Bruce A. Teitelbaum

Cystic maculopathy with normal capillary permeability secondary to docetaxel.

Background. Cystic maculopathy without leakage on fluorescein angiography has been described in cases of toxicity to niacin. We present a similar case of cystic maculopathy due to docetaxel (Taxotere) in the treatment of breast cancer. Case report. A 53-year-old Asian female presented with complaints of decreased vision soon after the initiation of treatment for breast cancer with docetaxel. A cystic maculopathy with a normal fluorescein angiogram was found on examination. Significant improvement in visual acuity along with resolution of the cystic maculopathy was found after changing to an alternate antineoplastic agent. Conclusion. Docetaxel may be associated with cystic maculopathy that does not display angiographic evidence of abnormal capillary permeability.

Effectiveness of Base in Prism for Presbyopes with Convergence Insufficiency

Purpose. Although the treatment of symptomatic convergence insufficiency (CI) with base-in (BI) prism in adults has a strong theoretical foundation, there have been very few studies addressing its efficacy. The purpose of this study was to investigate whether the application of BI prism, using a novel progressive addition lens design which incorporates BI prism in the near portion only, could help alleviate the symptoms in presbyopes with CI. Methods. A total of 29 symptomatic CI subjects aged 45 to 68 years were examined. All subjects took the CI Symptom Survey V-15 (CISS) and scored ≥16 points. Each subject was assigned two pairs of progressive addition glasses made by the same manufacturer in a randomized sequence, one with BI prism and one with the same lens prescription but no prism (placebo). Subjects wore each pair of glasses for 3 weeks and completed the CISS at the end of the 3rd week. Symptom level measured with CISS was the major outcome measure. Results. The mean (standard deviation) CISS score was 30.21 (9.30) at baseline and decreased to 13.38 (9.44) with the BI-prism glasses, vs. 23.62 (10.76) with the placebo glasses. There were significant differences between the baseline survey score and the score with the BI-prism glasses (p < 0.0001) and between the score with placebo glasses and the one with BI-prism glasses (p = 0.001). Conclusions. The progressive addition glasses with BI-prism were found to be effective in alleviating symptoms of presbyopes with symptomatic CI.

Occlusive retinal vasculitis in a patient with West Nile virus.

Background:  West Nile virus (WNV) was first identified in the United States in 1999. In addition to a spectrum of systemic manifestations, several ocular conditions secondary to the virus have been reported, including chorioretinitis, uveitis and optic neuritis. Age and diabetes mellitus (DM) have been reported to be associated risk factors for the more severe forms of the systemic disease. Only seven cases of occlusive retinal vasculitis have been reported in patients with WNV infection.

Prevalence of pigmented lens striae in a black population: A potential indicator of age-related pigment dispersal in the anterior segment

Purpose. To determine the prevalence of pigmented striae of the anterior lens capsule, with or without associated glaucoma, in a black primary eye care population. Methods. Over a 16-month period, five practitioners searched for pigmented lens striae (PLS) among consecutive patients who underwent pupillary dilation during routine eye care provided within the primary care service of an urban eye clinic in Chicago, Illinois. Results. Meeting the inclusion criteria were 1608 blacks (mean age ± SD, 40.9 ± 23.7 years; range, 5 to 100; 1056 females, 552 males). Among the group, 29 (1.8%) subjects had PLS (mean age, 66.5 ± 11.3 years; range, 33 to 88; 25 females, 4 males). PLS were bilateral 89% of the time. Sixteen of the 29 (55%) blacks had central corneal endothelial pigment dusting (14 bilateral), frequently creating a well-formed Krukenberg’s spindle. Trabecular pigmentation varied among the PLS subjects from mild to heavy. Using multiple logistic regression, age (in years) (odds ratio, 1.05; 95% confidence interval, 1.02 to 1.07; p = 0.0003), female gender (odds ratio, 4.46; 95% confidence interval; 1.03 to 19.19; p = 0.045), and hyperopic refractive error (in diopters) (odds ratio, 1.35; 95% confidence interval; 1.09 to 1.67; p = 0.006) were significant predictors of PLS. Conclusions. PLS were present in about 1.8% (2.4% females, 0.7% males) of our black population, and they were frequently associated with other signs of intraocular pigment dispersion. Age, female gender, and refractive error were significant predictors for PLS. This is new information that is helpful for understanding a clinical sign that may be an indicator of age-related pigment dispersal within the anterior segment.

