Investigating the Link Between Visual Quality and Vision-Related Quality of Life in Patients With Keratoconus.

PURPOSE: The purpose of the study was to investigate the optical and visual determinants of vision-related quality of life (VR-QoL) in patients with keratoconus. METHODS: A cross-sectional case-control study was conducted at the Department of Ophthalmology, Antwerp University Hospital, Belgium. Patients previously diagnosed with keratoconus and healthy emmetropic or ametropic volunteers were included. Patients younger than 18 years, with ametropia of more than ±10 D, or with a history of corneal surgery or relevant ocular comorbidity limiting visual acuity were excluded. Assessment included autorefraction, high-contrast visual acuity testing, corneal imaging, intraocular straylight analysis, contrast sensitivity, aberrometry, and the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). The Rasch-modified visual functioning scale (VFS) and socio-emotional scale were used to quantify VR-QoL. Stepwise linear regression was used to investigate the association between the clinical variables and VR-QoL. RESULTS: Seventy-seven patients with keratoconus (77 pairs of eyes) and 77 age-matched and sex-matched controls were included in the study. The scores on the VFS and the SES were significantly lower in patients with keratoconus compared with controls ( P < 0.001). Higher-order and lower-order aberrations, high-contrast visual acuity, and contrast sensitivity were poorer in patients with keratoconus ( P < 0.001). Bivariate analyses showed that spectacle-corrected high-contrast visual acuity, higher spatial frequency contrast sensitivity, and higher-order aberration metrics were strong predictors of SES ( P < 0.001) and of VFS ( P < 0.001). Higher-order aberration of the worse eye was the strongest predictor for both SES (b = 0.310, P < 0.001) and VFS (b = 0.638, P < 0.001) on stepwise regression. Contrast sensitivity was not included in the stepwise regression because of insufficient data in the keratoconus group (33/77 patients; 42.9%). CONCLUSIONS: Both higher and lower aberration showed a strong correlation with VR-QoL, surpassing high-contrast visual acuity. These findings underline the importance of visual quality measures within keratoconus research and clinical care.

Incidence of rhegmatogenous retinal detachment after bag-in-the-lens IOL implantation: extended follow-up in a larger cohort of patients.

PURPOSE: To report the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after cataract surgery using the bag-in-the-lens (BIL) intraocular lens (IOL) implantation technique. SETTING: Department of Ophthalmology, Antwerp University Hospital, Belgium. DESIGN: Prospective cohort study. METHODS: All consecutive BIL IOL surgeries performed between January 2001 and December 2010 were included, with the exclusion of combined procedures and IOL exchanges. The incidence of RRD was reported first in the total cohort, then in a subgroup of patients with 1 year to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors, except gender. Risk factors associated with RRD were examined using multiple Cox regression analysis with a random intercept. RESULTS: Rhegmatogenous RD was diagnosed in 36 eyes (1.06%) of 3385 BIL cases, with a mean follow-up of 48.28 ± 40.05 months (range 0 to 195 months). The 2-year cumulative RRD incidence rate was 0.66% (17 cases in 1024 eyes; 0.00% in patients without risk factors). The 5-year cumulative RRD incidence rate was 1.17% (26 cases in 931 eyes; 0.15% without risk factors). Five risk factors were confirmed: male sex, age less than 60 years at the time of surgery, axial length 25.0 mm or greater, a history of contralateral RD, and intraoperative surgical complications. CONCLUSIONS: The incidence of RRD after BIL IOL implantation is comparable with that of lens-in-the-bag (LIB) implantation. This larger study provided a longer follow-up and suggested that RRD incidence is even lower than that previously reported. This study also confirmed intraoperative surgical complications as an additional risk factor for RRD development, as already described with LIB implantation.

Long-term evolution of age-related distance esotropia.

