items with >20% of irrelevant responses and a third with ambiguous
scoring were removed. Only 2 pairs of items had Spearman correlation of 0.62 and
0.63 indicating minimal redundancy. The increase in IVI_C total score of the retained
25 items indicates greater difficulty in participation and correlated with worsening
distance and near VA (r=0.35 and 0.34;p<0.01 respectively). Internal consistency of total
mean score was high (α=0.84) and was not affected by sequential elimination of items.
There was a significant difference in the total mean score between the sighted and low
vision groups supporting discriminant validity (ANOVA;F=92;p<0.001). The Guttman
split-half correlations for temporal, mode (telephone and face) and inter-observer were
0.95, 0.90 and 0.72, respectively. Principal components analysis demonstrated that the
25 items contributed to one underlying theme and that 3 factors (social & academic
access, 21.8%; orientation & mobility, 10.2%; community acceptance, 6.8%) explained
39% of the variance in the data. The internal consistency for factors 1 and 2 was high
and moderate for factor 3 (α=0.78, 0.79 and 0.61 respectively).
Conclusions: The IVI_C possesses demonstrated reliability and validity. The findings
represent an important step toward providing assessment of participation in daily
activities and quality of life in children with low vision. Future validation of the
IVI_C will be to determine the measurement characteristics, unidimensionality and
item-person targeting using Rasch analysis.
CR: G.M. Cochrane, None; E.L. Lamoureux, None; J.E. Keeffe, None.
Support: Vision CRC, RVEEH 04/570H, RVEEH Wagstaff Fellowship, NHMRC
Fellowship
4845 - B1058
Risk Factors for Infantile Cataracts, 2000-2003
S.G. Prakalapakorn1,2, M.A. Honein1, S.A. Rasmussen1, S.R. Lambert2, National Birth
Defects Prevention Study. 1National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; 2Department
of Ophthalmology, Emory University School of Medicine, Atlanta, GA.
Purpose: Because the etiology of most cases of infantile cataracts is unknown, the
scope of primary prevention is limited. Since low birth weight has been shown to
be associated with infantile cataracts, we examined risk factors for low birth weight,
including maternal smoking, diabetes, and surrogates of maternal infection, and
their relation to cataracts.
Methods: We used data from the National Birth Defects Prevention Study, an ongoing
multi-site, case-control study of major birth defects for birth years 2000-2003. Infants
with a recognized chromosome abnormality or single gene disorder were excluded. For
this analysis, infants with a first-degree relative with infantile cataracts (26 case- and 2
control-infants) were also excluded. Cases were infants diagnosed with cataracts by an
ophthalmologist before age 1 year (N = 124) and controls were a random sample of live
births (N = 3263). Associations were explored for all, bilateral (N = 35) and unilateral
(N = 89) cases of infantile cataracts, adjusting for maternal age and race/ethnicity.
Results: Very low birth weight (<1500g) was associated with both bilateral (adjusted
odds ratio [OR] = 13.6; 95% Confidence Interval [CI] = 3.8-49.6) and unilateral (OR = 3.8;
95% CI = 1.1-13.1) cataracts, while low birth weight (1500-2499g) was only associated
with bilateral cataracts (OR = 4.3; 95% CI = 1.7-10.8). Infants with unilateral cataracts
were more likely to be born to primigravid women (OR = 1.7; 95% CI = 1.0-2.7) than
women with two or more previous pregnancies. Women who had infants with bilateral
cataracts were 2.6 times more likely to have used aspirin during pregnancy, although
this result was not statistically significant (95% CI = 0.9-7.6). Infantile cataracts were
not associated with maternal smoking, diabetes, reported maternal illness, fever, or
use of antibiotics, antitussives, or other analgesics during pregnancy.
Conclusions: Infants with cataracts are more likely to be of low birth weight or very
low birth weight. Our findings suggest that bilateral and unilateral cataracts have
different risk factors and should be examined separately.
CR: S.G. Prakalapakorn, None; M.A. Honein, None; S.A. Rasmussen, None; S.
R. Lambert, None.
Support: None
4842-4845
4846 - B1059
The Prevalence of Childhood Blindness in Bangladesh
4847 - B1060
The Epidemiology of Refractive Error in UK Children: The Aston Eye Study
Methodology
M.A. Muhit, S.P. Shah, C.E. Gilbert. International Centre for Eye Health, London
School of Hygiene & Tropical Medicine, London, United Kingdom.
Purpose: Reliable epidemiological data on the prevalence of severe visual impairment
and blindness (SVI/BL) in children are difficult to obtain, but are essential for planning.
No such data are available from Bangladesh. The aim of this study was to determine the
prevalence of SVI/BL in children and to identify high prevalence areas and groups.
Methods: Children (0-15 years) with presenting visual acuities of <6/60 in the better
eye, who lived in 40 of the country’s 507 Thanas (sub-districts), were identified by
a network of trained community volunteers (Key Informants). All eligible children
were examined by ophthalmologists and the cause of visual loss determined using
the WHO classification system. Population data were obtained from the 2001 census.
Prevalence (per 1000 children) was calculated by age, sex and cause.
Results: 2,279 children with SVI/BL were identified. Total child population in
the study Thana’s was 4,372,259. The overall prevalence of SVI/BL in children
aged 0-15 years was 0.52 (95% CI 0.50-0.54), but there was considerable variation
from Thana to Thana ranging from 0.25 in Chauhali and 0.94 in Singra (p<0.001).
The prevalence was significantly different between the genders (p<0.001),
being 0.63 (95% CI 0.60 -0.67) and 0.39 (95% CI 0.37 -0.42) in boys and girls
respectively. The prevalence also significantly increased with age (p<0.001).
The prevalence was 0.26 (95%CI: 0.23, 0.28), 0.53 (95%CI: 0.49, 0.56) and 0.88
(95%CI: 0.83, 0.93) in 0-5 years, 6-10 year and 11-15 year olds respectively.
The cause specific prevalence of lens, corneal, whole globe anomalies
and retinal related SVI/BL was 0.17 (95%CI: 0.16, 0.19), 0.09 (95%CI: 0.08,
0.10), 0.08 (95%CI: 0.07, 0.09) and 0.05 (95%CI: 0.05, 0.06) respectively.
Boys had significantly higher odds of lens related blindness (OR: 2.0, 95%CI: 1.6, 2.4,
p<0.001) and less odds of corneal blindness (OR 0.53, 95%CI: 0.43, 0.67) than girls.
Conclusions: This is the first study in a defined population in Bangladesh, with a large
number of blind children, to provide reliable prevalence data for program planners
and policy makers. Extrapolating these figures to the country, there are at least 26,000
children who are currently SVI/BL. By identifying high prevalence Thanas, groups
and causes, this study provides an opportunity to develop targeted strategies for
prevention of blindness in children to achieve the goals of Vision 2020.
CR: M.A. Muhit, None; S.P. Shah, None; C.E. Gilbert, None.
Support: Chirstoffel Blinden Mission (CBM) and Muslim Aid UK
4848 - B1061
Relationship between MultivItamin Usage & Diet vs Prevalence of Myopia in
Children of Asian Indian Descent
R.Durga, IV, S.Sonty. Ophthalmology, Midwest Eye Center SC, Calumet City, IL.
Purpose: To evaluate the Prevalence and Causes of Myopia in Children of Asian
Indian Descent and evaluate the role of Genetics and Dietary Habits - Multivitamin
Usage & Fortified & Non Fortified Food consumption
Methods: 112 children of 178 Parents ( 89 Pairs) from a Spelling Bee Group & Sunday
School Group were surveyed for Myopia among Parents & Children, Age & Sexes of
Children, Age of Onset of Myopia among Parents & Children, Dietary Food Habits
& Multivitamin Usage, Children’s Heights & Weights. The results were compared for
Prevalence of Myopia among the different variables.
Results:Survey among 89 Parents ( 178 Individuals) & their 112 Children from 6 - 20
years showed 73/178 ( 41%) Parents & 63/112( 56%) Children had Myopia showing
Higher prevalence among Children.34/66 (51%)Boys & 29/46(63%) Girls have Myopia.
Age wise 29/66(44%) of 6-10yrs & 34/46( 74%)11-20yrs had Myopia Heightwise 4/19(
21%) 3’1” - 4’0”, 35/56(63%) 4’1”-5’0” & 23/33( 69%) 5’1”-6’0” showing Increase in Myopia
with Heightand Older Age.Weightwise among Children Average Weight among Girls
with Myopia was 89 lbs & No Myopia 82 lbs and Boys with Myopia 93 lbs& No myopia
79 lbs showing Myopia associated with Larger Weight. Parents Average Height was
5’7” (Dad) & 5’2”(Mom) & Children 5’10”(Boys) & 5’4”(Girls) with projected Height
at 25 yrs. with Children Taller than their Parents.The Dietary habits analysis showed
among Myopic Children with Multivitamin Usage had Average Refractive Error - 3.8D
while those Myopic children without Multivitamin Usage - 3.00D showing almost a 1.0
Diopter more Myopia among Children with Multivitamin Usage. The Fortified Diet
consumption was 42% among Non Myopic Children & 33% Among Myopic Children of
Non Myopic Parents showing Fortified Food consumption having Protective influence
on Prevalence of Myopia among the Children of Nonmyopic Parents.
Conclusions: Compared to their Parents the Prevalence of Myopia is Greater among
of Children of Asian Indian Descent, Myopia appears Earlier in age and corresponds
to the Growing Heights and Larger Weights of these Children. Usage of Multivitamins
seems to effect Negatively while Fortified Food Consumption had Protective Effect
among the children of this Survey Population.
CR: R. Durga, None; S. Sonty, None.
Support: None
N.S. Logan1, A.R. Rudnicka2, P.Shah1, B.Gilmartin1, C.G. Owen2. 1School of Life &
Health Sciences, Aston University, Birmingham, United Kingdom; 2Division of
Community Health Sciences, St George’s, University of London, London, United
Kingdom.
Purpose: The Aston Eye Study (AES) is a cross-sectional study (started October 2005)
to determine the prevalence of refractive error and its associated ocular biometry in a
large multi-racial sample of school children from the metropolitan area of Birmingham,
United Kingdom.
Methods: A target sample of 1700 Year 2 (age 6-7 years) and 1200 Year 8 (age 12-13
years) children is being selected from Birmingham schools selected randomly with
stratification by area deprivation index (a measure of socio-economic status). Schools
with pupils predominantly (>70%) from a single race are excluded. Sample size
calculations account for the likely participation rate and the clustering of individuals
within schools. Procedures involve standardised protocols to allow for comparison
with international population-based data. Visual acuity, non-contact ocular biometry
(axial length, corneal radius of curvature and anterior chamber depth using IOLMaster
Zeiss, Jena) and cycloplegia (proxymetacaine 0.5% corneal anaesthesia followed
by cyclopentolate 1%) binocular open-field autorefraction (Shin-Nippon SRW5000,
Japan) are measured in both eyes. Distance and near oculomotor balance (cover test),
height and weight are also assessed. Questionnaires for parents (75 items) and Year
8 children (57 items) will allow the influence of environmental factors on refractive
error to be examined.
Results: Data collection is ongoing (currently N=330) with protocols being well
received by both parents and children. No adverse incidents or effects have been
reported to date. Current data indicate that almost 1 in 10 Year 8 children (N=286)
require refractive correction but do not have the provision of spectacles.
Conclusions: The AES will allow the ocular characteristics of 2900 children from
a large metropolitan area of the United Kingdom to be described. The association
between educational status, ethnic background and other environmental influences
on refractive outcome will be determined.
CR: N.S. Logan, None; A.R. Rudnicka, None; P. Shah, None; B. Gilmartin, None; C.
G. Owen, None.
Support: Central LOC Fund, UK; College of Optometrists, UK
4849 - B1062
Risk Factors for Developing Threshold Disease in Retinopathy of Prematurity
A.Fazelat1A, A.Srivastava1B, C.Sharma2, E.Baron1B. AOphthalmology, 1Albert Einstein
College of Medicine, Bronx, NY; 2U. of Conn. Schl of Med, Hartford, CT.
Purpose To determine which risk factors, if any, contribute to the development of
threshold disease in pre-mature infants at high risk for Retinopathy of Prematurity
(ROP).
Methods Demographic and clinical data were collected retrospectively from the
examination log books, paper chart and computer record for all infants in the neonatal
intensive care unit that were referred for ophthalmologic evaluation from January
1,2004 thru October 30, 2006. Any infant with a birth weight equal to, or less than 1500
grams and/or was born 28 weeks, or less premature was referred for examination.
Each infant received a baseline dilated fundoscopic examination upon presentation.
The infants were subsequently scheduled for either immediate treatment or followed
at a 1,2 or 3 week interval depending on the stage and characterization disease using
the International Committee on Classification of Acute ROP criteria.
Results Of the 174 babies referred for evaluation during the study period, 155 were
included in our study. 137 (88.3%) had some stage of retinopathy at presentation. 78
(50.3%) babies were born to mothers with Hispanic surnames. A total of 22 (14.2%)
babies developed threshold disease requiring laser photocoagulation. The mean
birth weight, gestational age, and age at presentation for those babies who developed
threshold disease was 743 grams (+/- 148), 25.3 weeks (+/-1.35) and 32.2 weeks (+/- 2.1)
respectively. The mean birth weight, gestational age, and age at presentation for those
babies who did not develop threshold disease was 1002 grams (+/- 294), 27.6 weeks
(+/- 2.1) and 33.7 weeks (+/- 2.5) respectively. 63.6% (14 of 22) of babies who developed
threshold disease were born to mothers with Hispanic surnames as compared to
only 48.1%(64 of 133) in the population that did not progress to threshold disease.
Multivariate regression analysis revealed that only birth weight (p-value <0.0001) and
Hispanic surname (p-value =0.0315) were significantly associated with the development
of threshold disease. There was no statistically significant difference with regard to
gestational age, age at initial presentation, stage, zone and presence or absence of
plus disease at presentation between those babies who developed threshold disease
and those who did not.
Conclusions We conclude that lower birth weight and Hispanic surname are
significantly associated with the development of threshold disease in babies with
Retinopathy of Prematurity.
CR: A. Fazelat, None; A. Srivastava, None; C. Sharma, None; E. Baron, None.
Support: None
4846-4849
4850 - B1063
Ocular Abnormalities From the Chernobyl Children’s Project USA
M.B. Strominger1,2, N.Nandakumar3. 1Ophthalmology, New England Eye Center,
Boston, MA; 2Ophthalmology, TUFTS-New England Medical Center, Boston, MA;
3
TUFTS University School of Medicine, Boston, MA.
Purpose: The Chernobyl Children’s Project USA is based in the greater Boston area
and was founded in 1995 as an effort to help provide medical and social support for
the children of Chernobyl. Each summer volunteer families welcome children from
Chernobyl into their homes, participate in social outings, and take them for their
various medical appointments. We report the ocular findings of seventeen children
who were evaluated over the past three years.
Methods: All the children underwent a complete ophthalmologic examination
including testing of visual acuity, refraction, motility, stereopsis, color vision, slit
lamp, cycloplegic retinopathy and ophthalmoscopy.
Results: The most common presenting findings were congenital anomalies (11 patients),
followed by trauma (4 patients), systemic disease (1 patient), and progressive myopia
(1 patient). Of the patients with congenital anomalies, four involved the optic nerve,
three the anterior segment, two had glaucoma, one had retinoblastoma, and one had
a retinal scar due to congenital toxoplasmosis.
Conclusions: Although some of the ocular abnormalities could not be prevented
irrespective of timely intervention, many of the children suffered from problems
where morbidity could be mitigated or reduced with timely intervention. From our
case series, one major conclusion that emerges is that a disaster such as the Chernobyl
incident disrupts the social fabric, affects access to medical care, and in turn leads to
an increase in preventable ocular morbidities in children.
CR: M.B. Strominger, None; N. Nandakumar, None.
Support: None
4851 - B1064
Measles Blindness in Indonesia: Results From Schools for the Blind Study in
Java
R.S. Sitorus1A, S.Abidin1A, J.Prihartono1B. ADepartment Ophthalmology-Faculty of
Medicine, BDepartment Community Medicine-Faculty of Medicine, 1University of
Indonesia, Jakarta, Indonesia.
Purpose: To define the prevalence of measles blindness among the avoidable causes
of blindness and severe visual impairment (BL/SVI) in schools for the blind in Java,
and to evaluate its temporal trends.
Methods: Four-hundred-seventy-nine of total 504 cases were examined in 5 schools
for the blind in Java. Data was collected using a modified-WHO/PBL eye examination
record for children.
Results: Anatomical site of SVI/BL were whole globe in 35.9%, retina 18.8%, lens 16.5%,
cornea 16.1%; while the major underlying aetiology of BL/SVI was undetermined
in 32.8% cases, hereditary factors 31.7%, and childhood/postnatal disorders 28.6%.
Corneal scars, corneal staphyloma and phtisical eye were predominant in the postnatal
disorders, which mainly attributed to eye infection due to measles and vitamin A
deficiency. Overall, 60.1% (288 cases) had potentially avoidable causes of BL/SVI.
Measles blindness accounted for 22.9 % of the avoidable causes. Corneal scars, corneal
staphyloma and phtisical eye mainly due to measles (110 cases) were responsible for
the highest proportion in the preventable blindness group. The high proportion of
measles causing blindness was also reported in other developing countries in North
India, Ethiopia and Nigeria. It has been known that there is a close relationship between
malnutrition, vitamin-A deficiency and the severity of measles infections. Exploration
on trends of SVI/BL among four different age groups 5-8 years, 9-12 years, 13-15 years
and ≥16years suggest that childhood disorders and corneal factors have declined .The
proportion of cases blind form corneal disorders was 0% (0) were aged 5-8 years, 7.4%
(2) were aged 9-12 years, 6.7%(3) aged 13-15 years and 18.1% (72) were ≥16 years (p=
0.01, chi2-test for trend). Study of etiological factors showed that childhood disorders
were responsible for 0.0% (0) in 5-8 year olds, 22.2% (6) in 9-12 year, 17.8% (8) in13-15
year and 31.0% (123) in ≥16 year olds. (p= 0.010, chi-test for trend). Changing trend
over the period of age groups for corneal disorders and childhood disorders, may
suggest that problem of measles/vitamin-A related blindness have declined over a
period of 10 years or more.
Conclusions: The decline in the proportion of corneal diseases and childhood factors
causing blindness may reflect improved vitamin A supplementation and measles
vaccination coverage in Indonesia in the past 10 years or more. Nevertheless ensuring
high coverage rates of measles vaccination and vitamin-A supplementation in the
short and long term still need to be pursued rigorously.
CR: R.S. Sitorus, None; S. Abidin, None; J. Prihartono, None.
Support: None
4852 - B1065
Comparison of Visual Acuity Measured With Lea Symbols and Lea Numbers at
Different Test Distances
4853 - B1066
Comparison of Visual Acuity Measured With Lea Symbols and Lea Numbers to
Adult Standards
D.Ah-Kine Ng Poon Hing, J.J. Vaidhyan, A.Pathak, N.Quinn, L.Deng, S.Lyons, B.Moore.
The New England College of Optometry, Boston, MA.
J.J. Vaidhyan1, P.Lietzen2, D.Ah-Kine Ng Poon Hing1, A.Pathak1, E.Ahonen2, N.Quinn1,
S.Lyons1, M.Leinonen2, L.Hyvarinen2, B.Moore1. 1The New England College of
Optometry, Boston, MA; 2Helsinki Polytechnic, Helsinki, Finland.
Purpose: Traditionally, visual acuity (VA) has been measured at 6 meters (m) in adults
and at 3m for children. The Lea Symbol and Lea Number tests are frequently used
to assess VA in children. VA is often measured at closer distances in the pediatric
and non-verbal populations to improve testability. The purpose of this study is to
compare the visual acuity of adults with normal VA at different distances using the
Lea Symbol and Lea Number charts.
Methods: 25 optometry students participated in the study. All subjects had bestcorrected Snellen VA of better than 20/25 at each session to be included in the study.
