Does Age-Related Macular Degeneration (AMD) Treatment Influence Patient Falls and Mobility? A Systematic Review.

PURPOSE: Age-related macular degeneration (AMD), a leading cause of irreversible blindness, increases fall risk through impaired central vision. Falls place an enormous economic burden on healthcare systems. We hypothesized that AMD treatments may reduce patients' falls risk. This systematic review (ID #: 172623) synthesized the current understanding of wet and dry AMD treatments' impact on patient falls and mobility, connecting these two public health issues. METHODS: On April 17, 2020, PubMed, Scopus, CINAHL, and the Cochrane Central Register of Controlled Trials were queried. Clinical trials and observational studies were included, while non-English and non-primary studies were excluded. Two authors screened, extracted data, and assessed bias using RoB-2 and ROBINS-I. A third author served as a tie breaker. RESULTS: This database search resulted in 3,525 studies, with an additional 112 identified through bibliography review. Ten articles met eligibility criteria. Most studies featured the outcome of interest as a secondary outcome (n = 4) and patient-reported adverse events (n = 5), rather than a primary focus (n = 2). Ten out of the 11 outcomes had a moderate to serious risk of bias. No two studies used the same instrument to measure falls or mobility. CONCLUSION: Despite the potential positive impact of AMD treatments on patient falls and mobility, quality data on this relationship are lacking. This work underscores the need to broaden ophthalmologic research outcomes beyond visual parameters to include patient-centred, functional measures. Incorporating standardized methods to track falls and screen for difficulty with walking and balance would enable evaluation of AMD treatments on functional outcomes, potentially helping guide management.

Biogeographical and Altitudinal Distribution of Cataract: A Nine-Year Experience Using Electronic Medical Record-Driven Big Data Analytics in India.

Purpose: To use electronic medical record data to study the altitude, UV exposure, and biogeographical distribution of senile cataract in India.Methods: This is a hospital-based, cross-sectional study of patients over 40 years old with an ophthalmologist-confirmed diagnosis of senile cataract (cortical, nuclear, posterior subcapsular, or a combination) in either or both eyes. Electronic medical record data entered between August 2010 to December 2019 were extracted from a large multi-tiered ophthalmology network in India. Residential districts were classified into their respective biogeographical zone based on nationally reported boundaries, and altitude at the geographic centroid was determined using Google Earth. Occupations were classified as low UV exposure and high UV exposure. Descriptive statistics, hypothesis testing, and multiple logistic regression analysis were done.Results: In the 1,127,232 eligible patients, associations were found between high UV exposure (OR = 1.47, 95%CI: 1.45-1.49), low socioeconomic status (OR = 1.54, 95%CI: 1.52-1.55), rural geographies (OR = 1.32), female gender (OR = 1.33, 95%CI: 1.32-1.34), and older age (OR≥3.98) with cataract. This Indian patient population did not demonstrate increased formation of cataracts at higher altitudes (OR≤0.97). Patients residing in the Deccan Peninsula (OR≥1.56) and those with high UV exposures within each increasing altitude category, except >750 m, (OR≥1.09) had higher odds of senile cataract comparatively.Conclusion: Female gender, occupations with high UV exposure, rural geography and increasing age were observed to have greater odds of developing senile cataract. Increased likelihood of cataracts in populations residing at low altitudes and within the Deccan Peninsula may be attributed to greater hospital development in those areas.

Outcomes and Complications of In-Office Laser Demarcation of Peripheral Rhegmatogenous Retinal Detachments.

BACKGROUND AND OBJECTIVE: To evaluate the outcomes of in-office laser demarcation (LD) for peripheral rhegmatogenous retinal detachments (RRDs). PATIENTS AND METHODS: This was a retrospective analysis of peripheral RRDs treated with LD. Patient demographics, visual acuity (VA), and RRD characteristics were recorded. Complications requiring additional procedures were recorded. Multiple logistic regression was used to characterize the association of RRD anatomy to treatment complications. RESULTS: A total of 112 eyes of 107 patients were analyzed with mean follow-up of 20 ± 12 months. VA at baseline and last follow-up was equivalent (0.16 logMAR, Snellen equivalent 20/29). Ninety-five (84.8%) eyes were successfully treated without an additional procedure. In multivariate analysis, the presence of VH (odds ratio [OR] = 4.0; 95% confidence interval [CI], 1.1-17; P = .04) and RRDs in the inferior 6 clock hours (OR = 6.2; 95% CI, 1.5-29; P = .01) were associated with complications. CONCLUSIONS: LD is successful in treating peripheral RRDs. RRD characteristics less conducive to laser include presence of VH and inferior RRD. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:428-434.].

Outcomes of Eyes Lost to Follow-up with Neovascular Age-Related Macular Degeneration Receiving Intravitreal Anti-Vascular Endothelial Growth Factor.