PURPOSE: To evaluate the evolution of horizontal deviation and fusional amplitudes both at distance and at near in patients with age-related distance esotropia (ARDET). METHODS: The medical records of consecutive patients diagnosed with ARDET between January 2008 and March 2016 were reviewed retrospectively. Patients with at least 60 months' follow-up were eligible for inclusion. Horizontal deviation, fusional convergence amplitude, and fusional divergence amplitude both at distance and at near were compared. RESULTS: Of 131 cases reviewed, 31 patients were identified for inclusion. Median age at diagnosis was 73 years. Median distance esodeviation was 6Δ esotropia at initial examination (range, 2Δ-12Δ esotropia) and 8Δ eostropia at final examination (range, 2Δ-25Δ esotropia). Median near deviation was orthophoria at initial examination (range, 10Δ exophoria to 8Δ esophoria) and 4Δ esophoria at final examination (range, 4Δ exophoria to 14Δ esophoria). Median fusional divergence amplitude at distance was 4Δ at initial and at final examinations. At near, median fusional divergence amplitude was 8Δ at initial and at final examinations. Median fusional convergence amplitude at distance was 14Δ at initial examination and 12Δ at final examination. At near, median fusional convergence amplitude was 26Δ at initial and at final examinations. Base-out prisms were prescribed in all patients. In 23 patients the prism correction gradually increased. Strabismus surgery was performed in 3 patients. CONCLUSIONS: Our patients with ARDET experienced a slight increase in distance esodeviation (P < 0.001), whereas no significant change in fusional amplitudes was observed over time (P ≥ 0.05).

Binocular Vision in Chronic Fatigue Syndrome.

INTRODUCTION AND PURPOSE: To compare binocular vision measurements between Chronic Fatigue Syndrome (CFS) patients and healthy controls. METHODS: Forty-one CFS patients referred by the Reference Centre for Chronic Fatigue Syndrome of the Antwerp University Hospital and forty-one healthy volunteers, matched for age and gender, underwent a complete orthoptic examination. Data of visual acuity, eye position, fusion amplitude, stereopsis, ocular motility, convergence, and accommodation were compared between both groups. RESULTS: Patients with CFS showed highly significant smaller fusion amplitudes (P < 0.001), reduced convergence capacity (P < 0.001), and a smaller accommodation range (P < 0.001) compared to the control group. CONCLUSION: In patients with CFS binocular vision, convergence and accommodation should be routinely examined. CFS patients will benefit from reading glasses either with or without prism correction in an earlier stage compared to their healthy peers. Convergence exercises may be beneficial for CFS patients, despite the fact that they might be very tiring. Further research will be necessary to draw conclusions about the efficacy of treatment, especially regarding convergence exercises. To our knowledge, this is the first prospective study evaluating binocular vision in CFS patients.

Procedural aspects of the organization of the comprehensive European Board of Ophthalmology Diploma examination.

The comprehensive European Board of Ophthalmology Diploma (EBOD) examination is one of 38 European medical specialty examinations. This review aims at disclosing the specific procedures and content of the EBOD examination. It is a descriptive study summarizing the present organization of the EBOD examination. It is the 3rd largest European postgraduate medical assessment after anaesthesiology and cardiology. The master language is English for the Part 1 written test (knowledge test with 52 modified type X multiple-choice questions) (in the past the written test was also available in French and German). Ophthalmology training of minimum 4 years in a full or associated European Union of Medical Specialists (UEMS) member state is a prerequisite. Problem-solving skills are tested in the Part 2 oral assessment, which is a viva of 4 subjects conducted in English with support for native language whenever feasible. The comprehensive EBOD examination is one of the leading examinations organized by UEMS European Boards or Specialist Sections from the point of number of examinees, item banking, and item contents.

Evaluation of UVA Cytotoxicity for Human Endothelium in an Ex Vivo Corneal Cross-linking Experimental Setting.

PURPOSE: To evaluate endothelial cytotoxicity after exposure of human corneas to ultraviolet-A (UVA) (λ = 365 nm; 5.4 J/cm(2)) in an experimental ex vivo corneal cross-linking setting. METHODS: Sixteen pairs of human donor corneas were cut into two pieces. One piece of each cornea was treated with 0.025% riboflavin solution prior to UVA irradiation (5 minutes; 18 mW/cm(2)), whereas the other piece was not irradiated but treated with riboflavin (right eye) or preservation medium (left eye). By irradiating from the endothelial side, the UVA dosage applied to endothelial cells exceeded at least eight times the cytotoxic threshold established in animal models (0.65 J/cm(2)). Endothelial cell counts were performed by two independent investigators after storage (4 to 5 days at 31 °C) and staining (trypan blue, alizarin red). Normality (Q-Q plot; Shapiro-Wilk test) and equivalence (mixed-effects modeling with a 10% equivalence threshold) of the endothelial cell counts of the different groups were evaluated. RESULTS: Equivalence of mean endothelial cell density between both groups was observed: 2,237 ± 208 cells/mm(2) in UVA-irradiated pieces and 2,290 ± 281 cells/mm(2) in control pieces (mean difference of 53 ± 240 cells/mm(2) between both groups). CONCLUSIONS: Despite direct irradiation of human donor endothelium using the clinical dosage for cross-linking, equivalence in endothelial cell counts was observed between irradiated tissues and controls. Ex vivo human corneal endothelial cells seem to be far more resistant to riboflavin-enhanced UVA irradiation than previously estimated by animal experiments.