LogMAR charts, calibrated for 4m with 7 optotypes per line, were constructed and
supplied by the Goodlite Co. The middle 5 optotypes were scored to ensure constant
crowding. Visual acuity of the right eye of each subject was tested at distances of
3.2, 4, 5 and 6.4m. Stimuli presentation was randomized for both chart distance and
optotype. Four measurements (two per session separated by one week) were obtained
for each chart. Repeated measures of ANOVA and multiple comparisons were utilized
in the statistical analysis.
Results: The mean LogMAR VA for Lea Numbers was -0.104 at 3.2m, -0.099 at 4m,
-0.117 at 5m, -0.096 at 6.4m. There were no significant differences between distances
(p-values>0.03). The mean LogMAR VA for Lea Symbols was -0.113 at 3.2m, -0.128 at
4m, -0.145 at 5m, -0.117 at 6.4m. For Lea Symbols, VA measured at 5m was significantly
different than that measured at 6.4m (p=0.007) and 3.2m (p=0.002). There was no
difference between acuities at 4m and 6.4m or between 4m and 5m (p-values>0.05).
Conclusions: In adult subjects, VA measurements using the Lea Number chart were
similar at all distances. Differences when using the Lea Symbol chart exist, but are
not clinically significant, since the greatest differences were equivalent to less than 2
optotypes. Further studies are necessary to evaluate the differences in testing distance
in the pediatric population.
CR: D. Ah-Kine Ng Poon Hing, None; J.J. Vaidhyan, None; A. Pathak, None; N.
Quinn, None; L. Deng, None; S. Lyons, None; B. Moore, None.
Support: None
Purpose: Lea Symbols (LS) and Lea Numbers (LN) are optotypes currently used to
measure visual acuity (VA) in young children. However, performance on these tests
has not been compared to recognized adult standards. The purpose of this study is
to compare LogMAR visual acuity measured with Lea Numbers and Lea Symbols to
Sloan letters (SL) and Landolt C (LC) charts in 2 populations of adults.
Methods: Group 1 consisted of 20 students at the Helsinki Polytechnic, Finland.
Group 2 consisted of 25 optometry students at The New England College of Optometry
(NECO), Boston, MA. LogMAR charts, calibrated for 4 meters (m) with 7 optotypes
per line, were constructed for LS, LN, SL and LC optotypes by the Goodlite Co. and
were used by both groups. The middle 5 optotypes were scored to ensure constant
crowding. Group 1 had best-corrected Snellen VA of better than 20/16 and was tested
binocularly. Group 2 had best-corrected Snellen VA of better than 20/25 and was
tested monocularly. Four measurements (two per session separated by one week) were
obtained for each chart. Repeated measures of ANOVA and multiple comparisons
were utilized in the statistical analysis. Standard deviations were used to determine
the variation within each group.
Results: In Group 1, the mean LogMAR VA was better for LS -0.26 and LC -0.26 than for
SL -0.22 and LN -0.22. In Group 2, the mean LogMAR VA was best for LS -0.13, followed
by SL -0.12, then LN -0.10 and LC -0.10. There are significant differences between LC
and LS (p<0.001) and LN and LS (p<0.001). The mean variation was 1.6 optotypes in
Group 1 (range 1.4-1.8) and 4.2 optotypes for Group 2 (range 4.0-6.0).
Conclusions: In both groups of adults, LogMAR VA obtained with LS and LN compares
well to that measured with adult standards. Although there were differences between
optotypes, it is unlikely that they are clinically significant. Further testing is necessary
to evaluate this relationship in the pediatric population.
CR: J.J. Vaidhyan, None; P. Lietzen, None; D. Ah-Kine Ng Poon Hing, None; A.
Pathak, None; E. Ahonen, None; N. Quinn, None; S. Lyons, None; M. Leinonen,
None; L. Hyvarinen, None; B. Moore, None.
Support: None
4850-4853
Thursday, May 10, 8:30 AM - 10:15 AM Palm A Paper Session Program Number Range: 4898-4904
502. Epidemiology of Visual Impairment and Refractive Errors Organizing Section: CL
4898 - 8:30AM
The Prevalence and Causes of Visual Impairment in Rural Myanmar: The
Meiktila Eye Study
4899 - 8:45AM
The Prevalence and Causes of Visual Impairment in an Urban Malay Population
in Asia: The Singapore Malay Eye Study (SiMES)
R.J. Casson1, H.S. Newland1, J.Muecke1, S.McGovern1, D.Selva1, T.Aung2.
1
Ophthalmology, South Australian Institute of Ophthalmology, Adelaide
University, Adelaide, Australia; 2Ophthalmology, Yangon Eye Hospital, Yangon,
Myanmar.
T.Y. Wong1, W.Wong2, A.W. P. Foong3A, J.J. Wang4, P.Mitchell4, D.Heng5, T.Aung2, D.T.
H. Tan2, S.M. Saw3B, SiMES Research Group. 1Centre for Eye Research Australia,
University of Melbourne, Melbourne, Australia; 2Singapore Eye Research Institute,
Singapore, Singapore; AOphthalmology, BCommunity, Occupational and Family
Medicine, 3National University of Singapore, Singapore, Singapore; 4Centre for
Vision Research, University of Sydney, Sydney, Australia; 5Epidemiology & Disease
Control Division, Ministry of Health, Singapore, Singapore.
Purpose: To determine the prevalence and causes of visual impairment in the Meiktila
District of central, rural Myanmar.
Methods: Randomized, stratified, cluster sampling of the inhabitants 40 years of age
and over from villages in the Meiktila District of central Myanmar was performed; 2481
eligible participants were identified and 2076 participated in the study. Participants
received an ophthalmic examination, including presenting and pinhole Snellen visual
acuity with an illiterate E chart, slit lamp examination of the anterior segment and
dilated stereoscopic fundus examination. The principal cause of visual impairment
was recorded. Visual impairment and blindness were defined by both presenting
(habitual) and pinhole visual acuity according to World Health Organization criteria:
better eye < 20/60 and < 20/400 respectively.
Results: Visual acuity was recorded in 2073 participants (83.6%) The prevalence
estimate of presenting visual impairment was 40.4% (95% CI 36.1-44.7), and of
presenting blindness was 8.1% (95% CI 6.5-9.9). After pinhole correction the
corresponding prevalences were 26.8% (95% CI 23.5-30.1) and 5.3% (95% CI 4.0-6.6).
Cataract, uncorrected refractive error and primary angle-closure glaucoma were
the commonest causes of visual impairment. In multivariate regression analyses,
increasing age was a strong predictor of blindness (P < 0.001).
Conclusions: Visual impairment and blindness remain major public health problems
in rural Myanmar. The prevalence of habitual blindness in this region is amongst the
highest ever reported in a population-based study. Specific programmes directed
towards the cataract burden need to be implemented.
CR: R.J. Casson, None; H.S. Newland, None; J. Muecke, None; S. McGovern,
None; D. Selva, None; T. Aung, None.
Support: Independent Research Grant from Pfizer
4900 - 9:00AM
Prevalence Rates and Risk Factors for Refractive Errors in an Urban Malay
Population: The Singapore Malay Eye Study (SiMES)
Purpose: To describe the prevalence and causes of visual impairment and blindness
in an urban Malay population.
Methods: A population-based, cross-sectional study of Malay persons aged 40-80 years
residing in Singapore was conducted in 2004-6. An age-stratified random sample of
5,600 Malay names residing in south-western Singapore (1,400 from each age decade)
was selected from a national database. Potential participants were contacted by
telephone and home visits to determine study eligibility, and invited to a centralized
clinic for a standardized assessment of presenting and best-corrected visual acuity
(VA). Visual impairment was defined as presenting LogMAR VA<0.30 (20/40) and
>1.00 (20/200) and blindness as LogMAR VA ≤1.00 (20/200) in the better eye. Prevalence
rates were adjusted to the 2000 Singapore Census
Results: Of the 5,600 names selected, 4,168 were eligible to participate. Of these,
3,280 (78.7%) were examined in the clinic, 41 (1%) were in their homes, 789 (18.9%)
declined to participate and 58 (1.4%) were not contactable. Presenting LogMAR VA
data were available from 3,273. There were 790 people who were visually impaired
(crude prevalence 24.1% and age-standardized prevalence 17.5%) and 60 individuals
who were blind (crude prevalence 1.8% and age-standardized prevalence 1.2%).
Older people were more likely to be visually impaired (9.5%, 16.3%, 27.3%, and 47.5%
among participants aged 40-49, 50-59, 60-69 and 70-80 years, respectively) and blind
(0.6%, 0.4%, 1.7% and 5.2%). After adjusting for age, women had higher rates of visual
impairment (21.3% vs 13.3%, p<0.001) and blindness (1.6% vs 0.7%, p=0.053) than
men.
Conclusions: In Singapore Malay adults aged 40-80 years, 1 in 6 were visually impaired
and 1 in 100 blind. Among Malay adults 70 years and older, 1 in 2 were visually
impaired and 1 in 20 blind. Cataract and under-corrected refractive error are the
leading causes of visual impairment and blindness.
CR: T.Y. Wong, None; W. Wong, None; A.W.P. Foong, None; J.J. Wang, None; P.
Mitchell, None; D. Heng, None; T. Aung, None; D.T.H. Tan, None; S.M. Saw,
None.
4901 - 9:15AM
Prevalence of Myopia in the United States: NHANES 1999-2002
S.-M.M. Saw1A, Y.-H.Chan1B, W.-L.Wong2, M.Sandar2, A.Shankar1A, P.Mitchell3, T.Aung2,
D.T. H. Tan2, T.-Y.Wong4. ACommunity Occup & Family Med, BBiostatistics Unit,
1
National Univ of Singapore, Singapore, Singapore; 2Singapore Eye Research
Institute, Singapore, Singapore; 3Centre for Vision Research, Sydney University,
Sydney, Australia; 4Ophthalmology, National University of Singapore, Singapore,
Singapore.
Purpose: To determine the prevalence and risk factors for refractive errors in a
population-based study of eye diseases in Singaporean Malays.
Methods: A population-based, prevalence survey of Malays aged 40-80 years in
Singapore was conducted in the South-Western part of Singapore. An age-stratified (10year age groups) random sampling procedure was used. Standardized comprehensive
eye assessments were conducted in a central clinic. Subjective refraction was
determined by trained ophthalmologists and autorefraction determined using the
Canon RK-F1 table-mounted autorefractor. Myopia was defined as spherical equivalent
(SE) < -0.5 Diopters (D) and high myopia as SE < -5.0 D. Astigmatism was defined as
cylinder > 0.5 D, hyperopia as SE > + 0.5 D, and anisometropia as SE difference > 1.0
D. Prevalence rates were adjusted to the 2000 Singapore Census.
Results: Of the 4,168 eligible participants from the sampling frame, 3,280 (78.7%)
participated. Refractive error data in the phakic right eyes were available for 2,974
for analysis. The age-adjusted rate of myopia was 26.2% [95% confidence interval (CI)
26.0, 26.4], and high myopia was 3.9% (95% CI 3.8, 4.0). The rates of myopia were higher
in females (26.8%) compared with males (22.2%). There was a U-shaped relationship
between myopia and age. The age-adjusted rate of astigmatism was 33.3%, hyperopia
was 27.4% and anisometropia was 9.9%. In a multiple logistic regression model,
adults who were female, had cataract, who used the computer regularly, and who
completed higher levels of education, were more likely to be myopic. Adults with
myopia, cataract, diabetes, who were shorter, and who were older, had higher risks
of astigmatism in multiple logistic regression analysis. Anisometropia was associated
with cataract, myopia and older age, while hyperopia was associated with older age
in multivariate analyses.
Conclusions: One in four adult Malay persons in Singapore have myopia. Educational
level, cataract and computer use are associated with myopia, while cataract, diabetes,
height and myopia are associated with astigmatism.
CR: S.M. Saw, None; Y. Chan, None; W. Wong, None; M. Sandar, None; A. Shankar,
None; P. Mitchell, None; T. Aung, None; D.T.H. Tan, None; T. Wong, None.
Support: National Medical Research Council NMRC/0796/2003
S.Vitale1A, M.F. Cotch1A, R.Sperduto1A, L.Ellwein1B, F.L. Ferris, III1A. ADivision of
Epidemiology & Clinical Research, 1National Eye Inst/NIH, Bethesda, MD.
Purpose: To estimate the prevalence of myopia in the U.S. using data from a national
survey.
Methods: The National Health and Nutrition Examination Survey (NHANES) is a series of
ongoing studies designed to assess the health of adults and children in the U.S., combining
interviews and physical examinations. NHANES examines a nationally representative sample
of about 5,000 persons each year, identified from households chosen by a complex nation-wide
multistage probability sampling design. In 1999-2002, the NHANES examination included
objective refraction measurements using a NIDEK ARK-760 autorefractor (Nidek Co, Ltd,
Tokyo, Japan) for participants aged 12 years or older. Three measurements were averaged
for each eye. We excluded eyes with cataract or refractive surgery. The eye with the largest
absolute value of spherical equivalent (SphEq) was used to characterize each participant.
Myopia was defined as SphEq ≤-1.0 D. Prevalence estimates were computed using NHANES
sampling weights to account for the multistage probability sampling design.
Results: 15,193 persons aged 12 years or older participated in the 1999-2002 NHANES;
14,203 presented to the mobile examination center. Of these, 12,680 had usable refraction
data (608 had cataract or refractive surgery in both eyes; 915 had missing data due to lack
of time, inability to complete the vision examination, or equipment failure). Individuals
with missing data tended to be older and were slightly more likely to be female. The overall
age-standardized prevalence of myopia was 32.6% (95% CI, 30.9-34.2%); prevalence varied
considerably by age, gender, and ethnicity. Myopia prevalence tended to be lowest in those
aged 60 years or older (significantly so for those of Black and those of White ethnicity).
Prevalence of myopia (SphEq≤-1.0D)
Age
Black
%
95% CI
12-19
32.4
29.2-35.7
20-39
30.9
27.1-34.8
40-59
32.7
27.4-37.9
60+
18.0
13.2-22.8
Total
29.1
26.4-31.8
%
31.2
37.2
41.7
20.4
34.4
White
95% CI
27.6-34.7
34.1-40.2
38.2-45.1
17.9-22.8
32.4-36.5
%
33.7
26.9
23.7
21.3
25.7
Hispanic
95% CI
30.0-37.4
21.7-32.1
19.3-28.2
14.4-28.3
22.4-29.0
%
37.3
39.5
28.8
28.4
33.6
Other
95% CI
26.5-48.1
29.4-49.7
19.2-38.4
15.8-41.0
27.9-39.3
%
32.3
34.5
38.1
20.5
32.6
Total
95% CI
29.9-34.8
32.1-36.9
35.2-41.0
18.2-22.7
30.9-34.2
The prevalence of high myopia (SphEq ≤-5.0 D) was 6.4% (95% CI, 5.5-7.2%) and was generally
higher in females than in males, particularly in the 20-39-year age group (8.8% [95% CI, 7.210.4%] versus 5.6% [95% CI, 4.1-7.0%]), although this gender difference varied substantially
by ethnicity and age.
Conclusions: Myopia is common in the U.S., affecting 68 million Americans aged 12 years
or older.
CR: S. Vitale, None; M.F. Cotch, None; R. Sperduto, None; L. Ellwein, None; F.L. Ferris,
None.
Support: NHANES is sponsored by the NCHS, CDC. Additional funding for the NHANES
Vision Component was provided by the NEI, NIH (Intramural Research Program grant
Z01EY000402)
4898-4901
Thursday, May 10, 8:30 AM - 10:15 AM Palm A Paper Session Program Number Range: 4898-4904
502. Epidemiology of Visual Impairment and Refractive Errors Organizing Section: CL
4902 - 9:30AM
Ten-Year Refractive Changes in an Older Australian Population
4903 - 9:45AM
Short-Term Changes in Diabetes Eye Care From Interventions to Improve
Process of Care
R.Fotedar, J.J. Wang, G.Burlutsky, P.Mitchell, Blue Mountains Eye Study.
Ophthalmology(Centre for Vision Research, Westmead Millennium Institute,
Westmead Hospital), University of Sydney, Sydney, Australia.
Purpose: To examine changes in spherical equivalent (SE) over 10 years in older
persons
Methods: The Blue Mountains Eye Study examined 3654 residents aged 49+ years in
1992-4, 2335 (75% of survivors) were re-examined after 5 and 1952 (76% of survivors)
after 10 years. At each visit, subjective refraction was performed according to a
modified ETDRS Protocol. SE was calculated as the sum of sphere + 0.5 × cylinder
power. At the 10-year exams, axial length was measured using an IOL master. Only
right phakic eyes with best-corrected visual acuity >20/40 (n=1340) were included
in this analysis.
Results: Over the 10-year period, the overall change was a hyperopic shift in mean SE
among persons younger than 65 years and a myopic shift associated with increasing
age among those older than 65 years: the gender-adjusted mean change in SE in
persons aged 49 to 54, 55 to 64, 65 to 74, and 75+ years at baseline examination was 0.40
D, 0.33D, -0.02D, -0.6D, respectively. Apart from age, refractive change was strongly
associated with baseline nuclear cataract. Eyes with nuclear cataract at baseline had
a mean myopic shift of -0.96D, compared to 0.26 D in eyes without nuclear cataract
(p<0.001). Baseline refractive status, education levels and the presence of diabetes
were not associated with SE changes. The age-adjusted mean change in SE was 0.19D,
0.22D and 0.23D for hyperopic, emmetropic and myopic eyes, respectively (p = 0.8).
There was no clinically meaningful change in mean cylinder power over the 10-year
period, with mean changes ranging from 0.02D in persons aged 49-54 years to 0.28D
in those aged 75+ years, with only 25% of these changes +0.5D or more. There was a
10% increase in “against the rule astigmatism” and a 2% decrease in “with the rule”
astigmatism in the 10-year period. Cross-sectional data collected at the 10-year visit
showed a reduction in axial length associated with age: the mean axial length was
23.61mm (CI 23.50-23.73) in subjects aged 49-54 years at baseline while it was 23.15mm
(CI 22.83-23.47) in those aged 75+ years.
Conclusions: These data confirm a previously reported hyperopic shift in persons
younger than 65 years and a myopic shift thereafter, likely due to the development of
nuclear cataract. There may also be age-related decreases in axial length.
CR: R. Fotedar, None; J.J. Wang, None; G. Burlutsky, None; P. Mitchell, None.
Support: Australian NHMRC grants 974159 & 211069
P.P. Lee1, D.Lobach2, G.McGwin, Jr. 3, W.Rafferty1, M.Hunt1, E.Postel1, L.Branch4.
1
Ophthalmology, Duke University Eye Center, Durham, NC; 2Community
and Family Medicine, Duke University, Durham, NC; 3Ophthalmology, UAB,
Birmingham, AL; 4Public Health, USF, Tampa, FL.
Purpose: Prior work has shown that community-based optometrists and
ophthalmologists perform less than 65% of the elements of care recommended by
the AAO and AOA practice guidelines. As part of an ongoing study of interventions
(1 - CME only; 2 - CME plus templated chart notes and office posters; 3 - CME plus
tablet computer with decision support system) to improve the process quality of
care, we sought to assess the extent of changes in the short-term (3 to 8 months) after
intervention implementation.
Methods: As part of a planned short-term assessment for the study, providers
responded to open-ended vignettes about the management of new and follow-up
patients with diabetes and diabetic retinopathy. Work in other fields suggests that
vignettes are a valid and reliable proxy for chart review and simulated patients.
We analyzed the content of the first 60 of 96 providers’ reports of what they would
typically do for these patients and then compared the scores to baseline scores using
linear regression, controlling for their baseline scores. At baseline, no differences
existed for any component of the evaluation.
Results: The vignette reported content of care did not change for those providers who
received only a CME course. Scores increased by at least 8 points (out of 100) in the
high technology (tablet computer) and low technology (templated paper form and
office poster) for diabetes history taking and elements of the fundus exam, However,
there was no difference on other aspects of history taking and examination elements,
nor in total evaluation score.
