Corneal Structural Changes in Congenital Glaucoma.

OBJECTIVE: To identify corneal structure differences on quantitative high-frequency ultrasound biomicroscopy (UBM) among subjects with congenital glaucoma compared with controls. METHODS: This prospective case-control study evaluated 180 UBM images from 44 eyes of 30 subjects (18 control and 12 glaucoma, mean age 5.2±8.0 years, range 0.2-25.8 years) enrolled in the Pediatric Anterior Segment Imaging and Innovation Study (PASIIS). ImageJ was used to quantify a comprehensive set of corneal structures according to 21 quantitative parameters. Statistical analysis compared corneal measurements in glaucoma subtypes and age-matched controls with significance testing and mixed effects models. RESULTS: Significant differences between congenital glaucoma cases and controls were identified in 16 of 21 measured parameters including angle-to-angle, central and peripheral corneal thicknesses, scleral integrated pixel density, anterior corneal radius of curvature, and posterior corneal radius of curvature. Eight parameters differed significantly between primary congenital glaucoma and glaucoma following congenital cataract surgery. CONCLUSION: Multiple measurable corneal structural differences exist between congenital glaucoma and control eyes, and between primary and secondary congenital glaucoma, including but not limited to corneal width and thickness. The structural differences can be quantified from UBM image analysis. Further studies are needed to determine whether corneal features associated with glaucoma can be used to diagnose or monitor progression of congenital glaucoma.

Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents.

Objective This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection. Study Design After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis. Setting This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute. Participants A total of 66 current residents and recent graduates of five residency programs were involved in this study. Main Outcomes and Measures This study evaluated four-letter personality type from each participant. Results Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) ( p = 0.049), thinking (T) than feeling (F) ( p = 0.027), and judging (J) than perceiving (P) ( p = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level. Conclusion Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one's training.

Back to the Future: Vitreous Pupillary Block and Glaucoma in a Child After Lensectomy.

The authors present a case of poorly controlled glaucoma following lensectomy. An examination under anesthesia revealed iris bombe of the anterior vitreous face. This case helps emphasize the importance of a generous anterior vitrectomy at the time of lensectomy in the pediatric population to avoid secondary glaucoma. [J Pediatr Ophthalmol Strabismus. 2020;57:e48-e50.].

Eleven Years of Cataract Surgery in Veterans Without Pre-existing Ocular Comorbidities.

INTRODUCTION: In 2017, over 75,000 cataract surgeries were performed within the Veterans Health Administration System (VHA). Previous reports of outcomes of cataract surgery in veterans include patients with pre-existing ocular disease, which can affect vision. To exclude the confounding factor of pre-existing ocular comorbidities, we investigated the long-term visual outcomes and complications associated with small incision cataract surgery performed on veterans without any pre-existing eye disease. MATERIALS AND METHODS: Institutional Review Board approved cohort study with detailed retrospective chart review of all phacoemulsification (small incision) cataract surgeries performed at the Veterans Affairs Medical Center in Washington D.C. over 11 years, including all pre-and postoperative visits until postoperative month 12. RESULTS: A total of 1,513 consecutive surgical cases without any pre-existing ocular disease except the cataract were included. Vision improved significantly after cataract surgery compared to the preoperative best-corrected visual acuity (BCVA) (p = 0.0001) and remained stable over the first intra- and postoperative year. All eyes without complicated surgery and 99.1% of eyes with complications achieved 20/40 or better final vision postoperatively. The most common intra-and postoperative complications were vitreous loss (3.1%) and cystoid macular edema (CME; 1.4%). Patients with complications achieved final mean BCVA of 0.04 (20/22, vitreous loss) and 0.06 (20/23, CME) mean logMAR (Snellen). CONCLUSION: Analysis of 11 years of small incision cataract surgery in eyes without pre-existing ocular disease within the VHA showed significant improvement in vision and stability 12 months after uncomplicated and complicated surgery in veterans.

The role of corneal hysteresis during the evaluation of patients with possible normal-tension glaucoma.

PURPOSE: There are multiple reports of the role of corneal hysteresis (CH) as an independent risk factor for the diagnosis and risk of progression of normal-tension glaucoma (NTG). Our study measured CH with the Ocular Response Analyzer (ORA) in patients with intraocular pressure (IOP) <21 mmHg to investigate if a low CH would identify NTG in this Asian-based practice. METHODS: This was a prospective cross-sectional study of patients who underwent routine eye examination during 2016 in a private practice in Honolulu, Hawaii, where most patients are Asian. Inclusion criteria are: 1) ≥65 years 2) IOP <21 (compensated IOP by ORA), and 3) CH values <10 using ORA as measured by a single experienced technician. Exclusion criteria are: 1) sight-limiting ocular or corneal disease that would preclude accurate measurements for the purposes of the study. 2) Any patient who had difficulty in being tested with the ORA. 3) Patients who had any history of any type of glaucoma. All patients that met the inclusion criteria underwent fundus photography to measure cup-to-disc ratio and cup-to-disc asymmetry and also had central corneal thickness measured. Thickness of the retina nerve fiber layer was measured by ocular coherence tomography. The eyes with an average retina nerve fiber layer thickness less than 80 µm were classified as possible NTG and were scheduled for a visual field test. The field examination was considered valid only if the fixation, false positives, and false negatives were within the acceptable range. Patient demographics and data on preexisting diseases were collected including age, sex, coexisting medical conditions, and previous intraocular surgery. Those with thinning of retina nerve fiber layer on optical coherence tomography had a Humphrey visual field test to confirm the diagnosis of glaucoma. RESULTS: Seventy-six eyes of 46 patients that met the eligibility criteria were included in the study. Twenty-one previously undiagnosed eyes were confirmed as having NTG, which corresponds to an incidence of 27.6%. CONCLUSION: CH measurement is a valuable test to assist in early diagnosis of NTG, especially in the elderly Asian population. With an established diagnosis, aggressive early treatments medically or surgically to further lower IOP can prevent irreversible blindness, which can severely impact the patient's family and socioeconomic status.