Clinical Features and Risk Factors for Uveitis in Patients with Ankylosing Spondylitis: A Survey-Based Study

Purpose@#We investigated the clinical features and risk factors associated with the onset of uveitis in patients with ankylosing spondylitis. @*Methods@#A survey was conducted targeting patients with ankylosing spondylitis who have experienced uveitis. The questionnaire collected information on demographic characteristics, clinical features, and lifestyle-related risk factors for uveitis including stress, sleep quality, rest periods, eating habits, and intake of caffeine, alcohol, and tobacco. Respondents were asked to recall their condition at the time of their most recent uveitis flare-up and rate it on a 5-point scale (1 = good to 5 = bad). @*Results@#The study included 47 patients with ankylosing spondylitis; the average age was 40.0 years, 68.1% were male, and 89.4% tested positive for human leukocyte antigen (HLA)-B27. The average treatment duration for uveitis was 5.2 weeks, with an average recurrence rate of 4.5 times. The most common symptom at the time of uveitis was eye redness (87.2%). The average scores for the surveyed risk factors were as follows: stress, 4.1 points; sleep, 3.1 points; rest, 3.4 points; eating habits, 2.9 points; caffeine intake, 3.3 points; alcohol intake, 2.4 points; and smoking, 2.5 points. No significant correlation was found between age, uveitis treatment duration, number of recurrences, and any of the surveyed scores. @*Conclusions@#Patients with ankylosing spondylitis appeared to experience higher levels of stress during episodes of uveitis; however, further investigation is needed.

Trends in the Prevalence of Blindness and Correlation With Health Status in Korean Adults: A 10-Year Nationwide Population-Based Study

Background@#Contemporary data on vision impairment form an important basis for public health policies. However, most data on the clinical epidemiology of blindness are limited by small sample sizes and focused not on systemic conditions but ophthalmic diseases only. In this study, we examined the ten-year trends of blindness prevalence and its correlation with systemic health status in Korean adults. @*Methods@#This study investigated 10,000,000 participants randomly extracted from the entire Korean population (aged ≥ 20 years) who underwent a National Health Insurance Service health checkup between 2009 and 2018. Participants with blindness, defined as visual acuity in the better-seeing eye of ≤ 20/200, were identified. The prevalence of blindness was assessed, and the systemic health status was compared between participants with blindness and without blindness. @*Results@#The mean prevalence of blindness was 0.473% (47,115 blindness cases) and tended to decrease over ten years (0.586% in 2009 and 0.348% in 2018; P 1.5 mg/dL), and bilateral hearing loss. In addition, except for those aged 30–39 and 40–49 years, high fasting glucose (≥ 126 mg/dL) and low hemoglobin (male: < 12 g/dL, female: < 10 g/dL) were significantly correlated with prevalent blindness. @*Conclusion@#Our ten-year Korean nationwide population-based study suggested a gradual decrease in the prevalence of blindness and its association with specific systemic health status. These conditions might be the cause or consequence of blindness and can be used as a reference for the prevention and/or rehabilitation of blindness to establish public health policies.

Effects of Axial Lengths in High Myopia on the Significance Maps of Optical Coherence Tomography

Purpose@#We corrected the axial lengths of the macular and peripapillary significance maps using software embedded in a commercial spectral domain optical coherence tomography (SD-OCT) package. We evaluated the accuracy of glaucoma diagnosis in patients with high myopia, and the clinical implications. @*Methods@#Seventy eyes of 70 highly myopic patients with or without normal-tension glaucoma were retrospectively reviewed. The sensitivities and specificities of the color-coded significance maps were calculated using 1% (red) or 5% (yellow) as the abnormality criteria, and the values compared before and after axial length corrections performed using embedded SD-OCT software. @*Results@#At the 1% level of the normative database, we found no significant difference in specificity or sensitivity. At the 5% level, the increase in specificity was significant only for the inferotemporal sectors of the macular significance map. The specificity of the inferotemporal sector of the inner scan circle increased from 61.9 to 78.6% (p = 0.016) and that of the outer scan circle from 69 to 83.8% (p = 0.031). The specificities of the entire chart, the superior sector of the superior/inferior chart, and the 12-clockwise map increased significantly from 54.8 to 78.6% (p = 0.002), 59.5 to 76.2% (p = 0.039), and 59.5 to 76.2% (p = 0.002) respectively. @*Conclusions@#Clinicians should note that axial length correction of significance maps reduces the false-positive glaucoma diagnostic rates in highly myopic eyes. Correction of significance maps using embedded software may thus aid clinicians in the diagnosis of glaucoma in high myopic eyes.

