Tung-Mei Kuang

Incidence and severity of iris pigmentation on latanoprost-treated glaucoma eyes.

PurposeThe purpose of the present study was to investigate the incidence and severity of iridial pigmentation under latanoprost topical use on brown eyes in Taiwan.MethodsRetrospective review study was conducted from April 1999 to October 2001 in the Department of Ophthalmology, Taipei Veterans General Hospital, Taiwan, for glaucoma clinic monthly follow-up patients; 140 open-angle glaucoma patients on 0.005% latanoprost were enrolled. Analyses of iridial pigmentation incidence, grading, patient age distribution, side effect, and time course were performed. Boys-Smith pigment gradation lens was used as standard for semiquantitative iris pigmentation grading.ResultBefore 0.005% latanoprost use, 90% of the patients enrolled were noted with iridial pigmentation grade I, and 10% were with grade I–II, but not reaching grade II scale standard. A total of 60 patients on 0.005% latanoprost developed increased pigmentation of the iris during the follow-up period. An increase of iris pigmentation was noted after an average of 7.27 months use of latanoprost (range 1–19 months, SD 2.65 months). For iridial pigmentation grading, 57.1, 30.7, 10.0, and 2.1% of our patients were noted to have grade I, II, III, and IV respectively. Most patients with latanoprost-induced iris hyperpigmentation were with grade II iridial pigmentation. There were 15 patients (10.7%) (10 female and five male) with hypertrichosis in the study group who were not compatible with the iridial pigmentation status. Among these patients, female patients had higher incidence of hypertrichosis than males, but this did not bother them. Only four patients (2.8%) were with conjunctiva chemosis and three patients (2.1%) with lid margin hyperpigmentation.ConclusionContrary to the belief that latanoprost rarely caused iris hyperpigmentation in yellow-brown eyes, our study showed that 42.8% iris hyperpigmentation did occur, especially after continual use for around 7 months. Higher hyperpigmentation incidence were noted in male than in female patients. This might be due to stronger adrenergic incidence in male than in female patients. Although hypertrichosis and increasing eyelid pigmentation together with iridial pigmentation represented a potentially permanent cosmetic side effect, they are very rare and occurred in no more than 3% in our patients. It is a good way to take Boys-Smith pigment gradation lens for iridial pigmentation grading and for long-term continual evaluation. The doctors should exert great care in differentiating drug-induced iris pigmentation and iris nevi from early stage uveal melanoma.

Visual Impairment and Falls in the Elderly: The Shihpai Eye Study

Background: To investigate the association between visual impairment and falls in a metropolitan elderly Chinese population. Methods: A population‐based cross‐sectional study of eye diseases among subjects 65 years of age and older was conducted in the Shihpai community of Taipei between July 1, 1999 and December 31, 2000. Results: Of the 2,045 subjects invited, 1,361 (66.6%) participated in both the questionnaire and the eye examination. Sixty‐two (4.6%; 95% confidence interval [CI], 3.4–5.7%) had experienced 2 or more falls in the previous 12 months. On univariate analysis, best‐corrected Snellen visual acuity of the better eye less than 6/12 (odds ratio [OR], 2.47; 95% CI, 1.18–5.18; p < 0.001), female gender (OR, 2.52; 95% CI, 1.49–4.26; p < 0.001), high waist‐to‐hip ratio (OR, 1.86; 95% CI, 1.00–3.47; p = 0.01), history of diabetes mellitus (OR, 3.88; 95% CI, 2.27–6.62; p < 0.001) and cardiovascular disease (OR, 2.26; 95% CI, 1.34–3.80; p = 0.04) were significantly related to falls. In the final multiple logistic regression model controlling for other covariates, visual impairment (OR, 1.98; 95% CI, 1.02–4.32; p < 0.001), female gender (OR, 2.34; 95% CI, 1.29–4.23; p < 0.01), history of diabetes (OR, 3.61; 95% CI, 2.03–6.40; p < 0.01) and cardiovascular disease (OR, 1.96; 95% CI, 1.13–3.40; p = 0.04) were significantly related to falls. Conclusion: Falls were significantly associated with a best‐corrected Snellen visual acuity of less than 6/12.

