I have read with great interest the article of Galvis et al about Prevalence of refractive errors in Colombia: MIOPUR study. It is a great effort and it might be the first study of its type in our country. In the discussion section, the inclusion criteria needs to be better explained.
1: Why did they exclude the participants with less than 20/40 corrected vision?
2: Is the vision exclusion criteria based on any eye or the better eye?
3: Why didn’t they use cyclopegic medication for the refraction exam?
These concerns affect the results because all of the amblyopic patients are excluded from the study and the hyperopic patients and those with an astigmatism that induce amblyopia are underreported, as seen in the table that shows a very low incidence in those refractive errors.
Tuning Of The Literature Related To The Airviscobubble (AVB) DALK Technique
Corresponding author:
Vincenzo Sarnicola
Address: Clinica degli Occhi Sarnicola,
Via Mazzini no. 62, Grosseto 58100, Italy.
Fax: +39-0564-413023
Tel: +39-3201158500
e-mail address: v.sarnicola@hotmail.it or sarnicolavincenzo@gmail.com
Affiliation:
1 Clinica degli Occhi Sarnicola, Grosseto, Italy
2 Ospedale Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy
3 Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
4 Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy;
We read with interest the article published by Scorcia et al.[1] It is encouraging to see others, such as Scorcia et al, embracing the use of ophthalmic viscoelastic device (OVD) injection as a second bubble a...
Tuning Of The Literature Related To The Airviscobubble (AVB) DALK Technique
Corresponding author:
Vincenzo Sarnicola
Address: Clinica degli Occhi Sarnicola,
Via Mazzini no. 62, Grosseto 58100, Italy.
Fax: +39-0564-413023
Tel: +39-3201158500
e-mail address: v.sarnicola@hotmail.it or sarnicolavincenzo@gmail.com
Affiliation:
1 Clinica degli Occhi Sarnicola, Grosseto, Italy
2 Ospedale Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy
3 Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
4 Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy;
We read with interest the article published by Scorcia et al.[1] It is encouraging to see others, such as Scorcia et al, embracing the use of ophthalmic viscoelastic device (OVD) injection as a second bubble attempt after a failed air big bubble (BB) with air. However, it looks unreasonable to use new acronym (VB-DALK).[1] We would like to highlight that the orginal technique was first described by Sarnicola et al in 2010 and named airviscobubble (indicated with the acronym “AVB”).[2] Scorcia et al probably did not notice this paper in literature, citing only a later study by Muftuoglu et al from 2013.[1-3] Consistency of terms that are well-established in literature should be maintained. Attempting to rename both the name (viscobubble DALK instead of airviscobubble) and the acronym (VB-DALK instead of AVB) of a recognized technique without specific reasons does not serve any purpose as it is confusing for to readers and problematic for the comparison of future studies.
The Authors also stated in the introduction of their paper that “…little data are available on the success rate, type of cleavage obtained, visual results and complications of this approach”.[1] A more complete review of the literature would demonstrate the inaccuracy of this statement.[4-9] Several studies have reported the efficacy of AVB as a rescue bubble technique, showing a 15% increase of descemetic DALK in 507 eyes, the advantages of using a cannula for the OVD injection, the usefulness of the technique even in cases of herpetic corneal scar, and the importance of performing a paracentesis before the AVB formation.[4-9]
Despite the manuscript is very well written and pleasant to read, we would like to draw attention to another small inaccuracy. The consideration statement reported in the 6th paragraph of the discussion section (“The loss of pressure … trephination size.”) is missing the appropriate reference.[1,3]
REFERENCES:
1. Scorcia V, DE Luca V, Lucisano A, et al. Br J Ophthalmol 2018;102:1288–1292. doi:10.1136/bjophthalmol-2017-311419
2. Sarnicola V, Toro P, Gentile D, et al: Descemetic DALK and predescemetic DALK: outcomes in 236 cases of keratoconus. Cornea 2010;29:53-9.
3. Muftuoglu O, Toro P, Hogan RN, et al. Sarnicola air-visco bubble technique in deep anterior lamellar keratoplasty. Cornea 2013;32:527-32.
4. Sarnicola V, Toro P. Blunt cannula for descemetic deep anterior lamellar keratoplasty. Cornea 2010;30:859-8.
5. Sarnicola V, Toro P. Deep anterior lamellar keratoplasty. In herpes simplex corneal opacities. Cornea 2011;29:60-4.
6. Sarnicola V, Toro P, Sarnicola C, et al. Long-term graft survival in deep anterior lamellar keratoplasty. Cornea. 2012;31:621-6.