Conclusions: Use of both high and low technology interventions had only a moderate
impact on process quality of care as measured by vignette responses by providers in the
short-term. Comparison to analyses with actual chart abstraction for process quality of
care (currently underway) will be critical to understanding whether the interventions
will have a larger impact as well as the means by which such interventions affect care,
since the vignettes responses suggest that the interventions result in only a modest
incorporation of care patterns in the providers’ consciousness.
CR: P.P. Lee, Duke University, P; D. Lobach, Duke University, P; G. McGwin, None;
W. Rafferty, Duke University, P; M. Hunt, Duke University, P; E. Postel, None; L.
Branch, None.
Support: NIH Grant EY15559; Research to Prevent Blindness
4904 - 10:00AM
The Economic Impact and Cost of Visual Impairment in the United States
M.L. Pezzullo1, R.Varma2, A.Crook1. 1Economics, Access Economics, Kingston,
Australia; 2University of Southern California, Los Angeles, CA.
Purpose: To quantify the total economic costs of vision loss in the United States.
Methods: Epidemiological prevalence data of vision loss, national healthcare and
other cost databases were used.
Results: Vision loss cost the United States an estimated $69.6 billion in 2005 in financial
costs and an estimated additional $103 billion is the loss of wellbeing (years of life lost
as a result of disability and premature mortality), with 3.56 million Americans visually
impaired. Health system expenditures were $50.1 billion for the 15.1 million people
treated for visually impairing conditions (excluding properly corrected refractive
error). Of this, hospital inpatient services cost $16.3 billion, pharmaceuticals and
office-based services (primary care practitioners, medical specialists and allied health
care) were each $10.2 billion and hospital outpatient services cost $5.2 billion. Other
financial costs included $16.1 billion in community care (paid and unpaid services that
provide home and personal care to people with visual impairment), productivity losses
($2.9 billion) and $346 million in devices and modifications (such as Braille/computer
modifications, lenses, canes and clocks). Each year, some 600,000 years of healthy
American life are lost due to low vision and blindness. Financial costs are borne 32%
by individuals (households), 36% by governments and 32% by the rest of society.
However, when the value of the net disease burden is included, 73% of the costs are
borne by individuals, 14% by governments and 13% by other social entities.
Conclusions: With demographic ageing, the overall population prevalence
and cost of visual impairment is projected to increase in coming decades.
Around 76% of visually impairing conditions are currently treated in
the United States to avoid vision loss and its costly disease burden.
Keywords: visual impairment; cost; economic impact
CR: M.L. Pezzullo, None; R. Varma, None; A. Crook, None.
Support: None
4902-4904
Thursday, May 10, 8:30 AM - 10:15 AM Hall B/C Poster Session Program Number/Board # Range: 5436-5457 / B682-B703
525. Epidemiology of Cataract and Cataract Surgery Organizing Section: CL
5436 - B682
Comparative analysis of the nuclear lens opacification by Oculus Pentacam and
Lens Opacities Classification System (LOCS III)
5437 - B683
The Impact of Community Screening for Cataract in a Rural Population of the
Guangdong Province, China
A.J. Cariello, E.P. F. Costa, F.H. C. Casanova, D.Bagiossi, A.L. Hofling-Lima.
Department of Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil.
E.M. Baruwa1A, M.He2, K.Frick1B, N.Congdon3. AInternational Health, 1Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD; 2Helen Keller International,
Guangdong, China; 3Chinese University of Hong Kong, Hong Kong, China.
Purpose: To compare the nuclear lens density acquired by Pentacam Scheimpflug
imaging to Lens Opacities Classification System III (LOCS III).
Methods: Based on LOCS III, sixty eyes were chosen with different nuclear lens
opacification grades and divided in six groups of ten eyes each one. The group 1
included nuclear opacity graduated between 1.0 to 1.9; the group 2 included nuclear
opacity graduated between 2.0 to 2.9; the group 3 included nuclear opacity graduated
between 3.0 to 3.9; the group 4 included nuclear opacity graduated between 4.0 to 4.9;
the group 5 included nuclear opacity graduated between 5.0 to 5.9 and the group 6
included nuclear opacity graduated between 6.0 to 6.9. All eyes were submitted to the
Pentacam examination. The Pentacam Scheimpflug image and the values provided
by the graphic of lens density were compared among the different groups. The mean
difference, standard deviation (SD) and 95% limits of agreement were calculated.
Results: The study was composed by 15 males and 21 females ranging from 52 to 84
years of age (mean, 69.36 ± 8.22 years). There was no significant difference regarding
gender (p=0.820) and age (p=0.218). The mean lens density by Pentacam Scheimpflug
imaging in the group 1 was 10.71 ± 1.00, in the group 2 was 15.23 ± 2.93, in the group
3 was 18.39 ± 5.46, in the group 4 was 19.92 ± 5.06, in the group 5 was 22.84 ± 4.36 and
in the group 6 was 23.78 ± 6.18. There was a significant difference among the groups
and a positive correlation between the LOCS III analysis and lens density acquired
by Pentacam Scheimpflug imaging (p<0.005).
Conclusions: There is a direct correlation between LOCS III and the graphic of
lens density acquired by Pentacam Scheimpflug imaging, especially in low grades
nuclear opacities.
CR: A.J. Cariello, None; E.P.F. Costa, None; F.H.C. Casanova, None; D. Bagiossi,
None; A.L. Hofling-Lima, None.
Support: None
Purpose:To determine whether a screening program for cataract can help improve the uptake
of cataract surgery in a poor, rural community of China.
Background:Cataract is the leading cause of blindness in China and cataract surgery rates are
low relative to the incidence of cataract. In August 2001, Helen Keller International (HKI) initiated
a cataract screening program in Yangjiang County, Guangdong Province in partnership with
the privately owned Guangming Eye Hospital (GEH) and community health workers of local
government health department. The goal was to increase awareness of cataract surgery and
its benefits in order to increase the uptake of cataract surgery. HKI provided training for GEH
surgeons and nurses, funded some of the nursing staff salaries as well as all the equipment
and supplies.
Methods:Three months after the program began in August 2001, a willingness to pay for
cataract surgery survey was conducted (the results are in a forthcoming paper by He et al,
Opthalmology). In June 2006 a second survey was conducted to see what impact the program
has had on familiarity with cataract surgery and the willingness to pay for cataract surgery in
rural communities. Standard statistical tests of differences in proportion were used.
Results:Significantly more people knew others who had undergone surgery and more people
were willing to pay for surgery. There has been an increase in the amount this population is
willing to pay for cataract surgery.
Conclusion:The screening program has increased this population’s familiarity with cataract
surgery. Most importantly, almost 3 times as many people who could benefit from surgery were
willing to pay at least 500 Renminbi for surgery in 2006 as were willing to do so in 2001. This
is significant because this is the price of HKI subsidized cataract surgery at the Guangming
Eye Hospital.
Population Charateristics and Study Outcomes
Population Characteristics
Mean Age (SE)
Gender (% Male)
Annual Income (Renminbi*)
<6000
>6000-<9000
>9000
% Literate
Visual Acuity (presenting, better eye)
>=6/12
6/18
6/60
<=6/60
Outcomes
% who knew someone who had undergone cataract surgery
% who were willing to pay for surgery
% willing to pay the cost of HKI provided cataract surgery (Renminbi*)
<500
>=500
**P-value <0.000, *8 Renminbi=1US$
2001 (N=325)
2006 (N=317)
69(8.3)
34%
73(8.2)
28%
256
46
23
46%
144
66
107
22%
67
31
183
44
69
47
131
70
15%
79%
N=257
63%
37%
38%**
91%**
N=289
9%
91%**
CR: E.M. Baruwa, None; M. He, None; K. Frick, None; N. Congdon, None.
Support: None
5438 - B684
Nepafenac 0.1% Compared to Ketorolac 0.5% and Placebo in Cataract Surgery
M.Nardi1, I.Cunliffe2, J.Cano3, B.Cochener4, R.Notivol5, T.Wiernas5. 1NeuroscienceClinica Oculistica, University of Pisa, Pisa, Italy; 2Ophthalmology, Birmingham
Heartlands Hospital, Birmingham, United Kingdom; 3Oftalmologia, Hospital
Municipal, Badalona, Spain; 4Ophtalmologie, CHU Morvan, Brest, France; 5R & D,
Alcon Research Ltd., Fort Worth, TX.
Purpose: To evaluate the efficacy and safety of nepafenac (NEP) 0.1% suspension
compared to placebo (PBO) and ketorolac tromethamine (KET) 0.5% solution for
the prevention and treatment of ocular inflammation and ocular pain after cataract
extraction with IOL implantation.
Design: Multi-center, double-masked, placebo- and active-controlled, randomized,
parallel-group trial.
Methods: Two-hundred twenty-seven patients at 15 European sites, 42 to 90 years of
age, of any race and either sex, scheduled for cataract extraction with implantation
of a posterior chamber intraocular lens were randomized to NEP or KET or PBO
(nepafenac vehicle). The surgical eye was treated with the randomized product 1
drop TID beginning 1 day prior to surgery, continued on the day of surgery and
for the first 21 days of the postoperative period. Visits were scheduled on the postoperative days 1, 3, 7, 14, 21 and 28. Primary efficacy was percent of patients cured
where cure was defined as absence of cells and flare at Day 14 and at all subsequent
study visits. Patients were considered a clinical success if they had less than 5 cells
and no flare at a visit and at all subsequent study visits. Safety assessments included
BCVA (logMAR), IOP, slit-lamp assessment, dilated fundus assessment, drop comfort
assessment, and adverse events.
Results: All 227 patients were included in the safety analysis (77 NEP, 73 KET, and
77 PBO), of which 225 qualified for intent-to-treat analysis. Overall, NEP was safe,
well-tolerated and had significantly higher cure rate at Day 14 compared to PBO;
significantly higher clinical success rate compared to both KET (Day 14) and PBO
(Day 7 and at all subsequent visits); significantly greater percentage of pain-free
patients compared to both KET (Day 3) and PBO (Day 3 and at all subsequent visits);
and superior drop comfort upon instillation compared to KET.
Conclusions: NEP is equal to or better than KET and superior to PBO for the prevention
and treatment of ocular inflammation and pain associated with cataract surgery, and
NEP is more comfortable upon instillation than KET.
CR: M. Nardi, None; I. Cunliffe, None; J. Cano, None; B. Cochener, None; R. Notivol,
Alcon, E; T. Wiernas, Alcon, E.
Support: None CT: www.clinicaltrials.gov, 2005 2647 35
5439 - B685
Association Between Cataracts and Incident Fractures Among Older Women
From the Study of Osteoporotic Fractures (SOF)
R.S. Momi1A, A.L. Coleman1A, F.Yu1A, K.L. Smith2, K.E. Ensrud 3, J.Cauley4, K.L. Pedula 5,
M.C. Hochberg6, C.M. Mangione1B, Study of Osteoporotic Fractures Research Group.
A
JSEI, BMedicine, 1University of California, Los Angeles, CA; 2CPMC Research
Institute, San Francisco, CA; 3Medicine, Minneapolis VA Medical Center,
Minneapolis, MN; 4Public Health, University of Pittsburgh, Pittsburg, PA; 5Kaiser
Permanente Center for Health Research, Portland, OR; 6Rheumatology, University
of Maryland, Baltimore, MD.
Purpose:To study relationship between cataracts and incident non-spine fractures in older
ambulatory women who participated in the Study of Osteoporotic Fractures (SOF).
Methods:A total of 5,482 women attended SOF V6 clinic visit in 1997-99. In a case-cohort
design, lens photographs were graded for women who suffered incident non-spine fractures
during follow-up (April, 2005) and a random sample of 5,482 women who attended V6
clinic visit. Cortical opacity, posterior subcapsular opacity, and nuclear sclerosis were
independently measured by two masked, trained graders using the modified Wisconsin lens
opacity grading protocol. Status of aphakia/pseudophakia, or intraocular lens (IOL) was
also determined for all women with gradable external and/or lens photographs. Primary
outcomes were 6-year non-spine fractures. Cox proportional-hazards regression models
were used to analyze the relationship between lens status and various types of cataracts
and incident fractures after adjusting for potential confounders including study sites, age,
race and cognitive function.
Results:Lens and cataract status were assessed by evaluating external and lens photographs
of 1,274 women in the random sample (mean age: 79.5 ± 4.5 years) and 499 women who
suffered incident non-spine fractures (mean age: 80.6 ± 4.4years). Over an average of 6.0 (±
1.7) years of follow-up, women with IOL in both eyes were at a higher risk for hip fractures
(hazard ratio [HR]=1.36, 95% confidence interval [CI]=1.03-1.78, p=0.028) than those who
were phakic in at least one eye, regardless of the status of cataracts. Women with 5% or
greater PSC in at least one eye were at a lower risk (HR=0.80, 95% CI=0.66-0.98, p=0.032)
for any non-spine fractures when compared to women with PSC less than 5% in both eyes,
regardless of the status of IOL.
Conclusions:Our findings suggest that individuals with IOL placement in both eyes are at
higher risk for hip fractures and that PSC is protective against any non-spine fractures. These
paradoxical results could possibly be associated with increased activity in patients with IOLs
vs. decreased activity in patients with PSC secondary to visual impairment.
CR: R.S. Momi, None; A.L. Coleman, None; F. Yu, None; K.L. Smith, None; K.E. Ensrud,
None; J. Cauley, None; K.L. Pedula, None; M.C. Hochberg, None; C.M. Mangione,
None.
Support: NIH Grant AG05407, AR35582, AG05394, AR35584, AR35583; Research to Prevent
Blindness.
5436-5439
5440 - B686
Visual Outcomes, Impact of Post-Operative Interventions and Uptake of
Additional Services in a Cataract Surgical Program in Rural China
5441 - B687
Refractive Outcomes in Cataract Surgeries Performed by Residents are Similar
to Outcomes Achieved by Attendings
N.G. Congdon1A, D.S. C. Lam1A, S.K. Rao1A, Y.P. Liu2, L.S. Zhang3, S.F. Lin3, A.H. Fan1A,
K.Choi1B. ADepartment of Ophthalmology and Visual Science, BSchool of Public
Health, 1Chinese University of Hong Kong, Kowloon, Hong Kong; 2Ophthalmology,
JSIEC, Shantou, China; 3Ophthalmology, Sanrao Hospital, Sanrao, China.
R.Stacy1, N.Brar1, F.A. Mir2, B.A. Henderson3, S.L. Cremers1. 1Ophthalmology, MEEI,
Boston, MA; 2Ophthalmology, Aga Khan University Medical College, Karachi,
Pakistan; 3Ophthalmology, Ophthalmic Consultants of Boston, Boston, MA.
Purpose: Poor results have been reported for cataract surgery in rural China, with low
uptake of services. We sought to assess the outcomes of cataract surgery, the impact
of post-operative interventions and potential for uptake of post-operative services
in a rural Chinese setting.
Methods: Patients undergoing surgery during the first three months of independent
operation by two recently-trained local Chinese surgeons using the sutureless,
large-incision, manual cataract extraction (SLIMCE) technique at a village hospital
were invited for examination and quality of life/visual function interviews. YAG
capsulotomy, cataract surgery in the fellow eye and spectacle prescriptions were
offered where clinically indicated.
Results: 239/313 (76%) of eligible subjects could be contacted; 176 (74%) of these were
examined, 60 (26%) underwent telephone interviews, and 3 refused exam or interview.
Examined and interviewed patients did not differ significantly from those who
could not be contacted with regards to age, gender, pre-op or Day 1 post-op vision.
Among examined patients, 38 (22%) had undergone bilateral surgery, 86% had pre-op
presenting VA <= 6/60 in the operative eye, and presenting and best-corrected post op
vision were >= 6/18 in 85% and 96% respectively. 16 patients (9%) were recommended
capsulotomy and 15 (94%) complied. 25/66 (38%) of patients who improved by >= 2
lines with refraction in either eye accepted spectacle prescriptions. 19/26 (73%) of
patients with presenting post-op VA < 6/18 in the operative eye could improve to
>= 6/18 with post-op interventions, and 15/26 (58%) accepted interventions. 17/65
(26%) of patients with visually significant cataract in the fellow eye accepted surgery.
Reasons for intervention refusal, quality of life, visual function, near vision and ocular
co-morbidities will be discussed.
Conclusions: This is one of the first detailed studies of cataract surgery and the
impact of post-operative interventions in rural China. Excellent results are possible
in this setting, though better uptake of post-operative services would improve these
results still further.
CR: N.G. Congdon, None; D.S.C. Lam, None; S.K. Rao, None; Y.P. Liu, None; L.S.
Zhang, None; S.F. Lin, None; A.H. Fan, None; K. Choi, None.
Support: Li Ka-shing Foundation
5442 - B688
Association of Selenium Supplement Use and Intraocular Lens (IOL) Among
Older Women
Purpose: To evaluate outcomes of cataract surgeries, including postoperative best
corrected visual acuities (BCVAs) and the mean differences between target and
end refractions, performed by surgeons in training and experienced surgeons at a
teaching hospital.
Methods: We performed a retrospective case study of 286 cataract surgeries from
January 1, 2004 to December 31, 2004 at the Massachusetts Eye and Ear Infirmary.
Postoperative BCVAs and refractions (as measured by technicians) were recorded
within the first 2 months after surgery for cases performed by residents without
any attending assistance and cases performed by attendings alone. 27 charts were
excluded from the study due to lack of postoperative refraction. Statistical analysis
was performed by student t-test and Z-test.
Results: Of the 286 cases reviewed, 176 cataract surgeries were performed by one
of 11 residents under the supervision of an attending physician, and 110 cases were
performed by one of 2 attending physicians. For resident cases, 52.3% (92/176) achieved
a postoperative BCVA of 20/20, compared to 52.7% (58/110) of attending cases. This
difference was not statistically significant (Z test, P=0.956). 88.1% (155/176) of resident
cases achieved a BCVA of 20/40 or better, which was lower but not significantly
different from the 95.5% (105/110) of attending cases achieving better than a 20/40
BCVA (Z test, P=0.056). Resident postoperative refractive error was within +0.50D of
target refraction in 55.7% (98/176) of resident cases, within +1.0D in 83% (146/176),
and within +2.0D in 96.6% (170/176). Attending case postoperative refractive error
was within +0.50D in 46.4% (51/110), within +1.0D in 70.9% (78/110), and within
+2.0D in 96.4% (106/110) of cases. The difference between resident and attending
refractive correction was significant at 1.0D (P= 0.15, 0.02, and 0.94 for 0.5D, 1.0D,
and 2.0D, respectively). The median differences in refractive errors between target
and post-op values for resident and attending cases were 0.75D for residents and
0.805D for attendings. This difference was statistically significant (Mann-Whitney
rank sum test, P=.009).
Conclusions: Cataract surgeries performed by residents do not result in significantly
lower BCVAs. Furthermore, postoperative refraction is closer to target refraction in
resident performed cases. Physicians at teaching hospitals can thus reassure patients
who may be anxious about cataract procedures performed by surgeons in training.
CR: R. Stacy, None; N. Brar, None; F.A. Mir, None; B.A. Henderson, None; S.L.
Cremers, None.
Support: None
5443 - B689
Current Situation of Cataract in South Nepal
L.L. Huang1A, A.L. Coleman1A,1B, F.Yu1A,1B, K.L. Stone2, K.E. Ensrud 3, J.A. Cauley4,
K.L. Pedula 5, M.C. Hochberg6, C.M. Mangione1A,1C, Study of Osteoporotic Fractures
Research Group. 1University of California, Los Angeles, CA; BOphthalmology/JSEI,
C
Medicine, 1University of California, Los Angeles, CA; 2California Pacific Medical
Center Research Institute, San Francisco, CA; 3Medicine, VA Medical Center,
Minneapolis, MN; 4Public Health, University of Pittsburgh, Pittsburgh, PA; 5Kaiser
Permanente Center for Health Research, Portland, OR; 6Rheumatology, University
of Maryland, Baltimore, MD.
Purpose: The epidemiological and clinical evidence on selenium’s protective role as an
anti-oxidant in the development of age-related eye diseases have been inconclusive. The
present cross-sectional study examines the relationship between supplement intake of
selenium and severe cataract in older ambulatory women who participated in the Study of
Osteoporotic Fractures (SOF).
