Journal Contents

Am Jour Ophthalmol
Br J Ophthalmol
Can J Ophthalmol
J Cat Ref Surg
Curr Eye Res
Eur J Ophthalmol
J Glaucoma
JAMA Ophthalmol
Graefes Ophthalmol
Indian J Ophthalmol
Int Ophthalmol Clin
Invest Ophth Vis Sci
Jpn J Ophthalmol
Korean J Ophthal
J Neuroophthalmol
Ophthalmic Epidemiol
Ophthalmic Genet
Ophthal Plast Rec Surg
Ophthalmic Res
Surv Ophthalmol
Ophthalmology Review Journal
Eye[JOUR] Established 1995
1. Eye (Lond). 2015 Jun 26. doi: 10.1038/eye.2015.107. [Epub ahead of print]

Comparison of two- and three-point sutures for advancing the levator aponeurosis 
in Asian eyelids.

Kim YS(1), Yoon JS(2), Jang SY(3).

Author information: 
(1)Department of Ophthalmology, Soonchunhyang University Bucheon Hospital,
Soonchunhyang University College of Medicine, Bucheon, Korea. (2)Department of
Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei
University College of Medicine, Seoul, Korea. (3)1] Department of Ophthalmology, 
Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of
Medicine, Bucheon, Korea [2] Yonsei University Graduate School of Medicine,
Seoul, Korea.

PurposeTo compare the functional and cosmetic outcomes of two- and three-point
sutures for advancing the levator aponeurosis in blepharoptosis surgery on
Asians.Patients and methodsThis retrospective study examined 60 Asian patients
with blepharoptosis who had undergone advancement of the levator aponeurosis: 34 
patients (46 eyelids) had ptosis correction using the two-point suture technique 
and 26 patients (41 eyelids) had ptosis correction using the three-point suture
technique. The postoperative marginal reflex distance (MRD1), lid height
difference, and eyelid contour were evaluated.ResultsTwenty-seven (79.4%) of the 
34 patients in the two-point group and 19 (73.1%) of 26 patients in the
three-point group had a postoperative MRD1 of 2-4 mm, lids within 0.5 mm of each 
other, and a satisfactory eyelid contour; this difference was not significant.
The rate of reoperation did not differ significantly between the two
groups.ConclusionTwo- and three-point sutures for advancing the levator
aponeurosis were equally effective for correcting blepharoptosis in Asians.Eye
advance online publication, 26 June 2015; doi:10.1038/eye.2015.107.

PMID: 26113504   [PubMed - as supplied by publisher]

2. Eye (Lond). 2015 Jun 26. doi: 10.1038/eye.2015.98. [Epub ahead of print]

Long-term outcomes of phakic patients with diabetic macular oedema treated with
intravitreal fluocinolone acetonide (FAc) implants.

Yang Y(1), Bailey C(1), Holz FG(1), Eter N(1), Weber M(1), Baker C(1), Kiss S(1),
Menchini U(1), Ruiz Moreno JM(1), Dugel P(1), Lotery A(1).

Author information: 
(1)Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, UK.

PurposeDiabetic macular oedema (DMO) is a leading cause of blindness in
working-age adults. Slow-release, nonbioerodible fluocinolone acetonide (FAc)
implants have shown efficacy in the treatment of DMO; however, the National
Institute for Health and Care Excellence recommends that FAc should be used in
patients with chronic DMO considered insufficiently responsive to other available
therapies only if the eye to be treated is pseudophakic. The goal of this
analysis was to examine treatment outcomes in phakic patients who received
0.2 μg/day FAc implant.MethodsThis analysis of the phase 3 FAME (Fluocinolone
Acetonide in Diabetic Macular Edema) data examines the safety and efficacy of FAc
implants in patients who underwent cataract extraction before (cataract before
implant (CBI) group) or after (cataract after implant (CAI) group) receiving the 
implant. The data were further examined by DMO duration.ResultsBest corrected
visual acuity (BCVA) after 36 months was comparable in the CAI and CBI groups.
Both the percentage of patients gaining ≥3 lines of vision and mean change in
BCVA letter score were numerically greater in the CAI group. In addition, most
patients who underwent cataract surgery experienced a net gain in BCVA from
presurgery baseline as well as from original study baseline.ConclusionsThese data
support the use of 0.2 μg/day FAc implants in phakic as well as in pseudophakic
patients. These findings will serve as a pilot for design of future studies to
evaluate the potential protective effect of FAc implants before cataract surgery 
in patients with DMO and cataract.Eye advance online publication, 26 June 2015;

PMID: 26113503   [PubMed - as supplied by publisher]

3. Eye (Lond). 2015 Jun 26. doi: 10.1038/eye.2015.93. [Epub ahead of print]

Diverse clinical phenotypes associated with a nonsense mutation in FAM161A.

Rose AM(1), Sergouniotis P(2), Alfano G(1), Muspratt-Tucker N(1), Barton S(3),
Moore AT(4), Black G(3), Bhattacharya SS(1), Webster AR(4).