To Study and Determine the Role of Anterior Segment Optical Coherence Tomography and Ultrasound Biomicroscopy in Corneal and Conjunctival Tumors.

Purpose. To analyze and describe corneal and conjunctival tumor thickness and internal characteristics and extension in depth and size and shape measured by two noninvasive techniques, anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). Design. Systematic review. Methods. This systematic review is based on a comprehensive search of 4 databases (Medline, Embase, Web of Science, and Cochrane Library). Articles published between January 1, 1999, and December 31, 2015, were included. We searched for articles using the following search terms in various combinations: "optical coherence tomography", "ultrasound biomicroscopy", "corneal neoplasm", "conjunctival neoplasm", "eye", "tumor" and "anterior segment tumors". Inclusion criteria were as follows: UBM and/or AS-OCT was used; the study included corneal or conjunctival tumors; and the article was published in English, French, Dutch, or German. Results. There were 14 sources selected. Discussion. Several studies on the quality of AS-OCT and UBM show that these imaging techniques provide useful information about the internal features, extension, size, and shape of tumors. Yet there is no enough evidence on the advantages and disadvantages of UBM and AS-OCT in certain tumor types. Conclusion. More comparative studies are needed to investigate which imaging technique is most suitable for a certain tumor type.

Incidence of rhegmatogenous retinal detachment after bag-in-the-lens intraocular lens implantation.

PURPOSE: To determine the incidence of rhegmatogenous retinal detachment (RRD) and associated risk factors after phacoemulsification and bag-in-the-lens intraocular lens (IOL) implantation. SETTING: Antwerp University Hospital, Department of Ophthalmology, Antwerp, Belgium. DESIGN: Prospective cohort study. METHODS: All consecutive bag-in-the-lens IOL implantations performed between January 2001 and December 2007 were included, with the exception of combined procedures and IOL exchanges. The retinal detachment (RD) incidence was studied in the total cohort, in a subgroup of patients with 1 to 5 years of follow-up, and finally in the group remaining after exclusion of all risk factors except gender. RESULTS: RD after bag-in-the-lens IOL implantation in 1323 eyes with an average follow-up of 44.75 months (range 0 to 152 months) was found in 19 eyes (1.44%). The 1-year RD incidence was 0.49% (5 RD cases in 1024 eyes) (0.00% in patients without risk factors). The 2-year cumulative RD incidence was 0.84% (9 RD cases in 931 eyes; 0.15% without risk factors). Four clinically significant risk factors were confirmed: male gender, young age at time of surgery (<60 years), axial myopia (axial length ≥25 mm), and history of contralateral RD in the total cohort. CONCLUSION: The RRD incidence following bag-in-the-lens IOL implantation was comparable to that seen after lens-in-the-bag (LIB) implantation. The wide variation in study design in the literature precludes direct comparison, so there is a need for standardization in evaluating RRD incidence after cataract surgery. Future prospective studies should consider patients with and without risk factors (except gender) separately. FINANCIAL DISCLOSURE: Prof. dr. M.J. Tassignon has intellectual property rights to the bag-in-the-lens intraocular lens (U.S. patent 6 027 531; EU patent 009406794; PCT/120268), which is licensed to Morcher GmbH, Stuttgart, Germany.

Pediatric bag-in-the-lens intraocular lens implantation: long-term follow-up.