7. Sarnicola E, Sarnicola C, Sarnicola V. Deep anterior lamellar keratoplasty: surgical technique, indications, clinical results and complications. In: Guell JL, ed. Cornea ESASO Course Series. Basel, Switzerland: Karger; 2015:81-101.
8. Sarnicola V, Sarnicola E, Sarnicola C. Recovery techniques in DALK, Chapter 120 In: Mannis M, Holland E Cornea 4th edition 2016. Editor: Elsevier - Health Sciences Division.
9. Sarnicola E, Sarnicola C, Sabatino F, et al. Cannula DALK versus Needle DALK for Keratoconus. Cornea 2016;35:1508-11.
I read with great interest the paper titled “Collateral vessels on optical coherence tomography (OCT) angiography in eyes with branch retinal vein occlusion (BRVO)” by Suzuki et al.1
The authors defined collateral vessels as dilated and tortuous capillaries occurring in pre-existing capillary beds and linking the obstructed vessel with the nearest patent vessel, according to previous reports.2-4 The authors demonstrated that collaterals were detected in 23 out of 28 (82%) eyes, all of which already existed at mean 0.95 months after the onset, and that all of the collaterals were observed in both the retinal superficial and the deep layers.
However, some of the vessels which are pointed out as collaterals in the study1 look like simply dilated/tortuous vessels, because they don’t seem to connect obstructed to non-obstructed adjacent vessels nor by-pass obstructions. In a previous report, the authors found collateral vessels in 18 out of 28 (64%) eyes at mean 25.1 months from the onset, while superficial and deep capillary telangiectasias were detected in 13 and 28 out of 28 eyes, respectively.4 Therefore, I suppose that some of the vessels defined as collaterals in this study1 may be simply telangiectasias.
Fruend et al.5 defined collateral vessels as the authors did. After excluding collaterals involving the perifoveal vascular ring, they demonstrated that collaterals were found in 23 out of 23 eyes (100%) at median time of 3.79 years from RVO...
I read with great interest the paper titled “Collateral vessels on optical coherence tomography (OCT) angiography in eyes with branch retinal vein occlusion (BRVO)” by Suzuki et al.1
The authors defined collateral vessels as dilated and tortuous capillaries occurring in pre-existing capillary beds and linking the obstructed vessel with the nearest patent vessel, according to previous reports.2-4 The authors demonstrated that collaterals were detected in 23 out of 28 (82%) eyes, all of which already existed at mean 0.95 months after the onset, and that all of the collaterals were observed in both the retinal superficial and the deep layers.
However, some of the vessels which are pointed out as collaterals in the study1 look like simply dilated/tortuous vessels, because they don’t seem to connect obstructed to non-obstructed adjacent vessels nor by-pass obstructions. In a previous report, the authors found collateral vessels in 18 out of 28 (64%) eyes at mean 25.1 months from the onset, while superficial and deep capillary telangiectasias were detected in 13 and 28 out of 28 eyes, respectively.4 Therefore, I suppose that some of the vessels defined as collaterals in this study1 may be simply telangiectasias.
Fruend et al.5 defined collateral vessels as the authors did. After excluding collaterals involving the perifoveal vascular ring, they demonstrated that collaterals were found in 23 out of 23 eyes (100%) at median time of 3.79 years from RVO diagnosis or initial visit, and that all collaterals were primarily located within the deep vascular complex. Indeed there are differences in patients’ and ocular backgrounds between the two studies.1,5 But the findings about the location of collaterals by Fruend et al5 may support my supposition that some of the vessels defined as collaterals in this study1 are simply telangiectasias.
I hope that the authors will comment on this point.
References
1. Suzuki N, Hirano Y, Tomiyasu T, et al. Collateral vessels on optical coherence tomography angiography in eyes with branch retinal vein occlusion. Br J Ophthalmol (in press).
2. Klein R, Klein B, Henkind P, et al. Retinal collateral vessel formation. Invest Ophthalmol 1971;10:471-80.
3. Christoffersen NL, Larsen M. Pathophysiology and hemodynamics of branch retinal vein occlusion. Ophthalmology 1999;106:2054-62.
4. Suzuki N, Hirano Y, Yoshida M, et al. Microvascular abnormalities on optical coherence tomography angiography in macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 2016;161:126-32.
5. Freund KB, Sarraf D, Leong BCS, et al. Association of optical coherence tomography angiography of collaterals in retinal vein occlusion with major venous outflow through the deep vascular complex. JAMA Ophthalmology 2018;136:1262-70.