Author information: 
(1)Department of Genetics, UCL Institute of Ophthalmology, London, UK. (2)1]
Department of Genetics, UCL Institute of Ophthalmology, London, UK [2] Department
of Genetic Medicine, Central Manchester University Hospitals, Manchester, UK.
(3)Department of Genetic Medicine, Central Manchester University Hospitals,
Manchester, UK. (4)1] Department of Genetics, UCL Institute of Ophthalmology,
London, UK [2] Department of Medical Retina Service, Moorfields Eye Hospital,
London, UK.

PURPOSE: Mutations in the FAM161A gene have been reported in association with
autosomal recessive retinitis pigmentosa (arRP) in several ethnic populations.
This study aimed to assess the prevalence of FAM161A-related retinopathy in a
British cohort and to characterise the phenotype associated with mutations in
this gene.
METHODS: The FAM161A coding region and intron-exon boundaries were screened by
Sanger sequencing in 120 retinitis pigmentosa (RP) patients (with likely
autosomal recessive inheritance) in whom mutations in other known major RP genes 
have been ruled out by commercially available testing. Homozygosity mapping was
performed in one consanguineous family, and high-throughput sequencing of
candidate genes was performed to identify disease-associated changes. Clinical
assessment of affected individuals included perimetry testing, fundus
autofluorescence imaging, and optical coherence tomography.
RESULTS: Two patients of British origin with a homozygous mutation in FAM161A
(c.1309A>T, p.Arg437*) were identified by Sanger sequencing. Homozygosity mapping
and subsequent high-throughput sequencing analysis identified a further family of
Pakistani origin with the same genotype. Clinical examination of affected members
of these families revealed that this mutation was associated with a diverse
clinical phenotype, ranging from mild disease with preservation of central acuity
to severe visual impairment.
CONCLUSIONS: Homozygosity for the c.1309A>T, p.Arg437* variant in FAM161A is a
relatively common cause of arRP. The mutation occurs in diverse ethnic
populations, associated with typical retinitis pigmentosa with disease onset
usually in the second or third decade of life.Eye advance online publication, 26 
June 2015; doi:10.1038/eye.2015.93.

PMID: 26113502   [PubMed - as supplied by publisher]

4. Eye (Lond). 2015 Jun 26. doi: 10.1038/eye.2015.111. [Epub ahead of print]

Insertion of sequential glaucoma drainage implant in a piggyback manner.

Välimäki J(1).

Author information: 
(1)Department of Ophthalmology, Päijät-Häme Central Hospital, Lahti, Finland.

PurposeThis pilot study, the first of its type, was conducted to determine the
clinical outcome of a sequential glaucoma drainage implant (GDI) inserted in
piggyback manner, that is into the bleb of a primary GDI.MethodsThis was a
retrospective chart study with a minimum 1-year follow-up involving 16 eyes of 14
uncontrolled glaucoma patients who had previously undergone sequential GDI
performed using a technique to convert a one-plate into a two-plate implant
system. Surgical success was defined as intraocular pressure (IOP) <21 mm Hg with
at least a 30% reduction in IOP from baseline on two consecutive follow-up
visits, IOP >5 mm Hg on two consecutive follow-up visits, and neither reoperation
of glaucoma nor loss of light perception vision.ResultsThe mean ±SD baseline IOP 
was 29.2±5.2 mm Hg, and the mean postoperative IOP was 17.3±3.4 mm Hg, with a
mean pressure drop of 39.4±10.4% (P<0.001). Life-table analysis showed an 88%
success rate after 12 months of follow-up. The mean preoperative best corrected
visual acuity (BCVA) was 0.2±0.2 logMAR (Snellen equivalent 6/9.5), compared with
0.3±0.3 logMAR postoperatively (Snellen equivalent 6/12; P=0.497). Postoperative 
complications included a flat anterior chamber and choroidal detachment (one
eye), uveitis and cataract (one eye), diplopia (one eye), and worsening of
pre-existing pseudophakic bullous keratopathy (one eye).ConclusionsIn glaucoma
eyes with useful vision the piggyback GDI seems to provide a significant IOP
lowering with minimal complications in patients in whom an initial GDI had failed
to control the IOP.Eye advance online publication, 26 June 2015;

PMID: 26113501   [PubMed - as supplied by publisher]

5. Eye (Lond). 2015 Jun 26. doi: 10.1038/eye.2015.110. [Epub ahead of print]

A review of therapies for diabetic macular oedema and rationale for combination

Amoaku WM(1), Saker S(1), Stewart EA(1).

Author information: 
(1)Academic Ophthalmology, Division of Clinical Neuroscience, University of
Nottingham, Queen's Medical Centre, Nottingham, UK.

