Publications by authors named "David O Hodge"

414 Publications

Risk, Prevalence, and Progression of Glaucoma in Eyes with Age-Related Macular Degeneration Treated with Intravitreal Anti-VEGF Injections.

Am J Ophthalmol 2022 Aug 3. Epub 2022 Aug 3.

Mayo Clinic Department of Ophthalmology, 200 1(st) St SW, Rochester, MN 55905. Electronic address:

Purpose: To examine the risk, prevalence, and progression of glaucoma development in age-related macular degeneration (AMD) eyes receiving intravitreal anti-VEGF injections compared to controls.

Design: Retrospective clinical cohort study METHODS: : Retrospective review of eyes receiving intravitreal anti-VEGF injections from 1/1/2004-12/31/2013 for exudative AMD. Age- and sex-matched control groups of eyes included: eyes with non-exudative AMD (NEAMD) and no AMD. Eyes with a diagnosis of glaucoma or glaucoma suspect were reviewed for injection details, type and date of glaucoma diagnosis, glaucoma treatments, standard automated perimetry (SAP), and SD-OCT. Qualitative progression was determined by indication of glaucoma progression in provider notes. Quantitative progression was assessed based on change in mean deviation (MD) on SAP, RNFL thickness on SD-OCT, and intraocular pressure (IOP).

Results: There were 707 eyes of 504 patients treated with anti-VEGF injections and 1008 eyes in the NEAMD and no AMD cohorts. There was no difference in glaucoma or suspect prevalence at initial presentation between eyes treated with injections and NEAMD (6.9% vs. 9.7%, p=0.22) or no AMD controls (vs. 8.5%, p=0.55). There was no difference in cumulative five-year probability of new glaucoma diagnosis after anti-VEGF injections compared to NEAMD (1.9% vs. 1.0%, p=0.69) or no AMD controls (vs. 1.6%, p=0.88). There was no difference in qualitative progression of glaucoma in the injection cohort vs. NEAMD (p=0.19) or no AMD controls (p=0.61). The rate of MD change in injection eyes was similar to NEAMD eyes (p=0.74) but greater than no AMD eyes (p=0.02). Eyes receiving injections required more topical glaucoma medications compared to NEAMD (p=0.03) and more glaucoma laser treatments compared to no AMD controls (p=0.009). Eyes receiving injections did not require more frequent incisional glaucoma surgery compared to NEAMD (21.0% vs. 15.0%, p=0.95) or no AMD controls (vs.10.0%, p=0.10).

Discussion/conclusion: Eyes treated with intravitreal anti-VEGF injections for exudative AMD did not have increased risk of developing glaucoma compared to controls. Of those with a glaucoma diagnosis, exudative AMD eyes receiving injections required a greater number of topical glaucoma medications compared with NEAMD eyes and had a greater rate of MD loss than no AMD controls.
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http://dx.doi.org/10.1016/j.ajo.2022.07.025DOI Listing
August 2022

Feasibility and Safety of Low-Dose Mesenchymal Stem Cell Infusion in Lung Transplant Recipients.

Stem Cells Transl Med 2022 Jul 26. Epub 2022 Jul 26.

Mayo Clinic in Florida, Jacksonville, FL, USA.

Background: We have previously shown bone marrow-derived mesenchymal stem cells (MSCs) may shift immune responses toward anti-inflammatory pathways and stabilize the course of obstructive chronic lung allograft syndrome (o-CLAD) after lung transplantation. In this study, we measured the response of lower dose infusions.

Methods: We infused low-dose MSCs intravenously in 13 patients who had developed moderate-to-severe o-CLAD. Three had previously received an infusion of MSCs from a different donor and were re-dosed at 1 × 106 MSC/kg, while 5 received a first dose at 1 × 106 MSC/kg and five received an even lower dose at 0.5 × 106 MSC/kg. We recorded pulmonary function tests before and after infusion, and patients were followed clinically for 12 months.

Results: Infusions were well tolerated, and no significant adverse events were recorded in the first 30 days. There was significant decline (mean ± SD) in forced vital capacity (FVC) (3.49 ± 1.03 vs 3.18 ± 0.94 L, P = .03) and forced expiratory volume in 1 second (FEV1) (2.28 ± 0.86 vs 1.77 ± 0.49 L, P = .04) over the year preceding infusion. FVC (3.18 ± 0.94 vs 3.46 ± 0.99 L, P = .53) and FEV1 was not significantly changed (1.77 ± 0.49 vs 1.88 ± 0.75, P = .72) when comparing values immediately prior to infusion to those obtained 1 year after infusion, indicating a possible stabilizing effect on lung function decline due to o-CLAD.

Conclusion: Intravenous infusions of bone marrow-derived MSCs are well tolerated in lung transplant recipients with moderate-to-severe CLAD. Low-dose MSCs appear to slow progression of CLAD in some patients.
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http://dx.doi.org/10.1093/stcltm/szac051DOI Listing
July 2022

Prevalence and clinical characteristics of age-related distance esotropia.

Strabismus 2022 Jul 7:1-6. Epub 2022 Jul 7.

Mayo Clinic Department of Ophthalmology, Mayo Clinic, Rochester, MN.

Age-related distance esotropia (ARDET) is characterized by an esodeviation greater at distance than near in older aged patients and generally managed with prism spectacles or surgery. The purpose of this study is to describe the prevalence, clinical characteristics, and natural history of age-related distance esotropia in a defined population. The medical records of all adult (≥19 years of age) residents of Olmsted County, Minnesota, diagnosed with an esodeviation at least 2 prism diopters (PD) greater at distance than near, from 1 January 1985, through 31 December 2004, were retrospectively reviewed. Seventy-three (9.7%) of 751 new cases of adult-onset strabismus were diagnosed with age-related distance esotropia during the 20-year period. The mean age of onset was 70 years (range, 19 to 93 years) and 48 (65.8%) were female ( = .007). The mean angle of esodeviation was 7.6 (range, 2 to 20) prism diopters (PD) at distance and 0.4 (range, 10 PD of XT to 12 PD of ET) PD at near. The Kaplan-Meier rate of progression, as defined by a ≥ 6 prism diopter (PD) increase in esotropia, was 50% by 15 years after diagnosis. Half of the patients had hypertension, while one-third had coronary artery disease or other cardiac comorbidities. Age-related distance esotropia comprised 1 in 10 adults with new-onset strabismus in this population and was significantly more common among women. Hypertension and cardiovascular disease may be risk factors for this form of strabismus, and approximately half of the patients worsened over a 15-year period.
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http://dx.doi.org/10.1080/09273972.2022.2097707DOI Listing
July 2022

Atrial Arrhythmia Ablation in Patients With D-Transposition of the Great Arteries and Atrial Switch.

Circ Arrhythm Electrophysiol 2022 Jul 28;15(7):e010546. Epub 2022 Jun 28.

Department of Cardiovascular Diseases (A.C., K.P.C., D.G., S.M.E., J.C.P.-D., S.D.P., C.J.M.), Mayo Clinic, Jacksonville, FL.

