Archives of Ophthalmology
ISSN / EISSN : 0003-9950 / 1538-3601
Published by: Rockefeller University Press (10.1001)
Total articles ≅ 29,972
Latest articles in this journal
Archives of Ophthalmology, Volume 130, pp 1597-1598; https://doi.org/10.1001/jamaophthalmol.2013.1306
Oxidative stress has been implicated in several age-related eye diseases, including age-related macular degeneration, glaucoma, and diabetic retinopathy, as well as in retinitis pigmentosa. Hahn et al1 have documented higher iron levels in eyes of patients with age-related macular degeneration than in eyes of age-matched controls (particularly chelatable iron deposition in the retinal pigment epithelium and Bruch membrane). Because iron catalyzes the Fenton reaction (which produces hydroxyl radical), these results may mean that iron-mediated oxidative stress contributes to retinal degeneration in age-related macular degeneration. Furthermore, mice deficient in the ferroxidases ceruloplasmin and hephaestin accumulate iron in the retina and subsequently have retinal degeneration with features of age-related macular degeneration.2,3 In these mice, iron chelation with the orally absorbed and cell-permeant iron chelator deferiprone (Ferriprox) ameliorated oxidative stress and protected against iron overload–induced retinal degeneration.4
Archives of Ophthalmology, Volume 130, pp 1579-1588; https://doi.org/10.1001/archophthalmol.2012.1325
To determine whether racial disparities exist in the use of ancillary testing to evaluate individuals with open-angle glaucoma (OAG). We identified all enrollees aged ≥40 in a large U.S. managed-care network with retinal or optic nerve conditions that could warrant the use of ancillary testing. Among persons with OAG or glaucoma suspects, we performed repeated measures multivariable logistic regression to determine the odds and probabilities each year of undergoing visual field (VF) testing, fundus photography (FP), and other ocular imaging (OOI) for black, white, Latino, and Asian-American males and females and compared the groups. Among the 797,879 eligible enrollees, 149,018 individuals had OAG. The odds of undergoing VF testing decreased for all groups from 2001–2009, decreasing most (63% and 57%) for Latinos and Latinas, respectively (adjusted odds ratio (OR)=0.37, 95% confidence interval (CI)=0.31–0.43 and OR=0.43, CI=0.37–0.50) and least (36%) for Asian males (OR=0.64, CI 0.51–0.80). By comparison, the odds of undergoing OOI increased for all groups from 2001–2009, increasing most (173%) for black males and females (OR=2.73, CI=2.34–3.18 for males and OR=2.73, CI=2.40–3.09 for females) and least (77%) for Latinas (OR=1.77, CI=1.49–2.09). Latinos and Latinas had considerably reduced odds of undergoing VF testing and OOI compared with other groups over the decade. Although increases in glaucoma testing have been noted in recent years among Latinos and Latinas for some types of ancillary tests, efforts should be made to better understand and overcome some of the persistent barriers to monitoring for glaucoma in this group.
Archives of Ophthalmology, Volume 130, pp 1612-1613; https://doi.org/10.1001/archophthalmol.2012.1652
Autologous serum eyedrops (ASEs) were first reported in the treatment of ocular disease in 1975 and have since been investigated in numerous ocular surface disorders.1 There are few studies from the United States, yet we know anecdotally that ASEs are used in tertiary care centers across the country.2 The lack of publicity about ASEs in the United States is, in large part, owing to unique barriers in implementing serum eyedrops as a standard treatment modality: laboratories must follow a manufacturing protocol in compliance with regulatory measures, patients must undergo phlebotomy, and patients must cover the cost. We report here a retrospective review of the first experience with ASEs in a large US patient population as an insurance-covered benefit.
Archives of Ophthalmology, Volume 130, pp 1591-1595; https://doi.org/10.1001/archophthalmol.2012.2365
Emily Dickinson is one of America's premier poets of the 19th century. Henry Willard Williams, MD, was one of the very first physicians to limit his practice to ophthalmology and was the established leader in his field in Boston, Massachusetts. They met during the time of the Civil War, when Emily consulted him about her ophthalmic disorder. No records of the diagnosis survive. Photophobia, aching eyes, and a restriction in her ability to work up close were her main symptoms. Iritis, exotropia, or psychiatric problems are the most frequent diagnoses offered to explain her difficulties. Rather than attempt a definitive conclusion, this article will offer an additional possibility that Dr Williams likely considered (ie, hysterical hyperaesthesia of the retina). This was a common diagnosis at that time, although it has currently faded from use.