Diabetic macular oedema (DMO) is responsible for significant visual impairment in
diabetic patients. The primary cause of DMO is fluid leakage resulting from
increased vascular permeability through contributory anatomical and biochemical
changes. These include endothelial cell (EC) death or dysfunction, pericyte loss 
or dysfunction, thickened basement membrane, loss or dysfunction of glial cells, 
and loss/change of EC Glycocalyx. The molecular changes include increased
reactive oxygen species, pro-inflammatory changes: advanced glycation end
products, intracellular adhesion molecule-1, Complement 5-9 deposition and
cytokines, which result in increased paracellular permeability, tight junction
disruption, and increased transcellular permeability. Laser photocoagulation has 
been the mainstay of treatment until recently when pharmacological treatments
were introduced. The current treatments for DMO target reducing vascular leak in 
the macula once it has occurred, they do not attempt to treat the underlying
pathology. These pharmacological treatments are aimed at antagonising vascular
endothelial growth factor (VEGF) or non-VEGF inflammatory pathways, and include
intravitreal injections of anti-VEGFs (ranibizumab, aflibercept or bevacizumab)
or steroids (fluocinolone, dexamethasone or triamcinolone) as single therapies.
The available evidence suggests that each individual treatment modality in DMO
does not result in a completely dry macula in most cases. The ideal treatment for
DMO should improve vision and improve morphological changes in the macular (eg,
reduce macular oedema) for a significant duration, reduced adverse events,
reduced treatment burden and costs, and be well tolerated by patients. This
review evaluates the individual treatments available as monotherapies, and
discusses the rationale and potential for combination therapy in DMO. A
comprehensive review of clinical trials related to DMO and their outcomes was
completed. Where phase III randomised control trials were available, these were
referenced, if not available, phase II trials have been included.Eye advance
online publication, 26 June 2015; doi:10.1038/eye.2015.110.

PMID: 26113500   [PubMed - as supplied by publisher]

6. Eye (Lond). 2015 Jun 26. doi: 10.1038/eye.2015.115. [Epub ahead of print]

New and emerging technologies for the treatment of inherited retinal diseases: a 
horizon scanning review.

Smith J(1), Ward D(1), Michaelides M(2), Moore AT(2), Simpson S(1).

Author information: 
(1)NIHR Horizon Scanning Centre, University of Birmingham, School of Health and
Population Sciences, Birmingham, UK. (2)1] UCL Institute of Ophthalmology,
London, UK [2] Moorfields Eye Hospital, London, UK.

The horizon scanning review aimed to identify new and emerging technologies in
development that have the potential to slow or stop disease progression and/or
reverse sight loss in people with inherited retinal diseases (IRDs). Potential
treatments were identified using recognized horizon scanning methods. These
included a combination of online searches using predetermined search terms,
suggestions from clinical experts and patient and carer focus groups, and contact
with commercial developers. Twenty-nine relevant technologies were identified.
These included 9 gene therapeutic approaches, 10 medical devices, 5
pharmacological agents, and 5 regenerative and cell therapies. A further 11
technologies were identified in very early phases of development (typically phase
I or pre-clinical) and were included in the final report to give a complete
picture of developments 'on the horizon'. Clinical experts and patient and carer 
focus groups provided helpful information and insights, such as the availability 
of specialised services for patients, the potential impacts of individual
technologies on people with IRDs and their families, and helped to identify
additional relevant technologies. This engagement ensured that important areas of
innovation were not missed. Most of the health technologies identified are still 
at an early stage of development and it is difficult to estimate when treatments 
might be available. Further, well designed trials that generate data on efficacy,
applicability, acceptability, and costs of the technologies, as well as the
long-term impacts for various conditions are required before these can be
considered for adoption into routine clinical practice.Eye advance online
publication, 26 June 2015; doi:10.1038/eye.2015.115.

PMID: 26113499   [PubMed - as supplied by publisher]

7. Eye (Lond). 2015 Jun 26. doi: 10.1038/eye.2015.106. [Epub ahead of print]

Detection of asymmetric glaucomatous damage using automated pupillography, the
swinging flashlight method and the magnified-assisted swinging flashlight method.

Waisbourd M(1), Lee B(1), Ali MH(1), Lu L(1), Martinez P(1), Faria B(1), Williams
A(1), Moster MR(1), Katz LJ(1), Spaeth GL(1).

Author information: 
(1)Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.

PurposeTo determine the sensitivity and specificity of various methods of
detecting a relative afferent pupillary defect (RAPD) in patients with
glaucoma-related diagnoses.Patients and methodsPatients underwent RAPD evaluation
using the swinging flashlight method (SFM), the magnifier-assisted SFM, and
pupillography using the Konan RAPDx. Main outcome measures were sensitivity and
specificity of three methods of RAPD evaluation in detecting visual field mean
deviation (MD), cup to disc ratio (CDR), disc damage likelihood scale (DDLS), and
retinal nerve fiber layer (RNFL) asymmetry.ResultsEighty-one consecutive patients
from the Wills Eye Hospital glaucoma service were enrolled, 60 with glaucoma and 
21 with ocular hypertension or glaucoma suspect. Thirty-one percent of subjects
had MD asymmetry>5 dB, 19.7% had CDR asymmetry≥0.20, 26.7% had DDLS asymmetry≥2, 
and 38.2% had RNFL asymmetry>10 microns. Sensitivity values for pupillography
were 93.3% (95% CI, 68.1-99.8) for detecting MD asymmetry, 80.0% (95% CI,
51.9-95.7) for CDR asymmetry, 100.0% (95% CI, 73.5-100.0) for DDLS asymmetry, and
69.2% (95% CI, 38.6-90.9) for RNFL asymmetry. Specificity values were 41.2% (95% 
CI, 24.7-59.3) for detecting MD asymmetry, 32.8% (95% CI, 21.3-46.0) for CDR
asymmetry, 33.3% (95% CI, 18.0-51.8) for DDLS asymmetry, and 42.9% (95% CI,
21.8-66.0) for RNFL asymmetry. Pupillography amplitude score was correlated with 
MD asymmetry (r(2)=0.41, P<0.001) and area under the curve was
0.84.ConclusionAutomated pupillography had higher sensitivity and lower
specificity in detecting MD, CDR, DDLS, and RNFL asymmetry. Within the bounds of 
the cohort tested, this method had limited case-finding ability.Eye advance
online publication, 26 June 2015; doi:10.1038/eye.2015.106.