Background: Patients with D-transposition of the great arteries and atrial switch have a high incidence of atrial arrhythmias. We sought to analyze the arrhythmia substrate, ablation strategies, and outcomes for catheter ablation in this population.

Methods: An in-depth analysis of all clinical and procedural data in patients with D-transposition of the great arteries, atrial baffles, and atrial arrhythmia ablation was performed.

Results: A cohort of 32 patients (72% male, mean age 38±7 years) underwent ablation for non-AV nodal reentrant tachycardia atrial arrhythmias, and 4 patients underwent AV nodal reentrant tachycardia ablation. Cavotricuspid isthmus flutter (CTI-flutter) was the most common arrhythmia, encountered in 75% of patients, followed by scar-related intraatrial reentrant tachycardia (non-CTI intraatrial reentrant tachycardia, 53%) and focal atrial tachycardia (focal atrial tachycardia, 6%). Among the 32 patients, 26 underwent 31 procedures at our institution. For patients with prior outside intervention, the index ablation at our institution revealed CTI-dependent flutter in 3/5 cases. However, redo ablation after an index ablation with demonstrated bidirectional CTI block revealed different/new arrhythmia substrates (80% non-CTI intraatrial reentrant tachycardia, 40% focal atrial tachycardia). Achieving bidirectional block across the CTI often required ablating on both sides of the baffle (retroaortic access, 81%; using a baffle leak, 11.5%; or transbaffle puncture, 7.7%). Combined approaches were necessary in 19% to reach the critical tissue. Acute procedural success was 81%, and recurrence was documented in 58% of patients. Despite recurrence, clinical arrhythmia burden was significantly reduced post-ablation (<0.001), with rare episodes, amenable to antiarrhythmic therapy. Redo ablation was required in 5 (19%) patients and uncovered new arrhythmia substrates. AV nodal reentrant tachycardia ablation also required transbaffle approaches in 3/4 patients.

Conclusions: CTI-dependent flutter was the most common arrhythmia in patients with Dextro-Transposition of the Great Arteries and atrial switch. Transbaffle approaches were often necessary, and, provided that bidirectional CTI block was achieved at the index ablation, late recurrence was due to different arrhythmia mechanisms. Despite recurrence, ablation was associated with significant clinical improvement.
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http://dx.doi.org/10.1161/CIRCEP.121.010546DOI Listing
July 2022

Major adverse cardiovascular events after diagnosis of myocardial injury and types 1 and 2 myocardial infarction.

Eur Heart J Acute Cardiovasc Care 2022 Jul;11(7):546-557

Department of Cardiovascular Diseases, Mayo Clinic, 200 1st St SW, Rochester, MN, USA.

Aims: Limited US outcome data exist among patients with myocardial injury and types 1 and 2 myocardial infarction (MI) evaluated with high-sensitivity cardiac troponin (hs-cTn).

Methods And Results: This is an observational US cohort study of emergency department (ED) patients undergoing hs-cTnT measurement. Cases with ≥1 hs-cTnT increase >99th percentile were adjudicated following the Fourth Universal Definition of MI. Post-discharge major adverse cardiovascular events (MACE) included death, MI, heart failure (HF) hospitalization, stroke or transient ischaemic attack, and new-onset atrial fibrillation or flutter during 2 years follow-up. Among 2002 patients, 857 (43%) had ≥1 hs-cTnT >99th percentile. Among these, 702 (81.9%) had myocardial injury, 64 (7.5%) had type 1 MI, and 91 (10.6%) had type 2 MI. Compared with patients without myocardial injury, type 2 MI [8.4 vs. 50%; adjusted hazard ratio (HR) 2.31, 95% confidence interval (CI) 1.49-3.58] and myocardial injury (8.4 vs. 47%; adjusted HR 3.13, 95% CI 2.39-4.09) had a higher risk of MACE, in large part because of death and HF hospitalizations. Compared with patients with type 1 MI, type 2 MI (23 vs. 50%; adjusted HR 2.24; 95% CI 1.23-4.10) and myocardial injury (23 vs. 47%; adjusted HR 2.02; 95% CI 1.20-3.40) also have a higher risk of MACE.

Conclusion: Among unselected US ED patients undergoing hs-cTnT measurement, most increases are due to myocardial injury, and type 2 MI is more frequent than type 1 MI. Patients with myocardial injury and type 2 MI have morbid outcomes, in large part due to death and HF.
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http://dx.doi.org/10.1093/ehjacc/zuac075DOI Listing
July 2022

Cancer Risk in Patients With Fuchs Endothelial Corneal Dystrophy.

Cornea 2022 Sep 27;41(9):1088-1093. Epub 2021 Sep 27.

Department of Ophthalmology, Mayo Clinic, Rochester, MN; and.

Purpose: The purpose of this study is to quantify cancer risk in patients with Fuchs endothelial corneal dystrophy (FECD).

Methods: Using the 2014 to 2016 Medicare Limited 5% Data Sets-Carrier Line File, US Medicare fee-for-service beneficiaries (aged 65 years or older) with FECD and cancer were identified through International Classification of Diseases , ninth and 10th Revision diagnostic codes from January 1, 2014, to December 31, 2016. The main outcome measures were odds ratios (ORs) of cancer at various anatomic locations in patients with versus without FECD.

Results: Of the 1,462,740 Medicare beneficiaries, 15,534 patients (1.1%) had an International Classification of Disease code for FECD. Compared with US Medicare beneficiaries without FECD, patients with FECD were at increased risk for the following malignancies: breast [OR: 1.32; 95% confidence interval (CI): 1.22-1.43; P < 0.001], cutaneous basal cell (OR: 1.42; 95% CI: 1.35-1.49; P < 0.001), cutaneous melanoma (OR: 1.20; 95% CI: 1.03-1.40; P = 0.02), cutaneous squamous cell (OR: 1.45; 95% CI: 1.38-1.53; P < 0.001), ovarian (OR: 1.84; 95% CI: 1.48-2.30; P < 0.001), and thyroid (OR: 1.32; 95% CI: 1.04-1.68; P = 0.02). By contrast, FECD cases were at lower odds of having lung (OR: 0.81; 95% CI: 0.71-0.93; P = 0.003) and prostate cancer diagnoses (OR: 0.88; 95% CI: 0.81-0.96; P = 0.002).

Conclusions: Patients with FECD aged 65 years or older may be at increased risk for cancer at several anatomic locations. Follow-up studies are needed to further explore the association of FECD and malignancy, elucidate potential disease mechanisms, and identify genetic and/or environmental risk factors.
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http://dx.doi.org/10.1097/ICO.0000000000002864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120714PMC
September 2022

Invasive Hemodynamic Predictors of Survival in Patients With Mitral Stenosis Secondary to Mitral Annular Calcification.

J Am Heart Assoc 2022 05 16;11(10):e023107. Epub 2022 May 16.

Department of Cardiovascular Diseases Mayo Clinic Rochester MN.