I read with interest and appreciate the article by Choi et al 1 on 'Intraocular pressure change after injection of intravitreal dexamethasone (Ozurdex) implant in Korean patients'.
As the study looks at the IOP changes after intravitreal dexamethasone implant, how the IOP was recorded for the patients is very important. The authors have reported that the intraocular pressure (IOP) was measured by non-contact tonometer (NCT) or Goldmann applanation tonometry (GAT) in this study. First, it is not mentioned as to which NCT was used for IOP measurement. If NCT was used to measure pre-injection IOP, was it used to measure post-injection IOP measurement also? Or on different visits IOP recording was done with NCT or GAT, is not clear. As GAT is still considered as a gold standard for IOP measurement, if IOP on NCT is found to be high, ideally it should be rechecked with GAT. Second, it is not mentioned whether a single IOP measurement was taken or multiple IOP measurements were obtained, taking the average value as the final IOP. Third, a s the lower range of age was 16 years (Table 1), was there any correlation of IOP change after the injection with the age?
Reference
1. Choi W, Park SE, Kang HG et al. Intraocular pressure change after injection of intravitreal dexamethasone (Ozurdex) implant in Korean patients. Br J Ophthalmol 2018. Epub ahead
of print. doi:10.1136/ bjophthalmol-2018-312958
We thank Drs Sabherwal and Sood for their interest in our article.(1) We would like to respond to the interesting points they raise.
Table 3 presents our analyses of potential predictors of the correct diagnosis by rural doctors of diabetic retinopathy (DR) requiring treatment. Details on a number of the characteristics assessed in this table are presented in the first paragraph of the Results section, but not, as Drs Sabherwal and Sood point out, the proportion having received didactic training. Among the 28 rural doctors, 13 (46.4%) received such training and 15 (53.6%) did not.
In the Methods, we describe in detail the training received by ophthalmologists in the CREST (Comprehensive Rural Eye Service and Training) program. As described there, only two doctors per hospital (not all of whom examined patients in the current study) could attend the didactic phase of training at the Zhongshan Ophthalmic Center (ZOC). This is due to the limited number of ophthalmologists at a typical rural Chinese county hospital, and the heavy load of clinical duties. For more doctors to have left their facilities for the two-month didactic training would not have been practical. However, all ophthalmologists participating in the CREST network and in the current study received intensive hands-on training by medical retina experts from ZOC at their own facilities, which included the diagnosis and laser treatment of diabetic retinopathy (DR) as well as the u...
We thank Drs Sabherwal and Sood for their interest in our article.(1) We would like to respond to the interesting points they raise.
Table 3 presents our analyses of potential predictors of the correct diagnosis by rural doctors of diabetic retinopathy (DR) requiring treatment. Details on a number of the characteristics assessed in this table are presented in the first paragraph of the Results section, but not, as Drs Sabherwal and Sood point out, the proportion having received didactic training. Among the 28 rural doctors, 13 (46.4%) received such training and 15 (53.6%) did not.
In the Methods, we describe in detail the training received by ophthalmologists in the CREST (Comprehensive Rural Eye Service and Training) program. As described there, only two doctors per hospital (not all of whom examined patients in the current study) could attend the didactic phase of training at the Zhongshan Ophthalmic Center (ZOC). This is due to the limited number of ophthalmologists at a typical rural Chinese county hospital, and the heavy load of clinical duties. For more doctors to have left their facilities for the two-month didactic training would not have been practical. However, all ophthalmologists participating in the CREST network and in the current study received intensive hands-on training by medical retina experts from ZOC at their own facilities, which included the diagnosis and laser treatment of diabetic retinopathy (DR) as well as the use of the United Kingdom National Health Service Diabetic Eye Screening Program (UK NHS DESP) DR grading system assessed in our study. The median number (inter-quartile range) of hands-on training sessions received in managing DR was 3 (1, 9). As mentioned in our article, CREST is a fully-funded program by Orbis International. It provides DR training well beyond what the typical rural county-level ophthalmologist in China would receive. Training in the UK NHS DESP system was comparable between non-medical graders and doctors. For these reasons, the authors would respectfully disagree with Drs Sabherwal and Sood’s suggestion that our study was biased in favour of non-medical graders. These graders achieved a level of accuracy consistent with the standards of the UK NHS DESP, and the use of non-medical graders has been recommended by bodies such as the UK Royal College of Ophthalmologists.(2)
Drs Sabherwal and Sood also indicate that our use of an arbiter may have improved the accuracy of non-medical graders and added to the expense of the program. Use of an arbiter is standard practice in the UK NHS DESP, whose protocols we follow in CREST, and in most DR screening programs of which we are aware. As noted in our article, performance of graders on those images where the grade was unchanged by arbitration remained good: the median sensitivity was 0.80, specificity was 0.98 and kappa ranged from 0.78-0.88. Use of arbitration is an inherent cost of most such programs, and will be included in our forthcoming paper on cost-effectiveness for DR screening of non-medical graders versus local ophthalmologists. It should be noted that task-shifting approaches such as the use of non-medical graders, by reducing even when they do not eliminate the role of more expensive ophthalmologists, are very likely to be more cost-effective than traditional ophthalmologist-driven approaches.