PMID: 26113498   [PubMed - as supplied by publisher]

8. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.103. [Epub ahead of print]

In vivo detection of clinically non-apparent ocular surface inflammation in
patients with meibomian gland dysfunction-associated refractory dry eye symptoms:
a pilot study.

Qazi Y(1), Kheirkhah A(1), Blackie C(2), Cruzat A(1), Trinidad M(1), Williams
C(1), Korb DR(2), Hamrah P(1).

Author information: 
(1)Ocular Surface Imaging Center, Cornea Service, Massachusetts Eye and Ear
Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA. 
(2)Korb Associates, Boston, MA, USA.

PurposeThe utility of in vivo confocal microscopy (IVCM) in the investigation of 
palpebral conjunctival and corneal inflammation in patients with meibomian gland 
dysfunction (MGD)-associated refractory dry eye symptoms following gland
expression, despite objective clinical improvement.MethodsA retrospective,
observational pilot study was conducted evaluating five patients with
MGD-associated refractory dry eye symptoms and three control groups: symptomatic 
untreated MGD patients (n=3), treatment-responsive MGD patients with improved
symptoms (n=3) and asymptomatic healthy normals (n=11). Ocular surface disease
index (OSDI) scores, tear break-up time (TBUT), the number of meibomian glands
yielding liquid secretion (MGYLS), palpebral conjunctival epithelial and
substantia propria immune cell (EIC, SIC), and corneal dendritic cell (DC)
densities were measured.ResultsDespite clinical improvement (TBUT: 6.4±1.2 s to
10.1±2.1 s, P=0.03; MGYLS: 3.5±0.8 glands to 7.0±1.1 glands, P=0.13) and a normal
clinical examination post treatment, MGD patients remained symptomatic. IVCM
revealed increased immune cells in the palpebral conjunctiva (refractory MGD
EIC=592.6±110.1 cells/mm(2); untreated MGD EIC=522.6±104.7 cells/mm(2), P=0.69;
responsive MGD EIC=194.9±119.4 cells/mm(2), P<0.01; normals EIC=123.7±19.2
cells/mm(2), P< 0.001), but not the cornea (refractory MGD DC=60.9±28.3
cells/mm(2); normals DC=25.9±6.3 cells/mm(2); P=0.43). EIC did not correlate with
TBUT (Rs=-0.26, P=0.33). OSDI scores correlated with both EIC (Rs=0.76, P<0.001) 
and TBUT (Rs=-0.69, P<0.01) but not SIC. Intraglandular immune cells were also
seen.ConclusionMGD-associated refractory symptoms and the symptom-sign disparity 
may be explained by clinically non-apparent, active inflammation of the palpebral
conjunctiva as detected by IVCM. These patients may benefit from
anti-inflammatory therapy.Eye advance online publication, 19 June 2015;

PMID: 26088680   [PubMed - as supplied by publisher]

9. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.100. [Epub ahead of print]

Dementia of the eye: the role of amyloid beta in retinal degeneration.

Ratnayaka JA(1), Serpell LC(2), Lotery AJ(1).

Author information: 
(1)Clinical and Experimental Science, Faculty of Medicine, University of
Southampton, Southampton, UK. (2)School of Life Sciences (Biochemistry, Dementia 
Research Group), University of Sussex, Brighton, UK.

Age-related macular degeneration (AMD) is one of the most common causes of
irreversible blindness affecting nearly 50 million individuals globally. The
disease is characterised by progressive loss of central vision, which has
significant implications for quality of life concerns in an increasingly ageing
population. AMD pathology manifests in the macula, a specialised region of the
retina, which is responsible for central vision and perception of fine details.
The underlying pathology of this complex degenerative disease is incompletely
understood but includes both genetic as well as epigenetic risk factors. The
recent discovery that amyloid beta (Aβ), a highly toxic and aggregate-prone
family of peptides, is elevated in the ageing retina and is associated with AMD
has opened up new perspectives on the aetiology of this debilitating blinding
disease. Multiple studies now link Aβ with key stages of AMD progression, which
is both exciting and potentially insightful, as this identifies a
well-established toxic agent that aggressively targets cells in degenerative
brains. Here, we review the most recent findings supporting the hypothesis that
Aβ may be a key factor in AMD pathology. We describe how multiple Aβ reservoirs, 
now reported in the ageing eye, may target the cellular physiology of the retina 
as well as associated layers, and propose a mechanistic pathway of Aβ-mediated
degenerative change leading to AMD.Eye advance online publication, 19 June 2015; 

PMID: 26088679   [PubMed - as supplied by publisher]

10. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.99. [Epub ahead of print]

Cup-to-disc and arteriole-to-venule ratios in preterm birth.