PURPOSE: To evaluate long-term follow-up results of pediatric cataract surgery using the bag-in-the-lens (BIL) intraocular lens (IOL) implantation technique. SETTING: Antwerp University Hospital, Edegem, Antwerp, Belgium. DESIGN: Prospective case series. METHODS: All pediatric cataract surgeries with BIL IOL implantation performed at the Antwerp University Hospital were evaluated. Only cases that completed a follow-up of 5 years at the hospital's Department of Ophthalmology were included in this study. RESULTS: Forty-six eyes of 31 children had a complete follow-up of 5 years or more after BIL IOL implantation. Sixteen cases were unilateral and 15 were bilateral. Patient age at time of surgery ranged from 2 months to 14 years. The mean refraction at the end of follow-up was -1.99 diopters (D) ± 3.70 (SD). In bilateral cases, a corrected distance visual acuity (CDVA) of better than 0.5 was attained in 86.7% and a CDVA of 1.0 was achieved in 56.7%. In unilateral cases, 31.2% achieved a CDVA of better than 0.5 but none obtained a CDVA of 1.0. A clear visual axis was maintained in 91.3% of cases during follow-up. Visual axis reopacification was detected in 4 eyes of 3 cases, all due to inadequate BIL IOL positioning. None of these eyes needed more than 1 intervention to maintain visual axis clarity. Other than 1 case of glaucoma, no severe complications were detected. CONCLUSION: Long-term follow-up results show that BIL IOL implantation is a safe, well-tolerated approach for treating pediatric cataract with a very low rate of visual axis reopacification and a low rate of secondary interventions for other postoperative complications. FINANCIAL DISCLOSURE: Dr. Tassignon has intellectual property rights to the bag-in-the-lens intraocular lens (U.S. patent 6 027 531; EU patent 009406794.PCT/120268), which is licensed to Morcher GmbH, Stuttgart, Germany. No other author has a financial or proprietary interest in any material or method mentioned.

Introduction of subspecialty examinations by the European Board of Ophthalmology (EBO) in close collaboration with European Subspecialty Ophthalmological Societies: FEBO-SA.

The European Board of Ophthalmology (EBO) aims to establish common European standards in ophthalmology. The comprehensive EBO Diploma (EBOD) examination has been officially used since 1995 by an increasing number of European countries to assess the level of education in ophthalmology of their residents at the end of their training. The current comprehensive EBOD examination ensures a minimum standard of knowledge. We present an update on the EBO plans to establish a subspecialty advanced EBOD (AdEBOD) examination in order to award ophthalmologists who complete subspecialty training with formal recognition of their expertise. The purpose, structure and process of the AdEBOD examination are presented.

Overview of the repeatability, reproducibility, and agreement of the biometry values provided by various ophthalmic devices.

PURPOSE: To present an overview of the measurement errors for various biometric devices, as well as a meta-analysis of the agreement between biometric devices using the Pentacam, Orbscan, and IOL Master as a reference. DESIGN: Meta-analysis of the literature. METHODS: The meta-analysis is based on data from 216 articles that compare a total of 24 different devices with the reference devices for the following 9 parameters: mean, steep and flat curvature of the anterior and posterior cornea; central corneal thickness; anterior chamber depth; and axial length. After the weighted average difference between devices has been determined, the "two one-sided t test" was used to test for equivalence between devices within certain thresholds defined by the measurement errors and the influence of these differences on the calculated refraction. RESULTS: In only 17 of the 70 comparisons a device was equivalent with the reference device within the thresholds set by the measurement error. More lenient thresholds, based on a change in calculated refraction of ±0.25 diopter, increased this number to a maximum of 25/50 comparisons (excluding pachymetry). High degrees of inconsistency were seen in the reported results, which could partially explain the low agreement between devices. CONCLUSION: As a rule, biometry measurements taken by different devices should not be considered equivalent, although several exceptions could be identified. We therefore recommend that clinical studies involving multiple device types treat this as a within-subject variable to avoid bias. The follow-up of individual patients using different devices should be avoided at all times.

Feasibility of multifocal intra-ocular lens exchange and conversion to the bag-in-the-lens implantation.

