Robert H. Kennedy

Blindness and glaucoma: a comparison of patients progressing to blindness from glaucoma with patients maintaining vision.

PURPOSE To compare patients becoming legally blind from glaucoma with those who did not go blind. DESIGN Retrospective, cohort, and case-control study. METHODS A retrospective community-based longitudinal study of residents of Olmsted County, Minnesota, who were newly diagnosed with open-angle glaucoma between 1965 and 1980 and followed through 1998. A case-control study was performed comparing patients progressing to legal blindness from glaucoma with aged-matched and visual field-matched patients not progressing to blindness. RESULTS Fifty-six of 290 patients progressed to legal blindness in at least one eye over the 34-year period of the study. Most who progressed to blindness had moderate to advanced visual field loss at the time of diagnosis of glaucoma. Those becoming legally blind had mean intraocular pressures (IOP) on therapy lower than or similar to patients who did not go blind, although the variability of IOP was higher in the blind group. Different susceptibilities to IOP were apparent, as some eyes with initially normal disks and visual fields became blind at an IOP of 20 mm, while others did not worsen. Changes in medical therapy after progression of visual field damage were less effective in lowering IOP in the group becoming blind than in the nonblind group. CONCLUSIONS Patients at greatest risk of blindness had visual field loss at the time of diagnosis of glaucoma. Different susceptibilities to IOP were apparent, with some patients becoming blind at pressures that others tolerated without significant progression. This suggests that continued monitoring of visual fields and reassessment of target IOP levels when field damage occurs are fundamental in the management of glaucoma.

Orbital implants in enucleation surgery: A report by the american academy of ophthalmology☆

OBJECTIVE To compare prosthetic and implant motility and the incidence of complications associated with porous and nonporous enucleation implants. METHODS Literature searches conducted in January 2002 for 1985 to 2001 and May 2002 for October 2001 to 2002 retrieved relevant citations. The searches were conducted in MEDLINE and limited to articles published in English with abstracts. Panel members reviewed the articles for relevance to the assessment questions, and those considered relevant were rated according to the strength of the evidence. RESULTS A randomized clinical trial and a longitudinal cohort study detected no difference in implant or prosthetic movement between nonpegged hydroxyapatite porous and spherical alloplastic nonporous implants. No controlled studies were retrieved that investigated whether pegging porous implants improves prosthetic movement. Several case series indicate that patients with pegged hydroxyapatite implants have some degree of improved prosthetic motility. Longitudinal cohort studies show that sclera-covered hydroxyapatite implants have higher exposure rates than sclera-covered silicone implants, and unwrapped porous polyethylene implants have higher exposure rates than unwrapped acrylic implants. There are numerous case series that document a wide range of implant exposure rates in patients with various enucleation implants. It is difficult to compare complication rates among implant types because patient populations vary, surgical techniques differ, and follow-up periods are often limited. CONCLUSIONS Based on one randomized clinical trial, spherical alloplastic nonporous and nonpegged porous enucleation implants provide similar implant and prosthetic motility when they are implanted using similar surgical techniques. Coupling the prosthesis to a porous implant with a motility peg or post appears to improve prosthetic motility, but there are few available data in the literature that document the degree of the improvement. There is a widely variable incidence of porous implant exposure, but certain surgical techniques and the type of wrapping material seem to reduce the exposure rate. Additional research is needed to document the long-term incidence of complications related to porous enucleation implants and associated surgical techniques. This includes the use of wrapping materials and what procedural modifications, both surgical and prosthetic, are most effective in reducing these complications.

Epidermal growth factor messenger RNA production in human lacrimal gland.

Experimental models and clinical investigations have suggested that epidermal growth factor (EGF) may have a role in corneal wound healing. It has been identified as a normal component of human tears. Rabbit and mouse lacrimal glands have recently been shown to synthesize EGF messenger RNA (mRNA). The purpose of the present study was to determine whether the human lacrimal gland synthesizes EGF mRNA. Total cellular RNA was isolated from pathologic specimens of normal human lacrimal glands from two individuals. Reverse transcriptase was used to generate complementary DNA (cDNA) using a human EGF-specific mRNA primer. Amplification of EGF-related cDNA sequences was performed with the polymerase chain reaction (PCR) and human EGF-derived up- and downstream primers. The PCR products from both lacrimal glands contained an amplified product of the expected length of approximately 410 base pairs. The PCR-generated fragment was verified as an EGF-related amplification product with Southern blotting using a synthetic oligonucleotide probe derived from the mature coding sequence of EGF. These results conclusively demonstrate that the human lacrimal gland synthesizes EGF and suggest that the lacrimal gland could have a regulatory role in maintaining the ocular surface and possibly regulating corneal wound healing through the secretion of EGF.

Estimated incidence of open-angle glaucoma in Olmsted County, Minnesota

PURPOSE To determine the incidence rates of open-angle glaucoma (OAG) in Olmsted County, MINNESOTA: DESIGN Retrospective population-based estimate of incidence. PARTICIPANTS From the medical histories of 60,666 residents of Olmsted County, Minnesota, who had ocular diagnoses during the study period, 114 subjects with newly diagnosed OAG were identified. METHODS The database of the Rochester Epidemiology Project was used to identify all Olmsted County residents with a coded diagnosis of OAG, glaucoma suspect, or ocular hypertension during the period 1965 to 1980. Subjects newly diagnosed with and treated for OAG who also had documented clinical evidence of elevated intraocular pressure, optic nerve damage, and/or visual field loss consistent with glaucoma were included as incident cases. Population data for Olmsted County were drawn from United States Census data. Crude incidence data were adjusted to the age and gender distribution of the 1990 United States white population. MAIN OUTCOME MEASURES Estimated incidence rates of OAG. RESULTS The overall age- and gender-adjusted annual incidence rate of OAG in a predominantly Caucasian population is conservatively estimated to be 14.5 per 100,000 population. The rates increased with age from 1.6 in the fourth decade of life to 94.3 in the eighth decade. There was no significant difference in incidence by gender. The average annual rate of OAG in the last 2 years of the study was 27.7 compared with 12.3 before 1979. This difference is suggestive of the effect of the introduction of a new medical therapy (timolol) for OAG during the last 2 years. CONCLUSIONS The incidence rates of OAG increase markedly with advancing age, and screening efforts should be targeted at both men and women in the older age groups. The advent of new diagnostic and therapeutic modalities can have an effect on incidence rates.

Addendum to ???Benefits of Specular Microscopy in Evaluating Eye Donors Aged 66 and Older??????

In the United States of America and worldwide, supplies of quality donor corneas continue to lag behind the demand. Some of what appears to be a shortage in the U.S.A. is really due to the custom of many surgeons to use only tissue from younger donors, thus creating an unnecessary waiting list. In reality, we do have a sizable pool of good donors in the older age group. With improved evaluation techniques, it is possible to identify these donors and to add their tissue to the supply of available corneas. This study shows that large numbers of corneas from donors over the age of 65 can be used successfully to restore vision. Specular microscopy provides valuable quantitative data to the surgeon, who ultimately makes the decision about the suitability of the donor tissue. For an eye bank, specular microscopy makes it easier to place older tissue, resulting in shorter waiting lists.