Background The aim of this study was to establish prognostic hemodynamic parameters in patients with mitral stenosis secondary to mitral annular calcification. Methods and Results A retrospective cohort of 105 patients undergoing transseptal catheterization for hemodynamic evaluation of mitral annular calcification-related mitral stenosis between 2004 and 2020 was studied. Mitral valve gradient (MVG) and mitral valve area (MVA; calculated by the Gorlin formula) were measured using direct left atrial and left ventricular pressures. The median age of the patients was 70.3 years (58.4-76.7 years), and 53.3% were women. The median MVA was 1.7 cm (1.3-2.3 cm) and MVG was 7.3 mm Hg (5.3-10.3 mm Hg); left ventricular end-diastolic pressure was 17.6±28.3 mm Hg. During a median of 2.1 years (0.7-4.5 years), there were 63 deaths; 1- and 5-year survival were 76% and 40%, respectively. There was no association between left ventricular end-diastolic pressure and survival. After adjusting for age and comorbidities, both MVA (hazard ratio [HR], 0.50 per cm; 95% CI, 0.34-0.73) and MVG (HR, 1.1 per mm Hg; 95% CI, 1.05-1.20) were independent predictors of death. Atrial fibrillation was also independently associated with mortality. When added to a combined model, MVA remained associated with death (HR, 0.51 per cm; 95% CI, 0.33-0.79) while MVG was not. Conclusions In patients with mitral annular calcification-related mitral stenosis, survival was poor. MVA and MVG were independently associated with death, but MVA was a better predictor of outcomes.
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http://dx.doi.org/10.1161/JAHA.121.023107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238574PMC
May 2022

Incidence and clinical characteristics of paediatric keratitis.

Br J Ophthalmol 2022 May 13. Epub 2022 May 13.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA

Background/aims: To report the incidence and clinical characteristics of paediatric keratitis diagnosed over a 10-year period in a well-defined population.

Design: Retrospective, population-based study.

Methods: Setting: multicentre.

Population: patients (<19 years) diagnosed with keratitis as residents of Olmsted County from 1 January 2000, through 31 December 2009.

Main Outcome Measures: calculated annual age-specific and gender-specific incidence rates, demographic information and initial and final visual acuity.

Results: A total of 294 diagnoses of keratitis occurred in 285 children during the 10-year period, yielding an incidence of 78.0 per 100 000 younger than 19 years (95% CI 69.0 to 87.1) or approximately 1 in 1282 children. The incidence increased throughout the 10-year study period (p<0.001). The mean age at diagnosis was 15.3 years (range, 0.2-18.9) and 172 (60.4%) were women. The observed forms included keratitis due to contact lens wear in 134 (45.6%), infectious keratitis in 72 (24.5%), keratitis not otherwise specified in 65 (22.1%) and keratitis sicca in 23 (7.8%). The visual acuity was reduced to ≤20/40 in 61 (21.4) of the 285 patients at the initial examination and in 24 (8.4%) at the final examination. Children with infectious keratitis had the poorest presenting vision and the best final vision, whereas the reverse was true for those with keratitis sicca.

Conclusions: Keratitis, regardless of aetiology, was observed in approximately 1 in 1300 children by 19 years of age in this population-based cohort. Nearly half were related to contact lens wear and a decrease in vision to ≤ 20/40 occurred in 1 in 12 patients.
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http://dx.doi.org/10.1136/bjophthalmol-2021-320793DOI Listing
May 2022

Graft Survival, Graft Rejection, and Glaucoma in a Consecutive Series of Descemet Stripping Endothelial Keratoplasty.

Cornea 2022 Apr 21. Epub 2022 Apr 21.

Department of Ophthalmology, Mayo Clinic, Rochester, MN; and.

Purpose: The goal of this study was to compare outcomes of Descemet stripping endothelial keratoplasty (DSEK) in eyes with glaucoma and abnormal anatomy to eyes with Fuchs endothelial corneal dystrophy (FECD).

Methods: In a retrospective interventional series of all cases of DSEK between April 1, 2006, and November 30, 2015, recipient diagnosis, preoperative glaucoma status, concurrent surgical procedures, and graft outcomes were recorded. Graft survival, risk of rejection, and subsequent glaucoma surgery were estimated by using Kaplan-Meier analysis with risk factors determined by proportional hazard models.

Results: Of 703 DSEKs in 666 eyes (509 subjects), the main recipient diagnoses were FECD (n = 496), pseudophakic corneal edema (n = 112), and failed graft (n = 83). Glaucoma was present in 150 cases before DSEK. Overall graft survival was 85%, 75%, and 71% at 5, 10, and 12 years, respectively, and for FECD without glaucoma was 95%, 89%, and 87% at 5, 10, and 12 years, respectively. Independent risk factors for graft failure included recipient diagnoses of pseudophakic corneal edema (HR = 8.3, P < 0.001), failed graft (HR = 6.4, P < 0.001), and preoperative medical glaucoma (HR = 7.1, P < 0.001) or surgical glaucoma (HR = 12.3, P < 0.001). Preoperative glaucoma treated by previous surgery resulted in graft survival of 28% at 10 years. Preoperative glaucoma was associated with an increased risk of graft rejection (HR = 6.8, P < 0.001) and subsequent glaucoma surgery (HR > 17.4, P < 0.001).

Conclusions: Preoperative glaucoma increases the risk of graft failure, graft rejection, and needing subsequent glaucoma surgery in the first decade after DSEK. With previous glaucoma surgery, DSEK graft survival was more favorable compared with published reports of Descemet membrane endothelial keratoplasty.
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http://dx.doi.org/10.1097/ICO.0000000000003050DOI Listing
April 2022

Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation.

Circulation 2022 06 10;145(23):1708-1719. Epub 2022 May 10.

Department of Cardiovascular Diseases (Y.L., L.D.M., R.L., R.G., A.S.J.), Mayo Clinic, Rochester, MN.

Background: There are good data to support using a single high-sensitivity cardiac troponin T (hs-cTnT) below the limit of detection of 5 ng/L to exclude acute myocardial infarction. Per the US Food and Drug Administration, hs-cTnT can only report to the limit of quantitation of 6 ng/L, a threshold for which there are limited data. Our goal was to determine whether a single hs-cTnT below the limit of quantitation of 6 ng/L is a safe strategy to identify patients at low risk for acute myocardial injury and infarction.

Methods: The efficacy (proportion identified as low risk based on baseline hs-cTnT<6 ng/L) of identifying low-risk patients was examined in a multicenter (n=22 sites) US cohort study of emergency department patients undergoing at least 1 hs-cTnT (CV Data Mart Biomarker cohort). We then determined the performance of a single hs-cTnT<6 ng/L (biomarker alone) to exclude acute myocardial injury (subsequent hs-cTnT >99th percentile in those with an initial hs-cTnT<6 ng/L). The clinically intended rule-out strategy combining a nonischemic ECG with a baseline hs-cTnT<6 ng/L was subsequently tested in an adjudicated cohort in which the diagnostic performance for ruling out acute myocardial infarction and safety (myocardial infarction or death at 30 days) were evaluated.