Methods: Lens photographs from a random sample of women at the year 10 (visit 6) clinic
visits in SOF in 1997-9 were graded. Cataract status was independently assessed by two
masked, trained graders using the Age-Related Eye Disease Study (AREDS) lens opacity
grading system, adapted from Wisconsin lens opacity grading protocol. The discrepancies
between two graders were adjudicated. Status of aphakia/IOL was also determined for all
women with gradable external and/or lens photographs. Daily intake of selenium from
supplements was calculated based on the Block Food Frequency Questionnaires (FFQ).
Relationship between the supplement use of selenium and IOL in at least one eye was
evaluated using the Fisher’s exact test and further analyzed using logistic regression models,
adjusted for potential confounders: study site, age, race, smoking status, alcohol consumption,
body mass index (BMI), education, walk for exercise, self-rated health status, and the presence
of diabetes, hypertension, and age-related macular degeneration.
Results: Among 1,274 women in the random sample, 1,190 (93%) had known lens status
and completed FFQ. 479 (40%) women had IOL in at least one eye. 35 (3%) women took daily
selenium from supplements, and they were less likely to have IOL compared with those
who did not take selenium from supplements in the adjusted analysis (odds ratio [OR]=0.44,
confidence interval [CI]=0.20-0.99, p=0.047).
Conclusions: Our finding suggests that higher intake of selenium may be associated with
decreased risk for progression to severe cataract in older women. This is consistent with
the anti-oxidative effect of selenium in delaying cataract development, as demonstrated in
previously published studies on animal models and epidemiologic data.
CR: L.L. Huang, None; A.L. Coleman, None; F. Yu, None; K.L. Stone, None; K.E. Ensrud,
None; J.A. Cauley, None; K.L. Pedula, None; M.C. Hochberg, None; C.M. Mangione,
None.
Support: NIH Grant AG05407, AR35582, AG05394, AR35584, AR35583; Research to Prevent
Blindness
T.Naito1, H.Shiota1, M.K. Sunuwar2, T.Kiryu2, K.B. Khadka 3, J.Akura4. 1Ophthalmology,
Tokushima University, Tokushima, Japan; 2Narayani Eye Care Project, Kathmandu,
Nepal; 3Gaur Eye Hospital, Gaur, Nepal; 4Kushimoto Rihabiri Center, Wakayama,
Japan.
Purpose:South Nepal was shown to be a cataract pocket zone. The purpose of this
study is to investigate the current situation of cataract in south Nepal.
Methods: Screening eye camps were conducted at 8 villages in Rautahat district, Nepal
in 2005. We investigated eye diseases and socio-economic factors of 4027 patients (2001
males and 2026 females) at the screening eye camps.
Results: Forty-eight percent (48%) of the patients ( 981 males and 933 females, mean
age 57.6 y.o. ) had cataract. Cataract is highly prevalent according to the age and 60%
of the age group between 41-60 years had cataract. The estimate prevalence rate of
cataract blindness is about 1% in the total population of Rautahat district. In this area,
64% people were farmers and only 28.2% were literate. However, 14% in the cataract
patients were literate and this rate was quite low.
Conclusions: Results in south Nepal suggest that the prevalence of cataract is quite
high and most cataract patients are very poor.
CR: T. Naito, None; H. Shiota, None; M.K. Sunuwar, None; T. Kiryu, None; K.B.
Khadka, None; J. Akura, None.
Support: None
5440-5443
5444 - B690
Rate of Endophthalmitis Following Cataract Surgery Among Medicare
Beneficiaries in All 50 States
5445 - B691
Comparison of Lens Opacity Evaluations From Digital and Film Fundus Reflex
Images
E.W. Gower1, L.Zhang1, A.Behrens1, J.M. Tielsch2, O.D. Schein1. 1Ophthalmology, Johns
Hopkins Wilmer Eye Inst, Baltimore, MD; 2International Health, Johns Hopkins
School of Public Health, Baltimore, MD.
S.E. Harris1, S.Reed1, L.D. Hubbard1, B.Zhang1, R.P. Danis, Jr.1, H.K. Li2.
1
Ophthalmology & Visual Sciences, FPRC, University of Wisconsin-Madison,
Madison, WI; 2Ophthalmology & Visual Sciences, University of Texas Medical
Branch, Galveston, TX.
Purpose:ETo estimate the rate of post cataract surgery endophthalmitis on a statewide
basis across the United States.
Methods:TThe Medicare 100% sample of research identifiable data for 2003and
2004 was used to collect information on all cataract surgeries and all cases of postcataract surgery endophthalmitis among Medicare beneficiaries. Beneficiaries
were limited to a maximum of two cataract surgery claims, and a maximum of one
endophthalmitis claim within the time period. Cataract surgery was defined using
Current Procedural Terminology Codes 66850, 66920, 66930, 66940, 66982, 66983,
and 66984. Endophthalmitis claims were limited to those claims with a diagnosis of
endophthalmitis using International Disease Classification Codes 360.0-360.04 that
occurred within six weeks following cataract surgery. Yearly state-based rates of
endophthalmitis were calculated.
Results:Over 1.6 million cataract surgeries were performed each year among Medicare
Beneficiaries, and approximately 2000 endophthalmitis cases occurred yearly. Five
states accounted for nearly 1/3 of all surgeries performed (PA, NY, CA, TX, FL). Rates
of endophthalmitis varied from 0 to approximately 3 per 1000 surgeries across states.
States with the highest rates of endophthalmitis varied by year; however, for both
years, Tennessee and West Virginia ranked among the top 5 highest annual rates.
Likewise, the states with the lowest rates varied between years. In over 2/3 of the
states, the endophthalmitis rate was higher in 2003 than it was in 2004, including all
five states with the highest number of surgeries.
Conclusions:There appear to be significant differences in endophthalmitis rates by
state. Further analyses will examine variations in rate over smaller geographic areas
and examine potential risk factors for higher rates.
CR: E.W. Gower, None; L. Zhang, None; A. Behrens, None; J.M. Tielsch, None; O.
D. Schein, None.
Purpose: To determine whether lens opacity evaluations from digital fundus reflex
(FR) images are comparable to film image evaluations.
Methods: UTMB-Galveston (H.L.) recruited subjects with diabetic retinopathy (154
eligible eyes) to investigate whether ETDRS retinopathy severity level evaluated from
digital color stereoscopic 30-degree fundus photos is comparable to that assessed
from film. Subjects were chosen to capture the full range of retinopathy severity. We
evaluated the FR images from this image set to investigate comparability of evaluating
lens opacities in digital vs. film images. Film images were evaluated for cortical
opacity to select a study sample of 50 eyes: 10 eyes with no cortical opacity, 10 with
small amounts (up to ~5% total) of cortical opacity and 30 eyes with more extensive
cortical opacity. Standardized procedures were developed to optimize illumination
and contrast of the digital images. Evaluation was done masked to group, and film
images were evaluated independently at least one week apart from corresponding
digital images to minimize recall. Digital images were evaluated using IMAGEnet
software. The AREDS lens opacity classification (AREDS report 4, AJO 2001; 131:167175) was applied to both digital and film images, special focus to the central zone
(5mm diameter circle).
Results: The intraclass correlation coefficient (ICC) was 0.92 between digital and
film images for cortical opacity area. There was no evidence of systematic difference
between imaging media for presence/absence. The group with more extensive area
had higher ICC (0.93), while the group with smaller area had less agreement (because
differences are proportionally greater compared to absolute amount).
Conclusions: This pilot study suggests that evaluations of cortical lens opacity
from digital and film images are comparable. The correlation is about the same as
observed for masked inter-evaluator comparisons between film FR images in AREDS 1
(AREDS report 4, AJO 2001; 131:167-175). This suggests that the variability we observed
between digital and film images may be due to variability of the evaluator rather than
differences between the imaging media.
CR: S.E. Harris, None; S. Reed, None; L.D. Hubbard, None; B. Zhang, None; R.P.
Danis, None; H.K. Li, None.
Support: Juvenile Diabetes Research Foundation International
5446 - B692
Lens Opacity Area by Computerized Planimetry vs. Manual Estimation on
Digitized Fundus Reflex Images
5447 - B693
1999-2006 - A Comparative Analysis of Factors Contributing to Wait Times for
Cataract Surgery
W.K. Benz, G.Chambers, L.D. Hubbard, B.Zhang, R.P. Danis, Jr.. Ophthalmology &
Visual Sciences, FPRC, Univ of Wisconsin-Madison, Madison, WI.
M.-J.Aubin1A,2, F.Djafari1A,2, R.Bruen1A,2, S.Couture1A,2, A.Laporte1A,2, J.Matteau1A,2,
J.Gresset1B,2, H.Boisjoly1A,2. AOphthalmology, BOptometry, 1University of Montreal,
Montreal, PQ, Canada; 2Ophthalmology, Maisonneuve-Rosemont Hospital
Research Centre, Montreal, PQ, Canada.
Purpose: To compare two methods of evaluating lens opacity area from digitized
fundus reflex images: planimetry (grader circumscribes the opacity; the computer
calculates area) and estimation (grader estimates percent opacity by grid subfield;
an algorithm calculates area).
Methods: Twenty-seven color stereo fundus reflex photos were selected from the
Age-Related Eye Disease Study (AREDS), a combined epidemiological study and
clinical trial of nutritive supplements for AMD and cataract. Neitz photo grading
had shown these eyes to have >5% posterior subcapsular (PSC) opacity in the central
5 mm diameter zone of the lens. The photos were digitized at high resolution, then
displayed and analyzed with Topcon IMAGEnet. Spatial calibration assumed a 12 mm
horizontal iris diameter, and a digital version of the AREDS lens grid was applied.
Lenses were viewed in stereo using the “ScreenVu Stereoscope”. Area of PSC opacity
in the central zone was estimated manually with the grid method (AREDS Report No.
4, Am J Ophthalmol 2001; 131:167-175). For each eye, manual estimation was immediately
followed by planimetry, in which PSC opacities were outlined with the IMAGEnet
“Area” tool. Two lens evaluators independently graded the entire image set.
Results: Within each evaluator, PSC opacity area by planimetry vs. estimation yielded
intra-class correlation coefficients (ICC) of 0.97+ (nearly perfect agreement), with no
evidence of systematic shift. Between evaluators, however, disagreements on opacity
boundaries (reflected similarly in grader vs. grader plots from both techniques)
lowered the ICC to ~ 0.7. Outliers that accounted for lower correlation had less stereo
effect, complicating identification of opacities as PSC. Contrast enhancement and
color separation are being explored to improve the grader’s ability to discern cataract
boundaries. We will also present data on using planimetry vs. estimation for evaluating
cortical opacities in digitized film images, and for PSC as well as cortical opacities
in natively digital images.
Conclusions: For determining area of PSC lens opacity, computerized planimetry on
digital images produces results nearly identical to those from the manual estimation
method. With digital images, planimetry may be a more efficient alternative.
CR: W.K. Benz, None; G. Chambers, None; L.D. Hubbard, None; B. Zhang, None; R.
P. Danis, None.
Support: NO1-E4-0-2130 CT: www.clinicaltrials.gov, 1
Background:Standards for visual acuity (VA) threshold as indication for cataract surgery
have decreased dramatically over the last 2 decades: from 6/60 (1.0 logMAR) or better in
1982 to 6/12 (0.3 logMAR) or better in 2000 (Setty R, et al., Br J Ophthalmol 2000;84(12):1439).
This decreasing surgical threshold, along with the aging of the population (27%
predicted increase in the population aged 65 and over between 2001 and 2011), means
that more patients are to be enlisted for cataract surgery. Other factors influencing
wait times (WT) include patient demand and access to operating room (OR) time.
Purpose:To compare WT for cataract surgery between 1999 and 2006 and to look at
the principal factors influencing the waiting list apart from the population dynamics:
VA threshold for cataract surgery and cataract surgical rates (CSR).
Methods:Comparative prospective study of patients enlisted for first-eye cataract
surgery at Maisonneuve-Rosemont Hospital (MRH), Montreal, in 1999 and in 2006. 594
patients (507 in 1999 and 85 in 2006) underwent a detailed visual exam including VA
(logMAR) within four weeks prior to surgery. Functional measures of cataract severity
were obtained using the VF-14 and the Cataract Symptom Score (CSS) questionnaires.
WT (days) were obtained from the surgical waiting list. The CSR (cataracts operated
per million population per year) were also calculated for the population pool in the
catchment area of MRH (0.5 million population).
Results:WT decreased from a mean of 180.95 days (approximately 6 months) in 1999 to
119.11 days (approximately 4 months) in 2006 (p < 0.05). The VA threshold for cataract
surgery decreased from 0.57 logMAR (6/24) in 1999 to 0.42 logMAR (6/15) in 2006 (p <
0.05). Functional measures of cataract severity also reflected this decrease in surgical
threshold with a better score on both the VF-14 and the CSS in 2006 (V-14 74.77; CSS
4.9) compared to 1999 (VF-14 64.66; CSS 5.7) (p < 0.05). The CSR increased from 3174
(1587 cataracts operated/0.5 million population/year) in 1999 to 7776 (3888 cataracts
operated/0.5 million population/year) in 2006 (p < 0.05).
Conclusions:Although there has been a greater patient load driven both by the
population dynamics and the reduced VA threshold, the cataract surgical output
more than doubled with the opening of an OR specially dedicated to cataract surgery.
Care should be taken in the selection of patients for cataract surgery to avoid putting
pressure on the system.
CR: M. Aubin, None; F. Djafari, None; R. Bruen, None; S. Couture, None; A. Laporte,
None; J. Matteau, None; J. Gresset, None; H. Boisjoly, None.
Support: FRSQ Reseau Vision, FROUM, Alcon Canada
5444-5447
5448 - B694
Prospective Longitudinal Study of Pseudoexfoliation
J.L. Yip1, W.P. Nolan2A, D.Uranchimeg3, J.Bassanhu 3, P.S. Lee2A, C.E. Gilbert1, A.Foster1,
P.J. Foster2A, P.T. Khaw2B, G.J. Johnson1. 1International Centre for Eye Health,,
London Sch of Hygiene & Tropical Med, London, United Kingdom; ADepartment
of epidemiology, BDepartment of pathology and Would healing, 2Insitute of
Ophthalmology, London, United Kingdom; 3Department of Ophthalmology, Health
Sciences University, UlaanBaatar, Mongolia.
Purpose: To determine If pseudoexfoliation (PXF) is associated with increased mortality
and progression of lens opacities.
Methods: In 1999, 833 volunteer participants aged >=50 years underwent full slit lamp
examination including Goldmann intraocular pressure,LOCS III grading for lens opacity,
optic disc assessment and photography. At follow up, 168/833 (20.2%) had died, and 346/665
(52.0%) of the remaining participants were traced and re-examined using similar methods.
Progression of lens opacity was identified as an increase of LOCSIII grades beyond
a threshold derived from the inter-observer variation tests. This was a change of 1.0
LOCSIII units for nuclear opacity (NO), colour (NC), and posterior subcapsular lens
opacity (PSCLO), and 1.5 units for cortical lens opacity (CLO). The effect of PXF, age and
gender on mortality and cataract progression opacity was assessed using the chi squared
test, t-test or the Wilcoxon rank sum test. The presence of climatic droplet keratopathy
(CDK) was used as a proxy indicator for ultraviolet (UV) exposure in the final model.
Differences in baseline cup-disc ratio (CDR) between subjects who did and did not attend
for re-examination were analysed to assess the effect of bias on the results.
Results: At baseline, 62/833 participants were diagnosed with PXF (7.4%, 95% CI, 6.5-8.3).
24.2% of those diagnosed with PXF at baseline had died compared to 19.3% without PXF
(Odds Ratio(OR)=1.33, 0.72-2.45, p=0.35, age-adjusted OR=0.8, 0.4-1.9, p=0.6). Progression
of NO was identified in 48/315 participants (15.2%; 13.2-17.2%), NC in 47 participants
(15.1%; 13.1 -17.1%), CLO in 67 participants (21.9%; 19.6-24.2%) and PSCLO in 10 participants
(3.3%; 2.3-4.3%). Participants with PXF were more likely to have progression of lens
opacity; for NO, OR=1.7, 0.6-4.9, p=0.3; for NC, OR=1.35, 0.4-4.2, p=0.6; CLO, OR= 2.0,
0.8-5.3, p=0.1; for PSCLO, OR=4.3, 0.8-22.3, p=0.06, although none of these effects were
statistically significant. The OR for the effect of PXF on progression was attenuated by
inclusion of age and gender. Inclusion of CDK had no effects on the final model. There
was no difference in median CDR between those examined and not re-examined (0.3,
IQR: 0.2-0.4 in both groups,p=0.49).
Conclusions: There is no evidence from this cohort that PXF is associated with increased
mortality or progression of lens opacity.
CR: J.L. Yip, None; W.P. Nolan, None; D. Uranchimeg, None; J. Bassanhu, None; P.S.
Lee, None; C.E. Gilbert, None; A. Foster, None; P.J. Foster, None; P.T. Khaw, None; G.
J. Johnson, None.
Support: British Council for Prevention of Blindness, CBMi, Wellcome trust
5449 - B695
Risk Factors for Cortical Opacities in a Population-Based Cohort of Adult
Latinos: The Los Angeles Latino Eye Study (LALES)
M.Torres, S.Azen, R.Varma, the LALES Group. Ophthalmology, University of
Southern California, Los Angeles, CA.
Purpose: To evaluate risk factors for cortical opacities in a population-based sample
of Latinos.
Methods: The data for this analysis is derived from the Los Angeles Latino Eye Study
(LALES) a population-based prevalence study of eye disease in Latinos (primarily
Mexican-Americans) age 40 and older. All participants underwent a complete eye
examination by a trained ophthalmologist including grading of the Lens at the slit
lamp using the Lens Opacities Classification System II (LOCS II). Cortical opacities
were defined by a grade>2 in either eye. Participants were considered to have cortical
only opacity if that was the only type present in both eyes. The reference group was
participants who had no opacities in both eyes. Frequency procedures were used
to determine the distribution of the risk indicators in each group (cortical opacity
versus no opacity). Univariate logistic regression analyses were conducted to evaluate
the associations of the risk factors for cortical opacity, adjusted for age and gender.
Independent risk indicators were then identified and odds ratios(OR) were calculated
using a multivariable logistic regression model. All statistical testing was conducted
at the 0.05 significance level, using SAS (SAS Institute, Cary, NC).
Results: Of the 6142 participants who underwent an eye examination, 5945 participants
had a LOCSII grading in at least one eye. 468 participants were identified as having
cortical only opacities and 4869 had no opacities. 608 participants were excluded
from the analyses because they were identified as having other types of opacities.
Participants in the cortical only opacity group were older (mean age±sd: 62 years
±8.6) compared to the group with no opacities (52 yrs ±8.6)(p<0.0001). Multivariate
analyses revealed that older age (OR=1.1), history of diabetes mellitus (OR=1.7), and
higher glycosylated hemoglobin levels (OR=1.1) were independent risk indicators
for cortical opacities (all p<0.01). No other risk indicators (gender, iris color, blood
pressure, and history of hypertension, macular degeneration or glaucoma, or family
history of cataracts, use of steroids or hormone replacement therapy) were found to
be significantly associated with cortical opacities.
Conclusions: The risk of cortical opacities was greater in older Latinos, Latinos
with a history of diabetes mellitus and those with higher glycosylated hemoglobing
levels. Since cortical lens opacities can cause visual impairment, increasing awareness
for prevention and control of diabetes mellitus may decrease the burden of visual
impairment in Latinos.
CR: M. Torres, None; S. Azen, None; R. Varma, None.
Support: NEI Grant EY 11753
5450 - B696
Lengsin Is Associated With Age-Related Cortical and Posterior Subcapsular
Cataracts
5451 - B697
Causes and Risk Indicators of Visual Impairment Following Cataract Surgery in
Adult Latinos: The Los Angeles Latino Eye Study(LALES).