Comparison of Blue and Green Confocal Scanning Laser Ophthalmoscope Imaging to Detect Retinal Nerve Fiber Layer Defects

PURPOSE: We detected retinal nerve fiber layer (RNFL) defects using a confocal scanning laser ophthalmoscopy (CSLO) with both blue and green laser sources and evaluated image quality based on laser wavelength. METHODS: This was a retrospective observational case study. Blue and green CSLO images of 181 eyes with suspected glaucoma were evaluated and compared. Three independent observers identified the presence of RNFL defects and determined which CSLO imaging source provided superior visibility of the defect. After assessing the defect imaging by laser source, demographics and image quality indices of optical coherence tomography between blue better and green better groups were analyzed. RESULTS: Both blue and green CSLO showed high discriminating ability for RNFL defects. The discriminating ability of blue CSLO was significantly greater than that of green CSLO (p = 0.004). Among eyes with a detectable RNFL defect, 61.8% were better visualized with the blue laser compared to the green laser. Compared with the blue better group, the green better group was significantly older (p = 0.009), had a greater proportion of females (p = 0.005), had poorer best-corrected visual acuity (p = 0.001), more severe cataracts (p = 0.001), lower signal strength (p = 0.003), and poor image quality indices (p = 0.001). CONCLUSIONS: Both blue and green CSLO imaging was useful for detecting RNFL defects, but blue CSLO was superior to green CSLO in quality of RNFL defect imaging in most patients with clear media.

Depressive Symptoms and Quality of Life in Age-related Macular Degeneration Based on Korea National Health and Nutrition Examination Survey (KNHANES)

PURPOSE: This study was conducted to investigate the depressive symptoms and quality of life (QOL) in patients with age-related macular degeneration (AMD) using data obtained from the Korea National Health and Nutritional Examination Survey V-2 (KNHANES V-2) conducted in 2011. METHODS: This was a population-based, cross-sectional study that selected 329 participants from the fifth KNHANES (2011) who were diagnosed with AMD by an ophthalmologist based on fundus photography. The prevalence of depressive symptoms and the health-related QOL (using EuroQol indices) in this cohort were also estimated. Factors associated with depressive symptoms, including socioeconomic status, QOL indices, and associated chronic diseases, were investigated using multivariate regression models. RESULTS: Depressive symptoms were observed more frequently in AMD patients than in non-AMD controls (p = 0.013). Among the total 329 AMD participants, 65 (19.8%) had depressive symptoms. There were 16 males (24.6%) and 49 females (75.4%). Upon multivariate analysis, significant factors found to be associated with depressive symptoms were female gender (odds ratio [OR], 2.082; 95% confidence interval [CI], 1.001 to 4.330), being in the “dependent” group for activities of daily living (OR, 4.638; 95% CI, 2.061 to 10.435), and having “some problems” in the “anxiety-depression” dimension of the EQ-5D (OR, 7.704; 95% CI, 1.890 to 31.408). CONCLUSIONS: Female gender and being dependent on others for activities of daily living increased the association of depressive symptoms in this cohort of AMD participants. Screening for depressive symptoms in East Asian AMD patients with these characteristics should be an important component of their care.