PURPOSE: Our purpose was to evaluate the surgical outcome after intra-ocular lens exchange in patients who presented impairing visual complaints after primary multifocal intra-ocular lens (MIOL) implantation. In particular, the study was undertaken to look at the number of eyes that could be equipped with the bag-in-the-lens (BIL) IOL after MIOL exchange. METHODS: This series consisted of 30 eyes of 21 consecutive patients scheduled for MIOL exchange. In 15 out of the 30 eyes, IOL misalignment was measured on slit lamp anterior segment photo's after defining the mathematical centres of the IOL optic, pupil and limbus. RESULTS: Diffractive MIOL was more frequently explanted (25; 83%) when compared with refractive MIOL (4; 13%) and progressive optic IOL (1; 4%). In 21 out of the 30 eyes (70%) a bag-in-the-lens could be implanted. In 7 out of the 30 eyes (23%), the capsule was not considered sufficiently stable to accommodate an IOL. An iris-fixated IOL or a sulcus-fixated IOL was then implanted. In 2 out of the 30 eyes (6%) the remaining capsular bag could accommodate a traditional lens-in-the-bag only. Eyes that underwent Nd:YAG laser capsulotomy prior to the MIOL exchange needed anterior vitrectomy peroperatively (11 eyes; 37%). Visual acuity improved postoperatively in 13 out of the 30 eyes and remained stable in 17 out of the 30 eyes. CONCLUSIONS: Since the BIL technique requires a very well-preserved capsular bag for the purpose of the IOL implantation, the success rate of BIL implantation after MIOL is a good indicator to evaluate the degree of difficulty to exchange MIOL.

Distance esotropia in the elderly.

AIM: To describe the clinical features of an under-recognised small esodeviation and horizontal diplopia on distance fixation seen in elderly patients not associated with lateral rectus underaction or coexisting neurological abnormalities. METHODS: 87 elderly patients (age range 62-91 years) with constant or intermittent horizontal diplopia at distance were prospectively recruited and assessed from February 2008 until February 2012. Ocular alignment, fusion amplitudes, and horizontal eye movements were measured for distance and near. RESULTS: Distance esodeviation varied from 2-18 prism dioptres (PD) esotropia (ET). At near fixation, deviation ranged from 10 PD exophoria to 12 PD esophoria. Divergence fusional amplitude at distance ranged from 0-10 PD while the divergence fusional amplitude at near ranged from 2-18 PD. Horizontal ductions and versions were full in all patients. Six patients presented with an increase of distance esodeviation combined with a decrease of divergent fusional amplitude over a period of 6-12 years. All patients were successfully treated with prisms, ranging from 2-16 PD base-out. CONCLUSIONS: Our findings indicate that patients with age-related distance ET may experience a slight increase in distance esodeviation over time, with a slow decrease of fusional divergence amplitudes with normal ocular motility. The aetiology is still unclear. However, patients may be assured that this is a benign condition with slow progression, and can be successfully treated with prism correction. Surgery may be reserved for the minority of cases with severe esodeviation.

Evaluation of adding item-response theory analysis for evaluation of the European Board of Ophthalmology Diploma examination.

PURPOSE: To investigate whether introduction of item-response theory (IRT) analysis, in parallel to the 'traditional' statistical analysis methods available for performance evaluation of multiple T/F items as used in the European Board of Ophthalmology Diploma (EBOD) examination, has proved beneficial, and secondly, to study whether the overall assessment performance of the current written part of EBOD is sufficiently high (KR-20≥ 0.90) to be kept as examination format in future EBOD editions. METHODS: 'Traditional' analysis methods for individual MCQ item performance comprise P-statistics, Rit-statistics and item discrimination, while overall reliability is evaluated through KR-20 for multiple T/F items. The additional set of statistical analysis methods for the evaluation of EBOD comprises mainly IRT analysis. These analysis techniques are used to monitor whether the introduction of negative marking for incorrect answers (since EBOD 2010) has a positive influence on the statistical performance of EBOD as a whole and its individual test items in particular. RESULTS: Item-response theory analysis demonstrated that item performance parameters should not be evaluated individually, but should be related to one another. Before the introduction of negative marking, the overall EBOD reliability (KR-20) was good though with room for improvement (EBOD 2008: 0.81; EBOD 2009: 0.78). After the introduction of negative marking, the overall reliability of EBOD improved significantly (EBOD 2010: 0.92; EBOD 2011:0.91; EBOD 2012: 0.91). CONCLUSION: Although many statistical performance parameters are available to evaluate individual items, our study demonstrates that the overall reliability assessment remains the only crucial parameter to be evaluated allowing comparison. While individual item performance analysis is worthwhile to undertake as secondary analysis, drawing final conclusions seems to be more difficult. Performance parameters need to be related, as shown by IRT analysis. Therefore, IRT analysis has proved beneficial for the statistical analysis of EBOD. Introduction of negative marking has led to a significant increase in the reliability (KR-20 > 0.90), indicating that the current examination format can be kept for future EBOD examinations.

Assessment of the bag-in-the-lens implantation technique in diabetic patients.