Archives of Ophthalmology, Volume 130, pp 1589-1590; https://doi.org/10.1001/archophthalmol.2012.2536
An optimal clear corneal incision creates a self-sealing intrastomal tunnel. Variability in incision length may pose surgical difficulties for subsequent phacoemulsification. An incision that is too long may lead to challenges including decreased instrument mobility, decreased visibility due to corneal striae, stromal hydration, and a difficult angle of approach to the cataract. These sequelae may lead to surgical complications or abandonment of the original incision. We describe a technique for shortening a long clear corneal incision with the intentional creation of a flap of corneal tissue at the posterior internal wound edge. This technique is a simple and quick modification that may avoid the pitfalls of an incision that is too long.
Archives of Ophthalmology, Volume 130, pp 1566-1569; https://doi.org/10.1001/archophthalmol.2012.2543
Thyroid-associated orbitopathy (TAO) is a common disease that affects many of the orbital soft tissues.1 Many of the changes in TAO can be attributed to expansion of orbital adipose tissue and extraocular muscles that lead to proptosis and congestion. The periorbital tissues are also involved in TAO.2,3 Kim and Kazim4 described involvement of the cheek fat. We have also been impressed that the soft tissues of the upper periorbital area, specifically the eyebrow fat pad, seem to be clinically involved.5 Eyebrow tissue involvement in TAO may be a useful clinical parameter to identify and characterize the disease in individual patients. We provide photographic evidence of eyebrow tissue expansion in patients with TAO and demonstrate consistency in grading using standardized photographs.
Archives of Ophthalmology, Volume 130, pp 1554-1559; https://doi.org/10.1001/archophthalmol.2012.2683
In 1989, Miyake et al1 first described the autosomal dominant inheritance of a hereditary macular dystrophy without visible fundus abnormalities. In all patients, focal macular electroretinography gave significantly abnormal results, making this test the gold standard for diagnosis. Several years later, after patients with similar findings were described in other parts of the world,2 the condition was renamed occult macular dystrophy (OMD).3 To date, there have been about 71 reported cases of OMD that often have been confused initially with more common ocular disorders, such as normal-tension glaucoma, retrobulbar optic neuritis, amblyopia, and even nonorganic visual loss.1-10
Archives of Ophthalmology, Volume 130, pp 1570-1574; https://doi.org/10.1001/archophthalmol.2012.2721
The formal assessment of surgical skills has grown in importance during recent years1 owing to increasing evidence that unstructured systems of assessment have poor reproducibility, large interobserver variation,2 and lack of quantifiable measures. A paradigm shift has therefore begun, with the emergence of more objective and quantitative tools devised to complement current practice. One such example is motion analysis.3-6
Archives of Ophthalmology, Volume 130, pp 1525-1533; https://doi.org/10.1001/archophthalmol.2012.2853
To compare the cost-effectiveness of two approaches for treating unilateral nasolacrimal duct obstruction (NLDO) 163 infants 6 to <10 months old with unilateral NLDO were randomly assigned to immediate office-based nasolacrimal duct probing (N=82) or to six months of observation/non-surgical management (N=81) followed by facility-based probing for persistent symptoms. Treatment success was defined as the absence of clinical signs of NLDO (epiphora, increased tear lake, mucous discharge) upon masked examination at 18 months of age. Cost of treatment between randomization and 18 months of age included costs for all surgeries and medications. In the observation/deferred facility probing group, NLDO resolved within 6 months without surgery in 44 of the 67 patients (66%, 95% confidence interval (CI)=54% to 76%) who completed the 6-month visit. Twenty-two (27%) of the 81 patients in the observation/deferred facility probing group underwent surgery, 4 of whom were operated within the initial 6 months. At 18 months of age, 69 (92%) of 75 immediate office probing group patients were treatment successes, compared with 58 (82%) of 71 observation/deferred facility probing group patients (difference=10%, 95%CI=−1% to 21%). The average cost of treatment was $562 in the immediate office probing group compared with $701 in the observation/deferred facility probing group (difference=−$139, 95%CI=−$377 to $94). The immediate office probing group had 3.0 fewer months of symptoms (95%CI=−1.8 to −4.0). The immediate office probing approach is likely more cost effective than observation followed by deferred facility probing if needed. Adoption of the immediate office probing approach would result in probing about two-thirds of infants who would have resolved with 6 months of non-surgical management, but would largely avoid the need for probing under general anesthesia. Although unilateral NLDO often resolves without surgery, immediate office probing is an effective and potentially cost-saving treatment option. The study is listed on www.clinicaltrials.gov (NCT00780741).
Archives of Ophthalmology, Volume 130, pp 1588-1588; https://doi.org/10.1001/archophthalmol.2012.301
Case Report from JAMA Ophthalmology — Anterior Capsular Phimosis Syndrome