David D. Castells

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.

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.

Optic nerve heads in pediatric African Americans using retinal tomography.

Purpose. To characterize optic nerve head (ONH) parameters including symmetry between the eyes in healthy African American children using the Heidelberg retinal tomograph II, and to determine if there are associations between these parameters and age, refractive error, or gender. Methods. The ONHs of 146 African American children aged 6 to 17 years without ocular disease were imaged with the Heidelberg retinal tomograph II. Mean values for 11 ONH parameters were determined as was their relationship to age, gender, and refractive error. Interocular symmetry of the parameters was determined. Results. The mean (±standard deviation) disc area, rim area, and cup area were 2.18 ± 0.57 mm2, 1.63 ± 0.40 mm2, and 0.52 ± 0.37 mm2, respectively. The mean linear cup-to-disc (C/D) ratio was 0.45 ± 0.15, and mean cup depth was 0.22 ± 0.10 mm. The mean retinal nerve fiber layer thickness was 0.26 ± 0.07 mm. The ONH parameters were not related to age or refractive error. With the exception of the C/D area ratio and linear C/D ratio, which were greater in boys than in girls, ONH parameters were not related to gender. Most parameters were strongly correlated between the right and left eyes. The average interocular differences in disc area, cup area, rim area, linear C/D ratio, and mean retinal nerve fiber layer thickness were 0.09 ± 0.31 mm2, 0.04 ± 0.22 mm2, 0.06 ± 0.40 mm2, 0.02 ± 0.11, and 0.00 ± 0.06 mm, respectively. Conclusions. ONH parameters were not related to age and refractive error, and only C/D area ratio and linear C/D ratio were greater in boys than girls in a clinical sample of African American children. These measures of normative ONH parameters and range of interocular differences may be helpful in clinical pediatric eye care to facilitate identification of African American children with abnormal optic discs.

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.

Anterior scleritis: three case reports and a review of the literature.

BACKGROUND Scleritis is a rare ocular condition involving vasculitis. It can result in severe ocular morbidity and has a high association with underlying systemic disease and mortality. Management can be challenging and under-diagnosis is a concern. Treatment usually requires systemic medications and co-management with a medical specialist in the appropriate field to manage any underlying systemic etiology. METHODS Three cases are presented: idiopathic nodular scleritis with complete recovery; bilateral, diffuse anterior scleritis with rheumatoid arthritis; and scleromalacia perforans treated with chemotherapeutic agents and co-managed with a rheumatologist. A search of the English language literature is reported, also. RESULTS The reported cases exemplify much of our knowledge regarding scleritis. The literature review focuses on the challenges of an accurate diagnosis and management. Management is challenging and, although standards exist, controversy remains. The literature discusses the relationship of scleritis to underlying systemic disease and the significant implication of this association. CONCLUSION Knowledge of scleritis may aid in determining a timely and accurate diagnosis and treatment of both the ocular and any underlying systemic conditions, thus decreasing morbidity and mortality.