Non-Cycloplegic and Cycloplegic Autorefraction with Retinomax: An Agreement Study in Preschoolers in Los Angeles, California.

PURPOSE: To evaluate the agreement between non-cycloplegic autorefraction (NCAR) and cycloplegic autorefraction (CAR) in an ethnically diverse population of preschool-aged children and the validity of the screening criteria used to refer for further evaluation. METHODS: This study included data from 7,073 preschoolers who underwent NCAR and CAR, which enabled refractive error classification based on the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2013 criteria. Right eye data of sphere and cylinder were used to compare NCAR to CAR via paired t-testing and vector analyses, and left eye data for an analysis on anisometropia. The sensitivity and specificity of screening referral criteria for refractive error were calculated. RESULTS: Mean values of sphere differed between NCAR and CAR by 1.95 ± 1.45 D (p < .05) with 95% limits of agreement (LoA) of -0.94 to 4.85 D, with less discrepancy found in myopic eyes. The mean values of cylinder differed by -0.08 ± 0.43 D (p < .05) with 95% LoA of -0.93 to 0.77 D. Power vector results reflected a similar lack of agreement. The sensitivity and specificity of our screening referral criteria were, respectively, 66% and 84% for myopia, 66% and 98% for hyperopia, and 98% and 58% for astigmatism. CONCLUSION: NCAR is insufficient in preschoolers for spherical refractive error referrals. Level of agreements was lower for spherical (15.5% within 0.5D) and higher for cylindrical refractive errors (89.6%) compared to CAR. In the absence of cycloplegic examination, screening programs using NCAR should utilize low referral thresholds for spherical refractive error.

Risk factors for Age-related Macular Degeneration in a Greek population: The Thessaloniki Eye Study.

PURPOSE: To assess the association of potential risk factors with early and late age-related macular degeneration (AMD) in the Thessaloniki Eye Study (TES) population Design: Population-based, cross-sectional study of subjects over age of 60 living in Thessaloniki, Greece Methods: Subjects without any AMD features and subjects with early and late AMD (neovascular AMD or geographic atrophy) were identified in the TES cohort using standardized procedures and masked grading of stereo color fundus photos. Demographic, lifestyle, systemic and other ophthalmic covariates were also collected during a detailed examination process. Their association with AMD was investigated using univariate and multivariate adjusted logistic regression models. RESULTS: Among the 2108 participants with gradable photos, the grading process identified 1204 subjects with no AMD, 848 subjects with early AMD, and 56 subjects with late AMD (24 with geographic atrophy and 32 with neovascular AMD). In multivariate analysis, compared to no AMD, late AMD was positively associated with older age (OR:1.16; 95%CI:1.10-1.22 per year of age), current smoking (smoking vs. never smoking, OR:2.34; 95%CI:1.12-4.90), prior cataract surgery (cataract surgery vs. no cataract surgery OR:2.06; 95%CI:0.96-4.40), marital status (divorced/separated vs. married, OR:3.10; 95%CI:1.08-8.93) and with 60% lower odds when sleeping in the afternoon (yes vs. no, OR:0.40; 95%CI:0.22-0.72). Early AMD was positively associated with older age (OR: 1.03; 95%CI:1.01-1.05 per year of age) and negatively with higher pulse pressure (OR:0.99; 95%CI:0.98-0.99 per mmHg). CONCLUSIONS: In TES, apart for well-known risk factors for AMD like age, smoking, and cataract surgery, two novel behavioral risk factors for prevalent late AMD were suggested. Sleeping in the afternoon was associated with 60% decreased odds for late AMD and 67% decreased odds for neovascular AMD. Being divorced/separated compared to married was associated with 3-fold higher odds for late AMD. Large longitudinal population-based studies will be necessary to further establish the potential late AMD risk effects of these two novel factors, to demonstrate potential implications of underlying pathogenetic mechanisms, and to explore preventive measures and therapeutic targets.

How Big Data Informs Us About Cataract Surgery: The LXXII Edward Jackson Memorial Lecture.

PURPOSE: To characterize the role of Big Data in evaluating quality of care in ophthalmology, to highlight opportunities for studying quality improvement using data available in the American Academy of Ophthalmology Intelligent Research in Sight (IRIS) Registry, and to show how Big Data informs us about rare events such as endophthalmitis after cataract surgery. DESIGN: Review of published studies, analysis of public-use Medicare claims files from 2010 to 2013, and analysis of IRIS Registry from 2013 to 2014. METHODS: Statistical analysis of observational data. RESULTS: The overall rate of endophthalmitis after cataract surgery was 0.14% in 216 703 individuals in the Medicare database. In the IRIS Registry the endophthalmitis rate after cataract surgery was 0.08% among 511 182 individuals. Endophthalmitis rates tended to be higher in eyes with combined cataract surgery and anterior vitrectomy (P = .051), although only 0.08% of eyes had this combined procedure. Visual acuity (VA) in the IRIS Registry in eyes with and without postoperative endophthalmitis measured 1-7 days postoperatively were logMAR 0.58 (standard deviation [SD]: 0.84) (approximately Snellen acuity of 20/80) and logMAR 0.31 (SD: 0.34) (approximately Snellen acuity of 20/40), respectively. In 33 547 eyes with postoperative VA after cataract surgery, 18.3% had 1-month-postoperative VA worse than 20/40. CONCLUSIONS: Big Data drawing on Medicare claims and IRIS Registry records can help identify additional areas for quality improvement, such as in the 18.3% of eyes in the IRIS Registry having 1-month-postoperative VA worse than 20/40. The ability to track patient outcomes in Big Data sets provides opportunities for further research on rare complications such as postoperative endophthalmitis and outcomes from uncommon procedures such as cataract surgery combined with anterior vitrectomy. But privacy and data-security concerns associated with Big Data should not be taken lightly.

Sources of binocular suprathreshold visual field loss in a cohort of older women being followed for risk of falls (an American Ophthalmological Society thesis).

PURPOSE: To determine the sources of binocular visual field loss most strongly associated with falls in a cohort of older women. METHODS: In the Study of Osteoporotic Fractures, women with severe binocular visual field loss had an increased risk of two or more falls during the 12 months following the eye examination. The lens and fundus photographs of the 422 women with severe binocular visual field loss, plus a random sample of 141 white women with no, mild, or moderate binocular visual field loss--47 white women with no binocular visual field loss, 46 white women with mild binocular visual field loss, and 48 white women with moderate binocular visual field loss--were evaluated for lens opacities, glaucomatous optic nerve damage, age-related macular degeneration, and diabetic retinopathy. RESULTS: Eighty-four percent of the women with severe binocular visual field loss had ocular disease in one or both eyes. Bilateral cataracts and glaucomatous optic nerve damage were the most common sources of this severe binocular visual field loss. Approximately 15.2% of women had no evidence of lens opacities, glaucomatous optic nerve damage, age-related macular degeneration, or diabetic retinopathy. CONCLUSION: Severe binocular visual field loss due primarily to cataracts, glaucoma, and age-related macular degeneration explains 33.3% of the falls among women who fell frequently. Because binocular visual field loss may be treatable and/or preventable, screening programs for binocular visual field loss and subsequent referral for intervention and treatment are recommended as a strategy for preventing falls among the elderly.