Time-of-Year Variation in Intraocular Pressure.

PRÉCIS: In this study conducted in Chicago, IL, intraocular pressure (IOP) level was found to have a subtle, but measurable, annual pattern. Reasonable evidence is presented for a time-of-year variation in IOP. Adequate numbers of subjects must be studied to detect this small variation. PURPOSE: The aim was to investigate the relationship between IOP and time of year. METHODS: During a separate investigation, patients from 2011 to 2018 (dataset A, N=3041) in an urban, academic facility in Chicago, IL received an examination that included Goldmann applanation tonometry. Regression analyses assessed the relationship between time of year and IOP. Two additional datasets, 1 collected in a similar manner during 1999 and 2002 (dataset B, N=3261) and another consisting of all first visits during 2012 and 2017 (dataset C, N=69,858), were used to confirm and further investigate trends. RESULTS: For dataset A, peak mean IOP occurred in December/January (15.7±3.7/15.7±3.8 mm Hg) and lowest in September (14.5±3.1 mm Hg). The analysis suggested conventional quarterly analysis (January to March, etc.) can conceal time-of-year relationships because of inadequate statistical power and timing of IOP variation. Multiple linear regression analysis, with a November-to-October reordering, detected an annual, downward IOP trend (P<0.0001). Analysis of dataset B confirmed this trend (P<0.001). Fourier analysis on datasets A and B combined supported a 12-month IOP cycle for right/left eyes (P=0.01/P=0.005) and dataset C provided stronger evidence for an annual periodicity (P<0.0001). Harmonics analysis of dataset C showed a repeating pattern where IOP trended downward around April, and then back upward around October. CONCLUSIONS: This analysis strongly supports a demonstrable annual, cyclical IOP pattern with a trough to peak variation of ≈1 mm Hg, which has a seasonal relationship.

Krukenberg's Spindles Strongly Suggest Long Anterior Zonule Associated Pigment Dispersion Mechanism in Older Patients.

Purpose: The purpose of this study was to further investigate factors associated with Krukenberg's spindle (KS) presence in a primary eye care setting. Methods: As part of a larger investigation, several practitioners in an academic eye care facility in Chicago, IL, USA evaluated patients for the long anterior zonule (LAZ) trait during 2011 to 2018, and data were collected on ocular/systemic health, lifestyle, and demographic variables, including the presence of a KS. Multivariate regression was used to assess relationships to KS presence. Results: Analysis included 3501 subjects with mean age of 51 ± 15 years (18-98 years; 65% women; and 84% African American). Among the right eyes, 57 (1.6%) had a KS, with this group having a mean age of 62 ± 13 years (25-86 years; 75% women; and 82% African American). There were 120 subjects (3.4%) with right eye LAZ, with mean age of 64 ± 11 years (36-91 years; 77% women; and 92% African American). There were 19 of 57 (33.3%) KS eyes that also had LAZ. Controlling for other factors, variables with the strongest relationship to KS presence were the LAZ trait (odds ratio [OR] = 12.2, 95% confidence interval [CI] = 6.5 to 22.8, P < 0.0001) and advancing age (OR = 1.3 per decade, 95% CI = 1.3 to 1.9, P < 0.0001). Conclusions: In the population studied, KS presence had its strongest relationship to the LAZ trait and advancing age. The KS-LAZ relationship may not be well-known, but these data strongly suggest that pigment dispersion signs, such as a KS, should prompt the clinician to consider the LAZ trait as a potential etiology, especially because LAZ is associated with higher IOP and possibly glaucoma.

The long-term effect of experimental beta-radiation therapy on the human cornea.

BACKGROUND: Radiation treatment of the human eye has been utilized in the United States since the early 1900s. Beta-radiation therapy was generally accepted by the medical community as a treatment option for a wide variety of anterior and posterior segment conditions from 1930 to the early 1950s. By the 1960s, beta-radiation therapy had fallen out of favor due to dangerous side effects; however an updated radiation procedure is now in use in ophthalmology to treat anterior and posterior segment disease. CASE REPORT: A 64-year-old Caucasian female presented for a routine eye examination with a history of experimental beta-radiation treatments to the eyes as a teenager. A high astigmatic refractive error was present and best corrected visual acuity was 20/40 OD, 20/30 OS. Slit lamp examination showed severe disruption throughout the lower third of both corneas, appearing densely calcified with inferior vascularization. The left eye had a central descemetocele. The patient's ocular and visual conditions were relatively stable and required no special treatment as of the writing of this report, decades after her original treatments. CONCLUSION: This patient is one example of the long-term effect of beta-radiation treatment on the eye. Ongoing care is needed to monitor the ocular health and vision of these individuals as radiation effects may necessitate observation and/or care throughout the patient's lifetime. Follow-up on more patients who underwent beta-radiation treatment decades ago, should it be possible to do so, would provide further insight into the long-term anterior segment changes that can occur as a result of such treatment.

Testing safety eyewear: how frame and lens design affect lens retention.

PURPOSE: The aim of this study was to determine the role that frame and lens design play in lens retention during high-impact testing of safety eyewear that advertises conformance to the performance-based ANSI Z87.1-2003 standard. METHODS: A total of 75 Z87 safety eyeglass frames (3 each of 25 frame models) were used in this study, procured from 5 of the leading U.S. safety frame manufacturers. Frames were fitted by an independent laboratory with 2.0-mm plano polycarbonate lenses in compliance with ANSI Z87.1-2003. Finished spectacles were sent to a subsequent laboratory testing facility where each frame was subjected to both high-mass and oblique-incidence high-velocity impacts to determine frame characteristics that were most highly associated with testing failure. Among the frame and lens parameters that were considered in this analysis were the A and B dimensions, effective diameter, distance between lenses, bridge type, frame material, bevel type, and frame cost. Certain variables were controlled for by maintaining consistency among all spectacle pairs, e.g., lens prescription, center thickness, and edge thickness. Multiple logistic regression was used to control potential confounding variables and to develop the best combination of them for predictive value. RESULTS: Of 25 separate frame models assessed, 10 passed both high-mass and high-velocity impact testing, i.e., none of the 3 frame/lens samples failed. Of the models that failed, 13 failures were caused by high-velocity testing, 1 by high-mass testing, and 1 failed both high-mass and high-velocity testing. None of the 15 spectacles with the SprinGuardtrade mark (Hilco, Plainville, Massachusetts) bevel design failed, although these were proprietary to 1 manufacturer and included only 5 frame models. Two spectacle designs (6 individual frames) incorporated an inverted bevel design of which 3 of the frames failed impact testing. Controlling for drop ball velocity among the 54 remaining standard "V" bevel spectacle pairs, the odds of failure were about 8 to 9 times higher for metal frames than Zylonite frames (odds ratio [OR], 8.5; 95% confidence interval [CI], 1.4 to 52.3; P = 0.02), and the odds of failure were about 4 times higher for lens effective diameters of less than 50 mm than for lens effective diameters more than 50 mm (OR, 4.1; 95% CI, 1.2 to 14.8; P = 0.03). CONCLUSION: Among our sample of safety spectacles, failure from high-mass impact resistance testing rarely occurred. No spectacles with the SprinGuard bevel design failed in our analysis, but this was limited to a small sample size from a single manufacturer. Among our sample of 54 spectacle pairs with a v-bevel design, metal frame material and an effective diameter of less than 50 mm were the strongest predictors of failure relative to high-velocity impact testing with a 45 degrees temporal angle projectile.