Jorge Rodriguez

Causes of blindness and visual impairment in a population-based sample of U.S. Hispanics

OBJECTIVE To describe the causes of blindness and visual impairment in a population-based sample of Hispanics. DESIGN A cross-sectional study. PARTICIPANTS A random sample of 4774 Hispanic residents of Santa Cruz and Pima Counties in Southern Arizona aged 40 years and older who participated in Proyecto VER (Vision Evaluation and Research). TESTING Subjects were interviewed and underwent a thorough ophthalmic examination. Presenting and best-corrected visual acuity was determined using the Early Treatment of Diabetic Retinopathy Study protocol, followed by a standardized ophthalmic examination to determine the causes of visual loss. Anterior and posterior segment specialists in ophthalmology confirmed the causes. MAIN OUTCOME MEASURES Causes of visual loss (best-corrected acuity worse than 20/40). RESULTS The response rate of eligible participants was more than 70%. Best-corrected acuity in the better seeing eye worse than 20/40 increased from 0.3% in those aged 40 to 49 to 5.6% in those aged 65 and older. The leading cause was cataract, accounting for 42% of all visual loss, followed by age-related macular degeneration (15%), and diabetic retinopathy (13%). Among 14 people who were bilaterally blind, open-angle glaucoma was the leading cause. Women had higher age-adjusted prevalence of severe cataract compared with men and were more likely to be visually impaired from cataract, diabetic retinopathy, and open-angle glaucoma, although gender differences were not statistically significant. CONCLUSIONS Causes of visual impairment differ from those reported in Caucasian populations, with open-angle glaucoma being the leading cause of blindness. Further work on gender-based obstacles to eye care in the Hispanic community may be warranted.

Risk factors for type ii diabetes and diabetic retinopathy in a mexican-american population: proyecto ver

PURPOSE Risk factors for type II diabetes and diabetic retinopathy were determined in a population-based study of Mexican-Americans. DESIGN Proyecto VER (Vision, Evaluation, and Research) is a cross-sectional study in a random sample of the self-described Hispanic populations in Tucson and Nogales, Arizona, age 40 and older. METHODS Of 6,659 eligible subjects, 4,774 (72%) participated in the home questionnaire and clinic visit. Diabetes was defined as self-report of a physician diagnosis or hemoglobin A(1c) value of > or = 7.0%. Only type II diabetes was included. Diabetic retinopathy was assessed on stereo fundus photographs of all persons with diabetes. Questions were asked about demographic, personal, socioeconomic, and diabetes related variables. RESULTS 1023 (21.4%) of the sample had type II diabetes, and 68% were in the low-income group (annual income less than

Incidence of vitreoretinal pathologic conditions within 24 months after laser in situ keratomileusis

20,000). Diabetes was associated with Native-American ancestry, higher acculturation, low income, less education, and increasing body mass index after age and gender adjustment. Persons with previously undiscovered diabetes were more likely to have no regular source of care, no insurance, and currently smoke compared with persons with known diabetes. Only low income was related to proliferative retinopathy, once adjusted for other factors (odds ratio [OR] = 3.93, 95%, confidence limitations [CL] = 1.31-11.80). CONCLUSIONS Several socioeconomic and other factors were associated with diabetes, but few were related to diabetic retinopathy. Persons in the low-income group appeared to be at greater risk of diabetes and the ocular complications of diabetes compared with those with more income. Further longitudinal studies in this population are needed to confirm the associations.

Cataract and uveitis management by pars plana lensectomy and vitrectomy by ultrasonic fragmentation

OBJECTIVE To report for the first time a case series of vitreoretinal pathologic conditions after laser in situ keratomileusis (LASIK) and to determine its incidence. DESIGN Case series. PARTICIPANTS Five refractive surgeons and 29,916 eyes that underwent surgical correction of ametropia (83.2% were myopic) ranging from -0.75 to -29.00 diopters (D; mean: -6.19 D) and from +1.00 to +6.00 D (mean: +3.23 D) participated in this retrospective study. MAIN OUTCOME MEASURES Vitreoretinal complications after LASIK. RESULTS The clinical findings of 20 eyes (17 patients) with LASIK-related vitreoretinal pathologic conditions are presented. Fourteen eyes experienced rhegmatogenous retinal detachments (RDs). Two eyes experienced corneoscleral perforations with the surgical microkeratome when a corneal flap was being performed (one experienced a vitreous hemorrhage and the other later experienced an RD). In four eyes, retinal tears without RDs were found. In one eye, a juxtafoveal choroidal neovascular membrane (CNVM) developed. Retinal tears were treated with argon laser retinopexy or cryotherapy. Corneoscleral perforations were sutured, and the RD was managed with vitrectomy. The remaining RDs were managed with vitrectomy, cryoretinopexy, scleral buckling, argon laser retinopexy, or pneumatic retinopexy techniques. The CNVM was surgically removed. The incidence of vitreoretinal pathologic conditions determined in our study was 0.06%. CONCLUSIONS Serious complications after LASIK are infrequent. Vitreoretinal pathologic conditions, if managed promptly, will still result in good vision. It is very important to inform patients that LASIK only corrects the refractive aspect of myopia. Complications of the myopic eye will persist.