Finally, Drs Sabherwal and Sood point out 33% of images being deemed of inadequate quality as a short-coming of our program. As clearly described in the Results section of our paper, the majority of such images were “inadequate” only in the sense that a single image, rather than two as required under UK NHS DESP protocols, had been made of the eye. In fact, as we reported, the proportion of eyes to which non-medical graders were unable to assign DR grades was 3.28% (24/732).
The authors would again like to thank Drs Sabherwal and Sood for their interest in our work, and the Editors for the opportunity to clarify the interesting and important issues they have raised.
1. Sabherwal S, Sood I. Comments on: "Accuracy of trained rural ophthalmologists versus non-medical image graders in the diagnosis of diabetic retinopathy in rural China". Br J Ophthalmol 2018. https://bjo.bmj.com/content/102/11/1471.responses
It has come to our attention that three of the patients (# 2 and #3, half-brothers, and #10) from our paper in BJO (1) have been reported previously with video recordings but without eye movement recordings at age 0 to 3 years in symposium proceedings (1) prior to the eye movement recordings made at age 6-11 presented in this study.
Yours sincerely
Irene Gottlob
References
1) Pieh C, Simonsz-Toth B, Gottlob I. Nystagmus characteristics in congenital stationary night blindness (CSNB). Br J Ophthalmol 2008;92:236-240.
2) Simonsz HJ, Gottlob I, Kommerell G, Hergersberg M, Eriksson AW: Transient Infantile Upgaze Holding Insufficiency: Frühsymptom bei inkompl. cong. stat. Nachtblindheit und periventrikulärer Leukomalazie. Der Ophthalmologe 1998;95(suppl 1/1):178.
We read the article published by McKenna, et al (1) with great interest and laud them on the quality and design of their study. Screening for diabetic retinopathy in rural, low resource settings is the need of the hour, however models which are cost effective, yet provide intensive screening and continuum of care are limited. Keeping this in mind, we feel that there are a few points requiring further clarity in this article.
The odds-ratio calculated in table 3 displays the significant effect of didactic training on correct diagnosis by rural doctors. However, for the odds-ratio to be calculated, there would have been a comparison group of rural doctors who were not provided didactic training. The numbers of these doctors have not been mentioned, and no details have been provided as to whether they were given any basic level of training related to the program. In the results provided for comparison between rural doctors and the non-medical graders, it has not been made clear whether doctors who had not been provided didactic training were included. In that case, results presented in the study may have been biased towards the non-medical graders.
In the study, the arbitrator changed the grade for a high percentage of the cases, moreover, 33% of the images were not found to be of adequate quality. Hiring an arbitrator, re-checking the grading and assuring high quality images (2) through standard equipment and trained personnel would drive up...
We read the article published by McKenna, et al (1) with great interest and laud them on the quality and design of their study. Screening for diabetic retinopathy in rural, low resource settings is the need of the hour, however models which are cost effective, yet provide intensive screening and continuum of care are limited. Keeping this in mind, we feel that there are a few points requiring further clarity in this article.
The odds-ratio calculated in table 3 displays the significant effect of didactic training on correct diagnosis by rural doctors. However, for the odds-ratio to be calculated, there would have been a comparison group of rural doctors who were not provided didactic training. The numbers of these doctors have not been mentioned, and no details have been provided as to whether they were given any basic level of training related to the program. In the results provided for comparison between rural doctors and the non-medical graders, it has not been made clear whether doctors who had not been provided didactic training were included. In that case, results presented in the study may have been biased towards the non-medical graders.
In the study, the arbitrator changed the grade for a high percentage of the cases, moreover, 33% of the images were not found to be of adequate quality. Hiring an arbitrator, re-checking the grading and assuring high quality images (2) through standard equipment and trained personnel would drive up the cost of the programme. The telemedicine model by itself has already been proved as cost effective for diabetic retinopathy screening. (3) Thus, as mentioned by the authors, calculation of cost-effectiveness of the model mentioned in the study, should be carried out assessing its’ scalability.
