The relationship between multiple deprivation and severity of glaucoma at diagnosis.

BACKGROUND: Socioeconomic deprivation is associated with higher odds of chronic diseases, with many individuals living with more than one illness. This study aimed to examine the relationship between deprivation and severity of glaucoma at diagnosis, an important risk factor for glaucoma blindness. METHODS: A retrospective study of 472 consecutive patients referred by community optometrists to the glaucoma clinic at a university hospital was performed. Glaucoma severity was determined by standard automated perimetry mean deviation (MD) in the worse eye. The Scottish Index of Multiple Deprivation (SIMD) was determined for each patient as a measure of deprivation based on postcode. Regression analyses were performed to determine the relationship between visual field MD and SIMD. RESULTS: There was a significant relationship between higher levels of deprivation (lower SIMD) and worse severity of glaucoma at diagnosis. 32 of 472 patients (6.8%) had a MD of ≤-6 dB and 11 (2.3%) ≤-12 dB in their better eye. MD in the worse eye was 0.04 dB (95% CI 0.014 to 0.062 dB, P = 0.002) worse for each 100-point decrease in SIMD, with lower SIMD indicating a higher level of deprivation. A higher proportion of patients living in most deprived areas had a MD ≤ -6 dB or ≤ -12 dB at presentation compared to those living in the least deprived areas (14.3% versus 6.8% for ≤ -6 dB and 4.8% versus 0.8% for ≤ -12 dB). CONCLUSIONS: Higher levels of deprivation were associated with worse glaucoma severity at presentation. The reasons for poorer outcomes in those from more deprived communities need further study so that inequalities can be addressed and the frequency of patients presenting with advanced glaucoma reduced.

The Eye in Forensic Medicine: A Narrative Review.

ABSTRACT: The eye, with its distinctive anatomy, not only reflects a wide variety of diseases in life but also undergoes a myriad of post-mortem changes. Consequently, the eye has long been an area of interest in forensic science, primarily for the estimation of post-mortem interval and therefore the time of death and also for assistance in ascertaining the cause of death. There has been significant progress in the knowledge of ophthalmic forensic science using new technologies which have allowed further possibilities to arise where understanding of this field can assist the forensic pathologist. This review aims to highlight the current knowledge which exists in this field and also to identify important avenues for further investigation. Post-mortem changes of the eye along with its current applications and challenges will be discussed. These include the important areas of post-mortem iris biometrics, pupil size correlation with post-mortem interval, use of point-of-care technology on vitreous humor, and the use of ophthalmic imaging in pediatric abusive head trauma.

Choroidal neovascularisation in a predicted female choroideraemia carrier treated with intravitreal anti-vascular endothelial growth factor.

PURPOSE: To report a case of choroidal neovascularisation and leakage in a myopic female predicted to be a choroideraemia carrier treated with intravitreal anti-vascular endothelial growth factor (anti-VEGF). METHODS: Case report. RESULTS: A female magazine editor presented with sudden decrease in vision in her right eye, with Snellen visual acuities (VAs) of 1/60 and 3/60 in the right and left eyes respectively. She was diagnosed with choroidal neovascularisation (CNV) formation and subretinal haemorrhage in her right eye. This is on a background of previous presentations, the first of which was 20 years ago for declining left eye vision. She was subsequently found to be a predicted choroideraemia carrier. However, she also has high myopia, and it is unclear whether the predicted choroideraemia carrier status or high myopia is the main underlying cause of her CNV, although we believe that the former is more likely. The first episode of CNV in her right eye was treated successfully with intravitreal anti-VEGF. However, she experienced four further CNV reactivations in her right eye, all of which were treated successfully with anti-VEGF. At her last follow-up visit to date, Snellen VAs were 6/9 and 3/60 in her right and left eye respectively. CONCLUSION: This is a unique case of CNV formation in a predicted choroideraemia carrier who also has co-existent high myopia. Prompt treatment of CNV activity with anti-VEGF has been efficacious in prevention of subretinal fibrosis and irreversible vision loss and allowed the patient to continue working in her chosen career.

Weight Loss in Idiopathic Intracranial Hypertension: A Retrospective Review of Outcomes in the Clinical Setting.

BACKGROUND: Weight loss is important in the management of idiopathic intracranial hypertension (IIH); however, extremely caloric restrictive diets have been used in published studies, which may not be practical for all patients. We aim to review the weight loss outcomes of IIH patients and weight loss methods used by patients who achieve clinical remission (CR) in a standard clinical setting. METHODS: The medical records of IIH patients were retrospectively reviewed. Measures evaluated included: reported symptoms, visual acuity, retinal nerve fiber layer analysis, automated visual fields, optic disc appearance, and cessation of medications. Patients were divided into different outcome groups and weight changes were compared. Patients who achieved CR were contacted to assess weight loss methods used. RESULTS: Of the 39 patients included in the analysis, 28 patients (71.8%) achieved CR with concomitant weight loss, 6 patients (15.4%) improved clinically with concomitant weight loss but did not achieve CR. Among the patients with CR, 10 patients (35.7%) were successfully weaned off their medications completely, whereas another 10 patients (35.7%) are in the process of this. Median weight loss from baseline to lowest weight for this group was 10.5 kg (11.5%) achieved using self-directed methods. CONCLUSION: This study demonstrated that a large proportion of IIH patients were able to achieve CR or improvement with self-directed weight loss regimens, reinforcing the evidence and the practicality of weight loss in the management of IIH in the clinical setting.

A systematic review of real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion.

This review assessed the real-world evidence of the management of macular oedema secondary to branch retinal vein occlusion (BRVO). A meta-analysis of 2530 eyes from 48 real-world studies of therapies for macular oedema secondary to BRVO was conducted. Baseline characteristics, visual, anatomical and safety outcomes were recorded. The weighted mean and weighted estimates from random-effects models were calculated for visual acuity (VA) and central subfield thickness (CST) changes at 6, 12 and 24 months. Primary outcome was change in VA (logMAR letters) at 12 months. Study quality was assessed using the quality appraisal checklist for case series developed by Institute of Health Economics. The mean baseline VA for the pooled data was 54.0 (51.5, 56.5) letters and the mean baseline CST was 501.3 (483.5, 519.1) µm. The random-effects estimate for mean (95% CI) change in VA was 14.6 (12.5, 16.7) letters at 12 months (n = 1727). The random-effects estimate for mean (95% CI) change in CST was -181.7 (-230.7, -132.7) µm at 12 months (n = 1325). The quality of studies varied considerably. Ocular and systemic adverse events were discussed in 79% and 42% of treatment arms respectively, with possible under-reporting. Visual and anatomical gains achieved in the real-world for anti-VEGF therapy were not as impressive as seminal RCTs, possibly due to reduced injection frequency in the real world and differences in baseline characteristics. There is an urgent need for consensus on the minimum efficacy, treatment burden and safety data to collect to strengthen the real-world evidence base.