Kim J(1), Choi DY(2), Park KA(2), Oh SY(2).

Author information: 
(1)1] Laboratory of Vascular Biology and Stem Cells, Graduate School of Medical
Science and Engineering, Korea Advanced Institute of Science and Technology
(KAIST), Daejeon, Republic of Korea [2] Department of Ophthalmology, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of
Korea. (2)Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Republic of Korea.

AimsTo investigate the influence of preterm birth on the optic disc and retinal
vessels by measurements of cup-to-disc (C/D) ratio and arteriole-to-venule (A/V) 
ratio.MethodsEighty-three eyes of 42 preterm births were included. In the age-
and sex-matched control group, 83 eyes of 42 full-term births were used. Fundus
color photographs were taken. ImageJ software was used to calculate C/D and A/V
ratios from the fundus images.ResultsFundus photographs were taken at 8.01±2.22
years of age for the preterm group and 8.01±2.13 years of age for the control
group. The mean gestational age of the preterm group was 27(4)/7 weeks (range,
24-34 weeks). The preterm group had significantly larger C/D ratio and smaller
A/V ratio (mean±standard deviation: 0.46±0.12 and 0.59±0.08, respectively) than
the control group (0.36±0.07 and 0.68±0.07, respectively) after spherical
equivalent refractive error was adjusted.ConclusionsPreterm birth is
significantly associated with larger C/D ratio and smaller A/V ratio. These
findings show the effect of preterm birth on the development of optic disc and
retinal vessel development.Eye advance online publication, 19 June 2015;

PMID: 26088678   [PubMed - as supplied by publisher]

11. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.102. [Epub ahead of print]

Reply to 'Factors influencing the outcome of polypoidal choroidal vasculopathy
following combined treatment with photodynamic therapy and intravitreal

Ho M(1), Lo EC(1), Young AL(1), Liu DT(1).

Author information: 
(1)Dennis Lam & Partners Eye Center, Hong Kong, China.

PMID: 26088677   [PubMed - as supplied by publisher]

12. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.97. [Epub ahead of print]

A novel imaging approach to periocular basal cell carcinoma: in vivo optical
coherence tomography and histological correlates.

Pelosini L(1), Smith HB(1), Schofield JB(2), Meeckings A(3), Dithal A(1),
Khandwala M(1).

Author information: 
(1)Ophthalmology Department, Maidstone & Tunbridge Wells NHS Trust, Maidstone,
Kent, UK. (2)Histopathology Department, Maidstone & Tunbridge Wells NHS Trust,
Maidstone, Kent, UK. (3)Michaelson Diagnostics Ltd, 11A Grays Farm Production
Village, Orpington, Kent, UK.

PurposeOptical coherence tomography (OCT) is a non-invasive imaging method widely
used in ophthalmology. Recent developments have produced OCT devices for imaging 
the skin. The purpose of this study was to investigate Fourier Domain OCT
morphological features of periocular basal cell carcinoma (BCC) in correlation
with conventional histopathology.MethodsConsecutive patients with periocular
nodular BCC were prospectively examined with VivoSight OCT (Michelson Ltd) prior 
to surgical excision. OCT slice mode images were analysed using criteria defined 
for conventional and HD-OCT; the images were correlated to haematoxylin and eosin
stained histology sections.ResultsA total of 15 patients with periocular BCC were
recruited. Three categories of BCC morphological features were identified from
slice mode OCT images: 1) Epidermal changes included epidermal thinning (15/15;
100%), ulceration and crusting (5/15, 33.3%) and decreased density of hair
follicles (8/15; 53.3%); 2) Intralesional features included hyporeflective
nodules (15/15; 100%), hyper-reflective edges (15/15; 100%) and hyporeflective
central necrosis (3/15; 20%) 3) Perilesional features included hyporeflective
borders (11/15; 73%), hypereflective margins (15/15; 100%) and dilated blood
vessels (5/15; 33%).ConclusionsThis study demonstrated that Fourier Domain OCT
imaging offers additional information in the identification of morphological
features of nodular BCC compared to conventional OCT diagnostic criteria.
VivoSight produced fast, non-invasive imaging of skin lesions in the periocular
region and high correlation with histology. Further studies are necessary to
investigate OCT features of different histological subtypes of BCC.Eye advance
online publication, 19 June 2015; doi:10.1038/eye.2015.97.

PMID: 26088676   [PubMed - as supplied by publisher]

13. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.85. [Epub ahead of print]

Ocular pulse amplitude as a diagnostic adjunct in giant cell arteritis.

Knecht PB(1), Bachmann LM(2), Thiel MA(3), Landau K(1), Kaufmann C(3); Medscape.

