Refractive lens exchange - who is getting it, what are they getting, how are they doing?

PURPOSE OF REVIEW: The purpose of this article is to provide a review of the literature on refractive lens exchange and present a retrospective analysis of 55 patients who underwent refractive lens exchange at a single practice. RECENT FINDINGS: Our study substantiates refractive lens exchange as an important option for presbyopic patients, hyperopic patients or patients with extremely high refractive error who desire spectacle independence. SUMMARY: Our study reveals that the refractive lens exchange population is younger than the average cataract population and their primary motivations are to resolve hyperopic or myopic refractive errors, gain spectacle independence, and address near vision loss. A variety of presbyopia-addressing intraocular lens options are available and we present our experience with multifocal, extended depth-of-focus, light-adjustable, and monofocal lenses.

Baseline risk factors that predict the development of open-angle glaucoma in a population: the Los Angeles Latino Eye Study.

OBJECTIVE: To determine which baseline sociodemographic, lifestyle, anthropometric, clinical, and ocular risk factors predict the development of open-angle glaucoma (OAG) in an adult population. DESIGN: A population-based, prospective cohort study. PARTICIPANTS: A total of 3772 self-identified Latinos aged ≥40 years from Los Angeles, California, who were free of OAG at baseline. METHODS: Participants from the Los Angeles Latino Eye Study had standardized study visits at baseline and 4-year follow-up with structured interviews and a comprehensive ophthalmologic examination. We defined OAG as the presence of an open angle and a glaucomatous visual field abnormality and/or evidence of glaucomatous optic nerve damage in ≥1 eye. Multivariate logistic regression with stepwise selection was performed to determine which potential baseline risk factors independently predict the development of OAG. MAIN OUTCOME MEASURES: Odds ratios for various risk factors. RESULTS: Over the 4-year follow-up, 87 participants developed OAG. The baseline risk factors that predict the development of OAG include older age (odds ratio [OR] per decade, 2.19; 95% confidence interval [CI], 1.74-2.75; P<0.001), higher intraocular pressure (IOP; OR per mmHg, 1.18; 95% CI, 1.10-1.26; P<0.001), longer axial length (OR per mm, 1.48; 95% CI, 1.22-1.80; P<0.001), thinner central cornea (OR per 40 µm thinner, 1.30; 95% CI, 1.00-1.70; P = 0.050), higher waist-to-hip ratio (OR per 0.05 higher, 1.21; 95% CI, 1.05-1.39; P = 0.007) and lack of vision insurance (OR, 2.08; 95% CI, 1.26-3.41; P = 0.004). CONCLUSIONS: Despite a mean baseline IOP of 14 mmHg in Latinos, higher IOP is an important risk factor for developing OAG. Biometric measures suggestive of less structural support such as longer axial length and thin central corneal thickness were identified as important risk factors. Lack of health insurance reduces access to eye care and increases the burden of OAG by reducing the likelihood of early detection and treatment of OAG. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Four-year incidence of open-angle glaucoma and ocular hypertension: the Los Angeles Latino Eye Study.

PURPOSE: To estimate the 4-year incidence of open-angle glaucoma (OAG) and ocular hypertension (OHT) among adult Latinos 40 years of age and older. DESIGN: Population-based longitudinal study. METHODS: Comprehensive ophthalmologic examinations including intraocular pressure, visual field testing, and stereoscopic fundus photography were performed at both baseline and the 4-year follow-up examination. Incident OAG at the 4-year follow-up examination was defined as the presence of an open angle and a glaucomatous visual field abnormality or evidence of glaucomatous optic disc damage, or both when not present at baseline. Incident OHT was defined as intraocular pressure of more than 21 mm Hg and the absence of optic disc damage or abnormal visual field results at the 4 year follow-up examination when not present at baseline. RESULTS: Among the 3939 participants (mean age, 54.7 ± 10.5 years) with complete data for a diagnosis of glaucoma at both baseline and follow-up examination, incident OAG at the 4-year follow-up was identified in 87 persons (4-year incidence rate, 2.3%; 95% confidence interval, 1.8% to 2.8%). Incident OHT at the 4-year follow-up was identified in 124 persons (4-year incidence rate, 3.5%; 95% confidence interval, 2.9% to 4.1%). In participants with OAG in 1 eye, the 4-year risk of OAG developing in the fellow eye was 5 times as high as the risk for those without OAG in either eye at baseline. In participants with OHT in 1 eye, the 4-year risk of OHT developing in the fellow eye was 10 times as high as the risk for those without OHT in either eye at baseline. The incidence rates of OAG and OHT were higher in older Latinos than in younger Latinos. CONCLUSIONS: Incidence of OAG in Latinos is higher than in non-Hispanic whites, but lower than in Afro-Caribbeans. The relatively high rate of incident OAG and OHT underscores the need for community screening programs in this fastest growing segment of the United States population.