G.Jun1A, B.E. K. Klein2, R.Klein2, T.Joshi1A, J.Capriotti1A, K.E. Lee2, S.K. Iyengar1A,1B.
A
Epidemiology and Biostatistics, BOphthalmology, 1Case Western Reserve
University, Cleveland, OH; 2Ophthalmology and Visual Sciences, University of
Wisconsin Medical School, Madison, WI.
K.Mazhar1, A.E. Barañano2, J.Wu1, S.P. Azen1, R.Varma1, LALES Group. 1Opthalmology,
Keck School of Medicine,University of Southern California, Los Angeles, CA;
2
Johns Hopkins School of Medicine, Baltimore, MD.
Purpose: Lengsin (GLULD1) is one of the most abundant RNA transcripts with almost
exclusive expression in the lens. It shows a 52-fold under expression in age-related
cataract compared with the normal lens, but has not been examined for association or
linkage. Lengsin is under our most significant linkage region (6q12) in both cortical (CC)
and posterior subcapsular cataract (PSC) genome scans. We investigated association
with both cataracts using the Beaver Dam Eye Study (BDES).
Methods: We selected four SNPs in GLULD1 and six SNPs in genes flanking GLULD1
for genotyping in a subset of the BDES (325 individuals from 102 pedigrees). Only SNPs
in GLULD1 showed significant association and led to a reduction in the linkage signal
on 6q12 using the associated SNPs as covariates. These SNPs were followed up in all
related individuals from BDES (2268 individuals in 626 pedigrees). The cataracts were
graded from photographs taken with dilated pupils, and the percent of the lens surface
as well as a central circle area affected was reported. We used three quantitative traits
after adjusting for covariates: % of lens surface with cortical cataract (CC), % of center
circle with PSC (CPSC), and % of lens surface with PSC (LPSC). We performed familybased association analyses using ASSOC (S.A.G.E.). Pairwise linkage disequilibrium
(D’) was estimated from the full BDES data using HAPFREQ in FBAT.
Results: Pairwise D’ among the genotyped SNPs in GLULD1 is > 0.90 in our data
similar to HapMap. The most significant association using the dominant model was
identified with SNP rs9343928 (CC: p=7.7x10 -4; CPSC: p=3.8x10 -10; LPSC: p=2.5x10 -6).
Other SNPs in GLULD1 showed the similar results.
Conclusions: GLULD1 accounts for the linkage on 6q12, and SNPs in this gene are
significantly associated with both CC and PSC. Previous expression results and our
evidence for association support it as being an important lens protein mediating
age-related cataractogenesis.
CR: G. Jun, None; B.E.K. Klein, None; R. Klein, None; T. Joshi, None; J. Capriotti,
None; K.E. Lee, None; S.K. Iyengar, None.
Purpose: To determine the primary causes, and risk indicators of visual impairment
(VI) in cataract-operated eyes in adult Latinos.
Methods: Participants in LALES- a population-based cross-sectional study of adult
Latinos aged 40 years and older residing in Los Angeles, California -underwent inhome interview and a comprehensive ophthalmologic examination. VI in the cataractoperated eye was defined by: presenting visual acuity (PVA) <20/40 or best corrected
visual acuity (BCVA) <20/40. Uncorrected refractive error in cataract operated eye
was defined as visual acuity ≤20/40 by PVA but visual acuity >20/40 by BCVA. The
primary cause of VI was assigned to the condition expected to cause the greatest
limitation of vision in the cataract-operated eye based on clinical examination findings,
lens grading, fundus photographs, and all information provided by the examining
ophthalmologist. Stepwise logistic regression evaluated the socio-demographic and
clinical variables as risk indicators associated with VI by BCVA in the worse seeing
cataract-operated eye.
Results: The analyses include 261 participants with at least one cataract extraction and
complete clinical examination data. There were 100 participants with unilateral and 161
with bilateral cataract extractions. Of the 422 cataract operated eyes, 203 (48%) had VI
defined by PVA compared to 136 (32%) by BCVA. Uncorrected refractive error (33%),
age related macular degeneration (13%), diabetic retinopathy (11%), corneal opacity
(8%), posterior capsular opacification (7%), glaucoma (5%), myopic degeneration (4%)
and retinal detachment (3%) were the major causes of VI in cataract-operated eyes.
Self-reported history of glaucoma (OR=2.9, CI=1.3-6.7), barriers to eye care (OR=2.6,
CI=1.1-6.2), and unmarried or not living with partner (OR=1.9, CI=1.01-3.4) were
independent factors associated with VI in cataract-operated eyes (p <0.05).
Conclusion: There remains a significant degree of VI after cataract extraction in adult
Latinos. Many of the underlying causes of this VI are amenable to improvement or
correction by careful clinical follow-up. Creating a program that facilitates access to
ophthalmic healthcare services would address many of the causes of VI in cataractoperated adult Latinos.
CR: K. Mazhar, None; A.E. Barañano, None; J. Wu, None; S.P. Azen, None; R.
Varma, None.
Support: NIH Grant EY03040, Nei Grant EY11753
5448-5451
5452 - B698
The Relationship of Axial Length and Three Main Types of Cataract in the
Population of a Tropical Area of China
5453 - B699
Hospital Based Study on Exfoliation Syndrome
J.Qu1A, H.Sasaki1A, Y.Kawakami1A, Y.Sakamoto1A, M.Kojima1A, J.Zhou2, K.Wu 3, J.Zhang4,
R.Honda1B, K.Sasaki1C. AOphthalmology, BHygiene, CSocial and Enviromental
Medicine, 1Kanazawa Medical University, Uchinada, Japan; 2Ophthalmology,
Shanxi Eye Hospital, Taiyuan, China; 3Ophthalmology, Zhongshan University,
Guangzhou, China; 4Ophthalmology, China Medical University, Shenyang, China.
Purpose:To describe the relationship between axial length and prevalence of the three
main types of cataract in the population of a tropical area of China.
Methods:Some 558 participants aged ≥50yrs (mean:61.0±10.7yrs) from Miaolin village
in Southern China (lat.18°) were examined in a Japanese/Chinese cooperative eye
study, March 2006. Axial lengths of eyes were measured with an A-scan ultrasound
device (US800, NIDEK) and crystalline lens were graded under maximal pupil dilation
from slit lamp and retroillumination images (EAS-1000, NIDEK) by a single observer
following the WHO grading system. After excluding eyes with aphakia, pseudophakia
or serious corneal opacity, 1023 eyes were enrolled. Associations between axial length
and cataract were assessed using the multivariate logistic regression model controlling
for age and sex. Based on the mean axial length (23.1±1.2mm), cases were divided into
3 groups: Short,<23mm, axial group (SA); medium,23 to 26mm, axial group (MA), and
long >26mm, axial group (LA).
Results:Prevalence of nuclear, cortical and posterior subcapsular cataract (PSC)
was 46.7%, 28.6% and 16.3%, respectively. Prevalences of nuclear cataract (84.2%)
and PSC (35.3%) in LA group were significantly higher than in the other two groups
. Increased risk of nuclear cataract and PSC at grade 1 and over was found in LA
compared with SA with odds ratio of 6.12 (95%CI 2.03~18.43) in nuclear and 3.27
(95%CI 1.23~8.69) in PSC.
Conclusions:The population in this tropical area of China had a high prevalence of
cataract. Even in a population with a high prevalence of nuclear cataract, eyes with
long axial length were at higher risk of nuclear cataract and PSC, however, axial length
did not seem to be related to the prevalence of cortical catarac.
CR: J. Qu, None; H. Sasaki, None; Y. Kawakami, None; Y. Sakamoto, None; M.
Kojima, None; J. Zhou, None; K. Wu, None; J. Zhang, None; R. Honda, None; K.
Sasaki, None.
Support: None
P.I. Vassileva, T.Hergeldzhieva, Y.Nikolaeva, I.Shandurkov. Eye Department, University
Hospital of St Anna, Sofia, Bulgaria.
Purpose: To study the prevalence of exfoliation syndrome in patients hospitalized
in the Department of Ophthalmology at University Hospital “St. Anna” and Medical
Center for Sight “Pashev” in Sofia, Bulgaria for the period of 1st January 2004 - 31st
December 2005.
Methods: A retrospective review of clinical records of 5228 hospitalized patients
was performed. Demographic data (gender, age, place of residence) were collected.
Exfoliation syndrome was diagnosed on the basis of documented detailed eye exam
of every hospitalized patient during study period.
Results: 5228 patients with mean age of 61.6 years were hospitalized. 608 patients had
ExS - 11.63%. 355 (58.4%) of the patients were women and 253 (41.6%) were men. The
average age of patients with ExS was 74 years (42-98). In most of patients with ExS both
eyes were affected. The youngest patient had unilateral exfoliation syndrome in the
eye with corneal transplantation surgery 22 years ago. Most patients were admitted
for surgical treatment of cataract and glaucoma. Specific surgical techniques to avoid
complications were evaluated and discussed.
Conclusions: Exfoliation syndrome (ExS) is frequent age related condition. According
to some studies ExS is diagnosed in more than a half of patients with glaucoma and
therefore it is the most frequent cause of secondary glaucoma. Exfoliation syndrome is
related also to cataract formation. ExS becomes more frequent with age. The analysis
of our data shows that patients with ExS are older as compared to patients with
other eye diseases treated during the same period of time. Our study demonstrates
no statistically significant difference between men 253 (41.6%) and women 355
(58.4%). Reported data for the frequency of ExS among our patients (11.63%) may be
underestimated because of lack of unawareness of the syndrome. Prospective study
is in a progress. Proper diagnosis and consideration of possible surgical complications
associated with ExS are of crucial importance in our daily clinical practice.
CR: P.I. Vassileva, None; T. Hergeldzhieva, None; Y. Nikolaeva, None; I.
Shandurkov, None.
Support: None
5454 - B700
The NASCA Study - Report 3: Cross-Sectional Analysis of Exposure to
Radiation in Space and Risk of Lens Opacification
5455 - B701
Antioxidant Nutrient Intake and Incidence of Age-Related Cataract: Blue
Mountains Eye Study
L.T. Chylack, Jr.1, A.H. Feiveson2, L.Peterson3, F.K. Manuel4, M.Wear5, W.H. Tung1,
D.Hardy6, L.Marak 5, C.Bell7, F.A. Cucinotta2. 1Surgery / Center for Ophthalmic
Research, Brigham & Womens Hosp/Harvard, Boston, MA; 2Lyndon B. Johnson
Space Center, NASA, Houston, TX; 3Public Health, The Methodist Hospital,
Houston, TX; 4Space Center Eye Associates, Houston, TX; 5Wyle Laboratories,
Houston, TX; 6Medicine, Baylor College of Medicine, Houston, TX; 7Division of
Space Life Sciences, USRA, Houston, TX.
A.G. Tan1A, J.J. Wang1A, G.Burlutsky1A, V.Flood1A, E.Rochtchina1A, G.L. Kanthan1A, R.G.
Cumming1B, P.Mitchell1A, Blue Mountains Eye Study. AOphthalmology (Centre for
Vision Research, Westmead Millennium Institute, Westmead Hospital), BSchool of
Public Health, 1University of Sydney, Sydney, Australia.
Purpose: The NASA Study of Cataract in Astronauts (NASCA) will assess risk of lens
opacification from exposure to radiation in space in US astronauts. This is Progress Report
#3.
Methods: This 5-yr study follows populations of US astronauts, military aircrew, and
ground-based subjects with annual eye exams, assessment of space radiation exposure
(SRE), solar ocular exposure (SOE), and nutrition. Nidek EAS 1000 digital lens images,
demographic and nutritional data were gathered. Statistical analysis consisted of fitting
customized non-normal regression models to six measures of opacity (3 nuclear (N), 1
cortical (C), and 2 PSC).We tested effects of subject group, SRE, and other variables on
each of the 6 measures. We identified variables that are possibly confounded with subject
group and used a free step-down resampling method to account for multiple testing with
a family-wise error rate of 0.05.
Results: Age is most important predictor of size and spread of C opacity. Astronauts who
have flown in space have significantly greater C mean area opaque than those who have
not. For astronauts who have flown in space, there is no relationship between total lens
dose of space radiation and mean or variance of age-adjusted C. For all gps increased SOE
was weakly associated with higher C opacity. We found also some evidence that larger
intake of Vitamin A was associated with reduced C opacity. Neither SRE, nor SOE, nor any
nutritional variable, was associated with increased or decreased N opacification. Age was
slightly associated with increased area of P opacification and the number of isolated PSC
centers of opacity. Only for ground based controls was there a gender effect of area of P
opacification (males:greater area opaque). Identified confounders are as follows: indicators
of hypertension (p=0.006) and asthma (p<0.001) are associated with greater C area opaque,
and max. logMAR acuity (p=0.001) associated with greater P area opaque.
Conclusions: SRE is a risk factor for greater C opacification. SOE, and the identified
cofounders are associated with greater C opacification, and higher vitamin A intake may
be associated with lower C area opaque. Other than age, no study variables were associated
with N opacification.
CR: L.T. Chylack, None; A.H. Feiveson, None; L. Peterson, None; F.K. Manuel, None; M.
Wear, None; W.H. Tung, None; D. Hardy, None; L. Marak, None; C. Bell, None; F.A.
Cucinotta, None.
Support: NASA Cooperative Agreement Number: NAG9-1491
Purpose: To investigate relationships between antioxidant nutrient intake and the
5- and 10-year incidence of age-related cataract.
Methods: The Blue Mountains Eye Study examined 3654 participants aged 49+ years at
baseline (1992-94); 2335 (75.1% of survivors) and 1952 persons (75.6% of survivors) were
re-examined after 5 and 10 years, respectively. At each visit, participants underwent
comprehensive eye examinations including lens photography. Interviews used
standardised questionnaires including a 145-item semi-quantitative food frequency
questionnaire (FFQ). At the 5- and 10-year examinations, 1989 (85%) and 1683 (86.2%),
respectively, had completed the FFQ at baseline. We constructed a nutrient database
that included alpha- and beta-carotene, beta cryptoxanthin, lutein and zeaxanthin,
lycopene, vitamins A, C and E, and the minerals iron and zinc. Lens photos were
graded using the Wisconsin Cataract Grading System. Cortical cataract was defined
for cortical opacity ≥ 5% of total lens area, nuclear cataract defined for nuclear opacity
≥ standard photo #4, and posterior subcapsular (PSC) cataract if present. Cataract
incidence was defined as development of cataract in one or both eyes in subjects
without cataract in either eye at baseline.
Results: Participants with the highest quintile of vitamin C intake (from diet and
supplements) had a reduced risk of 5-year incident nuclear cataract (adjusted odds
ratio, OR, 0.54, 95% confidence interval, CI, 0.36-0.83) compared to participants in
lower quintiles, after adjusting for multiple confounders. A similar reduction in the
risk of 10-year incident nuclear cataract was observed in the highest quintile group
(OR 0.68; 95% CI, 0.48-0.96). An above median value in the total intake of combined
antioxidants (vitamins C, E and beta-carotene) was associated with a reduced risk of
incident nuclear cataract: adjusted OR 0.65; 95% CI, 0.43-0.98 after 5 years; OR 0.56;
95% CI, 0.39-0.79 after 10 years. Antioxidant intake was not significantly associated
with the 5- or 10-year incidence of either cortical or PSC cataract.
Conclusions: Higher intake of vitamin C, or the combined intake of antioxidants
from diet and supplements, afforded long-term protection against nuclear cataract
(at both 5 & 10 years) in this older population. As nuclear cataract is a biological
marker of ageing, our findings support beneficial effects on ageing from vitamin C
and other antioxidants.
CR: A.G. Tan, None; J.J. Wang, None; G. Burlutsky, None; V. Flood, None; E.
Rochtchina, None; G.L. Kanthan, None; R.G. Cumming, None; P. Mitchell, None.
Support: Australian NHMRC grant nos. 932085, 974159, 211069
5452-5455
5456 - B702
Carbohydrate Nutrition, Particularly Glycemic Index of Foods Consumed, and
the 10-Year Incidence of Cataract
5457 - B703
Extracapsular Cataract Extraction Wound Rupture in Trauma: Demographics
and Outcomes
J.S. Tan1, J.Wang1, V.Flood1,2, S.Kaushik1, J.C. Brand-Miller2, A.Barclay2, P.Mitchell1,
Blue Mountains Eye Study. 1University of Sydney, Department of Ophthalmology
(Centre for Vision Research, Westmead Millennium Institute), Westmead Hospital,
Sydney, Australia; 2University of Sydney, Department of Molecular and Microbial
Biosciences, Sydney, Australia.
E.M. Salcone, M.T. Andreoli, C.M. Andreoli, C.Kloek. Ophthalmology, Massachusetts
Eye and Ear Infirmary/Harvard Medical School, Boston, MA.
Purpose: While dietary carbohydrates are thought to play a role in cataractogenesis,
few studies have examined links between carbohydrate nutrition and cataract.
Glycemic index measures the blood glucose response to a food compared with 50
grams of glucose. Glycemic load is the product of a food’s glycemic index and its
total available carbohydrate content. It generally represents an indication of both
quantity and quality of carbohydrate consumed. We investigated the relationship
between dietary glycemic index, glycemic load, carbohydrate & the 10-year incidence
of cataract in the Blue Mountains Eye Study.
Methods: Of 3654 baseline participants aged 49+years (1992-4), 2406 were seen after
5- and/or 10-years and had photographs taken to assess incident cataract using the
Wisconsin System. At each visit, participants completed a detailed food frequency
questionnaire. Glycemic index was calculated from a customised database of Australian
foods. Glycemic index, glycemic load, and all other nutrients were energy-adjusted.
Risk ratios (RR) and 95% confidence intervals (CI) were calculated using discrete
logistic models. The outcome measures were incident nuclear, cortical and posterior
subcapsular cataract or cataract surgery.
Results: The mean glycemic index of foods consumed at baseline was 57 (standard
deviation, SD, 5) and the mean glycemic load was 133 (SD 4). After controlling for
age, gender, diabetes, and hypertension, participants in the highest decile of glycemic
index, compared to the remaining population, were more likely to develop incident
cortical cataract (RR, 1.50, CI, 1.01-2.23). After adjustment for age, sex, diabetes and
other factors, higher carbohydrate consumption predicted cataract surgery (RR per SD
increase, 1.16; CI, 1.02-1.33). These findings were similar after excluding participants
with diabetes, although the association between glycemic index and cortical cataract
was attenuated (RR, 1.42, CI, 0.94-2.15). Higher glycemic load predicted cataract surgery
after excluding participants with diabetes (per SD increase, RR 1.15; CI, 1.01-1.32).
Conclusions: In an Australian cohort, poorer dietary carbohydrate quality, measured by
high glycemic index, predicted incident cortical cataract, and both higher carbohydrate
quantity and glycemic load were associated with incident cataract surgery.
CR: J.S. Tan, None; J. Wang, None; V. Flood, None; S. Kaushik, None; J.C. BrandMiller, None; A. Barclay, None; P. Mitchell, None.
Support: Australian RADGAC grant(1992-94) and NHMRC grant 932085, 974159 &
211069.
Purpose: Our aim was to evaluate the frequency, demographics, and clinical outcomes
of ruptured large-incision (nucleus expression) extracapsular cataract extraction
(ECCE) wounds due to trauma. These outcomes may be useful in counseling patients
as well as in risk-stratification based on presentation after injury.
Methods: In a retrospective case series study, all ruptured globe injuries presenting
to the Massachusetts Eye and Ear Infirmary from January 2000 to July 2006 were
reviewed. Characteristics evaluated include age, gender, final best-corrected visual
acuity, mechanism of injury, ocular events during the initial repair and recovery
period, and final clinical outcome of the globe.
Results: 42 of 641 total ruptured globes between 1/1/2000 and 7/1/2006 were ruptured
ECCE wounds (6.6%). Of all open-globes over the age of 65, over a third were ECCE
wound ruptures (39/109; 36%). The mean age of traumatic ECCE wound dehiscence was
considerably higher than that of all ruptured globe injuries (83.42 vs. 43.18; p<0.002)).