Cataract is a common condition observed in patients with diabetes mellitus frequently requiring surgical intervention. The bag-in-the-lens (BIL) intraocular implant is an alternative approach to standard lens-in-the-bag cataract surgery. The lens is supported by anterior and posterior capsulorhexes, which confers a number of advantages in terms of lens centration, rotational stability and prevention of posterior capsular opacity. The purpose of this report is to describe the results of BIL cataract surgery in a retrospective cohort of diabetic patients. Fifty-four cases of BIL surgery are included with a follow-up period of 1 year. Visual acuity outcomes were comparable to previously published standard lens-in-the-bag procedures. There were no reports of posterior capsular opacification and the grade of diabetic retinopathy remained stable. Three cases of clinically significant macular edema were detected over the follow-up period. We conclude that the BIL implantation technique is an advantageous approach to treating cataract in the diabetic population.

History and future of the European Board of Ophthalmology Diploma examination.

PURPOSE: The European Board of Ophthalmology Diploma (EBOD) examination has evolved over the last few years, especially with the introduction of negative marking (-0.5 points) for incorrect or blank answers (0 points for don't know option), which aimed to improve the quality and reliability of the examination. METHODS: In 2010, negative marking at the written part of the EBOD examination has been introduced in an attempt to improve not only the reliability of the examination as entity but also the statistical performance parameters of the individual questions. As lower pass rates and discrimination of female candidates are feared by the general public when negative marking is concerned, these parameters have been explicitly investigated. RESULTS: Introduction of negative marking has not only lead to improved reliability of the EBOD examination (increased Cronbach's alpha value: ≤0.80 without and ≥0.90 with negative marking), but also to improved statistical performance parameters of the individual questions. The pass rate of the EBOD examination has proven to remain at the same high level as without negative marking (around 90%). Furthermore, although female candidates do seem to have different answering strategies (p < 0.01, use of don't know option), no statistically significant difference has been found between total scores of male and female candidates (p > 0.05). CONCLUSION: Introduction of negative marking at the written EBOD examination has proven to be beneficial, not only for the organizers (improvement of the statistical performance of the examination and its questions), but also for candidates (better discrimination with borderline candidates). These results have been obtained without evidence of lower pass rates or discrimination of female candidates.

Five-decade profile of women in leadership positions at ophthalmic publications.

OBJECTIVE: To evaluate the balance between the sexes of published ophthalmic material at the editorial, reviewer, and author levels. DESIGN: Cross-sectional study of 3 journals, American Journal of Ophthalmology, Archives of Ophthalmology, and Ophthalmology, for 1969, 1979, 1989, 1999, and 2009. The data were compared with ophthalmologist-in-training and physician profile in major contributing states from North America and Europe during the same period. RESULTS: Of the 3 major ophthalmology journals, none had a female editor-in-chief. For all journals, the proportion of editorial board members who were women increased from 3.3% in 1969 to 18.8% in 2009. For all journals and all years, women composed a higher proportion of first authors (29.2% in 2009) compared with senior authors (22.9% in 2009), reviewers (18.9% in 2009), or assistant editors (12.5% in 2009). There was an abrupt shift toward women after 1989 in first authorship in Ophthalmology (1969, 4.6%; 1979, 5.4%; 1989, 12.3%; and 1999, 20.2%), Archives of Ophthalmology (1969, 6.6%; 1979, 5.1%; 1989, 15.6%; and 1999, 28.6%), and American Journal of Ophthalmology (1969, 5.6%; 1979, 4.2%; 1989, 9.2%; and 1999, 23.9%). There was also an abrupt increase in female senior authorship for American Journal of Ophthalmology after 1989 (1979, 8.5%; 1989, 8.1%; and 1999, 18.3%). The increase in female first authorship during the 5 decades was parallel with the increase in US female physicians. CONCLUSIONS: Women ophthalmologists are authoring publications in increasing numbers that match their prevalence in the academic and overall workforce. However, all editors are men. This discrepancy relates to the relatively younger generation of female ophthalmologists or selection bias, a subject that requires further investigation.

Safety of an artificial iris in a phakic eye.

This case report describes the one-year results of the implantation of a sectorial and foldable artificial iris in a phakic eye. To our knowledge, this is the first such report with a follow-up of 1 year. No perioperative or postoperative complications were seen. Corrected distance visual acuity remained unchanged (left eye, 1.5/10), the subjective complaints of glare and photophobia improved considerably, and the patient was very satisfied with the aesthetic result.