Publications by authors named "Joyce C Schiffman"

51 Publications

The Primary Tube Versus Trabeculectomy Study: Methodology of a Multicenter Randomized Clinical Trial Comparing Tube Shunt Surgery and Trabeculectomy with Mitomycin C.

Ophthalmology 2018 05 18;125(5):774-781. Epub 2017 Dec 18.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Purpose: To describe the methodology of the Primary Tube Versus Trabeculectomy (PTVT) Study.

Design: Multicenter randomized clinical trial.

Participants: Patients with medically uncontrolled glaucoma and no prior incisional ocular surgery.

Methods: Patients are being enrolled at 16 clinical centers and randomly assigned to treatment with a tube shunt (350-mm Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (0.4 mg/ml for 2 minutes).

Main Outcome Measures: The primary outcome measure is the rate of surgical failure, defined as intraocular pressure (IOP) more than 21 mmHg or reduced by less than 20% from baseline, IOP of 5 mmHg or less, reoperation for glaucoma, or loss of light perception vision. Secondary outcome measures include IOP, glaucoma medical therapy, visual acuity, visual fields, and surgical complications.

Conclusions: Practice patterns vary in the surgical management of glaucoma, and opinions differ among surgeons regarding the preferred primary operation for glaucoma. The PTVT Study will provide valuable information comparing the 2 most commonly performed glaucoma surgical procedures.
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http://dx.doi.org/10.1016/j.ophtha.2017.10.037DOI Listing
May 2018

Reply.

Ophthalmology 2016 10;123(10):e62-3

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

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http://dx.doi.org/10.1016/j.ophtha.2016.03.004DOI Listing
October 2016

Utilization of Ophthalmology-Specific Emergency Department Services.

Semin Ophthalmol 2018 6;33(2):185-190. Epub 2016 Sep 6.

a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA.

Objective: To describe utilization trends of an ophthalmology-specific emergency department (ED).

Methods: Prospective cohort study of new patients presenting in the ophthalmology ED for at least a 30-day period in the spring of each year for five consecutive years (2010-14) at a university referral center. A data form, including information about the ED visit and patient demographics, was included in each patient chart. Data were analyzed with Pearson chi-square test and multiple logistic regression.

Results: A total of 5323 chart data forms were completed. An average of 42.2 new patients per day presented to the ophthalmology ED. Most common diagnoses were viral conjunctivitis (8.7%), dry eye syndrome (6.6%), and corneal abrasion (6.6%). Non-emergent visits accounted for 35.8% of surveys completed. Factors associated with non-emergent visits included female gender, age 65 years or older, weekday visits, and patient symptom duration greater than one week (p < 0.0001 for each factor). When compared to all other insurance categories combined, patients who were members of the regional public assistance program were the most likely to present with a non-emergency (48.5% versus 34.9%, p < 0.001), while Workers' Compensation patients were least likely to present with a non-emergency (16% versus 36.5%, p < 0.001).

Conclusions: Over one-third of new patient visits were non-emergent. Factors predictive of non-emergent patient visits were female gender, age 65 years or older, duration of symptoms greater than one week, weekday visits, and the form of insurance coverage.
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http://dx.doi.org/10.1080/08820538.2016.1188129DOI Listing
April 2018

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Retina 2016 10;36(10):e104-5

*Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida †Miami Veterans Administration Hospital, Department of Ophthalmology, Miami, Florida.

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http://dx.doi.org/10.1097/IAE.0000000000001297DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117130PMC
October 2016

A Retrospective Comparison of Primary Baerveldt Implantation versus Trabeculectomy with Mitomycin C.

Ophthalmology 2016 Apr 30;123(4):789-95. Epub 2015 Dec 30.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Purpose: To compare the safety and efficacy of Baerveldt implantation (Abbott Medical Optics, Santa Ana, CA) and trabeculectomy with mitomycin C (MMC) in patients who have not undergone prior incisional ocular surgery.

Design: Retrospective, comparative case series.

Participants: A total of 125 patients with low-risk glaucoma undergoing primary glaucoma surgery, including 55 patients who received a 350-mm(2) Baerveldt glaucoma implant and 70 patients who underwent trabeculectomy with MMC.

Methods: Eligible patients were identified using Current Procedural Terminology codes, and their medical records were reviewed retrospectively.

Main Outcome Measures: The primary outcome measure was surgical success (intraocular pressure [IOP] ≤21 mmHg and reduced ≥20% from baseline, IOP >5 mmHg, no reoperation for glaucoma, no loss of light-perception vision). Secondary outcome measures included visual acuity, IOP, number of glaucoma medications, and complications.

Results: The cumulative probability of success at 3 years with or without medical therapy was 87% in the Baerveldt group and 76% in the trabeculectomy group (P = 0.23). Postoperative complications occurred in 11 patients (20%) in the Baerveldt group and 20 patients (29%) in the trabeculectomy group (P = 0.27). Mean follow-up ± standard deviation was 27±19 months in the Baerveldt group and 34±20 months in the trabeculectomy group (P = 0.053).

Conclusions: Similar rates of surgical success and postoperative complications were observed in patients undergoing trabeculectomy with MMC and in those undergoing Baerveldt implantation during 3 years of follow-up. Both are viable primary glaucoma procedures in patients who have not undergone prior ocular surgery.
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http://dx.doi.org/10.1016/j.ophtha.2015.11.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584064PMC
April 2016

Gene Therapy for Leber Hereditary Optic Neuropathy: Initial Results.

Ophthalmology 2016 Mar 19;123(3):558-70. Epub 2015 Nov 19.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida. Electronic address:

Purpose: Leber hereditary optic neuropathy (LHON) is a disorder characterized by severe and rapidly progressive visual loss when caused by a mutation in the mitochondrial gene encoding NADH:ubiquinone oxidoreductase subunit 4 (ND4). We have initiated a gene therapy trial to determine the safety and tolerability of escalated doses of an adeno-associated virus vector (AAV) expressing a normal ND4 complementary DNA in patients with a G to A mutation at nucleotide 11778 of the mitochondrial genome.