Twice as many women experienced ECCE wound dehiscence as men (28 vs.14). 27 of
42 ECCE wound ruptures occurred secondary to fall (64%). 86% were due to all forms
of blunt injury (including fall) and only 2 ECCE ruptures occurred during a motor
vehicle accident. Best corrected visual acuity (BCVA) outcomes were as follows: 9 of
38 ECCE wound ruptures (24%) had a BCVA outcome of 20/400 or better, and 76% had
count fingers vision or worse (no follow-up data available on 4 patients). Conversely, of
the 587 non-ECCE ruptured globes for which final BCVA is available, 61% had a final
visual outcome of 20/400 or better and 39% had finger-counting vision or worse. Of
note, 64% of ECCE ruptured globes had associated retinal pathology.
Conclusions: Ruptured ECCE wounds comprise a significant percentage of ruptured
globes in the elderly population. These injuries occur most commonly in elderly
women and frequently result from a fall. Compared to visual outcomes of all other
open-globes, visual outcomes in ECCE ruptured globes are poor, with only a quarter
of cases seeing better than 20/400. Despite the limbal location of ECCE wounds, a
majority of cases had associated retinal pathology, likely explaining the poor visual
outcome in this subset of patients.
CR: E.M. Salcone, None; M.T. Andreoli, None; C.M. Andreoli, None; C. Kloek,
None.
Support: None
5456-5457
527. Epidemiology of Ocular Trauma and Ocular Disorders Organizing Section: CL Contributing Section: AP
5480 - B726
Prevalence and Risk Factors of Ocular Trauma in an Urban Asian Population:
The Singapore Malay Eye Study (SiMES)
5481 - B727
Lash Ptosis in Normal and Ptotic Eyelids
S.Loon1,2, W.L. Wong2, S.M. Saw2,3, J.J. Wang4,5, T.Y. Wong2,5. 1Ophthalmology,
National University Hospital, Singapore, Singapore; 2Singapore Eye Research
Institute, Singapore, Singapore; 3Yong Loo Lin School of Medicine, Department of
Ophthalmology, National University of Singapore, Singapore; 4Ophthalmology,
Centre for Vision Research, Westmead Millennium Institute, Westmead Hospital,
University of Sydney, Australia; 5Ophthalmology, Centre for Eye Research
Australia, University of Melbourne, Australia.
Purpose: To describe the prevalence and risk factors of ocular trauma in a Malay
adult population in Singapore.
Malays aged 40-80 years was conducted during 2004-6 in Singapore. The study
population was selected based on an age-stratified random sampling procedure
among Malay people living in the south-western part of Singapore. Participants had
a face-to-face interview using a standardized questionnaire. Ocular trauma was
ascertained from 7 questions within the questionnaire, and defined as any eye injury
serious enough to require medical attention from a doctor.
Results: Of the 3280 participants, 149 (prevalence of 4.5%, 95% confidence interval,
CI, 3.8% to 5.3%) reported a history of ocular trauma. Of these 149 cases, 26.9% were
trauma from a blunt object, 36.5% from a sharp object, and 19.2% from chemical
burns. Men had a higher prevalence of ocular trauma than women (3.6% vs 0.9%,
age-adjusted odds ratio, OR, 3.6, CI 2.1-6.1), and older persons were less likely to have
ocular trauma than younger persons (per year increase in age, OR 0.93, CI 0.87-0.99).
Among men aged 50-59 years, a third (34.2%) reported a history of trauma in either
eye. Of all ocular trauma cases, 41.9% had monthly income <$1000, 28.9% worked in
the service industry, and 29.4% (n=32) required a hospitalization. After adjusting
for age and gender, we found no significant association of ocular trauma with the
presence of diabetes or hypertension, types of occupation, income or education levels
and cigarette smoking.
Conclusions: In this urban population of Malay adults in Singapore, we found a
relatively low prevalence of ocular trauma compared to the prevalence rates reported
from other Asian and western countries. The male predominant pattern in the
prevalence is likely due to a high frequency of occupational or outdoor exposure for
men than for women.
CR: S. Loon, None; W.L. Wong, None; S.M. Saw, None; J.J. Wang, None; T.Y. Wong,
None.
M.S. Lee, K.J. Malik, A.R. Harrison. Ophthalmology, University of Minnesota,
Minneapolis, MN.
Purpose: Lash ptosis refers to the downward displacement of the eyelashes in the
upper eyelid. The purpose of this study was to determine the prevalence of lash ptosis
(LP) in normal eyes and those with congenital or acquired ptosis.
Methods: A database search for patients with congenital and acquired ptosis seen
by a single oculoplastics provider at the University of Minnesota was performed.
Only patients with external photography were included. Three masked evaluators
graded photographs for the degree of LP in normal eyes and those with congenital
or acquired ptosis. Each patient was assessed using a semi-quantitative 4 point rating
scale for LP [0 = none, 1 = minimal, 2 = moderate, 3 = significant]. Any discrepancy
greater than 1 rating was adjudicated in an unmasked fashion.
Results: A total of 107 eyes of 87 patients demonstrated ptosis in the congenital
group and 121 eyes of 87 patients in the acquired group. Some degree of lash ptosis
(rating ≥ 1) was present in 91.6% of congenital ptosis eyes, 83.5% of acquired ptosis
eyes, and 27.5% of normal eyes. A moderate to significant rating of LP (rating ≥ 2)
occurred in 60.7% of congenital ptosis eyes, 28.9% of acquired ptosis eyes, and 9.2%
of normal eyes. The average LP rating was 2.08 for congenital ptosis (95% confidence
interval (CI): 1.93-2.23), 1.30 (95% CI: 1.03-1.57) for acquired ptosis, and 0.58 (95% CI:
0.45 - 0.72) for normal eyes.
Conclusions: Compared to normal eyes, lash ptosis is common among eyes with
ptosis especially the congenital form. Clinicians should note the degree of LP in the
preoperative evaluation and consider addressing it in their surgical approach.
CR: M.S. Lee, None; K.J. Malik, None; A.R. Harrison, None.
Support: Unrestricted Grant from Research to Prevent Blindness (New York, NY),
Lions Club of Minnesota
5482 - B728
Using a Latent Variable Model to Characterize Bias and Imprecision of Optic
Nerve Head Measurements
5483 - B729
Enucleation After Traumatic Open Globe: The Massachusetts Eye and Ear
Infirmary Experience
R.A. Bilonick, G.Wollstein, H.Ishikawa, L.Kagemann, M.L. Gabriele, K.A. Townsend,
J.S. Schuman. UPMC Eye Center, Eye and Ear Institute, Ophthalmology and
Visual Science, Department of Ophthalmology, University of Pittsburgh School of
Medicine, Pittsburgh, PA.
A.Savar, M.T. Andreoli, C.M. Andreoli, C.E. Kloek, P.A. D. Rubin. Ophthalmology,
Harvard Medical School/Massachusetts Eye & Ear Infirmary, Boston, MA.
Purpose: To quantify the relative bias and imprecision of three devices used to measure the optic
nerve head by employing latent variable modeling (LVM).
Methods: The linear measurement error model for measurement xij is: xij = αi + βi µj + εij where intercept
αi and slope βi characterize the relative bias for device i with the product of the β’s equals one, εij
is the random error which is Normally distributed with mean zero and standard deviation σi, and
µj is the true value for subject j. The variance of the µ’s is σ2. Each of 85 subjects was measured for
cup area by each of three devices: Heidelberg Retinal Tomograph (HRT, Heidelberg Engineering,
Heidelberg, Germany), RTVue (high speed ultra high resolution optical coherence tomograph;
Optivue, Fremont, CA) and Stratus Optical Coherence Tomograph (Stratus OCT, Carl Zeiss Meditec,
Inc., Dublin, CA). A latent variable model related the unobserved m to the measured x according
to the above equation. Maximum likelihood estimates of the parameters were computed using the
open source structural equation program Mx.
Results: Parameter estimates and 95% confidence intervals for cup area are shown in the table and
indicate that Stratus OCT almost certainly had a higher imprecision than both HRT and RTVue and
the slopes for RTVue and Stratus OCT were higher than for HRT.
HRT
Cup
Area
(mm 2)
Bias
Estimate
Lower
Upper
α1
-0.021
-0.127
0.080
β1
0.826
0.768
0.884
Impr.
SD
σ1
0.159
0.126
0.196
RTVue
Bias
α2
-0.094
-0.232
0.041
β2
1.173
1.105
1.245
Impr.
SD
σ2
0.103
0.000
0.167
Stratus OCT
Impr.
SD
α3
β3
σ3
0.092
1.032
0.243
-0.048
0.950
0.203
0.224
1.111
0.293
Bias
True SD
σ
0.490
0.421
0.579
The resulting calibration equations are:
RTVue = -0.064 + .42 HRT
HRT = 0.045 + 0.704 RTVue
Stratus = 0.8 + .249 HRT
HRT = -0.095 + 0.8 Stratus
Stratus = 0.75 + 0.88 RTVue
RTVue = -0.99 + 0.37 Stratus
Conclusions: The bias and imprecision were well-characterized by LVM as indicated by the narrow
confidence intervals. LVM should be used instead of naive regression which distorts the bias. BlandAltman plots of the paired differences as a function of the paired averages assume equal imprecision
and thus would be misleading for this data.
CR: R.A. Bilonick, None; G. Wollstein, Carl Zeiss Meditec, Inc., R; H. Ishikawa, Carl Zeiss Meditec,
Inc., R; L. Kagemann, None; M.L. Gabriele, None; K.A. Townsend, None; J.S. Schuman, Carl Zeiss
Meditec, Inc., P; Alcon; Allergan; Carl Zeiss Meditec, Inc.; Merck; Optoview; Heidelberg Engineering,
F; Alcon; Allergan; Carl Zeiss Meditec, Inc.; Clarity; Merck; Heidelberg Engineering, R.
Support: NIH RO1-EY13178-06, P30-EY08098; The Eye and Ear Foundation (Pittsburgh, PA), and an
unrestricted grant from Research to Prevent Blindness CT: www.clinicaltrials.gov, NTC00343746
Purpose: The indications for and rate of enucleation in the setting of traumatic open
globe injuries vary considerably. We report the experience of enucleation after open
globe injury at a large ophthalmic trauma referral center.
Methods: We carried out a retrospective review of all open globe injuries and
enucleations for trauma between January 1, 2000 and November 10, 2006 at the
Massachusetts Eye and Ear Infirmary. Variables assessed included age, sex, mechanism
of injury, indication for and timing of enucleation.
Results: During the study period 645 open globe injuries were evaluated and 52 (8%)
enucleations were performed for trauma. Patients with open globe injuries requiring
enucleation did not differ significantly from those not enucleated with respect to age
and gender. Mechanisms of open globe injury included: 229 blunt, 205 sharp, 151
projectile, and 60 other. Among those enucleated there were: 24 blunt, 2 sharp (p<0.001),
20 projectile, and 6 other injuries. Eleven (21%) enucleations were performed primarily
(at initial surgery) and 41 (79%) secondarily. Primary enucleations were performed
due to inability to repair the globe: the contents of the eye were unrecognizable or
the optic nerve had been avulsed. Of the open globe injuries that were repaired
(not primarily enucleated), 59 of 634 (9.3%) had resulting no light perception vision.
Of these, 35 (59%) went on to be enucleated: 6 for prophylaxis against sympathetic
ophthalmia and 29 for painful eye. An additional 3 eyes with light perception vision
and 3 with hand motion vision were enucleated for pain. During the study period
there was 1 case of sympathetic ophthalmia (0.16%) and 2 cases in which the diagnosis
was considered, but felt to be unlikely. None of these cases was in a patient with a
blind eye or required enucleation.
Conclusions: Most patients with open globe injuries can be successfully surgically
repaired, with only 11 of 645 (1.7%) requiring primary enucleation. Those injuries
requiring primary enucleation were extremely severe such that repair was not possible.
Injuries due to blunt mechanisms or projectiles were significantly more likely to
result in enucleation than those due to sharp objects. The most common indication for
secondary enucleation in this series was a blind painful eye. Although sympathetic
ophthalmia is a well-known risk it was seen infrequently (0.16%) and responded well
to treatment. The overall enucleation rate of 8% was less than that seen in previous
reports. A large proportion of the post repair no light perception eyes (41%) have been
observed without requiring enucleation.
CR: A. Savar, None; M.T. Andreoli, None; C.M. Andreoli, None; C.E. Kloek, None; P.
A.D. Rubin, None.
Support: None
5480-5483
5484 - B730
Reliability of Computed Tomography in the Diagnosis of Open-Globe Injuries
5485 - B731
Investigation of Paintball Ocular Trauma: A Path Towards Safer Paintballs
A.E. Wen, E.H. Black, C.Kim. Ophthalmology, Kresge Eye Institute/Wayne State
University, Detroit, MI.
W.E. Sponsel1, W.Gray2, A.Bonivtch2, C.E. Weiss2, F.W. Scribbick 3, J.D. Walker2, D.P.
Nicolella2. 1Ophthalmology, University of Texas Health Science Center at San
Antonio, San Antonio, TX; 2Southwest Research Institute, San Antonio, TX; 3Brooke
Army Medical Center, San Antonio, TX.
Purpose: To determine the sensitivity and false negative associations of orbital and
ocular computed tomography (CT) in the diagnosis of open-globe injuries in the
clinical setting.
Methods: Retrospective review was performed on charts of 107 consecutive patients
who underwent CT evaluation of the head and orbits and open globe repair at a tertiary
referral center between June 1998 and June 2006. CT scan results were reviewed for
patients with clinically or surgically confirmed open globe injuries; sensitivity and
false negative rates were calculated and correlated with specific clinical and CT
findings.
Results: The overall sensitivity of orbital and ocular CT in detecting open globe injuries
was 56.07%, with sensitivity being greatest in detecting injuries limited to the sclera
(73.68%), slightly less in injuries involving both the sclera and cornea (62.50%), and
least in injuries involving only the cornea (40.38%). The CT results were reviewed to
document comments on the presence of detectable intraocular pathology, such as
vitreous hemorrhage, intraocular emphysema, deformation of the globe or vitreous
space, displacement of the lens, or intraocular foreign body (IOFB). The percentage
of cases with identified intraocular pathology was 74.36% for scleral injuries, 62.50%
for corneoscleral, and 51.92% for corneal. Correctly identified open globe injuries
generally had a much higher association with detected intraocular pathology when
compared to cases in which the diagnosis was missed [Fig.1 Percentage of Intraocular
Pathology in True Positive vs. False Negative Cases by Wound Type].
Conclusions: CT is not sensitive enough to be relied upon as the sole diagnosis of open
globe injuries. CT is least sensitive when the injury is limited to the cornea. Cases in
which the injury is limited to the cornea may have relatively few CT findings, which
may increase the chance of a false negative diagnosis.
CR: A.E. Wen, None; E.H. Black, None; C. Kim, None.
Support: None
Purpose: Injuries due to paintball impact are a growing source of severe ocular
trauma. One realistic preventative goal is to design safer paintballs that break more
readily on contact, producing less globe displacement. To achieve this requires a
fundamental understanding of the dynamic biomechanical behavior of the eye within
the orbit (stress, strain, and pressure responses) to varying paintball impact conditions
(material, mass, impact angle, and velocity), and details of resulting trauma.
Methods: To validate the finite element models and determine failure and injury
criteria for the eye, repetitive in vitro testing was conducted. Instrumented porcine eyes
suspended in gel-filled transparent orbits were impacted with paintballs at varying
velocities and impact angles. The clear acrylic surrogate orbits afforded a realistic
representation of human orbit geometry and boundary conditions, allowing for dualangle high-speed video imaging. Paintball/ocular impact and dynamic mechanical
responses were studied through finite element analysis. The physics-based numerical
codes CTH and LS-DYNA were utilized while incorporating robust geometric and
constitutive models of the eye and orbit. Following impact, the eyes were subjected
to detailed histopathology. The type, location, and extent of trauma was correlated
to the impact conditions. Resulting associations were then used in conjunction with
the finite element models to predict injury, allowing for the formulation of alternative
paintball designs.
Results: Competitive (C) and amateur (A) grade 2.6mg paintballs delivered at
velocities 25-90m/s with kinetic energies of 4.5-13J, produced intraorbital posterior
globe displacements of 5.3-17.6mm, accompanied by AP globe compressions of 3.05.8mm. Ocular deformation was comparable with both grades of paintball, but globe
displacement was 37% greater with the more rigid A-grade paintballs, which produced
more severe ocular injury (lens subluxation, angle recession, retinal detachment,
etc).
Conclusions: Surface scoring and other shell alterations may enhance the superior
safety profile of existing C-grade paintballs. High-speed video provides dramatic,
memorable images that may help increase public awareness of the profound risks
posed by these recreational projectiles.
CR: W.E. Sponsel, None; W. Gray, None; A. Bonivtch, None; C.E. Weiss, None; F.
W. Scribbick, None; J.D. Walker, None; D.P. Nicolella, None.
Support: Southwest Research Institute and Research to Prevent Blindness
5486 - B732
Lagophthalmos After Ptosis Surgery: Incidence and Predictive Factors
5487 - B733
Nail Related Open Globe Injuries
S.P. Verb, E.H. Black, G.J. Gladstone, A.Bradley. Ophthalmology, Kresge Eye Institute,
Wayne State University/Detroit, MI.
M.E. Andreoli1, C.Westerfeld2, M.T. Andreoli2, C.Kloek 2, C.M. Andreoli2.
1
Ophthalmology, Loyola University, Chicago, IL; 2Ophthalmology, Massachusetts
Eye and Ear Infirmary/Harvard Medical School, Boston, MA.
Purpose: A levator muscle advancement procedure may be employed in all cases of
aponeurotic ptosis. Lagophthalmos (lag) is a known complication. The purpose of
this study is to (1) report the incidence of lag after levator muscle advancement for
aponeurotic ptosis (2) quantify the association between intra-operative and postoperative lag, and (3) determine the relationship between pre-operative factors and
post-operative lag.
Methods: Fifty-nine lids (fifty-four patients) that underwent levator muscle
advancement surgery by two surgeons (EHB, GJG) were retrospectively reviewed.
Unilateral and bilateral cases of aponeurotic ptosis [defined as a pre-operative measured
Burke levator muscle function (BLF) of at least 10 mm] were repaired by levator muscle
advancement. Data collected included pre-operative margin reflex distance (MRD1),
pre-operative BLF, and lag (mm) measured intra-operatively, immediately following
surgery, at 1 week, and at 1 month.
Results: Incidence of lag was 54/59 patients (91.5%) intra-operative, 48/59 (81.4%)
post-operative, 17/59 (28.8%) 1 week post-operative, and 6/59 (13.6%) 1 month postoperative. Patients with lag at 1 month after surgery had significantly more lag
(p<0.01)1 week following the operation than the group who did not have lag at 1
month; no difference was found intra-operatively or post-operatively. Patients with
lag at 1 month had an average pre-operative BLF significantly less than patients with
no lag at 1 month (p<0.005) and had a borderline-significant smaller pre-op MRD1
when compared to patients with no lag at 1 month. A significant positive correlation
existed between measured lag at 1 week and measured lag at 1 month (p<0.001,
Pearson’s=0.52, y=0.476x+0.022). A significant negative correlation existed between
pre-operative MRD1 and the amount of lag at 1 month (p<0.01, Pearson’s=-0.36, y=0.11x+0.22). A significant correlation was also found between preoperative BLF and
amount of lag at 1 month (p<0.001, Pearson’s=-0.5, y=-0.89x+1.49).
Conclusions: Intra-operative and post-operative lag should not cause the surgeon
to alter lid height during levator muscle advancement. Lag at 1 week correlated
with lid height at 1 month after surgery, supporting early intervention to correct
post-operative lag. Smaller pre-operative MRD1 is associated with larger values of
lag 1 month after surgery, indicating surgical accuracy may decrease with larger
advancements. Poor levator muscle function correlated with increased lag 1 month
after surgery. MRD1 and BLF measurements should be obtained pre-operatively and
may be predictive of outcome.
CR: S.P. Verb, None; E.H. Black, None; G.J. Gladstone, None; A. Bradley, None.