A cross-sectional study of Krukenberg spindles and pigmented lens striae in a predominately black population: two highly associated clinical signs of anterior segment pigment dispersal.

Purpose:To investigate the relationship of Krukenberg spindles (KS) and pigmented lens striae (PLS), clinical signs related to iris pigment dispersal and possibly glaucoma. Methods:During a 31-month period, 5 practitioners in an urban, primary eye care setting examined consecutive patients for KS and PLS. Multiple logistic regression was used to evaluate relationships among KS, PLS, and other variables. Results:Krukenberg spindles were present in 65 patients (52 females), comprised of 57 of 2647 (2.2%) blacks, 5 of 303 (1.7%) whites, 2 of 121 (1.7%) Hispanics, and 1 of 55 (1.8%) Asians. PLS were present in 64 subjects (56 females), comprised of 59 (2.2%) blacks, 3 (1.0%) whites, and 2 (3.6%) Asians. KS and PLS were coexistent in 27 subjects. Mean age ± SD (range) of the KS and PLS subjects was 63.1 ± 15.0 years (24-88 years) and 67.0 ± 10.4 years (33-88 years), respectively. Mean refractive error ± SD (range) of KS and PLS right eyes was +0.55 ± 2.32D (−6.50 to +5.50D) and +1.34 ± 2.18D (−6.50 to +7.25D), respectively. Controlling for other variables, PLS were highly predictive (OR = 30.2, P < 0.0001) of KS, and KS were highly predictive (OR = 29.5, P < 0.0001) of PLS. Ignoring presence or absence of PLS, increasing age (in decades) (OR = 1.60, P < 0.0001) was strongly associated with KS. Ignoring presence or absence of KS, age (OR = 1.74, P < 0.0001), female gender (OR = 2.96, P = 0.009), and increasing hyperopic refractive error (OR = 1.30, P < 0.0001) were strongly associated with PLS. Conclusions:Krukenberg spindles and PLS were strongly associated in our patient population, and the likelihood of both increased with increasing age. Female gender and increasing hyperopic refractive error were highly significant predictors of PLS.

Factors associated with base‐in prism treatment outcomes for convergence insufficiency in symptomatic presbyopes

Purpose:  The aim was to determine whether baseline measurements of binocular vision are associated with symptoms of convergence insufficiency (CI) both before and after CI treatment with base‐in prism in symptomatic presbyopes. We further determined the factors that predicted CI treatment outcomes.

Pigmented striae of the anterior lens capsule and age-associated pigment dispersion of variable degree in a group of older African-Americans: an age,race, and gender matched study

Purpose: To investigate pigmented striae of the anterior lens capsule in African-Americans, a potential indicator of significant anterior segment pigment dispersion. Methods: A group of 40 African-American subjects who exhibited pigmented lens striae (PLS) were identified from a non-referred, primary eye care population in Chicago, IL, USA. These subjects were then compared to an age, race, and gender matched control group relative to refractive error and the presence or absence of diabetes and hypertension. Results: The PLS subjects (mean age = 65.4 ± 8.8 years, range = 50–87 years) consisted of 36 females and 4 males. PLS were bilateral in 36 (85%) of the40 subjects. Among the eyes with PLS, 21 (55%) of 38 right eyes and 22 (61%) of 36 left eyes also had significant corneal endothelial pigment dusting, commonly in the shape of a Krukenberg’s spindle. Ten (25%) of the PLS subjects had either glaucoma or ocular hypertension (7 bilateral, 3 unilateral).The presence of trabecular meshwork pigment varied from minimal to heavy. The mean SD (range) refractive error of the PLS right eyes was +1.61 ± 1.43D (-1.50 to +5.00D) and +1.77 ± 1.37D (-1.00 to +5.00D) for the left eyes. Based on these data, the PLS right eyes were +1.63D (Students t, p = 0.0001; 95% CI = +0.82 to +2.44D) more hyperopic on average than the control right eyes, and the PLS left eyes were +1.77D (p = 0.0001; 95%CI = +0.92 to +2.63D) more hyperopic on average than the control left eyes. Trend analysis showed a gradually increasing likelihood of PLS with increasing magnitude of hyperopia in both eyes (Mantel-Haenszel chi-square, p = 0.001). Among PLS subjects, 24 (60%) of 40 were hypertensive and 9 (23%) of 40 were diabetic. However, these proportions were not significantly different (two-tailed Fishers exact test; hypertension: p = 0.30; diabetes: p = 0.70) from the randomly selected controls. Conclusions: Among our African-American group, which consisted predominately of females >50 years of age, the likelihood of PLS increased with increasing hyperopic refractive error. This finding is consistent with the possibility that PLS may, in some circumstances, indicate a significant pigment dispersal process due to iris-lens rubbing that may be associated with crowding of anterior segment structures. Additional study is warranted to further assess the nature of PLS, their precise relationship with an age-related pigment dispersal process, and their true significance as a risk factor for development of glaucoma.

