Elvis Ojaimi

Methods for a Population-Based Study of Myopia and Other Eye Conditions in School Children: The Sydney Myopia Study

Purpose: The Sydney Myopia Study will establish the prevalence of myopia and other eye diseases in a large representative sample of Sydney school children. It will also examine the relationship between myopia and potential modifiable risk factors and will assess potential gene-environment interactions by examining parents and siblings. Methods: The target population is a stratified random cluster sample of 1750 Year 1 (age 6 years) and 1500 Year 7 (age 12 years) students from Sydney metropolitan schools. Procedures (comprehensive parent-administered questionnaire and examination) involve standardized protocols to allow for comparison with international population-based data. Examinations include a detailed assessment of visual acuity, cover testing for strabismus, identification of amblyopia, slit-lamp examination, non-contact ocular biometry and cycloplegia (cyclopentolate) followed by autorefraction, optical coherence tomography, retinal thickness measurement, digital mydriatic retinal photography and aberrometry. Conclusions: The Sydney Myopia Study design and methodology will ensure valid findings on ocular development and health in a large representative sample of Sydney school children, for comparison with other population-based refraction data.

Assessment of Vision-Related Quality of Life in an Older Population Subsample: The Blue Mountains Eye Study

Purpose: To assess visual functioning and vision-specific health-related quality of life (HRQOL) in an older, community-dwelling-based population subsample, using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25). Methods: Three-quarters (76%, n = 892) of Extension Blue Mountains Eye Study participants (aged ≥ 50 years, mean 60.8 years) completed the self-administered NEI-VFQ-25, an instrument consisting of 12 dimensions and one summary composite score, and comprehensive eye examinations, including monocular distance visual acuity. Visual impairment was defined as visual acuity < 6/12. Unilateral and bilateral visual impairment was defined by the worse eye and better eye, respectively. Correctable visual impairment was defined as that which improved, and non-correctable visual impairment as that which persisted after subjective refraction. Mild visual impairment was defined as visual acuity < 6/12 but ≥ 6/24, moderate as < 6/24 but ≥ 6/60, and severe as < 6/60. Results: There were no significant differences in age, sex, or vision status between NEI-VFQ-25 responders and non-responders. Men had significantly better scores in three subscales than women but there were no significant differences in their overall composite scores (men 88.5± 0.5; women 88.1± 0.4). Persons aged 60–69 years had the best NEI-VFQ-25 profiles (mean composite score ± standard error, 90.2 ± 0.5; 50–59 years, 88.5 ± 0.4; ≥70 years, 86.2 ± 0.8). Presenting bilateral visual impairment (77.1 ± 1.4) was associated with significantly poorer functioning than unilateral (87.5 ± 0.8) or no visual impairment (89.4 ± 0.3). Increasing levels of impairment were associated with poorer levels of visual functioning. The impact of impairment was principally from non-correctable (49.2 ± 2.6) rather than refractive impairments (85.3 ± 1.4), although the latter accounted for over three-quarters (77.5%) of presenting bilateral impairment. Non-correctable unilateral impairment (85.3 ± 1.1) was associated with poorer functioning than no impairment. Conclusions: The findings from this community-dwelling older population show that the NEI-VFQ-25 differentiates well between various levels of visual impairment with regard to the magnitude of their impact on vision-specific quality of life. Greater impacts were noted among persons with bilateral compared to unilateral impairment, with increasing impacts at greater severities of visual impairment. Visual impairment from refractive errors is more frequent than from underlying pathologic disorders, but the impact of correctable visual impairment was considerably milder than the impact of non-correctable visual impairment.

Retinopathy Signs in People without Diabetes: The Multi-Ethnic Study of Atherosclerosis

OBJECTIVE To describe the prevalence of retinopathy and associations with cardiovascular risk factors in persons without diabetes in 4 racial/ethnic groups (white, black, Hispanic, and Chinese). DESIGN Population-based, cross-sectional study. PARTICIPANTS We included 6176 subjects aged 45-84 years without diabetes, selected from 6 United States communities. METHODS Fundus images were taken using 45° digital camera through dark-adapted pupils and were graded for retinopathy as defined by the Early Treatment Diabetic Retinopathy Study severity scale: microaneurysms, hemorrhages, cotton wool spots, intraretinal microvascular abnormalities, hard exudates, venous beading, and new vessels. MAIN OUTCOME MEASURES Retinopathy and the association with cardiovascular risk factors. RESULTS Prevalence rates of retinopathy in persons without diabetes were 12.5% overall, varying from 11.9% (white), 13.9% (black), 12.6% (Hispanic), to 17.2% (Chinese). Hypertension was strongly associated with retinopathy (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.23-1.75). After adjusting for age, gender, race, and other parameters, smoking (OR, 1.50; 95% CI, 1.09-2.06) and increased internal carotid intima media thickness (OR, 1.22; 95% CI, 1.05-1.41) were associated with retinopathy. A range of serum inflammatory factors were examined, but none were found to be significant. CONCLUSIONS Retinopathy in persons without diabetes is common, varies with race/ethnicity, and associated with cardiovascular risk factors, including hypertension, smoking, and carotid artery intima media thickness.

In vivo confocal microscopy and polarizing microscopy of the cornea in a patient with nephropathic cystinosis

The clinicopathological and in vivo confocal microscopic characteristics of the corneas from a patient with infantile cystinosis is reported. Crystals were demonstrated in the epithelium and stroma of this patient.

Vogt-Koyanagi-Harada Disease, Diabetes Mellitus, and Psoriasis in a Child

Purpose: To report a case of a child with near-simultaneous onset of Vogt Koyanagi Harada disease (VKH) and insulin-dependent diabetes mellitus (IDDM). Design: Interventional case report. Methods: An 11-year-old child with known psoriasis presented with headache and bilateral granulomatous panuveitis. Nine weeks later, he presented with diabetic ketoacidosis and IDDM. Diffuse choroidal depigmentation followed within months. HLA was positive for DRB1*0405. Despite aggressive local and systemic therapy, the ocular disease was complicated by bilateral cataracts, angle closure glaucoma, and choroidal neovascularization. Results: The patient is currently pseudophakic in one eye and aphakic in the other, with best-corrected visual acuity of 6/24 and 6/5, respectively. Conclusions: VKH may present in children with panuveitis in the setting of other autoimmune disorders. Treating such patients is complicated by the need to minimize systemic corticosteroid use. A combination of local therapy and systemic steroid-sparing agents should be the mainstay of treatment.

Intravitreal Methotrexate as Adjunctive, Palliative Therapy in Intraocular T-cell Lymphoma

Purpose: To report on the rapid and sustained effect following injection of intravitreal methotrexate (IVTMTX) in intraocular T-cell lymphoma. Design: Report of 2 cases. Methods: A young male with natural killer/T-cell lymphoma presented with infiltrative nodular iridocyclitis and received a single IVTMTX. An elderly female with peripheral T-cell lymphoma presented with a hypopyon, infiltrative iridocyclitis, and choroidal effusions and received 3 IVTMTX over 4 months. Results: Both patients responded well after the first injection, with resolution of signs within 1 week and improvement in vision. Conclusions: IVTMTX may be effective as a palliative, vision-restoring measure in patients with systemic T-cell lymphoma.