Design: In this prospective open-label trial (NCT02161380), the study drug (self-complementary AAV [scAAV]2(Y444,500,730F)-P1ND4v2) was intravitreally injected unilaterally into the eyes of 5 blind participants with G11778A LHON. Four participants with visual loss for more than 12 months were treated. The fifth participant had visual loss for less than 12 months. The first 3 participants were treated at the low dose of vector (5 × 10(9) vg), and the fourth participant was treated at the medium dose (2.46 × 10(10) vg). The fifth participant with visual loss for less than 12 months received the low dose. Treated participants were followed for 90 to 180 days and underwent ocular and systemic safety assessments along with visual structure and function examinations.

Participants: Five legally blind patients with G11778A LHON.

Main Outcome Measures: Loss of visual acuity.

Results: Visual acuity as measured by the Early Treatment Diabetic Retinopathy Study (ETDRS) eye chart remained unchanged from baseline to 3 months in the first 3 participants. For 2 participants with 90-day follow-up, acuity increased from hand movements to 7 letters in 1 and by 15 letters in 1, representing an improvement equivalent to 3 lines. No one lost vision, and no serious adverse events were observed. Minor adverse events included a transient increase of intraocular pressure (IOP), exposure keratitis, subconjunctival hemorrhage, a sore throat, and a transient increase in neutralizing antibodies (NAbs) against AAV2 in 1 participant. All blood samples were negative for vector DNA.

Conclusions: No serious safety problems were observed in the first 5 participants enrolled in this phase I trial of virus-based gene transfer in this mitochondrial disorder. Additional study follow-up of these and additional participants planned for the next 4 years is needed to confirm these preliminary observations.
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http://dx.doi.org/10.1016/j.ophtha.2015.10.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287094PMC
March 2016

REPRODUCIBILITY AND COMPARISON OF VISUAL ACUITY OBTAINED WITH SIGHTBOOK MOBILE APPLICATION TO NEAR CARD AND SNELLEN CHART.

Retina 2016 May;36(5):1009-20

*Eye Care Section, Miami Veterans Affairs Medical Center; and †Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.

Purpose: To investigate test-retest reproducibility of visual acuities obtained with a popular mobile application (app) and to explore the agreement with the standard clinic charts.

Methods: Records of patients who had visual acuity measured during the same routine clinic visit with Snellen chart, Rosenbaum near vision card, and SightBook mobile app were reviewed. Acuities were converted to approximate ETDRS letters for statistical purposes.

Results: One hundred and twenty-six patients were identified. SightBook, Snellen, and near card acuities had excellent test-retest reproducibility. SightBook acuities were significantly different from the near card acuities (mean absolute difference of 5.4 and 6.1 letters in the right and left eyes) and the Snellen acuities (mean absolute difference of 7.7 and 7.9 letters in the right and left eyes). The agreement was also poor between the near card and the Snellen acuities (mean absolute difference of 6.4 and 7.6 letters in the right and left eyes).

Conclusion: The discrepancy between SightBook mobile app and the clinic charts acuities may be large; however, the results are highly reproducible. Obtaining baseline SightBook acuity allows future vision comparisons. SightBook mobile app offers a new portable vision assessment tool for the office and remote patient monitoring.
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http://dx.doi.org/10.1097/IAE.0000000000000818DOI Listing
May 2016

Adverse vitreoretinal outcomes of glaucoma drainage devices based on verified and unverified financial claims data.

Ophthalmic Surg Lasers Imaging Retina 2015 Apr;46(4):463-70

Background And Objective: To determine adverse vitreoretinal outcome rates after glaucoma drainage device (GDD) surgery.

Patients And Methods: Medical records from the Anne Bates Leach Eye Hospital with financial claims from 1991 to 2005 for GDD surgery coded for endophthalmitis, choroidal hemorrhage, or retinal detachment were reviewed. Cumulative incidences were calculated before and after verifying claims with chart review.

Results: GDD surgery was performed in 2,661 eyes. Thirty-three cases of endophthalmitis were identified, with 10 attributable to GDD (1-, 5-, and 10-year cumulative incidences: 0.22%, 0.43%, and 0.83%, respectively). Forty cases of choroidal hemorrhage were identified, with 20 attributable to GDD (1-, 5-, and 10-year incidences: 0.81% for all time points). Rhegmatogenous retinal detachments developed in 148 eyes, with 42 attributable to GDD (1-, 5-, and 10-year incidences: 1.25%, 2.02%, and 2.67%, respectively).

Conclusion: This study's complication rates compare favorably with those previously reported. The use of claims data without chart review verification may result in overestimated event rates.
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http://dx.doi.org/10.3928/23258160-20150422-10DOI Listing
April 2015

Dilated eye examination screening guideline compliance among patients with diabetes without a diabetic retinopathy diagnosis: the role of geographic access.

BMJ Open Diabetes Res Care 2014 23;2(1):e000031. Epub 2014 Aug 23.

Department of Ophthalmology , University of Miami Miller School of Medicine , Miami, Florida , USA.

Objective: To estimate the prevalence of, and factors associated with, dilated eye examination guideline compliance among patients with diabetes mellitus (DM), but without diabetic retinopathy.

Research Design And Methods: Utilizing the computerized billing records database, we identified patients with International Classification of Diseases (ICD)-9 diagnoses of DM, but without any ocular diagnoses. The available medical records of patients in 2007-2008 were reviewed for demographic and ocular information, including visits through 2010 (n=200). Patients were considered guideline compliant if they returned at least every 15 months for screening. Participant street addresses were assigned latitude and longitude coordinates to assess their neighborhood socioeconomic status (using the 2000 US census data), distance to the screening facility, and public transportation access. Patients not compliant, based on the medical record review, were contacted by phone or mail and asked to complete a follow-up survey to determine if screening took place at other locations.

Results: The overall screening compliance rate was 31%. Patient sociodemographic characteristics, insurance status, and neighborhood socioeconomic measures were not significantly associated with compliance. However, in separate multivariable logistic regression models, those living eight or more miles from the screening facility were significantly less likely to be compliant relative to those living within eight miles (OR=0.36 (95% CI 0.14 to 0.86)), while public transit access quality was positively associated with screening compliance (1.34 (1.07 to 1.68)).