Author information: 
(1)Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland. 
(2)Horten Centre, University of Zurich, Zurich, Switzerland. (3)1] Department of 
Ophthalmology, University Hospital Zurich, Zurich, Switzerland [2] Department of 
Ophthalmology, Kantonsspital Lucerne, Lucerne, Switzerland.

BackgroundTo develop an algorithm based on the ocular pulse amplitude (OPA) to
predict the probability of a positive temporal artery biopsy (TAB) result in the 
acute phase of suspected giant cell arteritis (GCA).MethodsUnilateral TAB was
performed and ipsilateral OPA measurements were taken by Dynamic Contour
Tonometry. Among the clinical signs and laboratory findings tested in univariate 
analyses, OPA, Erythrocyte Sedimentation Rate (ESR) and thrombocyte count showed 
a strong association with a positive TAB result. Algorithm parameters were
categorized into three groups (OPA >3.5, 2.5-3.5, and <2.5 mm Hg; ESR <25, 25-60,
and >60 mm/h; thrombocyte count <250'000, 250'000-500'000, and >500'000/μl).
Score values (0, 1, and 2) were attributed to each group, resulting in a total
score range from 0 to 6. A univariate logistic regression analysis using the GCA 
diagnosis as the dependent and the total score as the independent variate was
fitted and probability estimates were calculated.ResultsThirty-one patients with 
suspected GCA undergoing TAB during an eighteen-month observation period were
enrolled. Twenty patients showed histologically proven GCA. Four patients had
score values ≤2, fourteen between 3 and 4, and thirteen of ≥5. The corresponding 
estimated probabilities of GCA were<7, 52.6, and >95%.ConclusionThe present study
confirms previous findings of reduced OPA levels, elevated ESR, and elevated
thrombocyte counts in GCA. It indicates that a sum score based on OPA, ESR, and
thrombocyte count can be helpful in predicting TAB results, especially at the
upper and the lower end of the sum score range.Eye advance online publication, 19
June 2015; doi:10.1038/eye.2015.85.

PMID: 26088675   [PubMed - as supplied by publisher]

14. Eye (Lond). 2015 Jun 19. doi: 10.1038/eye.2015.101. [Epub ahead of print]

Factors influencing the outcome of polypoidal choroidal vasculopathy following
combined treatment with photodynamic therapy and intravitreal ranibizumab.

Tan CS(1), Ngo WK(2), Lim LW(2), Lim TH(1).

Author information: 
(1)1] Fundus Image Reading Centre, National Healthcare Group Eye Institute,
Singapore, Singapore [2] National Healthcare Group Eye Institute, Tan Tock Seng
Hospital, Singapore, Singapore. (2)National Healthcare Group Eye Institute, Tan
Tock Seng Hospital, Singapore, Singapore.

PMID: 26088674   [PubMed - as supplied by publisher]

15. Eye (Lond). 2015 Jun 12. doi: 10.1038/eye.2015.96. [Epub ahead of print]

The association of vitamin D deficiency with tear break-up time and Schirmer
testing in non-Sjögren dry eye.

Kurtul BE(1), Özer PA(1), Aydinli MS(2).

Author information: 
(1)Department of Ophthalmology, Dr Sami Ulus Maternity and Children's Health and 
Diseases Training and Research Hospital, Ankara, Turkey. (2)Department of Family 
Medicine, Dr Sami Ulus Maternity and Children's Health and Diseases Training and 
Research Hospital, Ankara, Turkey.

PurposeTo investigate the effect of vitamin D deficiency on tear break-up time
(TBUT) and Schirmer test scores and to assess their relationship in non-Sjögren
dry-eye patients.MethodsThirty-four patients with serum vitamin D deficiency and 
21 control subjects with normal vitamin D levels were included in this study. The
TBUT and Schirmer-1 test without topical anesthesia were performed to all
patients.ResultsThe mean TBUT were 5.18±2.15 and 7.36±3.10 s and Schirmer scores 
were 12.18±6.44 and 18.57±8.99 mm in the study and control groups, respectively. 
TBUT scores and Schirmer-1 results of the study group were significantly lower
than the control group (P=0.01 and 0.007, respectively). The mean vitamin D
levels were 11.50±1.8 ng/ml in the study group and 32.8±8.72 ng/ml in control
group (P=0.001). Dry-eye symptoms were detected in all patients in the study
group and 15% of the patients in the control group.ConclusionsWe demonstrated
that vitamin D deficiency decreases the TBUT and Schirmer test values and may be 
associated with dry-eye symptoms in non-Sjögren syndrome.Eye advance online
publication, 12 June 2015; doi:10.1038/eye.2015.96.

PMID: 26066054   [PubMed - as supplied by publisher]

16. Eye (Lond). 2015 Jun 5. doi: 10.1038/eye.2015.91. [Epub ahead of print]

Direct ophthalmoscopy should be taught to undergraduate medical students-No.

Purbrick RM(1), Chong NV(2).

Author information: 
(1)Sussex Eye Hospital, Brighton, UK. (2)Oxford Eye Hospital, Oxford University
Hospitals, Oxford, UK.