Clinical Presentation and the Treatment of Glaucoma in Patients with a Facial Port-wine Stain

PURPOSE: To characterize the development of glaucoma, age of glaucoma onset, and treatments for patients with a facial port-wine stain (PWS). METHODS: We performed a retrospective analysis of the medical records of 58 patients (116 eyes) with facial PWS between January 2000 and August 2016. We noted patients' age at the initial examination, cup-to-disc ratio, corneal diameter, occurrence of ocular hypertension, development of glaucoma, age of glaucoma onset, and treatments. We compared the clinical features of eyes that developed glaucoma with those that did not develop glaucoma. Among those eyes with glaucoma, we investigated the differences between eyes that underwent surgery and those that did not undergo surgery. RESULTS: Among the 58 patients with a facial PWS (116 eyes), glaucoma was diagnosed in 38 patients (46 eyes; 39.66%). Of these, 26 patients (27 eyes; 58.69%) underwent glaucoma surgery. PWS-associated glaucoma usually developed by the age of 2 years (85.61%). In all patients, glaucoma developed on the same side of the face as the PWS. Of the 58 patients, 19 (32.76%) showed neurological symptoms, including seizures, developmental delays, intellectual disabilities, or hemiplegia, and 32 (55.17%) were diagnosed with Sturge-Weber syndrome. The mean number of glaucoma surgeries was 1.55 ± 0.93. The initial surgery included trabeculectomy (7 eyes), trabeculotomy (5 eyes), combined trabeculotomy/trabeculectomy (13 eyes), and aqueous drainage device insertion (2 eyes). The mean age at the first surgery was 35.14 ± 50.91 months. In 18 of 27 eyes (66.67%), the postoperative intraocular pressure (IOP) was controlled to below 21 mmHg, but 9 eyes (33.33%) showed elevated IOP and required a reoperation. CONCLUSIONS: PWS can be accompanied by ocular hypertension or glaucoma, so patients require regular ophthalmic examinations. When glaucoma occurs, it often does not respond to medication, making it difficult in some cases to control the IOP, so appropriate glaucoma surgery is necessary.

Macular Choroidal Thickness and Volume Measured by Swept-source Optical Coherence Tomography in Healthy Korean Children

PURPOSE: To evaluate the thickness and volume of the choroid in healthy Korean children using swept-source optical coherence tomography. METHODS: We examined 80 eyes of 40 healthy children and teenagers ( or =18 years) and compared adult measurements with the findings in children. RESULTS: The mean age of the children and teenagers was 9.47 +/- 3.80 (4 to 17) vs. 55.04 +/- 12.63 years (36 to 70 years) in the adult group (p < 0.001, Student's t-test). Regarding the Early Treatment Diabetic Retinopathy Study subfields, the inner temporal subfield was the thickest (247.96 microm). The inner and outer nasal choroid were thinner (p = 0.004, p = 0.002, respectively) than the surrounding areas. The mean choroidal volumes of the inner and outer nasal areas were smaller (p = 0.004, p = 0.003, respectively) than those of all the other areas in each circle. Among the nine subfields, all areas in the children, except the outer nasal subfield, were thicker than those in adults (p < 0.05). Regression analysis showed that age, axial length, and refractive error correlated with subfoveal choroidal thickness (p < 0.05). CONCLUSIONS: Overall macular choroidal thickness and volume in children and teenagers were significantly greater than in adults. The nasal choroid was significantly thinner than the surrounding areas. The pediatric subfoveal choroid is prone to thinning with increasing age, axial length, and refractive error. These differences should be considered when choroidal thickness is evaluated in children with chorioretinal diseases.

Retromode imaging: review and perspectives

Retromode imaging with infrared lasers is a novel imaging method which has been made possible by the newly introduced confocal scanning laser ophthalmoscope. Retromode imaging uses a laterally deviated confocal aperture with a central stop, which creates a shadow and allows deep retinal and retinal pigment epithelium changes to be visualized as pseudo-3-dimensional images. Its clinical value coupled with its simple, rapid, and noninvasive nature is increasingly appreciated. The combination of retromode imaging with conventional imaging methods such as fundus photography, fluorescein angiography, and optical coherence tomography can help to precisely and comprehensively evaluate pathophysiologic features of retinal disorders. This review summarizes basic principles of imaging and retromode findings in various retinal disorders and is expected to guide future investigations of retromode imaging