Conclusions: Less than one-third of patients returned for diabetic retinopathy screening at least every 15 months, with transportation challenges associated with noncompliance. Our results suggest that reducing transportation barriers or utilizing community-based screening strategies may improve compliance.
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http://dx.doi.org/10.1136/bmjdrc-2014-000031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4212567PMC
December 2014

Longitudinal changes in peripapillary atrophy in the ocular hypertension treatment study: a case-control assessment.

Ophthalmology 2015 Jan 7;122(1):79-86. Epub 2014 Sep 7.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida.

Purpose: To explore the association between peripapillary atrophy (PPA) area and conversion from ocular hypertension (OHT) to glaucoma.

Design: Prospective, longitudinal cohort study of cases and controls.

Participants: We included 279 age-matched and follow-up time-matched eyes with OHT that converted to glaucoma and 279 eyes with OHT that did not convert to glaucoma.

Methods: Initial and last acceptable optic disc photos were analyzed. Disc, α-zone, and β-zone PPA were traced independently by 2 trained readers and their areas were measured with Photoshop. The α-zone and β-zone areas were expressed as a percentage of optic disc area.

Main Outcome Measures: α-Zone and β-zone PPA size over time.

Results: Intraclass correlation coefficients (ICCs) demonstrated that readers had good agreement on disc area (ICC = 0.97) and β-zone (ICC = 0.82), but not α-zone (ICC = 0.48). The ß-zone, as a percentage of disc area, increased in size (P < 0.001) in both eyes with incident primary open-angle glaucoma (mean, 10.6%; standard deviation, 22.6%) and matched controls (mean, 10.1%; standard deviation, 33.7) over follow-up (mean, 12.3 years). The increase in size did not differ between cases and controls (P = 0.82). Enlargement of the β-zone was not correlated with follow-up time (P = 0.39).

Conclusions: The results did not show a difference in size of the β-zone at baseline between eyes that proceed to develop glaucoma and those that do not. Moreover, the β-zone enlarges equally in case and control eyes during follow-up.
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http://dx.doi.org/10.1016/j.ophtha.2014.07.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4682350PMC
January 2015

Ventriculoperitoneal shunt as a treatment of visual loss in idiopathic intracranial hypertension.

J Neuroophthalmol 2014 Sep;34(3):223-8

Bascom Palmer Eye Institute (LCH, TWW, AMH, PRR, JCS, JP, MT, BLL) and Department of Neurological Surgery (RST), University of Miami, Miller School of Medicine; Miami, Florida.

Background: The aims of this study were to evaluate visual function outcomes in idiopathic intracranial hypertension (IIH) patients who underwent ventriculoperitoneal (VP) shunt for visual loss and to determine a VP shunt survival curve over time.

Methods: A retrospective medical record review was performed of all new IIH patients first evaluated at our institution who underwent VP shunt placement over a 7-year period (2004-2010). There were 2 primary outcome measures: the first being visual acuity (VA) and the second being shunt survival. Patients who received VP shunt for visual loss were included in the visual outcome analysis, and all patients who received VP shunt for any reason were included in the shunt survival analysis.

Results: Of the 338 new patients with IIH, 19 patients (6%) met the inclusion criteria and 17 underwent VP shunt for visual loss and 2 for headaches. Average follow-up was 21.2 months (range, 5-1,342 days). Of the 17 patients who had VP shunt for visual loss, 5 patients had optic nerve sheath fenestration (ONSF) surgery before VP shunt, and 1 patient had bilateral ONSF surgery after VP shunt. Median VA before shunt was 20/200 in the worse eye (range, 20/20 to NLP) and 20/40 in the better eye (20/20 to HM). Median VA after shunt was 20/60 in the worse eye (20/20 to lumboperitoneal) and 20/30 in the better eye (20/20 to 20/800). The improvement in VA was statistically significant in both worse eyes (P = 0.002, Wilcoxon signed-rank test) and better eyes (P = 0.028). The mean automated visual field (AVF) mean deviation (MD) of available AVFs before shunt was 223.36 dB (range, 233.38 to 27.01 dB) for the worse eye (n = 11) and 219.66 dB (230.11 to 25.91 dB) for the better eye (n = 11). Mean AVF MD deviation of available AVFs after shunt was 220.68 dB (232.13 to 23.97 dB) for the worse eye (n = 11) and 216.35 dB (232.13 to 21.00 dB) for the better eye (n = 11): this improvement was not significant (P = 0.27, P = 0.26, respectively). Independent masked record reviews by 3 neuro-ophthalmologists showed that 9 (53%) patients improved, 5 (29%) unchanged, 1 (6%) worsened, and 2 (12%) were indeterminate. Kaplan-Meier analysis showed a persistent steady decrease of functioning VP shunts over the entire period of 36 months with 80%, 65%, and 48% of VP shunts functioning without replacement, removal, or revision at 12, 24, and 36 months, respectively.

Conclusion: VP shunts improve or stabilize most IIH patients presenting with severe progressive visual loss or those with visual loss refractive to medical treatment and ONSF. Survival analysis shows persistent decrease of functioning shunts over time.
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http://dx.doi.org/10.1097/WNO.0000000000000106DOI Listing
September 2014

Outcomes of glaucoma reoperations in the Tube Versus Trabeculectomy (TVT) Study.

Am J Ophthalmol 2014 Jun 14;157(6):1179-1189.e2. Epub 2014 Feb 14.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Purpose: To describe the incidence and outcomes of reoperations for glaucoma in the Tube Versus Trabeculectomy (TVT) Study.

Design: Cohort study of patients in a multicenter randomized clinical trial.

Methods: The TVT Study enrolled 212 patients with medically uncontrolled glaucoma who had previous cataract and/or glaucoma surgery. Randomization assigned 107 patients to surgery with a tube shunt (350 mm(2) Baerveldt glaucoma implant) and 105 patients to trabeculectomy with mitomycin C (0.4 mg/mL for 4 minutes). Data were analyzed from patients who failed their assigned treatment and had additional glaucoma surgery. Outcome measures included intraocular pressure (IOP), use of glaucoma medications, visual acuity, surgical complications, and failure (IOP >21 mm Hg or not reduced by 20%, IOP ≤5 mm Hg, additional glaucoma surgery, or loss of light perception vision).