Results: A total of 85 610 patients were evaluated in the CV Data Mart Biomarker cohort, among which 24 646 (29%) had a baseline hs-cTnT<6 ng/L. Women were more likely than men to have hs-cTnT<6 ng/L (38% versus 20%, <0.0001). Among 11 962 patients with baseline hs-cTnT<6 ng/L and serial measurements, only 1.2% developed acute myocardial injury, resulting in a negative predictive value of 98.8% (95% CI, 98.6-99.0) and sensitivity of 99.6% (95% CI, 99.5-99.6). In the adjudicated cohort, a nonischemic ECG with hs-cTnT<6 ng/L identified 33% of patients (610/1849) as low risk and resulted in a negative predictive value and sensitivity of 100% and a 30-day rate of 0.2% for myocardial infarction or death.

Conclusions: A single hs-cTnT below the limit of quantitation of 6 ng/L is a safe and rapid method to identify a substantial number of patients at very low risk for acute myocardial injury and infarction.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.122.059235DOI Listing
June 2022

Comorbid diseases of Hidradenitis Suppurativa: a 15-Year Population-Based study in Olmsted County, Minnesota, USA.

Int J Dermatol 2022 Apr 29. Epub 2022 Apr 29.

Department of Dermatology, Sutter Medical Foundation, Sacramento, CA, USA.

Background: Like other chronic, inflammatory skin disorders, hidradenitis suppurativa (HS) is increasingly recognized to be associated with various medical disorders.

Objective: Using the Rochester Epidemiology Project (REP), we sought to conduct the first American population-based study examining the association between HS and various comorbid conditions.

Methods: From the REP database, we identified patients diagnosed with HS from 2003 through 2018 who were residents of Olmsted County, Minnesota, USA, along with age- and gender-matched controls. The frequency of a wide variety of comorbid conditions was compared between the groups.

Results: A total of 1160 patients with HS were identified during the study period. Compared with age- and gender-matched controls, patients with HS had a significantly higher frequency of several medical conditions, including depression, anxiety, hyperlipidemia, acne conglobata, dissecting cellulitis, pilonidal cysts, polycystic ovary syndrome, diabetes, chronic kidney disease, psoriasis, atopic dermatitis, obesity, and disordered substance use, among others.

Limitations: Our study was limited by its retrospective design.

Conclusions: Providers caring for patients with HS should consider these results, along with those of similar studies, and obtain a thorough history, comprehensive physical examination, and, potentially, laboratory testing and referral to other specialists.
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http://dx.doi.org/10.1111/ijd.16228DOI Listing
April 2022

Incidence and Clinical Characteristics of Infantile Conjunctivitis in a Western Population.

Am J Ophthalmol 2022 Apr 22;241:145-148. Epub 2022 Apr 22.

From the Department of Ophthalmology, Mayo Clinic (C.E.B., S.A.M., B.G.M.), Rochester, Minnesota. Electronic address:

Objective: To describe the incidence and clinical characteristics of conjunctivitis in the first year of life.

Design: Population-based cohort study.

Participants: All infant (≤12 months of age) residents of Olmsted County, Minnesota, diagnosed with conjunctivitis from January 1, 2005, through December 31, 2014.

Methods: The medical records of all potential cases identified by the Rochester Epidemiology Project database were reviewed.

Main Outcome Measures: Incidence rate and clinical features of infantile conjunctivitis.

Results: A total of 2175 infants were diagnosed during the 10-year period, yielding an incidence of 10,422 per 100,000 children or approximately 1 in 10 infants by 1 year of age. The mean age at diagnosis was 4.9 months (range, 1 day-12 months), and 1001 (46.0%) were female. Both eyes were involved in 1180 (54.3%), the right eye alone in 506 (23.3%), and 489 (22.5%) in the left. Five hundred seventy-six (26.5%) of the 2175 were diagnosed at ≤30 days of life, from which topical cultures were obtained in 111 (19.7%). Only 36 (32.4%) of the cultures showed bacterial agents, with Chlamydia present in 3. Treatment for infantile conjunctivitis, where recorded, included topical antibiotics in 523 (90.8%) and simple observation in 47 (8.2%).

Conclusions: Conjunctivitis in the first year of life occurred in approximately 10% of infants in this population-based cohort. More than half involved both eyes, one-quarter were identified in the first 30 days of life, and sight-threatening infectious agents were rare.
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http://dx.doi.org/10.1016/j.ajo.2022.04.008DOI Listing
April 2022

Population-based incidence of intraocular tumours in Olmsted County, Minnesota.

Br J Ophthalmol 2022 Apr 21. Epub 2022 Apr 21.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA

Background/aims: To determine population-based incidence of intraocular tumours in Olmsted County, Minnesota.

Methods: Record review of the Rochester Epidemiology Project medical record linkage system from 1 January 2006 to 31 December 2015 for patient demographics, tumour type by clinical diagnosis and presence or absence of confirmation by histopathology. The incidence rate of any intraocular tumour and of each tumour type was calculated per million person-years. Poisson regression analysis was used to analyse changes in incidence over time.

Results: There were 948 patients diagnosed with intraocular tumours resulting in an age-adjusted and sex-adjusted incidence rate of 727.5 per million (95% CI: 680.8 to 774.2, p<0.05). Most tumours were benign (953, 98%). Of the benign lesions, melanocytic lesions were the majority (942, 97%), with adjusted incidence rates of 646.9 (95% CI: 602.8 to 691.1) for choroidal nevus and 55.8 (95% CI: 43.2 to 64.8) for iris nevus. Malignant lesions were rare (16, 2%) with 13 cases of choroidal melanoma and 1 case each of iris melanoma, retinal leukaemic infiltration and metastasis. The adjusted incidence rate for choroidal melanoma was 7.1 (95% CI: 2.5 to 11.8).

Conclusion: In a population-based setting, most intraocular tumours are benign and melanocytic. Although malignant lesions are less common, it is important to remain vigilant with appropriate monitoring given the potential for vision loss and life-threatening malignancy.
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http://dx.doi.org/10.1136/bjophthalmol-2021-320682DOI Listing
April 2022

Comparison of 1.5 Tesla and 3.0 Tesla Magnetic Resonance Imaging in the Evaluation of Acute Demyelinating Optic Neuritis.

J Neuroophthalmol 2022 Jul 13. Epub 2022 Jul 13.

Departments of Ophthalmology (MH, MTB, JJC) and Radiology (AAM, LJE), Mayo Clinic, Rochester, Minnesota; Division of Biostatistics (DOH), Mayo Clinic and Mayo Foundation, Rochester, Minnesota; and Department of Neurology (SJP, EPF, MTB, JJC), Mayo Clinic, Rochester, Minnesota.

Background: Optic neuritis (ON) is the most common optic neuropathy in young adults. MRI is reported to have a high sensitivity for ON. Higher signal strengths of MRI may enhance resolution and lead to better detection of ON. We sought to compare the sensitivity of 3.0 Tesla (T) MRI to that of 1.5 T MRI in detecting acute demyelinating ON.

Methods: A retrospective chart review was performed on patients with a clinical diagnosis of optic neuritis at Mayo Clinic Health System from January 2010 to April 2020. Among 1,850 patients identified, 126 patients met the eligibility criteria. Exclusion criteria comprised questionable or alternative diagnosis, diagnosis of ON before the study period, eye examinations performed elsewhere, or absence of fat-saturated head and orbits MRIs performed locally within 30 days of symptom onset. Gadolinium contrast enhancement, T2 hyperintensity, and the radiologic diagnosis of ON were recorded by a neuro-radiologist who was masked to the clinical history and the magnet strength of the MRI.