Comparison of Diagnostic Ability of 3D and Stratus Optical Coherence Tomography in Early Glaucoma

PURPOSE: To compare the ability of three dimensional spectral-domain optical coherence tomography (3D OCT) and Stratus OCT to detect early glaucoma. METHODS: The optic disc topographic and retinal nerve fiber layer (RNFL) thickness parameters were measured by 3D OCT and Stratus OCT in 69 normal eyes and 48 early glaucoma eyes. The discriminating abilities of the two techniques for detection of glaucoma were compared by the area under the receiver operating characteristic curves (AUC). RESULTS: The best Stratus OCT parameters and criterion that differentiated normal from early glaucoma based on AUC were horizontal integrated rim width (0.85) for optic nerve head parameters, inferior quadrant (0.88) for RNFL parameters, and > or =1 clock-hour abnormal at the 5% level (0.81) based on the normative database for criteria. The best 3D OCT parameters and criterion that differentiated normal from early glaucoma were vertical cup-to-disc ratio (0.85), 11 o'clock RNFL thickness (0.86), and > or =1 clock-hour abnormal at the 1% level (0.78), respectively. When all corresponding the best parameters and criterion were compared, there were no significant differences between the AUCs for Stratus OCT and 3D OCT (p = 0.95, p = 0.73, p = 0.45, respectively). CONCLUSIONS: Stratus OCT and 3D OCT had similar diagnostic ability for detection of early glaucoma.

Cystoid Macular Edema Detected by Scanning Laser Ophthalmoscopy in Retro-Mode

PURPOSE: To investigate the visualization of cystoid macular edema (CME) using noninvasive retromode imaging by a new scanning laser ophthalmoscope (SLO) and compare to previous imaging modalities. METHODS: The authors of the present study retrospectively reviewed the medical records of 21 eyes of 20 patients with CME due to various etiologies. All eyes were examined with fundus camera, fluorescein angiography (TRC-50EX, Topcon, Tokyo, Japan), SLO (F-10, Nidek, Gamagori, Japan), and spectral-domain optical coherence tomography (OCT) (3D OCT-1000, Topcon, Tokyo, Japan). In the present study the SLO was used in the retro-mode with an infrared laser. RESULTS: Previous fundus photography could not detect CME adequately although SLO retro-mode could show numerous oval or polygonal cystoid spaces more readily. Furthermore, each individual small cystoid space could be detected and the area of each cystoid space could be measured. The area of the largest cystoid space showed a correlation with its height, as measured with OCT (R = 0.606, p = 0.004). The area of the whole foveal cystoid space showed a correlation with central macular thickness, as measured with OCT (R = 0.493, p = 0.023). CONCLUSIONS: A new commercially available SLO (F-10) in the retro-mode can allow us to detect each cystoid space non-invasively and to measure the extent of CME.

Bilateral Simultaneous Acute Angle Closure Glaucoma Following Sexual Intercourse Aided by Sildenafil Citrate

PURPOSE: The authors of the present study report a case of bilateral simultaneous acute angle closure glaucoma following sildenafil citrate-aided sexual intercourse. CASE SUMMARY: A 63-year-old man visited the emergency department with sudden onset of bilateral ocular pain and blurred vision. The patient had taken 50 mg sildenafil citrate followed by sexual intercourse. His visual acuity on presentation was 0.3 in the right eye and 0.5 in the left eye. Intraocular pressure (IOP) was 54 mm Hg and 46 mm Hg in the right and left eye, respectively. Anterior chamber depths were shallow and angles were closed on gonioscopy in both eyes. The patient was treated with ocular hypotensive medication and subsequently managed with bilateral YAG laser peripheral iridotomies. During the 13 months of follow-up, there was no recurrent angle closure attack and IOPs were well-controlled. CONCLUSIONS: The mechanism of bilateral angle closure glaucoma caused by sildenafil citrate is not proven. Those who are predisposed towards developing angle-closure glaucoma may be at risk when having sexual intercourse aided by sildenafil citrate.