PMID: 26043708   [PubMed - as supplied by publisher]

17. Eye (Lond). 2015 Jun 5. doi: 10.1038/eye.2015.82. [Epub ahead of print]

MEK inhibitors: a new class of chemotherapeutic agents with ocular toxicity.

Duncan KE(1), Chang LY(2), Patronas M(1).

Author information: 
(1)Department of Ophthalmology and Visual Sciences, University of Maryland School
of Medicine, Baltimore, MD, USA. (2)University of Maryland School of Medicine,
Baltimore, MD, USA.

A new class of chemotherapeutic agents, MEK inhibitors, has recently been
developed and is proving to be an effective treatment for a number of cancers. A 
pattern of ocular adverse events has followed these drugs through clinical trials
and their association with retinopathy is only just beginning to be recognized.
We present two cases of MEK inhibitor-associated retinopathy followed by a review
of the current literature on ocular toxicity associated with MEK inhibitors.
Patients undergoing treatment with MEK inhibitors appear to have high rates of
multifocal serous retinal detachments as well as retinal vein occlusions. We
present the first report of cystoid macular edema associated with MEK inhibitor
use. The mechanism of these adverse events is still unclear though they seem to
be related to oxidative stress and blood retinal barrier breakdown. Management of
the ocular toxicity can range from observation to topical treatments or
intravitreal injections. Fortunately most ocular adverse events appear to be
self-limited and do not require discontinuing the MEK inhibitor. Discontinuation 
or decreased dosing of MEK inhibitors may be reserved for cases of severe
sight-threatening ocular toxicity.Eye advance online publication, 5 June 2015;

PMID: 26043707   [PubMed - as supplied by publisher]

18. Eye (Lond). 2015 Jun 5. doi: 10.1038/eye.2015.83. [Epub ahead of print]

Long-term visual outcomes of intravitreal ranibizumab treatment for wet
age-related macular degeneration and effect on blindness rates in south-east

Borooah S(1), Jeganathan VS(1), Ambrecht AM(1), Oladiwura D(2), Gavin M(2),
Dhillon B(1), Cackett P(1).

Author information: 
(1)Department of Ophthalmology, Princess Alexandra Eye Pavilion, University of
Edinburgh, Edinburgh, UK. (2)Department of Ophthalmology, Gartnavel General
Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK.

AimsTo evaluate patient visual acuity outcomes and blindness rates attributable
to wet AMD with a potential 5-year follow-up from intravitreal ranibizumab
treatment (IVTR) in south-east Scotland.MethodsData was analysed from 104 eyes of
96 patients who initiated treatment prior to September 2008. The main outcome
measures were LogMAR visual acuity, number of clinic visits and the number of
injections. Annual blind registration data in south-east Scotland were analysed
using blind certifications recorded by the Royal National Institute of Blind
People.ResultsPatients had a mean clinical follow-up of 4 years and 1 month and a
mean loss of 5.5 letters over the study period. Of the treated eyes 9.6% gained
≥15 letters whilst 24.0% lost ≥15 letters during this period. An average of 9.56 
injections were administered per patient. The age-sex standardised incidence of
legal blindness attributable to wet AMD in south-east Scotland peaked at 9.1
cases per 100 000 of the population in 2006 in either eye. Following the
introduction of IVTR there were annual decreases in the incidence of blindness
attributable to AMD falling to a trough of 4.8 cases per 100 000 of the
population in 2011.ConclusionsThis study demonstrates that the majority of
patients in a south-east Scotland maintain their vision following IVTR in wet AMD
in the real-world setting. Our study also suggests that the introduction of IVTR 
has had population wide benefits in reducing the blindness attributable to wet
AMD in the south-east Scotland population.Eye advance online publication, 5 June 
2015; doi:10.1038/eye.2015.83.

PMID: 26043706   [PubMed - as supplied by publisher]

19. Eye (Lond). 2015 Jun 5. doi: 10.1038/eye.2015.95. [Epub ahead of print]

A 10-year review of orbital biopsy: the Newcastle Eye Centre Study.

Ting DS(1), Perez-Lopez M(1), Chew NJ(1), Clarke L(1), Dickinson AJ(1), Neoh

Author information: 
(1)Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP,

PurposeTo review the histopathological diagnoses, visual outcome, and
complication rate of orbital biopsy in a UK tertiary referral centre.MethodsThis 
was a retrospective, clinical-pathological, interventional, consecutive case
series. All orbital biopsies performed between July 2004 and June 2014 in
Newcastle Eye Centre (Newcastle upon Tyne, UK) were included in this study. All
relevant data collected from the local electronic database and medical records
were analysed.ResultsA total of 166 orbital biopsies were identified during the
study period: 86 patients (53.1%) were female and the mean age was 53.7±19.7
years. Of all the cases, orbital biopsies were performed unilaterally in 158
(97.5%) patients and bilaterally in 4 (2.5%) patients. The mean follow-up period 
was 2.2±2.3 years. The two most common histopathological diagnoses were
non-specific inflammatory disease (62, 38.3%) and lymphoproliferative disease
(40, 24.7%). None of the patients experienced ≥2-Snellen line visual loss. There 
were 7 (4.2%) postoperative complications noted: 1 (0.6%) orbital haemorrhage
with no loss of vision, 4 (2.4%) diplopia, 1 (0.6%) short-term symblepharon, and 
1 (0.6%) conjunctival granuloma. Postoperative diplopia was associated with
lateral orbitotomy (P=0.044) and excisional biopsy (P=0.015).ConclusionsOrbital
biopsy serves as a safe diagnostic tool in managing orbital diseases. Patient
should be made aware of the risk of postoperative diplopia. Our data provides
useful guidance to clinicians when counselling patients for orbital biopsy.Eye
advance online publication, 5 June 2015; doi:10.1038/eye.2015.95.