Differentiation of asymptomatic patients from symptomatic patients by the slope of the forced vergence fixation disparity curve.

ABSTRACT Eighty‐nine optometry students were divided into an asymptomatic group and a symptomatic group on the basis of a case history. A forced vergence fixation disparity (FD) curve was generated for each subject using a Disparometer (Vision Analysis, Columbus, Ohio). Slopes were calculated for each curve. In addition, each curve was labeled steep or flat based on a previously determined cutoff point of −0.96 min/&Dgr; (Sheedy, 1980). Steep curves did not correlate well with symptomatic patients, whereas flat curves did not correlate well with asymptomatic patients. An independent t‐test found no significant difference between the two groups.

Anterior Chamber Depth, Lens Thickness, and Related Measures in African American Females With Long Anterior Zonules: A Matched Study With Control for Refractive Error.

Purpose:To investigate anterior chamber depth (ACD), lens thickness (LT), vitreous body length (VBL), and axial length (AL) in African American females with long anterior zonules (LAZ) while controlling for refractive error. Methods:The eyes of 50 African American females with LAZ were compared with 50 controls matched with age, race, sex, and refractive error. Central ACD, LT, VBL, and AL measurements were obtained in a masked manner using a-scan ultrasonography. Results:LAZ cases had a mean age±SD of 67.1±7.6 years (range, 52 to 85 y) and a mean refractive error of +1.85±1.41 D (−1.75 to +4.75 D). Parameters were similar for controls. Mean ACD for cases was 2.45±0.34 mm and 2.57±0.38 mm for controls. Mean LT for cases was 4.94±0.43 mm and 4.83±0.45 mm for controls. Mean VBL for cases was 15.00±0.72 mm and 15.17±0.76 mm for controls. Mean AL for cases was 22.39±0.82 mm and 22.57±0.76 mm for controls. Using multiple logistic regression to control for any residual differences in age and refractive error, no significant differences were present between LAZ eyes and control eyes relative to the a-scan variables (P>0.1). Conclusions:When refractive error was controlled for, this group of African American females with LAZ did not exhibit clinically significant differences in ACD, LT, VBL, and AL as compared with controls.

Symmetry of peripheral retinal nonperfusion in diabetic retinopathy by ischemic index

Purpose Diabetic retinopathy is the leading cause of blindness among working-age adults in most developed countries. It affects eyes bilaterally and is generally believed to be symmetrical, yet there are few studies evaluating the symmetry of diabetic retinopathy. The purpose of the present study was to evaluate the symmetry of the amount of peripheral retinal ischemia in patients with diabetic retinopathy. Methods Ultra-widefield fluorescein angiography images were obtained on both eyes of 54 subjects, mean age 56.4 years, from an urban eye clinic. A single, high quality image from the arteriovenous phase of the angiogram of each eye was selected for analysis. The total area of gradable fundus and area of nonperfusion seen in the arteriovenous phase of the ultra-widefield fluorescein angiogram were determined. An ischemic index (ISI) was calculated by dividing the non-perfused retinal area by the total retinal area and multiplying by 100. Results The mean ISI OD was 11.27, mean ISI OS was 11.64. The mean absolute value (±SD) of ISI difference between OD and OS was 4.46 ± 6.09. A difference in ISI of 10% or less was found in 92.6% of subjects. A statistically significant correlation was found in the ISI between right and left eyes (rs = 0.80, p < 0.0001) and there was no statistically significant difference in ISI between the right and left eyes (p = 0.85). Conclusion Asymmetrical retinopathy in diabetic patients is uncommon and additional pathological processes should be considered in the presence of asymmetric DR.