Results: Additional glaucoma surgery was performed in 8 patients in the tube group and 18 patients in the trabeculectomy group in the TVT Study, and the 5-year cumulative reoperation rate was 9% in the tube group and 29% in the trabeculectomy group (P = .025). Follow-up (mean ± SD) after additional glaucoma surgery was 28.0 ± 16.0 months in the tube group and 30.5 ± 20.4 months in the trabeculectomy group (P = .76). At 2 years after a glaucoma reoperation, IOP (mean ± SD) was 15.0 ± 5.5 mm Hg in the tube group and 14.4 ± 6.6 mm Hg in the trabeculectomy group (P = .84). The number of glaucoma medications (mean ± SD) after 2 years of follow-up was 1.1 ± 1.3 in the tube group and 1.4 ± 1.4 in the trabeculectomy group (P = .71). The cumulative probability of failure at 1, 2, 3, and 4 years after additional glaucoma surgery was 0%, 43%, 43%, and 43%, respectively, in the tube group, and 0%, 9%, 20%, and 47% in the trabeculectomy group (P = .28). Reoperations to manage complications were required in 1 patient in the tube group and 5 patients in the trabeculectomy group (P = .63).

Conclusions: The rate of reoperation for glaucoma was higher following trabeculectomy with mitomycin C than tube shunt surgery in the TVT Study. Similar surgical outcomes were observed after additional glaucoma surgery, irrespective of initial randomized treatment in the study.
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http://dx.doi.org/10.1016/j.ajo.2014.02.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584066PMC
June 2014

Trial end points and natural history in patients with G11778A Leber hereditary optic neuropathy : preparation for gene therapy clinical trial.

JAMA Ophthalmol 2014 Apr;132(4):428-36

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

IMPORTANCE Establishing the natural history of G11778A Leber hereditary optic neuropathy (LHON) is important to determine the optimal end points to assess the safety and efficacy of a planned gene therapy trial. OBJECTIVE To use the results of the present natural history study of patients with G11778A LHON to plan a gene therapy clinical trial that will use allotopic expression by delivering a normal nuclear-encoded ND4 gene into the nuclei of retinal ganglion cells via an adeno-associated virus vector injected into the vitreous. DESIGN, SETTING, AND PARTICIPANTS A prospective observational study initiated in 2008 was conducted in primary and referral institutional practice settings. Participants included 44 individuals with G11778A LHON, recruited between September 2008 and March 2012, who were evaluated every 6 months and returned for 1 or more follow-up visits (6-36 months) as of August 2012. EXPOSURES Complete neuro-ophthalmic examination and main measures. MAIN OUTCOMES AND MEASURES Visual acuity, automated visual field testing, pattern electroretinogram, and spectral-domain optical coherence tomography. RESULTS Clinical measures were stable during the follow-up period, and visual acuity was as good as or better than the other visual factors used for monitoring patients. Based on a criterion of 15 or more letters from the Early Treatment Diabetic Retinopathy Study chart, 13 eyes of 8 patients (18%) improved, but 24 months after the onset of symptoms, any further improvements were to no better than 20/100. Acuity recovery occurred in some patients despite continued marked retinal nerve fiber layer thinning indistinguishable from that in patients who did not recover visual acuity. CONCLUSIONS AND RELEVANCE Spontaneous improvement of visual acuity in patients with G11778A LHON is not common and is partial and limited when it occurs, so improvements in vision with adeno-associated virus-mediated gene therapy of a synthetic wild-type ND4 subunit gene should be possible to detect with a reasonable sample size. Visual acuity appears to be the most suitable primary end point for the planned clinical trial.
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http://dx.doi.org/10.1001/jamaophthalmol.2013.7971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266137PMC
April 2014

Ocular decompression with cotton swabs lowers intraocular pressure elevation after intravitreal injection.

J Glaucoma 2014 Oct-Nov;23(8):508-12

*Miami Veterans Affairs Medical Center †Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.

Objective: To determine the effect of preinjection ocular decompression by cotton swabs on the immediate rise in intraocular pressure (IOP) after intravitreal injections.

Methods: Forty-eight patients receiving 0.05 mL ranibizumab injections in a retina clinic were randomized to 2 anesthetic methods in each eye on the same day (if bilateral disease) or on consecutive visits (if unilateral disease). One method utilized cotton swabs soaked in 4% lidocaine applied to the globe with moderate pressure and the other 3.5% lidocaine gel applied without pressure. IOPs were recorded at baseline (before injection) and at 0, 5, 10, and 15 minutes after the injection until the IOP was ≤30 mm Hg. The IOP elevations from baseline were compared after the 2 anesthetic methods.

Results: The preinjection mean IOP (SD, mm Hg) was 15.5 (3.3) before the cotton swabs and 15.9 (3.0) before the gel (P=0.28). Mean IOP (SD, mm Hg) change immediately after injection was 25.7 (9.2) after the cotton swabs and 30.9 (9.9) after the gel (P=0.001). Thirty-five percent of gel eyes had IOP≥50 mm Hg compared with only 10% of cotton swab eyes immediately after the injection (P<0.001).

Conclusion: Decompressing the eye with cotton swabs during anesthetic preparation before an intravitreal injection produces a significantly lower IOP spike after the injection.
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http://dx.doi.org/10.1097/IJG.0b013e318294865cDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769433PMC
February 2015

Characterization of a clinician-scientist cohort in ophthalmology: a demographic analysis of k grant awardees in ophthalmology.

Ophthalmology 2013 Oct 28;120(10):2146-50. Epub 2013 Apr 28.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami Florida. Electronic address:

Objective: To analyze ophthalmologists who are National Institutes of Health (NIH) K grant awardees to characterize clinician-scientists in ophthalmology.

Design: Cohort study.

Participants: Ophthalmologists who have received a K award from 1996 through 2010.

Methods: K08 and K23 grant awardees were identified through the NIH Research Portfolio Online Reporter database. Information including gender, institution, educational degrees, and success in obtaining an R01 grant was analyzed.

Main Outcome Measures: Receipt of an R01 grant.

