The Wilmer Eye Institute at Johns Hopkins Medical Institutions conducted a retrospective cohort study of people enrolled in a large managed-care organization to determine the predictors of treatment for glaucoma and suspect glaucoma in a nationally representative sample of diagnosed persons.

The study included 35,754 four diagnosed suspects, 5,265 diagnosed glaucoma patients, and 2,633 people coded as having cupping of the optic disc. Researchers used linked pharmacy and patient care information to examine the predictors of initiating glaucoma treatment in this cohort of persons insured by a single managed care organization. Predictors entered into logistic regression models included diagnostic group (suspect vs. diagnosed), age group, gender, region of the country, provider type at the initial visit (optometrist or ophthalmologist), diagnosis index date divided into two periods (1995 to 1998 and 1999 to 2001) and health plan enrollment duration after the initial diagnosis. Main outcome measures were occurrence of and factors associated with treatment for glaucoma (argon laser trabeculoplasty [ALT], surgery or topical ocular hypotensives).

A logistic regression model adjusting for glaucoma status, age, region, clinician seen at initial visit and index date found that women were 24 percent less likely to undergo treatment (topical ocular hypotensives, ALT or surgery) than men, and that younger individuals were far less likely to be treated than older ones. Furthermore, treatment varied by region of the country. The authors believe that understanding the sources of these variations will help in determining how to arrive at better management strategies for individuals with glaucoma and suspect glaucoma.

Investigators at the University of Hong Kong (China) measured the extent of microbial hand contamination among ophthalmologists during routine clinic practice and examined its association with hand cleansing practices and beliefs, glove use and patient load.

The study was a single-masked analysis of resident and transient flora of ophthalmologists before and after patient examination and after hand washing by agar imprints of the dominant hand. Researchers used standardized questionnaires to collect information concerning subjects" hand cleansing practices and patient load.

Of the 108 cultures, 107 (99.1 percent) were culture positive, yielding 15 separate organisms. Gram-negative bacilli were the most common transient flora, followed by Gram-positive cocci and fungi. Thirty-five (97.2 percent) ophthalmologists were culture positive for at least one resident and eight (22.2 percent) ophthalmologists were culture positive for at least one transient organism, before patient contact. Regression models showed alcohol-based hand rub use, transient and resident floral load before patient contact and patient load collectively accounted for 58.7 percent of the variance in resident floral load after patient contact. Use of alcohol-based hand rubs was associated with a mean resident floral reduction of 324.4 CFUs and 31.6 CFUs after patient contact and hand washing, respectively. Hand washing with chlorhexidine was a significant predictor for transient floral load after hand washing.

The authors found that the extent of contamination with pathogenic organisms after contact with eye outpatients, who have traditionally been perceived as relatively "clean," was of concern. Previously identified risk factors for hand contamination in inpatient settings, such as patient load, only explained a small proportion of variance in microbial load in the ophthalmic outpatient setting.

Investigators in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study at Ohio State University’s College of Optometry found gender differences in patient history, vision, and ocular symptoms in keratoconus patients.

The observational, longitudinal study included 1,209 subjects at 16 clinics. For eye-specific categorical variables, investigators counted the number of eyes per subject with the characteristic. For eye-specific continuous variables, they calculated the mean of both eyes. They created multivariate linear (for continuous outcomes) and logistic (for categorical outcomes) regression models for each baseline characteristic with statistically significant differences between men and women. Age, race, education and corneal curvature were covariates.

Results showed that the women were older, more likely to report a family history of keratoconus, more likely to be nonwhite and less likely to complete college than men in the study. Vogt’s striae and monocular and binocular high-contrast entrance acuity were the only visual characteristics that varied between men and women in the multivariate model. Women were more likely than men to report ocular symptoms of dryness and complaints based upon a composite score of ocular symptoms. Women reported more hours per day of near work and were less likely to report the ability to wear contact lenses for enough hours to permit reading at home in the evening. Women also reported more visits to their eye care practitioner during the previous 12 months. NEI-VFQ results revealed differences in self-reported difficulty with distance activities and driving.

This British study aimed to determine whether systemic hypertension and glaucoma might coexist more often than expected, with possible implications for treatment.

In a case-control study using general practitioner database of 27,080 patients with glaucoma matched with controls for age and sex, hypertension was significantly more common in the patients with glaucoma (odds ratio [OR] 1.29, 95 percent confidence intervals [CI] 1.23 to 1.36) than in controls. Treatment by oral beta blockade appeared to protect from risk, but oral calcium channel antagonists or angiotensin converting enzyme (ACE) inhibitors did not. Oral corticosteroid treatment was associated with enhanced risk.

The authors of the study believe that common pathogenetic mechanisms in ciliary and renal tubular epithelia may explain the coincidence of glaucoma and systemic hypertension. The choice of cardiovascular treatment could substantially influence glaucoma incidence, with beta blockade protecting and ACE-inhibitors or calcium channel blockers not affecting underlying risk.

Perfluorocarbon liquid appears safe and effective to use as a short-term postoperative tamponade in managing retinal detachment from giant retinal tears, according to a retrospective consecutive case series study by Australia’s Sydney Eye Hospital.

The study included 62 eyes of 61 patients with retinal detachment from giant retinal tears who underwent vitrectomy using perfluorocarbon liquid as a short-term postoperative internal tamponade. The perfluorocarbon liquid was removed 5 to 14 days (mean 7.5 days) later and replaced by gas or silicone oil. Scleral buckling was performed in some cases with proliferative vitreoretinopathy. The surgeon removed the crystalline lens if there was interference with the surgical view or if it was subluxated. Investigators assessed the success rate of retinal reattachment, visual outcome and postoperative complications.

Follow-up time ranged from 8 to 69 months (mean 24.5 months). All retinas were attached intraoperatively. Fourteen eyes (22.6 percent) developed re-detachment; additional operations were performed in 13 eyes. At final visit, 58 eyes (93.5 percent) had retinas that remained attached with visual acuity 20/40 or better in 27 eyes (46.5 percent). The visual acuity improved in 34 eyes (54.8 percent) with 28 eyes (45.2 percent) improving at least two Snellen lines. It was unchanged in 20 eyes (32.3 percent) and was worse in eight eyes (12.9 percent). Three patients developed glaucoma that was controlled medically. No retained perfluorocarbon liquid was found in any eyes.