Impact of stereopsis on quality of life

PurposeTo investigate the impact of stereopsis on vision-related quality of life and general health status of the elderly.MethodsA quota of 200 subjects aged 65 years or older and had their households registered in Guando district was recruited for a general physical examination including ophthalmic evaluation. A structured questionnaire consisting of seven vision-specific items as well as 36-item short-form survey of the Medical Outcomes Study (SF-36) was administered. Stereoscopic level was divided into three groups: no stereopsis, gross stereopsis, and fine stereopsis. Fishers exact test was used to detect any difference in subjective visual functioning and Mann–Whitney U test was used for analyses of SF-36 scores.ResultsA total of 187 volunteers were recruited and 150 were analysed for stereoscopic levels. There was no significant difference in vision-specific difficulty among the three stereoscopic groups. For SF-36, having no stereopsis scored significantly less than having gross (P=0.005) and fine (P<0.0001) stereopsis in the vitality/energy dimension. General health perception dimension fared significantly lower in the group with no stereopsis compared to the fine stereoscopic group (P=0.01). In multivariate analysis, having fine stereopsis scored significantly higher in the energy/vitality dimension than having no stereopsis (P=0.02). On the other hand, visual impairment imposed significant adverse effect on five vision-specific items and had no significant relationship with the eight dimensions of SF-36.ConclusionsDefective stereopsis in the elderly imposes no significant adverse effect on vision-related quality of life. However, subjects may feel more exhausted in accomplishing their usual tasks.

Early and late endophthalmitis following trabeculectomy in a Chinese population.

Purpose To investigate the rate of bleb-related endophthalmitis over 5 years in a Chinese population. Methods Retrospective chart review. Results Of 988 trabeculectomies performed over 5 years, one case (0.1%) developed early endophthalmitis caused by Morganella morganii, which was rarely reported in the literature. Six cases (0.6%) developed late-onset endophthalmitis. Mitomycin C significantly increased the risk of late-onset endophthalmitis (p=0.0002). Conclusions Physicians should weigh the benefits against the risks of mitomycin C application in performing trabeculectomies.

Methylphenidate (Ritalin)-associated cataract and glaucoma.

Methylphenidate hydrochloride (Ritalin) is the drug of choice for attention deficit hyperactivity disorder (ADHD). However, an association of Ritalin with glaucoma has been reported. We report a case of Ritalin-associated cataract and glaucoma. A 10-year-old boy was diagnosed with ADHD and had received methylphenidate hydrochloride, 60 mg/day for 2 years. He presented with blurred vision. Best-corrected visual acuity was 6/60 in both eyes. Ocular examinations revealed intraocular pressure (IOP) of 30 mmHg under medication, dense posterior subcapsular opacity of lens, pale disc with advanced cupping, and marked constriction of visual field. Despite maximal anti-glaucomatous medication, IOP still could not be controlled. The patient then received combined cataract and glaucoma surgery. Visual acuity improved and IOP was within normal limits in both eyes postoperatively. Large dose of methylphenidate may cause cataract and glaucoma. The mechanism remains unclear. Doctors should be aware of the possible ocular side effects of methylphenidate.

Seven-Year Incidence of Age-Related Cataracts Among an Elderly Chinese Population in Shihpai, Taiwan: The Shihpai Eye Study