Results: One hundred five ophthalmologists were identified who received K08 or K23 grants from the National Eye Institute from 1996 through 2010. Overall, 75% of these were male, although 43% of K awardees were women from 2006 through 2010. Sixty-five percent (68/105) of individuals came from ophthalmology departments that ranked in the top 20 of NIH funding in 2010. The most predominant subspecialties represented were retina (32%), cornea (22%), and glaucoma (15%). Among the K awardees, 40% (42/105) had a doctor of philosophy (PhD) degree in addition to their medical doctor degree. From 1996 through 2000, 61% (23/38) were successful in obtaining an R01 grant, whereas only 13% (5/39) from 2001 through 2005 obtained R01 grants (P<0.001).

Conclusions: Gender disparities exist among K awardees in ophthalmology, but these seem to be improving over time. None of the other variables studied-gender, PhD degree, specialty, or funding tier-was associated with obtaining R01 funding. This study helps to characterize the clinician-scientist cohort in ophthalmology and to identify areas to improve the recruitment of these individuals.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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http://dx.doi.org/10.1016/j.ophtha.2013.02.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3735812PMC
October 2013

Randomized clinical trial of two anesthetic techniques for intravitreal injections: 4% liquid lidocaine on cotton swabs versus 3.5% lidocaine gel.

Expert Opin Drug Deliv 2012 Jul 3;9(7):735-41. Epub 2012 May 3.

University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, USA.

Objective: To compare same-day and next-day pain control and safety of two anesthetic techniques utilizing 4% liquid lidocaine applied with sterile cotton swabs versus 3.5% lidocaine gel for intravitreal injections. Main outcome measures were: discomfort during anesthetic preparation and needle penetration, 1 and 24 h after injection.

Methods: Patients were randomized to alternate anesthetic method at two consecutive injections in one eye or in different eyes on the same day if requiring bilateral injections. Overall satisfaction, corneal staining, and subconjunctival hemorrhage (SCH) were compared.

Results: Fifty patients were enrolled. Both methods resulted in similar mild discomfort during anesthetic preparation, 1 and 24 h later. The gel resulted in slightly higher discomfort during needle penetration (p = 0.026). Patients were satisfied with both techniques (p = 0.91), however, 52% patients preferred gel, 33% were indifferent, and 15% preferred cotton swabs (p = 0.002). There were significantly less corneal staining (p = 0.001) and SCH (p = 0.004) after the gel.

Conclusion: Both techniques are equally effective and yield mild discomfort scores during the procedure and the next day. The gel method results in significantly less ocular surface irritation.
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http://dx.doi.org/10.1517/17425247.2012.685155DOI Listing
July 2012

Used glasses versus ready-made spectacles for the treatment of refractive error.

Ophthalmic Surg Lasers Imaging 2012 May-Jun;43(3):235-40. Epub 2012 Mar 1.

Bascom Palmer Eye Institute, Miami, FL 33136, USA.

Background And Objective: To compare visual outcomes for used glasses versus ready-made spectacles in the treatment of refractive error.

Patients And Methods: In this prospective, comparative case series, undilated refractive error screening examinations were conducted over a 5-week period. Patients with bilateral refractive error were treated with used glasses and ready-made spectacles powered to match their prescriptions. Snellen visual acuity was measured with no correction, best (manifest) correction, unrefined autorefraction, used glasses, and ready-made spectacles. Main outcome measurements were the mean visual improvement from uncorrected acuity and median final visual acuity after treatment with used and ready-made spectacles.

Results: One hundred forty-one patients ages 18 and older with bilateral refractive error were examined. Uncorrected visual acuity in each eye improved an average of 4.5 lines with best correction, 4.0 lines with used glasses, and 3.5 lines with ready-made spectacles, with used glasses demonstrating a statistically significant advantage over ready-made spectacles (P < .001). The median visual acuity in the better eye improved from 20/60 uncorrected to 20/25 with all types of glasses. In patients with less than 1 diopter of anisometropia and greater than 1 diopter of astigmatism in each eye (49%), the ready-made spectacles performed equally as well as the used glasses (P = .95), improving vision an average of 3.9 lines for a median final visual acuity of 20/25 in the better eye.

Conclusion: Although both were effective, used glasses are better than ready-made spectacles for improving vision loss due to refractive error.
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http://dx.doi.org/10.3928/15428877-20120223-02DOI Listing
August 2012

The Tube Versus Trabeculectomy Study: interpretation of results and application to clinical practice.

Curr Opin Ophthalmol 2012 Mar;23(2):118-26

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida 33136, USA.

Purpose Of Review: The Tube Versus Trabeculectomy (TVT) Study is a multicenter randomized clinical trial comparing the safety and efficacy of tube-shunt surgery to trabeculectomy with mitomycin C (MMC) in eyes with previous cataract and/or failed glaucoma surgery. This article interprets results from the TVT Study and applies them to clinical practice.

Recent Findings: Both tube-shunt surgery and trabeculectomy with MMC produced intraocular pressure (IOP) reduction to the low teens throughout the 5-year duration of the study. Tube-shunt surgery was associated with use of more glaucoma medications than trabeculectomy with MMC during the first 2 years of the study, but medical therapy equalized with longer follow-up. Trabeculectomy with MMC had higher rates of surgical failure and reoperation for glaucoma compared with tube-shunt surgery. Vision loss occurred at a similar rate with the two surgical procedures. Early complications were more frequent after trabeculectomy with MMC relative to tube-shunt surgery, but both procedures had similar rates of late postoperative complications and serious complications.

Summary: Tube-shunt surgery and trabeculectomy with MMC are both viable surgical options for managing glaucoma in patients who have undergone prior cataract and/or failed filtering surgery. Results of the TVT Study support the expanding use of tube shunts beyond refractory glaucomas.
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http://dx.doi.org/10.1097/ICU.0b013e32834ff2d1DOI Listing
March 2012

Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up.

Am J Ophthalmol 2012 May 15;153(5):789-803.e2. Epub 2012 Jan 15.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Florida, USA.

Purpose: To report 5-year treatment outcomes in the Tube Versus Trabeculectomy (TVT) Study.

Design: Multicenter randomized clinical trial.

Methods:

Settings: Seventeen clinical centers.