Results: Fifty-three patients (42.1%) had 3.0 T MRI, and 73 patients (57.9%) had 1.5 T MRI. Overall, 88.9% (112/126) of patients were determined to have a positive MRI for ON. The radiographic sensitivity for ON was higher in the 3.0 T group compared with the 1.5 T group (98.1% vs 82.2%, respectively [ P = 0.004]). The frequency of gadolinium enhancement was found to be greater in the 3 T group compared with the 1.5 T group (98.1% vs 76.7%, respectively [ P < 0.001]). T2 hyperintensity was also more often seen in the 3.0 T group compared with the 1.5 T group (88.7% vs 68.5%, respectively [ P = 0.01]).

Conclusions: 3.0 T MRI is more sensitive than 1.5 T MRI in detecting ON. This finding suggests that 3.0 T MRI is a preferred imaging modality for the confirmation of ON.
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http://dx.doi.org/10.1097/WNO.0000000000001559DOI Listing
July 2022

Time in therapeutic range of anticoagulation among patients with atrial fibrillation and cerebral amyloid angiopathy.

Proc (Bayl Univ Med Cent) 2022 28;35(2):162-167. Epub 2021 Dec 28.

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

Atrial fibrillation (AF) and cerebral amyloid angiopathy (CAA) present risks of ischemic stroke and intracerebral hemorrhage (ICH). Vitamin K antagonist use is associated with fluctuations in international normalized ratio (INR), which predispose to a higher bleeding risk. Patients with a diagnosis of AF and ICH while on a vitamin K antagonist were identified using the Rochester Epidemiology Project. Sixty patients were identified (mean age 81.3 years; 24 men). Thirty-three (55%) exhibited characteristics consistent with possible (n = 25) or probable (n = 8) CAA. Mean time in therapeutic range in the 30 days preceding ICH was 55.4%, with no difference between CAA and non-CAA patients. Mean time spent above therapeutic range (INR > 3.0) was 17.7%, with no difference between CAA and non-CAA patients. Following ICH, 21 (35%) died within 30 days, with total mortality at 76.7% after 176.4 person-years of follow-up (mean 2.9 years). Time in therapeutic range in the 30 days prior to ICH had no significant impact on 7-day mortality, nor risk of recurrent ICH or ischemic stroke. Patients with warfarin-related ICH were often outside of the therapeutic range within the month preceding hemorrhage but more frequently were subtherapeutic. Even with careful avoidance of supratherapeutic INR, vitamin K antagonist use in CAA patients is unlikely to have a major effect in preventing ICH and must be used with caution.
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http://dx.doi.org/10.1080/08998280.2021.2013393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8865288PMC
December 2021

Visual Function in Pseudophakic Eyes with Fuchs' Endothelial Corneal Dystrophy.

Am J Ophthalmol 2022 07 4;239:98-107. Epub 2022 Feb 4.

Frome the Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota (S.V.P, E.J.T, K.H.B); Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida, USA (D.O.H).

Purpose: To assess vision in pseudophakic eyes with Fuchs' endothelial corneal dystrophy (FECD) before the onset of clinically detectable corneal edema.

Design: Cross-sectional study.

Methods: Sixty-one otherwise healthy pseudophakic eyes of 38 subjects with FECD (without clinically detectable edema) and 17 otherwise healthy pseudophakic eyes of 9 subjects with normal corneas. Subjects underwent clinical examination to determine the morphologic distribution of guttae (severity grading). Standardized best-corrected high-contract and low-contrast (photopic and mesopic) visual acuity (HCVA, LCVA) and straylight were measured. Scheimpflug tomography posterior elevation and pachymetry maps were interpreted for 3 tomographic features of subclinical edema: loss of regular isopachs, displacement of the thinnest point of the cornea, and presence of posterior surface depression.

Results: In FECD without tomographic features of edema (ie, normal tomography patterns), HCVA, LCVA, and straylight did not differ from that of eyes with normal corneas (P ≥ .09); these eyes encompassed the full range of severity grading of guttae. In FECD with all 3 tomographic features of edema, the same parameters were worse compared with eyes with normal corneas (P ≤ .02). In FECD with 1 or 2 tomographic abnormalities, mesopic LCVA (P = .04) and straylight (P = .003) were worse compared with eyes with normal corneas.

Conclusions: Impairment of vision was associated with the presence of tomographic edema in eyes with FECD. When tomography patterns were normal in FECD (ie, guttae were present without tomographic edema), visual acuity and straylight were normal, and therefore corneal surgical intervention would not typically be indicated to improve vision.
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http://dx.doi.org/10.1016/j.ajo.2022.01.016DOI Listing
July 2022

Clinical characteristics and outcomes of ocular adnexal mantle cell lymphoma.

Orbit 2022 Feb 4;41(1):97-104. Epub 2022 Jan 4.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.

Purpose: To compare characteristics of initial ocular adnexal (OA) mantle cell lymphoma (MCL) and initial systemic MCL.

Methods: Retrospective, comparative case series. Patients treated for MCL at Mayo Clinic from 1/1/1990 to 11/30/2020. MCL was classified as initial OA if first site was OA or initial systemic if first site was elsewhere with progression or recurrence to the OA region.

Outcome Measures: Features, treatment, and survival.

Results: There were 50 patients with MCL, 23 initial OA and 27 initial systemic. Patients with initial OA MCL had more conjunctival (52% vs. 19%, p = .017) involvement and less frequently received chemotherapy plus autologous stem cell transplant (ASCT) (9% vs. 33%, p = .046) as initial treatment. Complete remission was achieved in 41 (91% vs. 74%, p = .152) patients. Five-year disease-specific survival was similar in initial OA and initial systemic MCL (92% vs. 83%, p = .187). Subanalysis of patients with initial OA MCL revealed 9 (39%) patients developed tumor recurrence, with mean time to recurrence of 28 months. Comparison (no recurrence vs. recurrence) of initial OA MCL patients revealed those with no recurrence had shorter mean final follow-up (3.3 vs. 9.8 years, p = .005) and more frequent initial treatment with rituximab-based chemotherapy plus ASCT (43% vs. 0%, p = .048). Recurrence had no effect on the 5-year age-adjusted risk of death from lymphoma (HR 2.17, 95% CI 0.55-9.09, p = .266).

Conclusions: Initial OA and initial systemic MCL patients differ in presentation and management but have similar survival.
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http://dx.doi.org/10.1080/01676830.2021.2018715DOI Listing
February 2022

Telemedicine for Preoperative Evaluation of Upper Eyelid Malposition: Reliability of Diagnosis and Surgical Plan.