PURPOSE To report the 7-year incidence of age-related cataracts in a metropolitan Chinese elderly population. METHODS The Shihpai Eye Study 2006 included 460 (55.8%) of 1361 participants in the 1999 baseline survey for a follow-up eye examination. Cataract was graded by one ophthalmologist using the Lens Opacities Classification System III. RESULTS The 7-year incidence of pure nuclear opacity was 18.5% (95% confidence interval [CI]: 12.7%-24.3%)]; 34.7% (95% CI: 27.6%-41.8%) for cortical opacity; and 0.6% (95% CI: 0%-1.8%) for posterior subcapsular opacity. On the other hand, 11.6% (95% CI: 6.8%-16.4%) participants developed both nuclear and cortical opacity, 3.5% (95% CI: 0.8%-6.2%) nuclear and posterior subcapsular opacity; and 1.7% (95% CI: 0%-3.6%) cortical and posterior subcapsular opacity. A total of 3.5% (95% CI: 0.8%-6.2%) of participants developed all three types of cataract. Nuclear cataract was significantly associated with current smoking (P = 0.04; relative risk [RR]: 2.05; 95% CI: 1.05-3.99). Males were almost half as likely (P = 0.04; RR: 0.57; 95% CI: 0.34-0.97) to develop cortical opacity, whereas participants with a history of diabetes were approximately twice as likely to develop cortical opacity (P = 0.05; RR 2.43; 95% CI: 1.02-5.81). A higher level of education (P = 0.03; RR: 0.40; 95% CI: 0.18-0.91) and a higher body mass index (P = 0.02; RR: 0.28; 95% CI: 0.10-0.79) was protective of posterior subcapsular cataract. CONCLUSIONS This study indicated a high incidence of cortical opacities and lower incidence of nuclear opacities compared with Caucasians. Posterior subcapsular opacity incidence and cataract surgery rate were comparable.

The association of visual impairment and 3-year mortality among the elderly in Taiwan: The Shihpai Eye Study

Background The association between visual impairment and mortality has been controversial. Moreover, literature on the relationship was very limited in the Asian population. The purpose of this study was to investigate whether visual impairment increases the 3‐year risk of mortality in a cohort of urban Chinese elderly individuals. Methods Participants in the Shihpai Eye Study, who were aged ≥65 years, with a baseline examination conducted between July 1, 1999 and December 31, 2000, were recruited for the current study. The total number of possible participants identified was 4750. Of those, 3746 persons were eligible, and 2045 persons were randomly selected to be invited to participate in the study. Of those 2045 individuals, 1361 (66.6%) participated in both the questionnaire and eye examination. A follow‐up of a fixed cohort was also conducted after 3 years. The death of any participants was confirmed through the household registration system. Results Of the 1361 participants included at baseline, 54 (3.97%) died before the 3‐year follow‐up. Multiple logistic regression analysis showed that mortality was significantly associated with a fall history [relative risk (RR): 2.12; 95% confidence intervals (CI): 1.08–3.98] and a history of diabetes (RR: 2.06; 95% CI: 1.03–3.95). Visual impairment was not a significant predictor of mortality after adjustment for confounders. Conclusion After adjustments were made for age, sex, education, marital status, lifestyle factors, depression symptoms, fall history, and history of systemic diseases, visual impairment was not a significant predictor of 3‐year mortality in elderly persons.

Changes in refractive status in an elderly Chinese population in a 7-year follow-up: The Shihpai Eye Study

Background Refractive error is the major cause of moderate and severe visual impairment. Visual impairment limits peoples ability to perform daily tasks and affects their quality of life. Longitudinal data on the refractive status of the elderly was available only for whites and Africans. The purpose of this study was to report the 7‐year incidence of myopia, hyperopia and refractive error change as well as their associated risk factors in a metropolitan elderly Chinese population. Methods The Shihpai Eye Study 2006 included 460/824 (55.8%) subjects (age range 72–94 years old) of 1361 participants in the 1999 baseline survey for a follow‐up eye examination. Incidences were calculated for those who had emmetropia (−0.50D < spherical equivalent (SE) <+0.50D) at baseline. Refractive error change at 7 year was defined as (SE at the 7‐year visit – SE at baseline). Results 90 (26.4%) subjects were emmetropic, 61 (17.9%) were myopic and 190 (55.7%) hyperopic. The mean refractive error was 0.49 ± 2.19 D and the average change in refractive error was −0.13 ± 1.03 D. The incidence of myopia at seven‐year was 26.8 % [95% Confidence interval (C.I.): 22.8%–30.9%] and the incidence of hyperopia was 19.7% (95% C.I.: 16.1%–23.3%). Nuclear sclerosis (>Grade 2 vs. ≤Grade 2) [p < 0.0001; relative risk (RR): 8.94; 95% C.I.: 4.40–18.2], anterior chamber depth (mm) [p = 0.05; RR: 0.43; 95% C.I.: 0.18–1.01] and lens thickness (mm) [p < 0.01; RR: 2.35; 95% C.I.: 1.17–2.73] were significantly associated with myopic shift. On the other hand, hyperopic shift was significantly associated with cortical opacity (>Grade 2 vs. ≤Grade 2) (p = 0.02; RR: 1.21; 95% C.I.: 1.02–3.54). Conclusion In this elderly Asian population, there was on average a slight myopic shift. The incidence of myopia was comparable to population‐based studies of other ethnic groups, whereas the incidence of hyperopia was substantially higher.

