Sarah R. Wellik

Surgical and refractive outcomes of cataract surgery with toric intraocular lens implantation at a resident-teaching institution.

PURPOSE: To evaluate the refractive and surgical outcomes of cataract surgery with toric intraocular lens (IOL) implantation performed at a teaching institution. SETTING: Miami Veterans Affairs Medical Center, Miami, Florida, USA. DESIGN: Retrospective case series. METHODS: All data were obtained by a retrospective chart review and entered into a standard computerized database for analysis. Main outcome measures included refractive and surgical outcomes after Acrysof toric IOL placement, including the deviation from the expected spherical and cylindrical correction and the incidence of ocular complications. RESULTS: The study comprised 94 eyes (80 patients). The mean deviation from the anticipated spherical correction (94 eyes) was +0.06 diopter (D) ± 0.8 (range −2.6 D to +3.6 D), with 80% of eyes achieving a spherical equivalent within ±1.00 D of the target refraction. The postoperative refractive cylinder was significantly reduced from baseline, with 79% of eyes having at least a 0.50 D improvement in astigmatism after surgery (P<.0005). The mean deviation from the anticipated refractive cylinder (85 eyes) was −0.48 ± 1.2 D (range −5.0 to +2.8 D). The IOL was placed in an incorrect position in 2 patients, requiring a reoperation with IOL rotation into the proper axis. The mean follow‐up was 7 months (range 1 to 28 months). CONCLUSION: The added complexity associated with toric IOL placement resulted in spherical and astigmatic improvements without compromising patient safety beyond a level inherent in resident‐based cataract surgery. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Reversal of Glaucoma Hemifield Test Results and Visual Field Features in Glaucoma

PURPOSEnTo develop a visual field (VF) feature model to predict the reversal of glaucoma hemifield test (GHT) results to within normal limits (WNL) after 2 consecutive outside normal limits (ONL) results.nnnDESIGNnRetrospective cohort study.nnnPARTICIPANTSnVisual fields of 44u2009503 eyes from 26u2009130 participants.nnnMETHODSnEyes with 3 or more consecutive reliable VFs measured with the Humphrey Field Analyzer (Swedish interactive threshold algorithm standard 24-2) were included. Eyes with ONL GHT results for the 2 baseline VFs were selected. We extracted 3 categories of VF features from the baseline tests: (1) VF global indices (mean deviation [MD] and pattern standard deviation), (2) mismatch between baseline VFs, and (3) VF loss patterns (archetypes). Logistic regression was applied to predict the GHT results reversal. Cross-validation was applied to evaluate the model on testing data by the area under the receiver operating characteristic curve (AUC). We ascertained clinical glaucoma status on a patient subset (nxa0= 97) to determine the usefulness of our model.nnnMAIN OUTCOME MEASURESnPredictive models for GHT results reversal using VF features.nnnRESULTSnFor the 16u2009604 eyes with 2 initial ONL results, the prevalence of a subsequent WNL result increased from 0.1% for MD <xa0-12 dB to 13.8% for MD ≥-3 dB. Compared with models with VF global indices, the AUC of predictive models increased from 0.669 (MD ≥-3 dB) and 0.697 (-6 dB ≤ MD <xa0-3 dB) to 0.770 and 0.820, respectively, by adding VF mismatch features and computationally derived VF archetypes (P < 0.001 for both). The GHT results reversal was associated with a large mismatch between baseline VFs. Moreover, the GHT results reversal was associated more with VF archetypes of nonglaucomatous loss, severe widespread loss, and lens rim artifacts. For a subset of 97 eyes, using our model to predict absence of glaucoma based on clinical evidence after 2 ONL results yielded significantly better prediction accuracy (87.7%; P < 0.001) than predicting GHT results reversal (68.8%) with a prescribed specificity 67.7%.nnnCONCLUSIONSnUsing VF features may predict the GHT results reversal to WNL after 2 consecutive ONL results.

Relationship between central corneal thickness and hypotony-related complications after glaucoma surgery.

BACKGROUND AND OBJECTIVEnTo examine the hypothesis that patients with increased central corneal thickness may have an overestimation of Goldmann applanation tension and a predisposition to hypotony-related complications.nnnPATIENTS AND METHODSnA case-control analysis of patients with an intraocular pressure of 7 mm Hg or less on two consecutive postoperative visits following glaucoma filtration or drainage implant surgery was performed. Forward stepwise multiple logistic regression was used to determine the model that best predicted hypotony-related complications defined as choroidal effusion or hypotony maculopathy.nnnRESULTSnForty-three eyes (17 with hypotony-related complications and 26 controls) of 43 patients were enrolled. Eyes with pseudophakia (P = .006) and lower postoperative intraocular pressure (P = .013) were significantly more likely to develop hypotony-related complications. Mean central corneal thickness was similar in eyes with hypotony-related complications (519 +/- 32 microm) and controls (525 +/- 37 microm) and was not a significant predictor of hypotony-related complications in the multivariate model (P = .90).nnnCONCLUSIONnIncreased central corneal thickness does not represent a risk factor for hypotony-related complications following glaucoma surgery.

The Effect of Patient Characteristics and Sleep Quality on Visual Field Performance Reliability

Purpose To investigate the association of automated visual field (VF) reliability indices (false positive [FP], false negative [FN], and fixation loss [FL]) and sleep quality, VF experience, and age. Methods Prospective, cross-sectional study. Adult patients (ageu2009≥u200918 years) completing automated VF testing were invited to participate. Baseline participant characteristics were obtained, and all participants were asked to complete the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Nonparametric Spearman correlations and logistical regression models were performed. Results 63 patients were enrolled. Lower PSQI score was correlated with higher percentage (%) FL in the right eye (p = 0.03). Fewer prior VF was significantly correlated with higher %FP in the right eye (p = 0.008). Older age was significantly correlated with higher %FN in the left eye (p = 0.01). Greater mean deviation (MD) and pattern standard deviation (PSD) were strongly correlated with higher %FN in the right (p = 0.02 and 0.002, resp.) and left eyes (p = 0.01 and 0.02, resp.). Conclusion In this prospective, cross-sectional study, worse MD and PSD are strongly correlated with increased FN in both eyes. Increased FN in the left eye associated with older age might be attributable to test fatigue. Worse sleep quality is associated with decreased FL in the right eye.

Impact of Natural Blind Spot Location on Perimetry

We study the spatial distribution of natural blind spot location (NBSL) and its impact on perimetry. Pattern deviation (PD) values of 11,449 reliable visual fields (VFs) that are defined as clinically unaffected based on summary indices were extracted from 11,449 glaucoma patients. We modeled NBSL distribution using a two-dimensional non-linear regression approach and correlated NBSL with spherical equivalent (SE). Additionally, we compared PD values of groups with longer and shorter distances than median, and larger and smaller angles than median between NBSL and fixation. Mean and standard deviation of horizontal and vertical NBSL were 14.33°u2009±u20091.37° and −2.06°u2009±u20091.27°, respectively. SE decreased with increasing NBSL (correlation: ru2009=u2009−0.14, pu2009<u20090.001). For NBSL distances longer than median distance (14.32°), average PD values decreased in the upper central (average difference for significant points (ADSP): −0.18u2009dB) and increased in the lower nasal VF region (ADSP: 0.14u2009dB). For angles in the direction of upper hemifield relative to the median angle (−8.13°), PD values decreased in lower nasal (ADSP: −0.11u2009dB) and increased in upper temporal VF areas (ADSP: 0.19u2009dB). In conclusion, we demonstrate that NBSL has a systematic effect on the spatial distribution of VF sensitivity.