Ophthalmic Plast Reconstr Surg 2022 Jul-Aug 01;38(4):364-368. Epub 2022 Jan 13.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

Purpose: Outpatient visits and surgeries for nonurgent indications in ophthalmology have intermittently been restricted during the COVID-19 pandemic. Telemedicine services have rapidly gained acceptance during this period, and could improve patient access for routine oculoplastic evaluations in the future. The objective of this study is to investigate interobserver and intraobserver reliability of eyelid and brow position assessment and surgical plan when comparing photography-based and face-to-face evaluation.

Methods: This was an observational study conducted at a single academic center. Thirty randomly selected patients who had completed an in-office evaluation for chief complaint of "drooping eyelids" between June 2019 and March 2020 were included. Virtual assessment of brow position, dermatochalasis, blepharoptosis, and margin-reflex distance 1 was performed by 2 oculoplastic surgeons based on external photographs, and a surgical plan was formulated. Fraction of agreement and Cohen's κ were determined to evaluate reliability of the virtual assessment compared to face-to-face examination.

Results: For 60 eyes from 30 study subjects, diagnostic reliability for observer A was near perfect for brow ptosis, substantial for blepharoptosis and moderate for dermatochalasis (κ = 0.86, 0.67, and 0.57, respectively); for observer B, reliability was moderate for brow and blepharoptosis and substantial for dermatochalasis (0.47, 0.59, and 0.79). Fraction of agreement for blepharoptosis was 94% in eyes where the eyelid margin was visible, and 66% in eyes where the eyelid margin was obscured by overhanging skin. Virtual margin-reflex distance 1 measurements were highly correlated with those obtained face to face (r = 0.77, p < 0.01). Fraction of agreement for surgical plan after virtual examination by observer A/B, respectively, was 100%/94% for brow lift, 90%/87% for blepharoptosis repair and 83%/83% for functional upper blepharoplasty.

Conclusions: Virtual evaluation of upper eyelid and brow malposition can be performed with acceptable reliability. Co-existing dermatochalasis or brow ptosis may require special photographic technique or video examination to ensure an appropriate diagnosis. A photography-based preliminary surgical plan offers a viable alternative to face-to-face encounters.
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http://dx.doi.org/10.1097/IOP.0000000000002117DOI Listing
July 2022

Single versus multiple and incidental versus symptomatic subsegmental pulmonary embolism: clinical characteristics and outcome.

J Thromb Thrombolysis 2022 Jul 7;54(1):82-90. Epub 2022 Jan 7.

Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA.

It remains unexplored if the clinical picture and outcome of subsegmental pulmonary embolism (SSPE) differ between single versus multiple, and incidental versus symptomatic embolism. Consecutive patients anticoagulated for SSPE at the Mayo Thrombophilia Clinic (03/01/2013-12/31/2020) were followed forward to assess venous thromboembolism (VTE) recurrence, mortality, major bleeding, and clinically relevant non-major bleeding (CRNMB); expressed as a rate per 100 person-years. Among 3878 VTE patients, 1541 had pulmonary embolism including 224 (14.6%) with SSPE either single (n = 139) or multiple (n = 85; 46 bilateral and 39 unilateral emboli); 134 had incidental and 90 symptomatic SSPE. Patients with single were less often symptomatic and less often had coexisting DVT than multiple SSPE. Patients with incidental had a two-fold higher frequency of cancer compared to symptomatic SSPE. During the study period, 1 patient with single and 2 with multiple SSPE had VTE recurrence (rate of 1.14 vs 3.63, p = 0.280). Single SSPE patients experienced 2 episodes of major bleeding (rate of 2.36) while the multiple SSPE group had no major bleeding. Seven patients in each group had CRNMB events (rate of 8.20 vs 13.58 for single and multiple SSPE, respectively, p = 0.282). Patients with single SSPE had a higher death rate compared to multiple SSPE (43.07 vs 22.22, p = 0.031) but no difference was noted after adjusting for cancer (p = 0.388). Also, incidental had similar clinical outcomes to symptomatic SSPE.Interpretation Anticoagulated SSPE patients with single and multiple as well as incidental and symptomatic have a different clinical profile but similar clinical outcomes.
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http://dx.doi.org/10.1007/s11239-021-02623-zDOI Listing
July 2022

Association of metabolic health phenotypes, obesity, and hepatocellular carcinoma risk.

Dig Liver Dis 2022 07 23;54(7):964-972. Epub 2021 Dec 23.

Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA. Electronic address:

Background: The obesity and hepatocellular carcinoma (HCC) risk association may differ by individuals' metabolic health status.

Aim: To investigate the association between obesity categories and HCC risk among individuals with different metabolic health phenotypes.

Methods: A case-control study among 518 HCC cases and 1,036 frequency-matched controls was conducted. Body mass index (BMI) was assessed before diagnosis. Pre-diagnosis data on dyslipidemia, hypertension, and diabetes were used to categorize participants as metabolically healthy or metabolically unhealthy. Participants were further categorized into metabolically healthy normal weight (MHNW), metabolically healthy overweight (MHOW), metabolically healthy obese (MHO), metabolically unhealthy normal weight (MUNW), metabolically unhealthy overweight (MUOW), and metabolically unhealthy obese (MHO). We used logistic regression to calculate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Being overweight (OR=1.68, 95%CI=1.21-2.34) or obese (OR=1.49, 95%CI=1.11-1.89) was associated with higher HCC risk. Among metabolically healthy participants, no association was found between being overweight or obese and HCC risk. However, among the metabolically unhealthy participants, being overweight (OR=1.89, 95%CI=1.31-2.72) or obese (OR=1.50, 95%CI=1.07-2.09) was associated with higher HCC risk. Compared to the MHNW phenotype, no association was found between the MHOW and MHO phenotypes and HCC risk, but the MUNW (OR=1.94, 95%CI=1.09-3.43), MUOW (OR=3.78, 95%CI=2.15-6.65), and MUO (OR=2.93, 95%CI=1.70-5.05) phenotypes were associated with higher HCC risk.

Conclusion: The association between BMI and HCC appears to be restricted to individuals with underlying metabolic abnormalities.
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http://dx.doi.org/10.1016/j.dld.2021.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9213572PMC
July 2022

Outcomes of Patients With Diabetes Versus Patients Without Diabetes Hospitalized With Acute Heart Failure.

Am J Cardiol 2022 02 18;165:65-71. Epub 2021 Dec 18.

Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

The objective is to define the clinical echocardiographic characteristics and cardiovascular outcome in patients with acute heart failure (HF) with versus without diabetes mellitus (DM). Demographic, clinical, laboratory, and echocardiographic data were collected in Olmsted County adults hospitalized for acute HF between 2005 and 2008. Analyses were performed for mortality and acute HF hospitalization outcomes stratified by diabetic status, systolic function, and diastolic function. There were 912 subjects who met inclusion criteria, and mean age was 79 (SD 13.1) years with 53% women. Prevalence of DM was 42% in the study population, and those with DM had worse diastolic function and increased mortality and HF rehospitalization. Among those with DM and acute HF, reduced left ventricular ejection fraction and worse diastolic function conferred increased HF rehospitalization (p = 0.010 and p = 0.022, respectively). In conclusion, DM is common in those hospitalized for acute HF and is associated with worse long-term clinical outcomes. The subgroup of DM with acute HF and left ventricular systolic dysfunction or diastolic dysfunction had worse HF rehospitalization outcomes.
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http://dx.doi.org/10.1016/j.amjcard.2021.11.006DOI Listing
February 2022

Association of Metabolic Syndrome With Glaucoma and Ocular Hypertension in a Midwest United States Population.