Study Population: Patients 18 to 85 years of age who had previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure (IOP) ≥18 mm Hg and ≤40 mm Hg on maximum tolerated medical therapy.

Interventions: Tube shunt (350-mm(2) Baerveldt glaucoma implant) or trabeculectomy with mitomycin C ([MMC]; 0.4 mg/mL for 4 minutes).

Main Outcome Measures: IOP, visual acuity, use of supplemental medical therapy, and failure (IOP >21 mm Hg or not reduced by 20%, IOP ≤5 mm Hg, reoperation for glaucoma, or loss of light perception vision).

Results: A total of 212 eyes of 212 patients were enrolled, including 107 in the tube group and 105 in the trabeculectomy group. At 5 years, IOP (mean ± SD) was 14.4 ± 6.9 mm Hg in the tube group and 12.6 ± 5.9 mm Hg in the trabeculectomy group (P = .12). The number of glaucoma medications (mean ± SD) was 1.4 ± 1.3 in the tube group and 1.2 ± 1.5 in the trabeculectomy group (P = .23). The cumulative probability of failure during 5 years of follow-up was 29.8% in the tube group and 46.9% in the trabeculectomy group (P = .002; hazard ratio = 2.15; 95% confidence interval = 1.30 to 3.56). The rate of reoperation for glaucoma was 9% in the tube group and 29% in the trabeculectomy group (P = .025).

Conclusions: Tube shunt surgery had a higher success rate compared to trabeculectomy with MMC during 5 years of follow-up in the TVT Study. Both procedures were associated with similar IOP reduction and use of supplemental medical therapy at 5 years. Additional glaucoma surgery was needed more frequently after trabeculectomy with MMC than tube shunt placement.
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http://dx.doi.org/10.1016/j.ajo.2011.10.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460598PMC
May 2012

Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up.

Am J Ophthalmol 2012 May 14;153(5):804-814.e1. Epub 2012 Jan 14.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Florida, USA.

Purpose: To describe postoperative complications encountered in the Tube Versus Trabeculectomy (TVT) Study during 5 years of follow-up.

Design: Multicenter randomized clinical trial.

Methods:

Settings: Seventeen clinical centers.

Study Population: Patients 18 to 85 years of age who had previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure (IOP) ≥18 mm Hg and ≤40 mm Hg on maximum tolerated medical therapy.

Interventions: Tube shunt (350-mm(2) Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC 0.4 mg/mL for 4 minutes).

Main Outcome Measures: Surgical complications, reoperations for complications, visual acuity, and cataract progression.

Results: Early postoperative complications occurred in 22 patients (21%) in the tube group and 39 patients (37%) in the trabeculectomy group (P = .012). Late postoperative complications developed in 36 patients (34%) in the tube group and 38 patients (36%) in the trabeculectomy group during 5 years of follow-up (P = .81). The rate of reoperation for complications was 22% in the tube group and 18% in the trabeculectomy group (P = .29). Cataract extraction was performed in 13 phakic eyes (54%) in the tube group and 9 phakic eyes (43%) in the trabeculectomy group (P = .43).

Conclusions: A large number of surgical complications were observed in the TVT Study, but most were transient and self-limited. The incidence of early postoperative complications was higher following trabeculectomy with MMC than tube shunt surgery. The rates of late postoperative complications, reoperation for complications, and cataract extraction were similar with both surgical procedures after 5 years of follow-up.
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http://dx.doi.org/10.1016/j.ajo.2011.10.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3653167PMC
May 2012

Treating uncorrected refractive error in adults in the developing world with autorefractors and ready-made spectacles.

Clin Exp Ophthalmol 2011 Nov 21;39(8):729-33. Epub 2011 Apr 21.

Bascom Palmer Eye Institute, Miami, Florida 33136, USA.

Background: To evaluate a method for treating uncorrected refractive error in adults in the developing world.

Design: Prospective, cross-sectional study in outpatient community health centres.

Participants: Eight hundred and forty subjects aged 18 and older from rural villages in Haiti and Belize.

Methods: Undilated refractive error screening exams were conducted over a 5-day period in rural Haiti and Belize using portable autorefractors. Isometropic, spherical, ready-made spectacles were provided to patients with bilateral refractive error, astigmatism ≤ 1 dioptre in each eye and visual acuity worse than 6/9 in each eye. Visual acuity was measured with and without corrective spectacles.

Main Outcome Measures:   The mean visual improvement and median final visual acuity after treatment with ready-made glasses.

Results: Eight hundred and forty patients aged 18 and older were screened with autorefractors. One hundred and eighty-nine subjects (22.5%) were found to have visually significant bilateral refractive error. Fifty-eight per cent (110/189) of these patients met criteria for treatment with ready-made spectacles. Visual acuity improved an average of 4.2 lines in the better eye and 4.1 lines in the worse eye with corrective glasses. The median visual acuity in the better eye was 6/6 after treatment.

Conclusion: Autorefractors and ready-made spectacles allow for effective treatment of uncorrected refractive error in adults in the developing world.
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http://dx.doi.org/10.1111/j.1442-9071.2011.02546.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139100PMC
November 2011

Antimicrobial resistance profiles of ocular and nasal flora in patients undergoing intravitreal injections.

Am J Ophthalmol 2011 Dec 20;152(6):999-1004.e2. Epub 2011 Aug 20.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Florida, USA.

Purpose: To identify the resistance profiles of conjunctival and nasal bacterial isolates in patients undergoing intravitreal injections and to determine if frequent exposures to topical fluoroquinolones increased antimicrobial resistance among these organisms.

Design: Prospective cohort study.

Methods: Patients undergoing intravitreal injection at our institution were enrolled in this study. The conjunctiva and nares of both sides of the patient's face were swabbed and cultured before antiseptic preparation for intravitreal injection. At the time of the study, all patients received 3 days of moxifloxacin eye drops after each intravitreal injection as prophylaxis against endophthalmitis. Resistance to antimicrobials was analyzed using the chi-square test and t test.