Sub-basal Corneal Nerve Plexus Analysis Using a New Software Technology

Cataract and uveitis occurs usually in young individuals and produces loss of vision from opacification of both the lens and vitreous. The condition does not lend itself to conventional surgery. In the experience of the authors and several other investigators, pars plana lensectomy and vitrectomy by ultrasonic fragmentation not only improves vision but apparently causes a remission of uveitis. A retrospective study of 23 eyes with cataract and uveitis undergoing pars plana lensectomy and vitrectomy by ultrasonic fragmentation (21 eyes) or vitrectomy alone (2 eyes) showed improved vision in 91.3%, no operative complications, and remission of the uveitis in 100% with observation periods of 1-11 years (average, 5 years). Pars plana lensectomy and vitrectomy appears to be the treatment of choice in cataract and chronic uveitis.

Pars Plana Lensectomy and Vitrectomy by Ultrasonic Fragmentation: Part III - Results in Eyes Without Other Ocular Pathology or an Implant

Purpose: To study sub-basal corneal nerve plexus (SCNP) parameters by in vivo corneal confocal microscopy using a new software technology and examine the effect of demographics and diabetes mellitus (DM) on corneal nerves morphology. Methods: A Confoscan 4 (Nidek Technologies) was used in this cross-sectional study to image the SCNP in 84 right eyes at the Miami Veterans Affairs eye clinic. Images were analyzed using a new semiautomated nerve analysis software program (The Corneal Nerve Analysis tool) which evaluated 9 parameters including nerve fibers length (NFL) and nerve fibers length density (NFLD). The main outcome measure was the examination of SCNP morphology by demographics, comorbidities, and HbA1c level. Results: Interoperator and intraoperator reproducibility were good for the 9 parameters studied (Intraclass Correlations [ICCs] 0.73–0.97). Image variability between two images within the same scan was good for all parameters (ICC 0.66–0.80). Older individuals had lower SCNP parameters with NFL and NFLD negatively correlating with age (r=−0.471, and −0.461, respectively, P<0.01 for all). Patients with diabetes had lower mean NFLD 10987.6 &mgr;m/mm2 (±3,284.6) and NFL 1,289.5 &mgr;m/frame (±387.2) compared with patients without diabetes (mean NFLD 15077.1 &mgr;m/mm2 [±4,261.3] and NFL 1750.0 &mgr;m/frame [±540.7]) (P<0.05 for all). HbA1c levels in patients with diabetes were inversely correlated with NFL and NFLD (r= −0.568, and −0.569, respectively, P<0.05 for all). Conclusions: The Corneal Nerve Analysis tool is a reproducible diagnostic software technique for the analysis of the SCNP with confocal microscopy. Older age, DM, and higher level of HbA1c were associated with a significant reduction in SCNP parameters.

The Prevalence of Glaucoma in a Population-Based Study of Hispanic Subjects: Proyecto VER

The records of 320 eyes without other ocular pathology undergoing pars plana lensectomy and vitrectomy by ultrasonic fragmentation for routine cataract extraction without an implant were reviewed retrospectively. Three hundred two (302/320-94.4%) had vision between 20/20-20/40. Reasons for vision less than 20/40 in 18/320 (5.6%) eyes included 5/320 (1.5%) with retinal detachments, 11/320 (3.4%) with clinically apparent cystoid maculopathy, 1/320 (0.3%) with a macular hole, and 1/320 (0.3%) with retained lens material. Comparison was made between 184 lensectomies performed by the original technique and 136 pars plana lensectomies performed by the modified technique. Vision between 20/20-20/40 was achieved by 168/184 (91.3%) of the original technique group versus 134/136 (98.5%) of the modified technique group. In the latter group, there was one retinal detachment (0.7%), one macular hole (0.7%) and no clinical cystoid maculopathy. Fluorescein angiography performed three months postoperatively in eyes having vision of 20/20-20/40 of the modified lensectomy group showed cystoid maculopathy in one eye which had undergone trauma-induced wound dehiscence.