We appreciate the opportunity to be able to discuss our views on the subject and the article in question.
References
1. McKenna M, Chen T, McAneney H, et al. Br J Ophthalmol 2018;102:1471–1476.
2. Taylor DJ, et al. Image-quality standardization for diabetic retinopathy screening. Expert Rev Ophthalmol. 2009;4(5):469–76.
3. Sharafeldin N, Kawaguchi A, Sundaram A, et al. Br J Ophthalmol 2018;102:1485–1491.
We thank the authors of the article “Intravitreal Methotrexate for Retinoblastoma” published in Ophthalmology in 2011 for their letter to the editor and adjustment of our discussion in our paper. As was found in your experience, as well as ours, intravitreal chemotherapy plays an important role in the treatment of retinoblastoma outside of its currently accepted use for intravitreal seeds. We look forward to hearing about your continued successful experience with intravitreal melphalan for use beyond intravitreal seeds.
In their report, entitled “Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds“, Abramson and corkers report on the successful use of intravitreal chemotherapy in 52 patients for subretinal seeds and recurrent retinal tumours [1]. They state that, prior to their experience, intravitreal chemotherapy had been used exclusively to control persistent or recurrent vitreous seeding in retinoblastoma that had been refractory to systemic intravenous or intra-arterial chemotherapy.
In fact, intravitreal chemotherapy as an adjuvant treatment for both subretinal seeds and recurrent retinal tumours, including its use instead of systemic chemotherapy in the setting of chemothermotherapy for small unresponsive primary retinoblastomas, has been in regular use already for a decade at the Ocular Oncology Service, Helsinki University Eye Hospital. Indeed, three of the first four patients that we reported during the congress of the International Society of Ocular Oncology in 2009 [2], and published in 2011 [3], received intravitreal methotrexate for reasons other than vitreous seeds. Subsequent experience with intravitreal chemotherapy with methotrexate and, later, with melphalan has strengthened our initial findings, as does the comprehensive report of Abramson and coworkers.
1. Abramson DH, Ji X, Francis JH, et al. Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds. Br J Ophthalmol 2018 Jun 6. pii: bjophthalmol-...
In their report, entitled “Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds“, Abramson and corkers report on the successful use of intravitreal chemotherapy in 52 patients for subretinal seeds and recurrent retinal tumours [1]. They state that, prior to their experience, intravitreal chemotherapy had been used exclusively to control persistent or recurrent vitreous seeding in retinoblastoma that had been refractory to systemic intravenous or intra-arterial chemotherapy.
In fact, intravitreal chemotherapy as an adjuvant treatment for both subretinal seeds and recurrent retinal tumours, including its use instead of systemic chemotherapy in the setting of chemothermotherapy for small unresponsive primary retinoblastomas, has been in regular use already for a decade at the Ocular Oncology Service, Helsinki University Eye Hospital. Indeed, three of the first four patients that we reported during the congress of the International Society of Ocular Oncology in 2009 [2], and published in 2011 [3], received intravitreal methotrexate for reasons other than vitreous seeds. Subsequent experience with intravitreal chemotherapy with methotrexate and, later, with melphalan has strengthened our initial findings, as does the comprehensive report of Abramson and coworkers.
1. Abramson DH, Ji X, Francis JH, et al. Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds. Br J Ophthalmol 2018 Jun 6. pii: bjophthalmol-2018-312037. doi: 10.1136/bjophthalmol-2018-312037.
2. Kivelä T, Eskelin S, Lindahl P, Majander A. Intravitreal methotrexate monotherapy as salvage treatment for recurrent retinoblastoma after standard chemoreduction. In: ISOO Metting 2009: Programme and Abstracts, p. 279. http://www.xcdsystem.com//isoo/webimages/pdf%20%236%20isoo%202009%20camb... (accessed on November 1, 2018)
3. Kivelä T, Eskelin S, Paloheimo M. Intravitreal methotrexate for retinoblastoma. Ophthalmology 2011;118(8):1689, 1689.e1-6. doi: 10.1016/j.ophtha.2011.02.005.
I commend the authors on an excellent study looking into the stratification of impact of macular degeneration on vision-specific function in patients with early stage AMD vs. late stage AMD. I would like to report similar findings in a United States based population with data gathered from the National Health and and Nutrition Examination Survey 2007-2008 (NHANES) which is a population based cross-sectional survey that represents the non-institutionalized population of the United States.