Support: None
Purpose: There is a paucity in the literature regarding the epidemiology and outcomes
of nail related open globe injuries, despite their relative frequency. Here we review a
large series of nail related open globe injuries in order to identify prognostic factors
and outcomes that will help manage these patients.
Methods: The charts of 648 consecutive patients with open globe injuries presenting
to a major eye trauma center were reviewed with attention given to the age of the
patient, gender, mechanism, location of trauma event, presence of an intraocular
foreign body (IOFB), and presenting and post-operative visual acuity.
Results: Of the 648 consecutive open globe patients reviewed, 80 patients were found
to have nail induced open globe injuries (12.3%). This was the fourth most common
mechanism recorded following other projectiles (20%), blunt trauma (16.8%) and falls
(14%). Patient age ranged from 1 year to age 67 years with a mean of 34. Injuries occurred
in male patients in 79 out of 80 cases (98.8%). In cases where the location of the trauma was
documented, 23 out of 39 occurred at work (60.0%). The average follow-up was 266 days.
Best post-operative visual acuity was LP in 2 cases (2.5%), HM or CF in 8 cases (10%),
> 20/200 in 68 cases (85.0%), and > 20/40 in 56 cases (70.0%). These results were better
than the overall population of open globe injuries. Final visual acuity was improved
from presenting acuity in 70 cases (87.5%), remained the same in 3 cases, and declined
in only 4 cases (5.0%).
An IOFB (i.e. nail) was documented at the time of presentation in 11 out of 80 cases (13.8%). The
patients with an IOFB on presentation had similar final visual acuities to those without IOFBs.
On surgical repair, 51 were founds to have a laceration in Zone I, 18 Zone II, and14
in Zone III. Post-injury complications included 12 (15%) patients who developed and
intraocular pressure of greater than 25 during at least one postoperative visit and 8
(10%) patients with retinal detachments. Eighteen (13%) patients required lensectomy
during original repair and 24 (30%) more developed a cataract in follow-up. No
patient with nail related injury developed phthisis or required enucleation during
the study period.
Conclusions: Nail related open globe injuries occur with relatively high frequency.
The vast majority of these injuries occur in young men while they are at work. Surgical
repair typically results in equal or improved final visual outcome in the vast majority
of cases. There is a very high rate of lens damage in these patients and moderate rate
of retinal detachment.
CR: M.E. Andreoli, None; C. Westerfeld, None; M.T. Andreoli, None; C. Kloek,
None; C.M. Andreoli, None.
Support: None
5484-5487
5488 - B734
Missed Radiologic Diagnosis of Soft Tissue Entrapment in Orbital Fractures in
the Pediatric Population Compared to the Adult Population
K.E. Galler, K.Parbhu, L.A. Mawn. Ophthalmology, Vanderbilt University, Nashville,
TN.
5489 - B735
Clincal and Laboratory Factors Predictive of Temporal Artery Biopsy Results
J.A. Liss1, C.Chiu2, K.Dolphin1, B.Levine1, E.T. Kim1. 1Ophthalmology, Weill Cornell
Medical Center/New York-Presbyterian Hospital, New York, NY; 2Ophthalmology,
University of California at San Francisco, San Francisco, CA.
Purpose: To compare the timing, radiologic, and clinical indication for surgical
management of orbital floor fractures in the pediatric and adult populations.
Methods: The records of all pediatric and adult patients who underwent primary
repair of an orbital floor fracture by a single surgeon on the oculoplastics service
at Vanderbilt Eye Institute between December 1, 1998 and December 1, 2006 were
reviewed. Variables assessed for each population included age, sex, mechanism of
injury, time to surgical intervention, clinical indication for surgical intervention,
official CT report, intraoperative findings, and associated injuries.
Results: 24 pediatric patients and 31 adult patients were identified. Of the 24
pediatric patients, 17 were male. The mean age at injury was 11.8 (range 2-17)
years. Of the 31 adult patients, 20 were male. The mean age at injury was 35.5
(range 19-69). The mechanism of injury in pediatric floor fractures included:
motor vehicle accident in 10, fall in 7, sports-related injury in 4, and assault in 3.
The mechanism of injury in adult floor fractures included: motor vehicle accident
in 13, sports-related injury in 6, assault in 6, fall in 5, and gunshot wound in 1.
The mean time to surgical intervention differed between the pediatric (mean 7.38 days,
range 0-39) and adult (mean 36.8 days, range 0-221) populations (p<0.01). The clinical
indication for surgery in the pediatric group was entrapment in 21, enophthalmia in
2, and large fracture in 1. The clinical indication for surgery in the adult group was
enophthalmia in 14, large floor fracture in 11, and entrapment in 6. Radiologic evidence
of entrapment was reported in 9 pediatric cases whereas an intraoperative finding
of entrapment was seen in 21 cases (p=0.0005, concordance rate of 50%). Radiologic
evidence of entrapment was reported in 7 adult cases while an intraoperative finding
of entrapment was seen in 8 cases (p=0.625, concordance rate of 87%).
Conclusions: In our series, pediatric orbital floor fractures were repaired on average
3 weeks earlier than the adult fractures. The most common clinical indication for
surgery was entrapment in the pediatric group versus enophthalmia in the adult
group. Notably, there was a statistically significant underestimation of entrapment
reported on CT in the pediatric group when compared to the clinical indications
and intraoperative findings, suggesting that clinical exam may be more sensitive
at detecting entrapment than CT in the pediatric population. Interestingly, there is
good concordance between radiologic, clinical and intraoperative findings in the
adult population.
CR: K.E. Galler, None; K. Parbhu, None; L.A. Mawn, None.
Support: None
Purpose: Giant cell arteritis is a debilitating disease with the potential to cause
bilateral blindness, and a high level of clinical suspicion must be maintained to
prevent missing the diagnosis. Several reviews have been performed to determine
which clinical signs and symptoms and laboratory results are reliable predictors
of temporal artery biopsy results. Based on a review of the current literature, jaw
claudication, visual changes and constitutional symptoms are fair predictors of a
positive biopsy result, and a normal sedimentation rate (ESR) and lack of temporal
artery abnormalities are predictive of a negative biopsy result. Our aim was to further
determine which clinical and laboratory factors are correlated with temporal artery
biopsy result. (Note: Chart review is still underway and there will be a larger sample
size at the time of presentation)
Methods: We reviewed 40 consecutive temporal artery biopsies performed at a
single institution over a 3 year period. Factors considered were patient’s age and
gender, presence of constitutional symptoms, temporal artery abnormalities or related
symptoms, ESR, length of biopsy, and biopsy result.
Results: 6 of the 40 biopsies were positive. All 6 patients with positive biopsies were
female. There was a trend toward a higher incidence of constitutional symptoms in
the patients with positive biopsies compared to those with negative biopsies. Two of
the patients with positive biopsies had a normal ESR. The mean age, ESR, frequency
of temporal artery abnormalities, visual changes, jaw claudication and headache, as
well as length of biopsy sample were similar between the two groups.
Conclusions: In this sampling, female gender and the presence of constitutional
symptoms were predictors of a positive biopsy result. ESR and symptoms related to
temporal artery abnormalities were not predictive of biopsy result.
CR: J.A. Liss, None; C. Chiu, None; K. Dolphin, None; B. Levine, None; E.T. Kim,
None.
Support: None
5490 - B736
Long-Term Efficacy and Safety of Botulinum Toxin Injetions
5491 - B737
Eye Injuries Treated at a Primary Eye Care Clinic in Iraq, April 2003-March 2004
A.Cetinkaya, O.Ababneh, P.A. Brannan, D.R. Kulwin. Ophthalmology, University of
Cincinnati, Cincinnati, OH.
F.S. Siringo1,2, D.Boese3. 1New York University School of Medicine, New York,
NY; 2Former Captain, United States Army, 4th Infantry Division, Fort Hood, TX;
3
Infineum, Linden, NJ.
Purpose: This study is designed to determine the efficacy and safety of botulinum
toxin A (BOTOX) injections after 10 years of treatment.
Methods: Medical records of 64 consecutive patients who received BOTOX injections
between 10/2005 and 05/2006 were retrospectively reviewed. Patients treated for
more than 10 years with at least 1 injection each year were included in the study.
Clinical diagnoses, patient characteristics, injection dates and doses, peak effect
durations, and adverse effects were collected. Response ratings were obtained using
a subjective self-evaluation scale of 0-4. Statistical analyses were conducted with SPSS
11.0 package. Wilcoxon signed-rank test was used for computations (p<0.05 accepted
as statistically significant).
Results: Thirty-two out of 64 patients (mean age, 57.6±12.3 years; 25 female) met the
inclusion criteria. The diagnoses were benign essential blepharospasm (BEB) (n=21),
hemifascial spasm (HFS) (n=9), myokymia (n=1), and Bell’s palsy (n=1). Only one eye
of each patient was evaluated for statistical analysis. The mean follow-up duration was
14±4 years (range; 10-19.5), with a mean of 44.7±19.3 total visits. The patients received
3.5±1.5 and 3.3±1.1 treatments per year during first and the last years, respectively
(p=0.253). A higher mean injection dose units per visit (26.4±10.3) was used in the last
year, compared to first year (22.6±7.6) (p<0.005). The mean peak effect durations for
the first and last years were, 12.6±7.1 and 14.5±7.1 weeks, respectively (p=0.116). There
was no difference in response ratings for the first (3.3± 0.6) and last (3.4± 0.5) years
(p=0.395). Most common adverse effects noted during the mean 14 years of follow-up
were ptosis (13 from 12 patients), lagophthalmos (12 from 11 patients), and dry eye
(12 from 12 patients). Twelve of these events were reported during the 1st year, 18
between 1 and 10 years, and only 7 events after 10 years. Other rare side effects were
diplopia (n=4), ectropion (n=3), hematoma (n=2), photophobia (n=2), and continuous
nasal discharge (n=1). None of these reactions were life-threatening.
Conclusions: BOTOX provides a satisfactory and safe long-term treatment after
10 years of continuous use. Similar efficacy of treatment, requiring higher doses of
injections, comes with diminished adverse effects.
CR: A. Cetinkaya, None; O. Ababneh, None; P.A. Brannan, None; D.R. Kulwin,
None.
Support: None
Purpose: To report the number and causes of eye injuries treated in the Optometry
section of the Fourth Infantry Division during the first year of Operation Iraqi Freedom.
Design: Retrospective case series.
Participants: 169 consecutive United States military personnel, civilian contract workers,
and enemy prisoners of war, presenting with eye injuries.
Methods: We analyzed Department of the Army Eye Injury Reporting System
(EIRS) data sheets for each patient treated April 1, 2003 through March 16, 2004.
Main Outcome Measures: Etiology, diagnosis, time to treatment, lost duty hours, and
protective eyewear use.
Results: The most common etiology was mechanical trauma (87%): dirt/sand (37%), metal
(19%), and contact lens (8%). Corneal foreign body (32%), and corneal abrasion (25%), were the
most frequent diagnoses. 85% of patients were treated within 20 minutes, (mean 18 minutes,
standard deviation 20 minutes). Lost duty hours was a bimodal distribution, with peaks at 2
hours (30%), and 24 hours, (12%). 83% of patients wore no eyewear at the time of injury.
Conclusions: Eye injuries presenting to an optometry clinic in Iraq were almost
uniformly treatable on-site, facilitating rapid return to duty and maximizing force
strength. Many injuries were preventable through the proper use of militaryissue safety eyewear, or the discontinuation of contact lens wear while deployed.
Two articles recently described combat eye injuries in Iraq and their treatment with surgical
intervention i,ii. The authors describe complex trauma involving systemic as well as ophthalmic
injuries, which required valiant intervention to preserve sight and/or prevent infection. A third
paper studied data from eye injuries in Iraq and Afghanistan which required medical evacuation
out of the theater of combat iii. This paper describes another common category of eye injuries,
those largely sustained during non-combat operations, and treatable without aeromedical
evacuation. Optometric care at the division level allows for rapid intervention and return to
duty of these patients, minimizing resource-draining, time-consuming transfer to facilities
with ophthalmologic services. To our knowledge, there have been no such studies to date.
Endnotes
i
Mader TH, Carroll RD, Slade CS, et al. Ocular War Injuries of the Iraqi Insurgency, JanuarySeptember 2004. Ophthalmology 2006; 113:97-104.
ii
Thach AB, Ward TP, Dick JSB, et al. Intraocular Foreign Body Injuries during Operation
Iraqi Freedom. Ophthalmology 2005; 112:1829-1833.
iii
Ari AB. Eye Injuries on the Battlefields of Iraq and Afghanistan: pulic health implications.
Optometry 2006 Jul;77(7):329-39.
CR: F.S. Siringo, None; D. Boese, None.
Support: None
5488-5491
5492 - B738
Cutaneous Nevi and Freckles Are Associated With Uveal Melanoma: A MetaAnalysis
5493 - B739
The Changing Landscape of Military Eye Care
C.P. Shah1A, E.Weis2, M.Lajous3, J.A. Shields1B, C.A. Shields1B. 1Wills Eye, Philadelphia,
PA; BOncology Service, 1Wills Eye, Philadelphia, PA; 2University of Alberta,
Edmonton, AB, Canada; 3Harvard School of Public Health, Boston, MA.
Purpose: To review the literature and conduct a meta-analysis of observational studies
examining the relationship between cutaneous nevi and uveal melanoma.
Methods: The authors extracted risk factor data from 11 observational studies and
categorized the data into four a priori groups: 1) atypical cutaneous nevi, 2) common
cutaneous nevi, 3) cutaneous freckles, and 4) iris nevi.
Results: Meta-analysis of four studies (850 cases) examining atypical cutaneous
nevi yielded a summary OR of 4.26 (1.44 - 12.57, p=0.009). Common cutaneous nevi
was reported in four studies (825 cases), yielding a summary OR of 1.74 (1.27 - 2.39,
p=0.001). Cutaneous freckles using 7 studies (2122 cases) found an OR = 1.22 (1.03
- 1.45, p= 0.022). Iris nevi using 4 studies (825 cases) found an OR of 1.53 (1.03 - 2.27, p
= 0.036). There was no evidence of publication bias for the aforementioned risk factors,
with the exception of atypical cutaneous nevi (p = 0.03).
Conclusions: This meta-analysis supports an association between uveal melanoma
and atypical cutaneous nevi, common cutaneous nevi, cutaneous freckles, and iris
nevi. The reported association between uveal melanoma and atypical cutaneous nevi
may be overestimated due to publication bias.
CR: C.P. Shah, None; E. Weis, None; M. Lajous, None; J.A. Shields, None; C.A.
Shields, None.
Support: None
R.C. Read, Jr.. Telemedicine & Advanced Technology Research Center, U. S. Army
Medical Research and Materiel Command, Ft. Detrick, MD.
Purpose: The military community faces the same problems in caring for the eye
as the population at large (age related macular degeneration, diabetic retinopathy,
cataracts, etc.), however, because we are a nation at war we focus heavily on battlefield
casualties.
Methods: Foster innovative and military relevant research by funding broad agency
announcement (BAA) proposals based on areas of research focus; guide congressionally
funded research efforts toward areas of research focus within legislative specifications;
promote awareness and stimulate the environment of collaboration between military/
military and military/civilian colleagues and their respective research; and provide
financial oversight of the research funds program.
Results: We have established five major areas of research focus. 1) modulating ocular
response to injury and disease, 2) ocular and visual restoration, 3) refractive surgery,
4) tele-robotics and simulation, and 5) novel projects. For example, in the first focus
area we want to alter conrea injury response, minimize retinal laser injury, study
anterior segment dry eye and examine surgical wound healing.
Conclusions: Our goal is to present a clear and consistent vison of future ocular
health research goals while remaining receptive to innovative and creative ideas. The
accomplishment of this goal will be publicized through presentations at professional
meetings such as ARVO, Advanced Briefing for Industry, American Telemedicine
Association, Medicine Meets Virtual Reality and the Academy of Ophthalmology.
CR: R.C. Read, None.
Support: None
5494 - B740
The Southwest Eye Registry: A Twelve-Year Evaluation
5495 - B741
Giant Cell Arteritis in Alaskan Natives
D.K. Wheaton1, B.D. Stier1, S.J. Bowne2, L.S. Sullivan2, S.P. Daiger2, D.G. Birch1. 1Retina
Foundation of Southwest, Dallas, TX; 2Human Genetics Center, UT-Houston,
Houston, TX.
R.P. Werner, T.Mader, D.Chamberlain. Department of Ophthalmology, Alaska Native
Medical Center, Anchorage, AK.
Purpose: The Southwest Eye Registry (SER) is a regional database for patients with
retinal degenerative diseases and allied inherited disorders. The patient population is
primarily derived from Texas and neighboring states with the Dallas metropolitan area
comprising the core referral area. Clinical, functional, and molecular genetic data are
maintained in the registry as a source of patients for natural history studies, genotype/
phenotype analyses, and clinical intervention trials. Additional demographic data
were added to the registry after a 5-year evaluation of the database in order to increase
epidemiological research capabilities. Reported here are the results of an interim reevaluation of the database conducted 12 years after inception.
Methods: The database population (n=2940) includes patients (n=2115), as well as
carriers, unaffected, and at-risk relatives (n=825). Individuals are categorized according
to disease status and genetic subtype. Data include demographics, visual function
measures (visual acuity, electroretinogram, visual field, dark adaptation), pedigree,
blood sample/DNA tracking and results of genetic analysis. The database population
was assessed according to disease classification, inheritance pattern, and genetic
mutation status.
Results: The distribution of disease classifications for patients affected with retinal
disease was: 52% retinitis pigmentosa (RP), 9% heritable macular degeneration, 11%
cone/cone-rod dystrophy, 3% Usher syndrome, 3% Leber congenital amaurosis, and
21% other retinal/allied disorders. The RP category by genetic subtype was: 29%
adRP, 13% arRP, 14% xlRP, 36% isolate, and 8% atypical. Genetic analysis identified
causative mutations for 273 individuals (116 probands), attributable to the RHO, RDS,
RP1, IMPDH1, PRPF31, PRPF8, PRPF3, RPGR, ABCA4, CRX, CNGB3, USH2A, RPE65,
AIPL1, and CHM genes. Among all unrelated patients with adRP, the frequencies of
disease-causing mutations detected in this population were 24% RHO, 5% RDS, <1%
RP1, 1% IMPDH1, 2% PRPF31, 3% PRPF8, and <1% PRPF3. Visual function data are
available for 89% of the database population.
Conclusions: This registry serves as a rich source of well-characterized patients
to elucidate the origin and treatment of retinal degenerative diseases. The recent
inclusion of supplemental demographic parameters will allow the estimation of
disease prevalence among our geographically-defined population, thereby increasing
the epidemiological utility of the database.
CR: D.K. Wheaton, None; B.D. Stier, None; S.J. Bowne, None; L.S. Sullivan, None; S.
P. Daiger, None; D.G. Birch, None.
Support: NIH Grant EY05235, NIH Grant EY07142, Foundation Fighting Blindness
Purpose:Giant Cell Arteritis (GCA) has predilection for certain racial and northern
geographic distributions. In the U.S. most patients share a northern European
ancestry with a lower incidence in Hispanics and Asians. Alaska Natives share similar
susceptibilities to genetically influenced diseases with their Pacific Rim neighbors. We
surveyed the Alaska Native population for the incidence of this disease.
Methods:: All Alaska Natives are served exclusively by a network of affiliated Indian
Health Service Hospitals, which has maintained a computerized diagnostic database
for the last twenty years. A retrospective review of Medical Diagnoses codes for GCA,
Temporal Artery Biopsy and AION was performed and evaluated for a biopsy proven
diagnoses of Giant Cell Arteritis.
Results:A total of 3 patients had positive biopsy results out of twenty biopsies that
were performed on Alaska Natives in twenty years. All presented with new onset
headache and other systemic complaints and had elevated westergrin sedimentation
rates. There were 2 females and 1 male. The average presenting age was 71. Only one
patient presented with visual symptoms and lost vision. Patients responded well to
standard therapy and have all subsequently died from causes not related to GCA.