Results: Two hundred eight conjunctival and nasal specimens were cultured from 104 patients. Forty-two (45%) of 93 patients had at least 1 fluoroquinolone-resistant organism in the nose or conjunctiva. Twelve (48%) of 25 patients with no previous injections had at least 1 resistant organism; 14 (45%) of 31 patients with 1 to 4 previous injections had at least 1 resistant organism; 8 (33%) of 24 patients with 5 to 9 previous injections had at least 1 resistant organism; and 8 (62%) of 13 patients with 10 or more previous injections had at least 1 resistant organism (P = .88; chi-square test, linear by linear association).

Conclusions: In this small study, there was no correlation between the number of exposures to topical fluoroquinolones and resistance to fluoroquinolones in nasal and conjunctival flora, but there was a high prevalence of fluoroquinolone resistance among all patient groups.
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http://dx.doi.org/10.1016/j.ajo.2011.05.026DOI Listing
December 2011

Comparison of automated analysis of Cirrus HD OCT spectral-domain optical coherence tomography with stereo photographs of the optic disc.

Ophthalmology 2011 Jul 12;118(7):1348-57. Epub 2011 Mar 12.

Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA.

Objective: To evaluate a new automated analysis of optic disc images obtained by spectral-domain optical coherence tomography (SD OCT). Areas of the optic disc, cup, and neural rim in SD OCT images were compared with these areas from stereoscopic photographs to represent the current traditional optic nerve evaluation. The repeatability of measurements by each method was determined and compared.

Design: Evaluation of diagnostic technology.

Participants: One hundred nineteen healthy eyes, 23 eyes with glaucoma, and 7 glaucoma suspect eyes.

Methods: Optic disc and cup margins were traced from stereoscopic photographs by 3 individuals independently. Optic disc margins and rim widths were determined automatically in SD OCT. A subset of photographs was examined and traced a second time, and duplicate SD OCT images also were analyzed.

Main Outcome Measures: Agreement among photograph readers, between duplicate readings, and between SD OCT and photographs were quantified by the intraclass correlation coefficient (ICC), by the root mean square, and by the standard deviation of the differences.

Results: Optic disc areas tended to be slightly larger when judged in photographs than by SD OCT, whereas cup areas were similar. Cup and optic disc areas showed good correlation (0.8) between the average photographic reading and SD OCT, but only fair correlation of rim areas (0.4). The SD OCT was highly reproducible (ICC, 0.96-0.99). Each reader also was consistent with himself on duplicate readings of 21 photographs (ICC, 0.80-0.88 for rim area and 0.95-0.98 for all other measurements), but reproducibility was not as good as SD OCT. Measurements derived from SD OCT did not differ from photographic readings more than the readings of photographs by different readers differed from each other.

Conclusions: Designation of the cup and optic disc boundaries by an automated analysis of SD OCT was within the range of variable designations by different readers from color stereoscopic photographs, but use of different landmarks typically made the designation of the optic disc size somewhat smaller in the automated analysis. There was better repeatability among measurements from SD OCT than from among readers of photographs. The repeatability of automated measurement of SD OCT images is promising for use both in diagnosis and in monitoring of progression.
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http://dx.doi.org/10.1016/j.ophtha.2010.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3129482PMC
July 2011

Three-year follow-up of the tube versus trabeculectomy study.

Am J Ophthalmol 2009 Nov 11;148(5):670-84. Epub 2009 Aug 11.

Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.

Purpose: To report 3-year results of the Tube Versus Trabeculectomy (TVT) Study.

Design: Multicenter randomized clinical trial.

Methods:

Setting: Seventeen clinical centers.

Study Population: Patients 18 to 85 years of age who had previous trabeculectomy, cataract extraction with intraocular lens implantation, or both and uncontrolled glaucoma with intraocular pressure (IOP) > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy.

Interventions: A 350-mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC 0.4 mg/ml for 4 minutes).

Main Outcome Measures: IOP, visual acuity, use of supplemental medical therapy, surgical complications, and failure (IOP >21 mm Hg or not reduced by 20%, IOP < or =5 mm Hg, reoperation for glaucoma, or loss of light perception vision).

Results: A total of 212 eyes of 212 patients were enrolled, including 107 in the tube group and 105 in the trabeculectomy group. At 3 years, IOP (mean +/- standard deviation [SD]) was 13.0 +/- 4.9 mm Hg in the tube group and 13.3 +/- 6.8 mm Hg in the trabeculectomy group (P = .78). The number of glaucoma medications (mean +/- SD) was 1.3 +/- 1.3 in the tube group and 1.0 +/- 1.5 in the trabeculectomy group (P = .30). The cumulative probability of failure during the first 3 years of follow-up was 15.1% in the tube group and 30.7% in the trabeculectomy group (P = .010; hazards ratio, 2.2; 95% confidence interval, 1.2 to 4.1). Postoperative complications developed in 42 patients (39%) in the tube group and 63 patients (60%) in the trabeculectomy group (P = .004). Surgical complications were associated with reoperation and/or loss of > or =2 Snellen lines in 24 patients (22%) in the tube group and 28 patients (27%) in the trabeculectomy group (P = .58).

Conclusions: Tube shunt surgery had a higher success rate compared to trabeculectomy with MMC during the first 3 years of follow-up in the TVT Study. Both procedures were associated with similar IOP reduction and use of supplemental medical therapy at 3 years. While the incidence of postoperative complications was higher following trabeculectomy with MMC relative to tube shunt surgery, most complications were transient and self-limited.
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http://dx.doi.org/10.1016/j.ajo.2009.06.018DOI Listing
November 2009

Bevacizumab in inflammatory eye disease.

Am J Ophthalmol 2009 Nov 5;148(5):711-717.e2. Epub 2009 Aug 5.

Bascom Palmer Eye Institute, Miami, FL, USA.

Purpose: To report the effect of intravitreal bevacizumab (Avastin; Genentech Inc, South San Francisco, California, USA) on visual acuity and macular thickness in patients with inflammatory choroidal neovascularization (CNV) or cystoid macular edema (CME).

Design: Retrospective, noncomparative, interventional case series.

Methods: Each eye received 1.25 mg of intravitreal bevacizumab at baseline. Follow-up examinations were scheduled at 1- to 2-month intervals, with additional injections at the discretion of the physician. Comprehensive evaluations, including Snellen best-corrected visual acuity (BVCA) and optical coherence tomography measurements, were performed at each visit. Main outcome measures were BCVA and central subfield thickness (CST), as measured by optical coherence tomography.