As the author's of this study looked at the impact of early and late ARM on vision specific functioning, I assessed a similar question using the NHANES database, specifically looking at whether patients with early and late AMD reported insufficient correction with their currently prescribed glasses or contact lenses, another measure of vision-specific functioning. After survey weighting, the sample represented a US Population of 108,719,628 people with 3.2% of participants (N=3,992) self-reporting a diagnosis of age-related macular degeneration. This represented a weighted sample of 3,479, 028 people. Of these participants reporting a diagnosis of AMD, they had a higher odds of reporting trouble seeing even with correction with glasses or contacts (OR 2.98, Confidence Interval 1.87-4.6). This relationship was held valid when controlling for age, gender, diabetes, race, self reported glaucoma, self reported cataract surgery, retinal exam evidence of retinopathy, and smoking of...
I commend the authors on an excellent study looking into the stratification of impact of macular degeneration on vision-specific function in patients with early stage AMD vs. late stage AMD. I would like to report similar findings in a United States based population with data gathered from the National Health and and Nutrition Examination Survey 2007-2008 (NHANES) which is a population based cross-sectional survey that represents the non-institutionalized population of the United States.
As the author's of this study looked at the impact of early and late ARM on vision specific functioning, I assessed a similar question using the NHANES database, specifically looking at whether patients with early and late AMD reported insufficient correction with their currently prescribed glasses or contact lenses, another measure of vision-specific functioning. After survey weighting, the sample represented a US Population of 108,719,628 people with 3.2% of participants (N=3,992) self-reporting a diagnosis of age-related macular degeneration. This represented a weighted sample of 3,479, 028 people. Of these participants reporting a diagnosis of AMD, they had a higher odds of reporting trouble seeing even with correction with glasses or contacts (OR 2.98, Confidence Interval 1.87-4.6). This relationship was held valid when controlling for age, gender, diabetes, race, self reported glaucoma, self reported cataract surgery, retinal exam evidence of retinopathy, and smoking of at least 100 cigarettes in their lifetime. This finding and the finding of the authors was further confirmed with the NHANES data showing that patients who self-reported trouble seeing with correction did not have increased odds of showing signs of early AMD on examination (OR 1.08, Confidence Interval 0.638-1.829) but had increased odds of showing signs of late AMD on examination (OR 5.16, Confidence Interval 2.97 - 8.97). Additional analysis into vision-specific function in relation to quality of life showed that these late AMD patients who reported trouble seeing even with correction had higher odds of reporting that they worried about their eyesight on a daily basis (OR 2.06, Confidence Interval 1.86-2.29).
These findings using the NHANES database confirm the findings of the authors, whom looked at a Singaporean based population and strengthen the importance of preventive public health strategies in the United States to prevent progression of early AMD to late AMD to avoid deterioration in visual acuity and quality of life.
Best regards,
I have read with great interest the article of Galvis et al about Prevalence of refractive errors in Colombia: MIOPUR study. It is a great effort and it might be the first study of its type in our country. In the discussion section, the inclusion criteria needs to be better explained.
1: Why did they exclude the participants with less than 20/40 corrected vision?
2: Is the vision exclusion criteria based on any eye or the better eye?
3: Why didn’t they use cyclopegic medication for the refraction exam?
These concerns affect the results because all of the amblyopic patients are excluded from the study and the hyperopic patients and those with an astigmatism that induce amblyopia are underreported, as seen in the table that shows a very low incidence in those refractive errors.
Tuning Of The Literature Related To The Airviscobubble (AVB) DALK Technique
Corresponding author:
Vincenzo Sarnicola
Address: Clinica degli Occhi Sarnicola,
Via Mazzini no. 62, Grosseto 58100, Italy.
Fax: +39-0564-413023
Tel: +39-3201158500
e-mail address: v.sarnicola@hotmail.it or sarnicolavincenzo@gmail.com
Authors:
Vincenzo Sarnicola, MD1
v.sarnicola@hotmail.it
Enrica Sarnicola, MD1-3
e.sarnicola@hotmail.it
Caterina Sarnicola, MD 4
c.sarnicola@hotmail.it
Affiliation:
1 Clinica degli Occhi Sarnicola, Grosseto, Italy
2 Ospedale Oftalmico di Torino, Struttura Complessa Oculistica 2, Turin, Italy
3 Ospedale San Giovanni Bosco, Struttura Complessa Oculistica 2, Turin, Italy
4 Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy;
Competing interests: None.