J Glaucoma 2022 Jun 2;31(6):e18-e31. Epub 2021 Dec 2.

Department of Ophthalmology, Mayo Clinic, Rochester, MN.

Prcis: For patients with glaucoma, metabolic syndrome was associated with higher intraocular pressure and greater central corneal thickness. Patients with metabolic syndrome were more likely to have ocular hypertension.

Purpose: The purpose of this study was to determine whether glaucomatous optic neuropathy, also known as glaucoma, and ocular hypertension are more likely to occur in patients with metabolic syndrome.

Patients And Methods: Patients in Olmsted County, MN, were identified as having metabolic syndrome based on diagnosis codes, laboratory values, and/or medication use to meet 3 or more of the 5 standard criteria for diagnosing metabolic syndrome: systemic hypertension, hyperglycemia, hypertriglyceridemia, reduced high-density lipoprotein cholesterol, and central adiposity defined by increased body mass index. Patients with glaucoma, including primary open angle, low tension, pigment dispersion, and pseudoexfoliation, were identified using diagnostic codes. The charts of patients with glaucoma were individually reviewed to collect visual acuity, intraocular pressure, cup to disc ratio, central corneal thickness, visual field mean deviation, retinal nerve fiber layer thickness, and treatment of intraocular pressure. Patients with ocular hypertension were separately identified and similarly evaluated.

Results: For patients with glaucoma, those with metabolic syndrome had higher intraocular pressure and greater central corneal thickness compared with those without metabolic syndrome. After adjustment for central corneal thickness, there was no longer a significant difference in intraocular pressure between groups. Metabolic syndrome was also associated with the diagnosis of ocular hypertension, and although central corneal thickness trended higher in patients with metabolic syndrome, it did not attain statistical significance.

Conclusion: In Olmsted County, though metabolic syndrome was associated with ocular hypertension and higher intraocular pressure in patients with glaucoma, the results were likely related to a thicker central corneal in this patient population.
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http://dx.doi.org/10.1097/IJG.0000000000001968DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9337265PMC
June 2022

Ocular Sequelae in a Population-Based Cohort of Youth Diagnosed With Diabetes During a 50-Year Period.

JAMA Ophthalmol 2022 Jan;140(1):51-57

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.

Importance: Despite the increasing prevalence of type 2 diabetes (T2D) diagnosed in childhood, little is known about the natural history of ocular sequelae in youth-onset T2D compared with type 1 diabetes (T1D).

Objective: To assess the risk of developing diabetes-associated ocular complications among youth diagnosed with diabetes.

Design, Setting, And Participants: This retrospective, population-based medical record review included all residents of Olmsted County, Minnesota (95.7% White in 1990), diagnosed with diabetes at younger than 22 years (hereinafter referred to as children) from January 1, 1970, through December 31, 2019.

Main Outcomes And Measures: Risk of developing ocular complications over time.

Results: Among 1362 individuals with a diagnostic code of diabetes, medical record reviews confirmed a diagnosis of T1D or T2D in 606 children, of whom 525 (86.6%) underwent at least 1 eye examination (mean [SD] age at diabetes diagnosis, 12.1 [5.4] years; 264 [50.3%] male). Diabetes-associated ocular complications occurred in 147 of the 461 children (31.2%) with T1D and in 17 of the 64 children (26.6%) with T2D. The hazard ratio illustrating the risk between T2D and T1D rates was 1.88 (95% CI, 1.13-3.12; P = .02) for developing any diabetic retinopathy (nonproliferative or greater), 2.33 (95% CI, 0.99-5.50; P = .048) for proliferative diabetic retinopathy, 1.49 (95% CI, 0.46-4.89; P = .50) for diabetic macular edema, 2.43 (95% CI, 0.54-11.07; P = .24) for a visually significant cataract, and 4.06 (95% CI, 1.34-12.33; P = .007) for requiring pars plana vitrectomy by 15 years after the diagnosis of diabetes.

Conclusions And Relevance: Diabetic retinopathy, proliferative diabetic retinopathy, and the need for pars plana vitrectomy occurred within a shorter diabetes duration for children with T2D compared with T1D in this population-based cohort. Children with T2D had almost twice the risk of developing retinopathy compared with those with T1D. These findings suggest that to prevent serious ocular complications, children with T2D may require ophthalmoscopic evaluations at least as frequently as or more frequently than children with T1D.
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http://dx.doi.org/10.1001/jamaophthalmol.2021.5052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640948PMC
January 2022

Epidemiology of Uveitis in Olmsted County, Minnesota: A Population-Based Follow-Up Study.

Ocul Immunol Inflamm 2021 Nov 22:1-7. Epub 2021 Nov 22.

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.

Purpose: To update the incidence of uveitis in a Midwestern U.S. county population.

Methods: Retrospective population-based cohort study. All Olmsted County, Minnesota residents diagnosed with uveitis from January 1, 2006 to December 31, 2015 were identified via the Rochester Epidemiology Project. Diagnoses were confirmed by a uveitis specialist.

Results: There were 371 incident uveitis cases, yielding an overall age- and sex-adjusted incidence rate of 26.9 per 100,000 per year (95% CI: 24.1-29.7). Females accounted for 202 (54.4%) cases, 306 (82.5%) were White, and 299 (80.6%) were anterior uveitis. Highest incidence was observed in patients ≥65 years old. No difference in incidence existed between sexes ( = .17). Incidence rates increased with age for uveitis overall (all anatomic subtypes) ( < .001), anterior uveitis ( < .001), and posterior uveitis ( < .001). Idiopathic uveitis accounted for 168 (45.3%) cases, more frequently diagnosed in females (50.0%) than males (39.6%) ( = .05).

Conclusion: Uveitis incidence increased 1.6-fold over a 50-year span in this predominately White U.S. Midwestern county population.
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http://dx.doi.org/10.1080/09273948.2021.1988113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124234PMC
November 2021

Multiple Systemic Vascular Risk Factors Are Associated With Low-Tension Glaucoma.

J Glaucoma 2022 01;31(1):15-22

Department of Ophthalmology, Mayo Clinic, Rochester, MN.

Prcis: Multiple systemic vascular-associated conditions including systemic hypertension and hypotension, diabetes mellitus, migraine headache, peripheral vascular disease, Raynaud syndrome, and anemia were associated with low-tension glaucoma.

Purpose: The purpose of this study was to identify systemic risk factors associated with low-tension glaucoma.

Patients And Methods: A retrospective case-control study design was employed to identify patients seen at the Mayo Clinic Department of Ophthalmology between 2005 and 2015 with low-tension glaucoma and an age-matched and sex-matched control group, each containing 277 patients.