Results: Thirty-four eyes of 30 patients with inflammatory CNV (n = 21 eyes of 19 patients; 9 male, 10 female) or CME (n = 13 eyes of 11 patients; 4 male, 7 female) were identified. Median ages were 52 years (range, 7 to 83) and 67 years (range, 17 to 83) for the CNV and CME groups, respectively. The median length of follow-up for CNV eyes was 7 months (range, 1 to 28) while the median follow-up for CME eyes was 13 months (range, 1 to 20). Both groups received a median of two injections (range, 1 to 9 for CNV and 1 to 4 for CME). For eyes with CNV, BCVA improved significantly at follow-up month 1, but was not different from baseline thereafter; CST remained unchanged throughout follow-up. For eyes with CME, neither BCVA nor CST changed significantly over the course of follow-up.

Conclusions: Bevacizumab appears to stabilize BCVA and CST for eyes with inflammatory CNV or CME.
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http://dx.doi.org/10.1016/j.ajo.2009.06.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4115327PMC
November 2009

Five-year follow-up optic disc findings of the Collaborative Initial Glaucoma Treatment Study.

Am J Ophthalmol 2009 Apr 18;147(4):717-724.e1. Epub 2009 Jan 18.

University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida 33136, USA.

Purpose: To determine the effect of intraocular pressure (IOP) lowering on the optic disc in patients of the Collaborative Initial Glaucoma Treatment Study (CIGTS) after 5 years.

Design: Randomized clinical trial.

Methods: The baseline and 5-year stereoscopic optic disc photographs of 348 eyes (patients) randomized to medical or surgical treatment of open-angle glaucoma (OAG) were assessed by 2 independent readers for change in a masked side-by-side comparison, and confirmed by an independent committee.

Results: Three hundred and three (87.1%) eyes showed no change, 22 (6.3%) showed enlargement of the cup along any meridian (progression), and 23 (6.6%) showed a reduction in the cup along any meridian (reversal of cupping). Incidence of optic disc progression was higher (P = .007) in the medicine group, 18/185 (10%) than in the surgical group 4/163 (3%); and the incidence of reversal of cupping was higher (P < .001) in the surgical group, 21/163 (13%), than the medicine group, 2/185 (1%), (P < .001). Visual field (VF) worsening (mean deviation) was significantly associated with progression of optic disc cupping (P < .001). Reversal of cupping was also associated with lower postoperative IOP (P < .001). Reversal of cupping was not associated with improvement of either visual acuity or central VFs.

Conclusions: Surgery prevents or delays glaucomatous progression as measured by optic disc criteria in patients with early OAG. Reversal of cupping occurs more frequently in the surgical group than in the medical treatment group. Reversal is associated with lower IOP, but is not associated with improved visual function.
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http://dx.doi.org/10.1016/j.ajo.2008.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2714658PMC
April 2009

Motility disturbances in the tube versus trabeculectomy study during the first year of follow-up.

Am J Ophthalmol 2009 Mar 26;147(3):458-66. Epub 2008 Nov 26.

Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33136, USA.

Purpose: To describe the preoperative and postoperative motility disturbances encountered in the Tube Versus Trabeculectomy (TVT) Study during the first year of follow-up.

Design: Multicenter randomized clinical trial.

Methods: settings: Seventeen clinical centers. population: Patients 18 to 85 years old who had previous trabeculectomy and/or cataract surgery and uncontrolled glaucoma with intraocular pressure > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy. interventions: 350-mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). main outcome measures: Preoperative and postoperative evaluation of ocular motility and diplopia.

Results: Motility disturbances were detected in 55 patients (28%) at baseline. New-onset persistent diplopia was reported in 5 patients (5%) in the tube group and no patients in the trabeculectomy group at 1 year (P = .06). A new postoperative motility disturbance developed or worsened in 7 patients (9.9%) in the tube group and no patients in the trabeculectomy group during the first year of follow-up (P = .005). Postoperative motility disturbances were also associated with increasing age (P < .001) and right eye surgery (P = .044).

Conclusions: Preoperative motility disturbances were common among patients in the TVT Study. New postoperative motility disturbances were more frequent following tube shunt surgery than trabeculectomy with MMC after 1 year of follow-up.
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http://dx.doi.org/10.1016/j.ajo.2008.09.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145604PMC
March 2009

Ocular trauma and visual outcome secondary to paintball projectiles.

Am J Ophthalmol 2009 Feb 4;147(2):239-242.e1. Epub 2008 Oct 4.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.

Purpose: To describe ocular injuries attributable to paintball-related trauma and their management and results.

Design: Retrospective, interventional case series.

Methods: setting: University practice and emergency department. patient population: Thirty-six eyes of 36 patients who sustained ocular injuries secondary to paintballs between July 1, 1998 and January 1, 2005. observation procedure: Age, gender, laterality, setting, eye protection, best-corrected visual acuity (BCVA), and initial diagnosis were documented. main outcome measures: Medical and surgical intervention within the first three days postinjury and further treatment after this time period were recorded. BCVA at the initial and final clinical visit were compared.

Results: The mean follow-up interval was 11.7 months (one to 40). Mean age was 21 years (three to 64), 31 (86%) were male, 34 (97%) were not wearing eye-protection device when injured, and initial BCVA was worse than 20/200 in 28 eyes (78%). The most common ocular finding was hyphema in 29 eyes (81%). Initially, 20 eyes (56%) were managed medically and nine eyes (25%) required primary repair of a ruptured globe. Ultimately, 29 eyes (81%) had surgical intervention including eight eyes (22%) enucleations. Final visual acuity was 20/40 or better in 13 eyes (36%), whereas 18 eyes (50%) were worse than 20/200. Visual acuity (VA) at initial presentation correlated strongly with final VA (r = 0.64; P < .001).

Conclusions: Paintball-related ocular injuries are frequently severe and visually devastating. The compulsive use of protective eyewear may have eliminated 97% of injuries in this series and continues to need emphasis to paintball users.
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http://dx.doi.org/10.1016/j.ajo.2008.08.007DOI Listing
February 2009