Keywords: DALK; airviscobubble; AVB; dDALK; descemetic DALK.
Word Count: 303
To the Editor:
We read with interest the article published by Scorcia et al.[1] It is encouraging to see others, such as Scorcia et al, embracing the use of ophthalmic viscoelastic device (OVD) injection as a second bubble a...
Show MoreI read with great interest the paper titled “Collateral vessels on optical coherence tomography (OCT) angiography in eyes with branch retinal vein occlusion (BRVO)” by Suzuki et al.1
Show MoreThe authors defined collateral vessels as dilated and tortuous capillaries occurring in pre-existing capillary beds and linking the obstructed vessel with the nearest patent vessel, according to previous reports.2-4 The authors demonstrated that collaterals were detected in 23 out of 28 (82%) eyes, all of which already existed at mean 0.95 months after the onset, and that all of the collaterals were observed in both the retinal superficial and the deep layers.
However, some of the vessels which are pointed out as collaterals in the study1 look like simply dilated/tortuous vessels, because they don’t seem to connect obstructed to non-obstructed adjacent vessels nor by-pass obstructions. In a previous report, the authors found collateral vessels in 18 out of 28 (64%) eyes at mean 25.1 months from the onset, while superficial and deep capillary telangiectasias were detected in 13 and 28 out of 28 eyes, respectively.4 Therefore, I suppose that some of the vessels defined as collaterals in this study1 may be simply telangiectasias.
Fruend et al.5 defined collateral vessels as the authors did. After excluding collaterals involving the perifoveal vascular ring, they demonstrated that collaterals were found in 23 out of 23 eyes (100%) at median time of 3.79 years from RVO...
I read with interest and appreciate the article by Choi et al 1 on 'Intraocular pressure change after injection of intravitreal dexamethasone (Ozurdex) implant in Korean patients'.
As the study looks at the IOP changes after intravitreal dexamethasone implant, how the IOP was recorded for the patients is very important. The authors have reported that the intraocular pressure (IOP) was measured by non-contact tonometer (NCT) or Goldmann applanation tonometry (GAT) in this study. First, it is not mentioned as to which NCT was used for IOP measurement. If NCT was used to measure pre-injection IOP, was it used to measure post-injection IOP measurement also? Or on different visits IOP recording was done with NCT or GAT, is not clear. As GAT is still considered as a gold standard for IOP measurement, if IOP on NCT is found to be high, ideally it should be rechecked with GAT. Second, it is not mentioned whether a single IOP measurement was taken or multiple IOP measurements were obtained, taking the average value as the final IOP. Third, a s the lower range of age was 16 years (Table 1), was there any correlation of IOP change after the injection with the age?
Reference
1. Choi W, Park SE, Kang HG et al. Intraocular pressure change after injection of intravitreal dexamethasone (Ozurdex) implant in Korean patients. Br J Ophthalmol 2018. Epub ahead
of print. doi:10.1136/ bjophthalmol-2018-312958
Dear Editor,
We thank Drs Sabherwal and Sood for their interest in our article.(1) We would like to respond to the interesting points they raise.
Table 3 presents our analyses of potential predictors of the correct diagnosis by rural doctors of diabetic retinopathy (DR) requiring treatment. Details on a number of the characteristics assessed in this table are presented in the first paragraph of the Results section, but not, as Drs Sabherwal and Sood point out, the proportion having received didactic training. Among the 28 rural doctors, 13 (46.4%) received such training and 15 (53.6%) did not.
In the Methods, we describe in detail the training received by ophthalmologists in the CREST (Comprehensive Rural Eye Service and Training) program. As described there, only two doctors per hospital (not all of whom examined patients in the current study) could attend the didactic phase of training at the Zhongshan Ophthalmic Center (ZOC). This is due to the limited number of ophthalmologists at a typical rural Chinese county hospital, and the heavy load of clinical duties. For more doctors to have left their facilities for the two-month didactic training would not have been practical. However, all ophthalmologists participating in the CREST network and in the current study received intensive hands-on training by medical retina experts from ZOC at their own facilities, which included the diagnosis and laser treatment of diabetic retinopathy (DR) as well as the u...
Show MoreDear Editor,
It has come to our attention that three of the patients (# 2 and #3, half-brothers, and #10) from our paper in BJO (1) have been reported previously with video recordings but without eye movement recordings at age 0 to 3 years in symposium proceedings (1) prior to the eye movement recordings made at age 6-11 presented in this study.