Distribution and associated factors of optic disc diameter and cup-to-disc ratio in an elderly Chinese population

Background: Glaucoma is the second leading cause of blindness worldwide and East Asian people account for almost half of those affected. Vertical elongation of the optic cup is a characteristic feature of glaucoma. However, there is a significant overlap in the vertical cup‐to‐disc ratio (VCDR) between normal eyes and eyes affected by glaucoma. The purpose of this study was to determine the distribution of VCDR and vertical disc diameter (VDD) and their predictive factors in a population of elderly Chinese residents in Taiwan. Methods: Four hundred and sixty elderly Chinese residents aged 72 years and older in the Shihpai district, Taipei, Taiwan participated in this study. Slit lamp biomicroscopic measurement of the VCDR and VDD after pupil dilation with a 78 diopter lens was performed by one glaucoma specialist. Multiple linear regression analyses were used to fit the best model for independent variables. Results: The VCDR was recorded for 438 right eyes and 430 left eyes. After excluding participants with glaucoma, the mean ± SD VCDR was 0.44 ± 0.17 for both eyes, and the 97.5th percentile was 0.8. A greater VCDR was associated with a longer axial length [VCDR = −0.47 + 0.04(axial length)] under multiple regression analysis. The VDD was obtained for 420 right eyes and 406 left eyes. The mean ± SD VDD for all participants was 1.77 ± 0.22 mm for the right eye and 1.79 ± 0.22 mm for the left eye. A higher body mass index (BMI) and a longer axial length were significantly associated with a larger VDD under multiple regression analysis. [VDD = −0.05 + 0.07 (axial length) + 0.06 (obesity); if BMI <24, then obesity = 0; if BMI ≥24, then obesity = 1]. A larger VDD was associated with a larger VCDR (p < 0.001) and the VCDR could be predicted by the equation VCDR = −0.07 + 0.3VDD. Conclusion: A greater VCDR was related to a longer axial length. A greater VDD was related to a higher BMI and a longer axial length.

Angle Closure Glaucoma in High Myopic Eyes-Report of Two Cases

Purpose: High myopic patients with angle-closure glaucoma are uncommon. We reported two cases with angle closure and high myopia and evaluated their clinical characteristics. Possible mechanisms for angle closure were proposed in these atypical patients. Method: Two patients with myopic spherical equivalent of more than six diopters and angle closure were reviewed. Data recorded included age at time of initial consultation, gender, slit-lamp examination, gonioscopy, biometric parameters, clinical diagnosis, and therapy. Result: There are one female and one male. The mean age at the time of consultation was 69.5 years and the mean axial length was 25.26 mm. Mean anterior chamber depth was 2.47 mm. Mean lens thickness was 4.90 mm. Both of the patients were diagnosed with primary pupillary block. Conclusion: Angle closure in eyes with high myopia is uncommon but possible. Lens swelling related pupillary block is the possible cause in these patients. Careful gonioscopy accompanied by biometric examination can lead to the correct diagnosis and individualized management in these eyes.