PMID: 26043705   [PubMed - as supplied by publisher]

20. Eye (Lond). 2015 Jun 5. doi: 10.1038/eye.2015.89. [Epub ahead of print]

Retinal pigment epithelium transplantation: concepts, challenges, and future

Alexander P(1), Thomson HA(1), Luff AJ(1), Lotery AJ(1).

Author information: 
(1)Clinical Neurosciences Research Group, Clinical and Experimental Sciences,
Faculty of Medicine, University of Southampton, University Hospital Southampton, 
Southampton, UK.

The retinal pigment epithelium (RPE) is a single layer of cells that supports the
light-sensitive photoreceptor cells that are essential for retinal function.
Age-related macular degeneration (AMD) is a leading cause of visual impairment,
and the primary pathogenic mechanism is thought to arise in the RPE layer. RPE
cell structure and function are well understood, the cells are readily
sustainable in laboratory culture and, unlike other cell types within the retina,
RPE cells do not require synaptic connections to perform their role. These
factors, together with the relative ease of outer retinal imaging, make RPE cells
an attractive target for cell transplantation compared with other cell types in
the retina or central nervous system. Seminal experiments in rats with an
inherited RPE dystrophy have demonstrated that RPE transplantation can prevent
photoreceptor loss and maintain visual function. This review provides an update
on the progress made so far on RPE transplantation in human eyes, outlines
potential sources of donor cells, and describes the technical and surgical
challenges faced by the transplanting surgeon. Recent advances in the
understanding of pluripotent stem cells, combined with novel surgical
instrumentation, hold considerable promise, and support the concept of RPE
transplantation as a regenerative strategy in AMD.Eye advance online publication,
5 June 2015; doi:10.1038/eye.2015.89.

PMID: 26043704   [PubMed - as supplied by publisher]

21. Eye (Lond). 2015 Jun 5. doi: 10.1038/eye.2015.94. [Epub ahead of print]

Performance of a computerised visual acuity measurement device in subjects with
age-related macular degeneration: comparison with gold standard ETDRS chart

Bokinni Y(1), Shah N(2), Maguire O(2), Laidlaw DA(2).

Author information: 
(1)Addenbrookes's Hospital, Cambridge University NHS Foundation Trust, Cambridge,
UK. (2)Department of Ophthalmology, St Thomas' Hospital, London, UK.

PurposeThe aim of the study was to compare the performance of two different
COMPlog computerised, single letter scoring, visual acuity (VA) measurements
against gold standard Early Treatment Diabetic Retinopathy Study (ETDRS) chart
measurements in patients with age-related macular degeneration (AMD). One
computerised algorithm presented five and the other presented three letters per
line; both computerised algorithms utilised half, rather than the full-letter
width spacing standard on ETDRS charts that might induce crowding, fixation
problems, increased test-retest variability (TRV), and bias.MethodsFifty patients
with AMD (mean age 83 years) underwent timed test and retest VA measurements
using ETDRS charts and COMPlog five (C5) and three (C3) letters per line
computerised VA measurement algorithms. All tests utilised single-letter scoring 
methodology. Bland and Altman methods were employed. Performance was measured in 
terms of bias, TRV, and test time.ResultsThe C5 and C3 scores showed no bias
compared with the ETDRS chart measurements. C5 measurements had equal TRV to the 
ETDRS chart (±0.13 logMAR) with similar median test times (105 and 96 s,
respectively). C3 measurements were slightly more variable (TRV ±0.17 logMAR),
but 30 s quicker than ETDRS chart measurements.ConclusionsThe closer letter
spacing employed in COMPlog testing algorithms appears to have no adverse effect 
on VA measurements compared with the gold standard ETDRS chart in patients with
AMD. The three letter per line testing algorithm facilitates faster testing but
with a two letter increase in TRV.Eye advance online publication, 5 June 2015;

PMID: 26043703   [PubMed - as supplied by publisher]

22. Eye (Lond). 2015 Jun 5. doi: 10.1038/eye.2015.90. [Epub ahead of print]

Direct ophthalmoscopy should be taught to undergraduate medical students-yes.

Yusuf IH(1), Salmon JF(1), Patel CK(1).

Author information: 
(1)Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe
Hospital, Oxford, UK.

PMID: 26043702   [PubMed - as supplied by publisher]