Population and high-risk group screening for glaucoma: the Los Angeles Latino Eye Study.

PURPOSE: To evaluate the ability of various screening tests, both individually and in combination, to detect glaucoma in the general Latino population and high-risk subgroups. METHODS: The Los Angeles Latino Eye Study is a population-based study of eye disease in Latinos 40 years of age and older. Participants (n = 6082) underwent Humphrey visual field testing (HVF), frequency doubling technology (FDT) perimetry, measurement of intraocular pressure (IOP) and central corneal thickness (CCT), and independent assessment of optic nerve vertical cup disc (C/D) ratio. Screening parameters were evaluated for three definitions of glaucoma based on optic disc, visual field, and a combination of both. Analyses were also conducted for high-risk subgroups (family history of glaucoma, diabetes mellitus, and age ≥65 years). Sensitivity, specificity, and receiver operating characteristic curves were calculated for those continuous parameters independently associated with glaucoma. Classification and regression tree (CART) analysis was used to develop a multivariate algorithm for glaucoma screening. RESULTS: Preset cutoffs for screening parameters yielded a generally poor balance of sensitivity and specificity (sensitivity/specificity for IOP ≥21 mm Hg and C/D ≥0.8 was 0.24/0.97 and 0.60/0.98, respectively). Assessment of high-risk subgroups did not improve the sensitivity/specificity of individual screening parameters. A CART analysis using multiple screening parameters-C/D, HVF, and IOP-substantially improved the balance of sensitivity and specificity (sensitivity/specificity 0.92/0.92). CONCLUSIONS: No single screening parameter is useful for glaucoma screening. However, a combination of vertical C/D ratio, HVF, and IOP provides the best balance of sensitivity/specificity and is likely to provide the highest yield in glaucoma screening programs.

Prevalence of open-angle glaucoma and ocular hypertension in Latinos: the Los Angeles Latino Eye Study.

OBJECTIVE: To estimate age- and gender-specific prevalences of ocular hypertension and open-angle glaucoma (OAG) in adult Latinos. DESIGN: Population-based, cross-sectional study. PARTICIPANTS: Six thousand three hundred fifty-seven Latinos 40 years and older from 6 census tracts in Los Angeles, California. METHODS: The study cohort consisted of all self-identified Latinos of primarily Mexican ancestry 40 years and older residing in 6 census tracts in La Puente, California. All participants underwent a complete ophthalmologic examination, including measurement of intraocular pressure (IOP), visual field (VF) testing using an automated field analyzer, and simultaneous stereoscopic fundus photography of the optic disc. Ocular hypertension was defined as IOP of >21 mmHg and the absence of optic disc damage or abnormal VF test results. Open-angle glaucoma was defined as the presence of an open angle and various criteria that included a glaucomatous VF abnormality and/or evidence of glaucomatous optic disc damage in at least one eye. MAIN OUTCOME MEASURES: Prevalence of open-angle glaucoma and ocular hypertension. RESULTS: For the 6142 participants who underwent a complete ophthalmologic examination at the clinical center, the prevalence of OAG was 4.74% (95% confidence interval [CI], 4.22%-5.30%). The prevalence of ocular hypertension was 3.56% (95% CI, 3.12%-4.06%). The prevalences of OAG and ocular hypertension were higher in older Latinos than in younger Latinos (P<0.0001). No gender-related differences in prevalences of OAG and ocular hypertension were present. The mean IOP, mean deviation, and mean vertical cup-disc ratio in persons with OAG were 17 mmHg, -9.6 decibels, and 0.6, respectively. Seventy-five percent of Latinos with OAG and 75% of Latinos with ocular hypertension were previously undiagnosed. Further, 17% of Latinos with OAG and 23% of Latinos with ocular hypertension had received treatment for "glaucoma." CONCLUSION: Our data suggest that the prevalence of OAG is high among Latinos of Mexican ancestry. The higher prevalence of OAG in older Latinos emphasizes the public health importance of providing eye care services for the early diagnosis and management of this condition in Latinos.