PURPOSE: To determine outcomes of eyes with neovascular age-related macular degeneration (nAMD) receiving intravitreal anti-vascular endothelial growth factor (VEGF) injections who return after a period of being lost to follow-up (LTFU). DESIGN: Retrospective, cross-sectional study. PARTICIPANTS: Eyes that received intravitreal bevacizumab, ranibizumab, or aflibercept for nAMD and were LTFU for >6 months. METHODS: Comparison of visual outcomes and structural parameters at the visit before LTFU, return visit, and final visit. MAIN OUTCOME MEASURES: Logarithm of the minimum angle of resolution (logMAR) visual acuity (VA), presence of subretinal fluid and intraretinal fluid, and central foveal thickness (CFT) by OCT. RESULTS: A total of 93 eyes of 77 patients were included in the analysis. Mean duration from date of LTFU to return was 346 (±122) days. Overall, 53.7% of patients had worse median logMAR VA by the final visit. Median logMAR VA worsened from 0.60 (0.40-2.00) (Snellen 20/80 [20/50-20/2000]) at the visit before LTFU to 1.00 (0.48-2.00) (20/200 [20/60-20/2000]) at the return visit (P < 0.001). Median logMAR VA remained worse at 6- and 12-months after return from LTFU: 1.00 (0.48-2.00) (20/200 [20/60-20/2000]) (P = 0.001) and 0.70 (0.44-1.30) (20/100 [20/55-20/399]) (P = 0.004), respectively. Despite a mean of 383 (±270) days of follow-up after returning and 5.0 (±5.1) additional injections, the median logMAR VA remained worse at 1.00 (0.54-2.00) (20/200 [20/70-20/2000]) at the final visit compared with the visit before LTFU (P < 0.001). There was greater worsening in mean logMAR VA from the visit before LTFU to the final visit in eyes that received bevacizumab (0.32) and ranibizumab (0.28) compared with aflibercept (P = 0.003, P = 0.04, and P = 0.03, respectively). Mean CFT increased from 201 (±106) µm at the visit before LTFU to 240 (±147) µm at return (P = 0.004). By the final visit, the mean CFT had decreased to 183 (±101) µm, which was not significantly different from the visit before LTFU (P = 0.10). CONCLUSIONS: Eyes with nAMD receiving intravitreal anti-VEGF that were LTFU experience significant VA decline at the return visit that persists on final follow-up despite normalization of CFT.

Delayed Retinal Breaks and Detachments after Acute Posterior Vitreous Detachment.

PURPOSE: To determine the incidence and timing of delayed retinal breaks and retinal detachments (RDs) after acute posterior vitreous detachment (PVD) and associated risk factors. DESIGN: Retrospective case-control study. PARTICIPANTS: Acute PVD eyes treated between October 2015 and August 2018 at a single academic retina practice. METHODS: Eyes with a PVD diagnosis and history of extended ophthalmoscopic examination on presentation were identified using diagnostic billing codes. The number of eyes with a history of laser retinopexy, cryotherapy for retinal tear, or RD repair was determined using procedural billing codes, and the duration between initial and treatment visits was measured. Records of eyes with a delayed retinal break or RD and of a reference group comprising the first 100 presenting eyes with no initial or delayed retinal break or RD were reviewed to determine and compare the presence of select risk factors on initial examination. MAIN OUTCOME MEASURES: Development of a delayed retinal break or RD. RESULTS: Of 7999 eyes with acute PVD, 1280 (16.0%) showed a retinal break and 499 (6.2%) showed an RD on presentation. Delayed retinal breaks and RDs were found in 209 (2.6%) and 80 (1.0%) eyes, respectively. Of delayed breaks, 116 (55.5%) were found in 6 weeks or less and 93 (44.5%) were found more than 6 weeks after presentation. Of delayed RDs, 26 (32.5%) were found in 6 weeks or less and 54 (67.5%) were found more than 6 weeks after presentation. Compared with the reference group, vitreous hemorrhage (hazard ratio, 2.53 [P < 0.001] and 2.80 [P = 0.001]) and male gender (hazard ratio, 1.36 [P = 0.03] and 1.87 [P = 0.02]) were risk factors for delayed retinal breaks and RDs, respectively. Pseudophakia (hazard ratio, 2.10; P = 0.004) was also a risk factor for delayed RD; older age (odds ratio, 0.96; P = 0.01) was slightly protective. Vitreous hemorrhage was a risk factor for earlier retinal breaks (≤6 weeks vs. >6 weeks; odds ratio, 3.58; P < 0.001). CONCLUSIONS: Clinically significant rates of newly detected retinal breaks and RDs may occur after acute PVD, suggesting that repeat examination may be prudent in these patients.

Readability of Spanish language online information for the initial treatment of burns.

OBJECTIVE: This study's aim is to identify the most popular online resources for burn treatment information available in the Spanish language, and to evaluate the readability of this information. METHODS: The phrase "tratamiento de quemaduras" (burn treatment) was entered into search engines Google and Bing on 9/15/2014 and 9/13/2017. The top 12 Spanish web results on each site were identified and analyzed using Readability Studio Professional Edition v2012.1. The software generated a "mean grade reading level" for each article, or the grade of students that could be expected to understand the article's language. RESULTS: 21 distinct articles were identified at T1 and 17 at T2, with seven overlapping between T1 and T2. The average grade reading level of all the websites ranged from 7.8 to 13.8 at T1 (approximately 8th grade to sophomore year of college) and 7.8 to 12.2 at T2. CONCLUSIONS: No websites were within 1 standard deviation of the American Medical Association recommended 6th grade reading level. With readability showing little improvement during the past three years, providers should be aware of the complexity of online literature, and the potential complications this presents to patients. Additionally, burn centers should prioritize generating more accessible information for the Spanish speaking public.