Results: The low-tension glaucoma group had more myopic refractive errors (-1.6 vs. -1.0 D, P<0.001), lower intraocular pressure (14.2 vs. 15.2 mm Hg, P<0.001), and a higher cup-to-disc ratio (0.7 vs. 0.3, P<0.001). The low-tension glaucoma group was significantly less likely to be obese (body mass index >30, P=0.03). This group had a significantly higher prevalence of systemic hypertension [odds ratio (OR): 1.64, P=0.004], diabetes mellitus (OR: 3.01, P<0.001), peripheral vascular disease (OR: 2.61, P=0.009), migraine headache (OR: 2.12, P=0.02), anemia (OR: 2.18, P=0.003), systemic hypotension (OR: 4.43, P<0.001), Raynaud syndrome (OR: 3.09, P=0.05), and angiotensin-converting enzyme inhibitor (OR: 1.64, P=0.01) or calcium channel blocker use (OR: 1.98, P=0.004). After adjusting for systemic hypertension, calcium channel blocker use remained significant (OR: 1.70, P=0.03). No significant difference was found between groups with respect to hyperlipidemia, obstructive sleep apnea, coronary artery disease, carotid stenosis, stroke, or statin, angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, or metformin use.

Conclusions: Multiple vascular-associated conditions were associated with low-tension glaucoma including systemic hypertension, diabetes mellitus, peripheral vascular disease, migraine headache, Raynaud syndrome, anemia, systemic hypotension, and calcium channel blocker use. This study strengthens the evidence for the vascular hypothesis of low-tension glaucoma.
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http://dx.doi.org/10.1097/IJG.0000000000001964DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9337264PMC
January 2022

Quadrant-Specific Changes in Corneal and Tear Fluid Reservoir Thickness for After 2 Hours of Wear.

Eye Contact Lens 2021 Nov;47(11):582-587

Department of Ophthalmology (C.B.N., M.M.S.), Mayo Clinic, Rochester, MN; Atwater Eye Care Center (S.D.), School of Optometry, Indiana University, Bloomington, IN; and Department of Quantitative Health Sciences (D.O.H.), Mayo Clinic, Jacksonville, FL.

Objective: To measure corneal swelling and thickness of the tear fluid reservoir (TFR) after wearing scleral lenses (SLs).

Methods: Thirty-five participants had 1 eye fitted with each of three SLs (15.0-mm Jupiter, 18.2-mm Jupiter, and 18.0-mm Digiform). Scheimpflug images were obtained before wear, after application, after 2 hr of wear, and after removal. Initial and final TFR thickness and corneal thickness were measured in the central cornea and 3 mm from the center in the superior, inferior, temporal, and nasal quadrants.

Results: Corneal thickness increased with wear, but no between-lens differences were observed in the superior (P=0.09), inferior (P=0.38), or temporal (P=0.53) quadrants. The greatest change in central and nasal cornea thickness was with the 15.0-mm SL (P<0.001). All areas showed settling, with no between-lens differences. Greater final TFR thickness was noted for the superior and nasal quadrants with the 18.0-mm SL (P<0.001), and less final TFR thickness was noted in the inferior (P<0.001) and temporal (P<0.001) quadrants with the 15.0-mm SL. Corneal thickness was not associated with the final TFR thickness.

Conclusions: The greatest corneal swelling was observed in the inferior quadrant with the 15.0-mm SL, although this lens had the least TFR thickness inferiorly. TFR thickness alone did not account for observed corneal swelling.
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http://dx.doi.org/10.1097/ICL.0000000000000808DOI Listing
November 2021

Prevalence of pseudophakia: U.S. population-based study.

J Cataract Refract Surg 2022 06;48(6):717-722

From Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota (Erie, Mahr); Department of Quantitative Health Science, Mayo Clinic, Jacksonville, Florida (Hodge).

Purpose: To determine the current prevalence and trends of pseudophakia in a well-defined U.S. population, calculating values for Olmsted County, Minnesota, from 1988 through 2018.

Setting: Mayo Clinic, Rochester, Minnesota.

Design: Population-based cohort study.

Methods: Rochester Epidemiology Project (REP) databases were used to identify all cases of pseudophakia in Olmsted County, Minnesota, between January 1, 1988, and December 31, 2018. Age- and sex-specific prevalence rates were calculated in 1988, 1998, 2008, and 2018 using REP census population estimates and mortality counts. Poisson regression analysis was used to assess changes in prevalence over time. Mortality rates were estimated by Kaplan-Meier analysis.

Results: In 2018, 10 024 county residents were pseudophakic in at least 1 eye, for a total population prevalence of 6.5%. The prevalence increased 67% in the last 10 years and 590% in the last 30 years (P < .001). By 2018, 51% of residents aged 75 years and 88% of residents aged 85 years and older were pseudophakic in at least 1 eye, 53% of residents with pseudophakia aged 65 years and older were bilaterally pseudophakic, and 29% of residents with pseudophakia had lived with pseudophakia for more than 10 years. The prevalence was higher among women than men and increased with age (P < .001). Overall, pseudophakia had a lower all-cause mortality compared with the general Minnesota population (P < .001).

Conclusions: In 2018, most residents aged 75 years and older were pseudophakic in at least 1 eye. These numbers underscore the changing visual status of older adults and the large number of adults who benefit from cataract surgery.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000827DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8957633PMC
June 2022

Automatic wide complex tachycardia differentiation using mathematically synthesized vectorcardiogram signals.

Ann Noninvasive Electrocardiol 2022 01 25;27(1):e12890. Epub 2021 Sep 25.

Division of Cardiovascular Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.

Background: Automated wide complex tachycardia (WCT) differentiation into ventricular tachycardia (VT) and supraventricular wide complex tachycardia (SWCT) may be accomplished using novel calculations that quantify the extent of mean electrical vector changes between the WCT and baseline electrocardiogram (ECG). At present, it is unknown whether quantifying mean electrical vector changes within three orthogonal vectorcardiogram (VCG) leads (X, Y, and Z leads) can improve automated VT and SWCT classification.

Methods: A derivation cohort of paired WCT and baseline ECGs was used to derive five logistic regression models: (i) one novel WCT differentiation model (i.e., VCG Model), (ii) three previously developed WCT differentiation models (i.e., WCT Formula, VT Prediction Model, and WCT Formula II), and (iii) one "all-inclusive" model (i.e., Hybrid Model). A separate validation cohort of paired WCT and baseline ECGs was used to trial and compare each model's performance.

Results: The VCG Model, composed of WCT QRS duration, baseline QRS duration, absolute change in QRS duration, X-lead QRS amplitude change, Y-lead QRS amplitude change, and Z-lead QRS amplitude change, demonstrated effective WCT differentiation (area under the curve [AUC] 0.94) for the derivation cohort. For the validation cohort, the diagnostic performance of the VCG Model (AUC 0.94) was similar to that achieved by the WCT Formula (AUC 0.95), VT Prediction Model (AUC 0.91), WCT Formula II (AUC 0.94), and Hybrid Model (AUC 0.95).

Conclusion: Custom calculations derived from mathematically synthesized VCG signals may be used to formulate an effective means to differentiate WCTs automatically.
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http://dx.doi.org/10.1111/anec.12890DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8739609PMC
January 2022
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