Yours sincerely
Irene Gottlob
References
1) Pieh C, Simonsz-Toth B, Gottlob I. Nystagmus characteristics in congenital stationary night blindness (CSNB). Br J Ophthalmol 2008;92:236-240.
2) Simonsz HJ, Gottlob I, Kommerell G, Hergersberg M, Eriksson AW: Transient Infantile Upgaze Holding Insufficiency: Frühsymptom bei inkompl. cong. stat. Nachtblindheit und periventrikulärer Leukomalazie. Der Ophthalmologe 1998;95(suppl 1/1):178.
Dear Editor,
We read the article published by McKenna, et al (1) with great interest and laud them on the quality and design of their study. Screening for diabetic retinopathy in rural, low resource settings is the need of the hour, however models which are cost effective, yet provide intensive screening and continuum of care are limited. Keeping this in mind, we feel that there are a few points requiring further clarity in this article.
The odds-ratio calculated in table 3 displays the significant effect of didactic training on correct diagnosis by rural doctors. However, for the odds-ratio to be calculated, there would have been a comparison group of rural doctors who were not provided didactic training. The numbers of these doctors have not been mentioned, and no details have been provided as to whether they were given any basic level of training related to the program. In the results provided for comparison between rural doctors and the non-medical graders, it has not been made clear whether doctors who had not been provided didactic training were included. In that case, results presented in the study may have been biased towards the non-medical graders.
In the study, the arbitrator changed the grade for a high percentage of the cases, moreover, 33% of the images were not found to be of adequate quality. Hiring an arbitrator, re-checking the grading and assuring high quality images (2) through standard equipment and trained personnel would drive up...
Show MoreTo the editor and auther Kivela et al.:
We thank the authors of the article “Intravitreal Methotrexate for Retinoblastoma” published in Ophthalmology in 2011 for their letter to the editor and adjustment of our discussion in our paper. As was found in your experience, as well as ours, intravitreal chemotherapy plays an important role in the treatment of retinoblastoma outside of its currently accepted use for intravitreal seeds. We look forward to hearing about your continued successful experience with intravitreal melphalan for use beyond intravitreal seeds.
In their report, entitled “Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds“, Abramson and corkers report on the successful use of intravitreal chemotherapy in 52 patients for subretinal seeds and recurrent retinal tumours [1]. They state that, prior to their experience, intravitreal chemotherapy had been used exclusively to control persistent or recurrent vitreous seeding in retinoblastoma that had been refractory to systemic intravenous or intra-arterial chemotherapy.
In fact, intravitreal chemotherapy as an adjuvant treatment for both subretinal seeds and recurrent retinal tumours, including its use instead of systemic chemotherapy in the setting of chemothermotherapy for small unresponsive primary retinoblastomas, has been in regular use already for a decade at the Ocular Oncology Service, Helsinki University Eye Hospital. Indeed, three of the first four patients that we reported during the congress of the International Society of Ocular Oncology in 2009 [2], and published in 2011 [3], received intravitreal methotrexate for reasons other than vitreous seeds. Subsequent experience with intravitreal chemotherapy with methotrexate and, later, with melphalan has strengthened our initial findings, as does the comprehensive report of Abramson and coworkers.
1. Abramson DH, Ji X, Francis JH, et al. Intravitreal chemotherapy in retinoblastoma: expanded use beyond intravitreal seeds. Br J Ophthalmol 2018 Jun 6. pii: bjophthalmol-...
Show MoreI commend the authors on an excellent study looking into the stratification of impact of macular degeneration on vision-specific function in patients with early stage AMD vs. late stage AMD. I would like to report similar findings in a United States based population with data gathered from the National Health and and Nutrition Examination Survey 2007-2008 (NHANES) which is a population based cross-sectional survey that represents the non-institutionalized population of the United States.
As the author's of this study looked at the impact of early and late ARM on vision specific functioning, I assessed a similar question using the NHANES database, specifically looking at whether patients with early and late AMD reported insufficient correction with their currently prescribed glasses or contact lenses, another measure of vision-specific functioning. After survey weighting, the sample represented a US Population of 108,719,628 people with 3.2% of participants (N=3,992) self-reporting a diagnosis of age-related macular degeneration. This represented a weighted sample of 3,479, 028 people. Of these participants reporting a diagnosis of AMD, they had a higher odds of reporting trouble seeing even with correction with glasses or contacts (OR 2.98, Confidence Interval 1.87-4.6). This relationship was held valid when controlling for age, gender, diabetes, race, self reported glaucoma, self reported cataract surgery, retinal exam evidence of retinopathy, and smoking of...
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