These cases all came from coastal areas of Alaska where intermarriage with people of
Russian and European ancestry was common. No cases where found from the more
isolated central and northern population centers. The calculated incidence of GCA in
the Alaska Native population is 1/100,000 in those over 50 years old. The percentage of
positive biopsies (15%) in our survey is typical for other surveys done for this disease
and represents a routine degree of clinical suspicion for the diagnosis.
Conclusions:: This is the first widespread, long-term study of a Native American
population for the incidence of this disease. Our study suggests that GCA is essentially
non-existent in a genetically isolated Alaska Native population. However, it does occur
in the more racially diverse coastal regions where intermarriage is more common.
The low incidence of GCA found in the Alaska Native population is similar to those
rates reported for Japan and other pacific rim countries which share a common genetic
heritage, but contrasts with high reported rates of European countries of equivalent
northern latitudes. Our calculated incidence of 1/100,000 in those over 50 years old
is similar to the incidence documented in Asian populations. Valuable population
based studies in this geographically isolated population are made possible by a free
and carefully monitored public health care system.
CR: R.P. Werner, None; T. Mader, None; D. Chamberlain, None.
Support: None
5492-5495
Thursday, May 10, 10:45 AM - 12:30 PM Grand Floridian H Paper Session
543. Epidemiology of Cataract & Retinal Diseases Organizing Section: CL
5675 - 10:45AM
Ten-Year Incidence of Age-Related Cataract and Cataract Surgery in an Older
Australian Population: The Blue Mountains Eye Study
5676 - 11:00AM
Birth Cohort Effects on Cataract Endpoints. The Beaver Dam Eye Study
B.E. K. Klein1A, R.Klein1A, K.E. Lee1A, R.E. Gangnon1B. AOphthalmology, BPopulation
Health Sciences, 1Univ of Wisconsin-Madison, Madison, WI.
G.L. Kanthan, J.J. Wang, E.Rochtchina, A.G. Tan, E.-M.Chia, A.Lee, P.Mitchell, Blue
Mountains Eye Study. Ophthalmology (Centre for Vision Research, Westmead
Australia.
Purpose: To estimate the 10-year incidence of cataract and cataract surgery in an
older Australian population.
Methods: Persons aged 49+ years living in two postcode areas, west of Sydney,
Australia were invited to participate in the Blue Mountains Eye Study. 3654 (82.4%
of the eligible) participants were seen at baseline (1992-4) and 2454 were seen after 5and/or 10-years. Eye examinations were performed and lens photographs were taken
at baseline and at each follow-up visit. These photographs were graded in a masked
fashion using the Wisconsin Cataract Grading System. Intergrader and intragrader
reproducibility of lens grading was assessed using quadratic weighted kappa statistics
and ranged from 0.52 to 0.92, indicating acceptable reproducibility.
Results: The 10-year person-specific incidence was 36.0% for nuclear, 28.0% for
cortical and 9.1% for posterior capsular (PSC) cataract, and 17.8% for cataract surgery.
Corresponding rates were 31.7%, 24.4%, 8.2%, and 14.4%, respectively, in men and
39.3%, 30.8%, 9.8% and 20.1%, respectively, in women. The incidence for each type of
cataract and cataract surgery was increased strongly with age (p<0.0001). The female
excess in cataract incidence was significant for all three types of cataract and for
cataract surgery, after adjusting for age (p<0.0001). Among persons who developed
any cataract, 22% had more than one type and 1.3% had all three types. The incidence
of both nuclear and PSC cataract was a significant predictor of visual impairment
(corrected visual acuity worse than 20/40) presented at the time of examinations.
The mean age at cataract surgery was 75.8 years and there was no significant gender
difference (p=0.88). Of participants with nuclear, cortical or PSC cataract in the right
eye at baseline, 32.5%, 26.8% and 40.9%, respectively, underwent cataract surgery in
that eye during the subsequent 10-year period.
Conclusions: The age- and gender-specific cataract incidence in this study was
similar to that reported by the Beaver Dam Eye Study. We found that almost threequarters (72%) of persons aged 49 or older, developed one or more types of cataract
or required cataract surgery over a 10-year follow-up period. Cataract and cataract
surgery thus clearly represent a substantial public health burden in the current
aging population.
CR: G.L. Kanthan, None; J.J. Wang, None; E. Rochtchina, None; A.G. Tan, None; E.
Chia, None; A. Lee, None; P. Mitchell, None.
Support: Australian NHMRC Grant nos 974159 and 211069
Purpose:To investigate the possibility of cohort effects on prevalence of age-related
cataract endpoints.
Methods:The population in the Beaver Dam Eye Study (n=4926) were examined in
1988-90, 1993-95, 1998-2000, and 2003-05. Standardized photographs of the lens were
taken at each examination and graded by protocols. Other information was collected
at each examination including a standard medical interview. With multiple visits, we
are able to examine birth cohort effects by comparing prevalence rates of similarly
aged persons at each exam phase (thus, different birth cohorts).
Results:The age-specific prevalence of cataract declined in later birth cohorts. For
example, among persons 65-69 at each examination, 10.6% (95% confidence interval
[CI] 4.9, 16.3) of those born in 1938-42 (seen at the 2003-05 examination) had nuclear
cataract, while 16.0% (95% CI 12.6, 19.8) of those born in 1933-37 (seen at 1998-2000
examination) and 27.7% (95% CI 23.5, 30.8) of those born in 1923-27 (seen at 1993-95
examination) had nuclear cataract. Similar cohort differences appear for cortical,
posterior subcapsular cataract, and surgery prevalence. In addition, our data suggest
cohort effects on incidence.
Conclusions:Age-related cataract prevalence appears to be influenced by cohort
effects such that among similarly aged persons, those in more recent birth cohorts
are relatively protected compared to persons born earlier.
CR: B.E.K. Klein, None; R. Klein, None; K.E. Lee, None; R.E. Gangnon, None.
Support: National Institutes of Health grant EY06594 (R. Klein, B.E.K. Klein), and, in
part, by Research to Prevent Blindness (R. Klein and B.E.K. Klein, Senior Scientific
Investigator Awards), New York, NY
5677 - 11:15AM
Serum Vitamin C, Retinol and Zeaxanthin Are Inversely Associated With
Cataract in a North Indian Population
5678 - 11:30AM
Historical, Genetic, and Biochemical Risk Factors Predictive of Retinopathy and
Visual Acuity in Patients With 50 Years or More of Type 1 Diabetes Mellitus
A.E. Fletcher1, M.K. Dherani1, G.V. S. Murthy2, S.K. Gupta2, I.Young3, G.M. Price1,
N.John2, U.Chakravarthy4, G.Maraini 5, M.Camparini 5. 1Epidemiology & Population
Health, London Sch of Hygiene & Trop Med, London, United Kingdom; 2Dr
RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences,
Delhi, India; 3Clinical Sciences, Queen’s University, Belfast, United Kingdom;
4
Ophthalmology & Vision Science, Queens University, Belfast, United Kingdom;
5
Sezione di Oftalmologia, Università degli Studi di Parma, Parma, Italy.
J.K. Sun1A,2, H.A. Keenan1B, J.D. Cavallerano1A, A.Doria1B, L.P. Aiello1A,2, G.L. King1B.
A
Beetham Eye Institute & Eye Research Section, BResearch Division, 1Joslin
Diabetes Center, Boston, MA; 2Dept. of Ophthalmology, Harvard Medical School,
Boston, MA.
Purpose: To investigate associations of serum antioxidants with cataract in the Indian
setting.
Methods: People aged 50 years and over were identified from enumeration of the
50+ age group age in 11 randomly sampled villages from a rural district of Haryana,
North India. Digitised images of cortical and posterior subcapsular opacities and
photographs of nuclear opacities were graded using LOCS II (>2 grade for any opacity
or dense opacities that could not be graded were considered as cataract). A blood
sample was taken and analysed for antioxidants. Potential confounders including
tobacco use, alcohol drinking, biomass fuel use, and sunlight exposure were collected
by interview. Survey logistic regression was used to investigate associations of tertiles
of antioxidants with cataract.
Results: Of 1443 people aged 50 years or above enumerated, 94% completed a
questionnaire, 87 % attended an eye examination and 78% gave a blood sample.
The prevalence of any cataract was high (73.5%), mostly nuclear or mixed cataracts.
Antioxidant levels tended to be low especially vitamin C (12.96 µmol/l for men and
16.75 µmol/l for women). Vitamin C levels were significantly inversely associated with
cataract. Odds ratios for the highest (>= 15 µmol/l) compared to the lowest (<6.3 µmol/
L) tertile were 0.58, (95% CI 0.47 - 0.72). Retinol and zeaxanthin were also associated
with reduced odds of cataract for the highest compared to the lowest tertile.
Conclusions: Our results in a population with high levels of cataract suggest the
importance of vitamin C in lens protection
CR: A.E. Fletcher, None; M.K. Dherani, None; G.V.S. Murthy, None; S.K. Gupta,
None; I. Young, None; G.M. Price, None; N. John, None; U. Chakravarthy, None; G.
Maraini, None; M. Camparini, None.
Support: Wellcome Trust UK (G 066082)
Purpose: To evaluate the relationship of historical, genetic, and biochemical risk factors
with retinopathy and visual acuity (VA) outcomes in a large cohort of patients who have
lived 50 or more years with type 1 diabetes mellitus (DM).
Methods: One hundred and eighty-four patients underwent Early Treatment Diabetic
Retinopathy Study (ETDRS) VA testing, dilated fundus exam, and ETDRS protocol 7standard field fundus photography; measurement of hemoglobin A1c (HbA1c), lipids, islet
cell antibodies, interleukin-6, and C-peptide; and HLA DQB1, DQA1, and DRB1genotyping.
Fundus photos were graded by 2 readers for severity of diabetic retinopathy (DR) and
macular edema (ME). Grading discrepancies were adjudicated by a third reader.
Results: In the eye with the more severe level of DR, 7.1 % of patients (13) had no discernible
DR, 1.6% (3) had questionable DR, 31.5% (58) had mild nonproliferative DR (NPDR), 9.2%
(17) had moderate NPDR, 0.5% (1) had severe NPDR, and 47.8% (88) had proliferative DR
(PDR). Four patients (2.2%) had fundus photos that were ungradable in both eyes due
to media opacities and/or missing ETDRS fields. Of 88 eyes with PDR, 93.2% had scars
from previous scatter photocoagulation and 97.3% had achieved quiescence. Clinically
significant ME was apparent in at least one eye in 8.7% of patients. VA was 20/20 or
better in 56.0%, 20/40 or better in 96.2%, and 20/200 or worse in 1.6% of patients. After
multivariate models were used to test for possible confounders, logistic regression
analysis revealed that less severe DR was independently correlated with the presence of
any of the three HLA alleles (p = 0.022), the presence of IA2 autoantibodies (p = 0.046),
and the absence of microalbuminuria (p = 0.003). Visual acuity of 20/20 or better was
correlated with less severe DR (p<0.0001) and lower current HbA1c (p=0.039). Neither DR
severity nor VA were significantly related to age, duration of DM, hypertensive status,
C-peptide, or lipid levels.
Conclusions: In this cohort of patients with 50 years or more of type 1 DM, an unexpectedly
high number (40.2%) have no or mild NPDR and over 50% retain 20/20 VA or better. In
addition, biochemical and genetic factors, such as the presence of HLA alleles or IA2
autoantibodies appear correlated with protection against the development of PDR even
after 50 years of DM. Subsequent studies of this unique cohort may further elucidate
molecular mechanisms that suppress retinopathy and other microvascular complications
of diabetes.
CR: J.K. Sun, None; H.A. Keenan, None; J.D. Cavallerano, None; A. Doria, None; L.
P. Aiello, None; G.L. King, None.
Support: NIH Grants K12 EY16335, T32 DK07260, and 5P30 DK 36836; Lions Eye Fund;
JDRF CIRG; Brehm Foundation; Lilly Foundation
5675-5678
Thursday, May 10, 10:45 AM - 12:30 PM Grand Floridian H Paper Session
543. Epidemiology of Cataract & Retinal Diseases Organizing Section: CL
5679 - 11:45AM
A Population Based Assessment of Diabetic Retinopathy in Pakistan. The
National Blindness and Visual Impairment Survey
5680 - 12:00PM
Retinal Vessel Measures and Ten-Year Incidence of Hearing Impairment in
Older Adults in Beaver Dam, WI
S.P. Shah1, A.Shaikh2, M.Z. Jadoon3, C.E. Gilbert1, R.R. Bourne1, B.Dineen1, M.A. Khan3,
M.D. Khan3, On behalf of the Pakistan National Eye Survey Study Group. 1International
Centre for Eye Health, London School of Hygiene & Tropical Medicine, London,
United Kingdom; 2CHK, Prevention of Blindness Cell, Sindh, Pakistan; 3Kyber
Institute of Medical Sciences, Pakistan Institute of Community Ophthalmology,
Peshawar, Pakistan.
K.J. Cruickshanks1A, B.E. K. Klein1A, R.Klein1A, W.Zhong1B, D.M. Nondahl1A.
A
Ophthalmology & Visual Sciences, BPopulation Health Sciences, 1Univ of
Wisconsin-Madison, Madison, WI.
Purpose:To estimate the prevalence and risk factors for diabetic retinopathy (DR)
in Pakistan.
Methods:Multi-stage, cluster random sampling, with probability proportionalto-size procedures selected a nationally representative sample of adults aged ≥30
years. Diabetics were identified by a positive medical history or, in any suspected
participants, a random blood glucose level of >140mg/dl. All participants underwent
fundus examination, those with a visual acuity of <6/12 in either eye had an indepth examination including fundus photography. Logistic regression modeling
investigated risk factors.
Results:16,507 (95.3% response rate) adults included in the survey, 660 of whom were
diabetic (4%). Provincial differences in prevalence of diabetes found (Punjab 5.0%;
Sindh 3.3%; North West Frontier Province 3.1%, and Balochistan 0.4%, p<0.001). The
prevalence was highest in the sixth decade of life (7.1%). Urban dwellers had a higher
prevalence than rural dwellers (7% vs. 2.5%, p<0.001). Diabetics were more likely to
have visual loss than non-diabetics (8.8% and 48% of diabetic participants were <6/60
and <6/12 respectively in their better eye compared with 4.7% and 25.9% among nondiabetics). 101 diabetic adults (15.3%) had signs of DR. The standardized prevalence of
DR was 0.6% (95%CI: 0.5, 0.7%). In urban dwellers the prevalence was 1.1% compared
to 0.4% in rural areas (p<0.001). 12.9% of participants with DR were <6/60 and 69.3%
were <6/12. Only 0.2% of blind (<3/60) and 0.4% of visually impaired (<6/12) adults
were attributed to DR. Non proliferative DR (mild or moderate) was the commonest
type (70.3%), however 30 individuals had signs of active proliferative disease. Literacy,
urban dwelling, increasing age and increasing body mass index were statistically
significant risk factors for DR in the multivariable model.
Conclusions:In this survey, nearly half the diabetic population was visually impaired
and 1 in 6 had signs of diabetic retinopathy. We estimate 90,000 adults in Pakistan
are at immediate risk of visual loss from proliferative DR. Pakistan is projected to
have one of the largest increases in diabetes prevalence in the forth coming years,
and effective models for screening and treatment need to be established to prevent
diabetic retinopathy from becoming an important cause of visual loss.
CR: S.P. Shah, None; A. Shaikh, None; M.Z. Jadoon, None; C.E. Gilbert, None; R.
R. Bourne, None; B. Dineen, None; M.A. Khan, None; M.D. Khan, None.
Support: International Blindness Prevention Collaberative Group
Purpose: To evaluate the associations of retinal arteriolar and venular diameters,
predictors of age-related vascular disorders, and age-related hearing loss.
Methods: Measures of retinal vessel caliber were obtained from digitized fundus
photographs from the 5-yr follow-up of the Beaver Dam Eye Study (1993-95) and
hearing impairment was measured in the same cohort as part of the baseline and
follow-up studies of the Epidemiology of Hearing Loss Study (1993-95, 98-00, 20035). Hearing loss was assessed with pure-tone air and bone conduction audiometry.
Central retinal artery equivalent (CRAE) and the central retinal vein equivalent
(CRVE) were determined for right eyes. Cox proportional hazard models were used
in these analyses (n=1578).
Results: In preliminary analyses adjusting for age and gender, CRAE was associated
with the 10-year incidence of hearing impairment (4th quartile vs 1st quartile, HR=1.39,
95%CI=1.05, 1.84) as was CRVE (4th quartile vs 1st quartile, HR=1.45, 95%CI=1.09, 1.93).
Adjusting for body mass index, smoking, and glycosylated hemoglobin did not alter
these findings. Similar associations were found in analyses using a continuous outcome
of the change in the average of pure-tone thresholds at four frequencies.
Conclusions:These preliminary data demonstrate that ocular measures of vascular
factors may be important markers for risk of developing other chronic conditions
such as presbycusis. Incorporating these measures in epidemiological studies of these
disorders may help to elucidate etiologic pathways.
CR: K.J. Cruickshanks, None; B.E.K. Klein, None; R. Klein, None; W. Zhong,
None; D.M. Nondahl, None.
Support: NIH Grants AG11099 and EY06594
5681 - 12:15PM
Influences on Retinal Vessel Measurements in Childhood and Their
Significance
P.Mitchell1,2, T.Y. Wong3, B.Taylor1, E.Rochtchina1, J.J. Wang1, Sydney Childhood Eye
Study. 1Ophthalmology, University of Sydney, Sydney, Australia; 2Ophthalmology,
University of Sydney (Centre for Vision Research, Westmead Millennium Institute,
Westmead Hospital), Sydney, Australia; 3Centre for Eye Research Australia,
University of Melbourne, Melbourne, Australia.
Purpose: To examine variables influencing the calibre of retinal vessels in a populationbased sample of 6-year old Australian children. These measurements are shown to
predict cardiovascular & other systemic diseases in older adults. Understanding the
roles of these factors in childhood could provide useful insights into the genesis of
microvascular processes in adults.
Methods: The Sydney Childhood Eye Survey is a random cluster sampled crosssectional survey of eye conditions in 4,108 children (2 age groups; 6 and 12 years)
attending schools across the Sydney metropolitan area. The current analysis includes
1572 (of 1740) 6-year old children with complete data. Digital retinal photographs
(Canon 60UVi) were taken & standardised computer-assisted measurements made of
vessel calibre (one eye per child), to determine mean arteriolar & venular diameters.
The exam also measured height, weight, blood pressure, and took a detailed birth
history (with infant health records).
Results: Higher blood pressure (BP, systolic or diastolic) was associated with
significantly narrower retinal arterioles (by BP quartiles, p for trend <0.0001), but not
venules (2.0 microns per 10 mmHg increase in BP, after controlling for confounders).
Low birth weight was also associated with narrower retinal arterioles (1.1 microns per
500g decrease). Prematurity & maternal smoking independently contributed to this
effect. Body-mass effects were observed, particularly wider venular calibre (2.1 microns
for BMI levels above cardiovascular risk threshold). Greater BMI, weight & body
surface area predicted wider venules while greater BMI & larger waist circumference
predicted narrower arterioles. Among ocular parameters, longer axial length (AL)
predited narrower arterioles (3.66 microns per SD increase) while darker iris colour (or
non-Caucasian ethnicity, ?surrogate for darker fundus colour), led to wider measured
calibres, indicating measurement artifact.
Conclusions: Our findings suggest that the vascular effects of BP may manifest early
in life. Other variables also influence retinal vessel calibre, including birth parameters,
body-mass & magnification effects, plus fundus pigmentation. These data provide a
comprehensive view of the ‘physiological’ influences on retinal vessel calibre in young
children, that may be relevant to ongoing adult studies of these signs.
CR: P. Mitchell, None; T.Y. Wong, None; B. Taylor, None; E. Rochtchina, None; J.
J. Wang, None.
Support: Australian NHMRC
5679-5681

Sunday, May 6, 8:30 AM - 10:15 AM Hall B/C

Transcription

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