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Alley C.L.,Wills Eye Institute
Current Opinion in Ophthalmology | Year: 2013

PURPOSE OF REVIEW: To discuss the current preschool vision screening (PVS) guidelines and review some of the newest vision screening techniques. The different vision screening practices and barriers to screening are discussed. RECENT FINDINGS: Vision screening guidelines, which have been developed in response to the advances in technology and increased understanding of the developing visual system, have been recently updated by some of the major medical organizations that endorse vision screening. With advances in vision screening technology, there is a growing trend for screening at younger ages. SUMMARY: PVS has been widely endorsed by various medical organizations as an effective way to detect preventable and treatable vision problems of childhood. Although PVS is widely recommended, actual screening rates remain low. There are several real and perceived barriers to screening which often prevents successful screening programs. Current vision screening guidelines take into account the recent advances in technology. With the development of new devices, vision screening can effectively be performed at younger ages. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Stalmans P.,University Ziekenhuizen Leuven | Benz M.S.,Retina Consultants of Houston | Gandorfer A.,Ludwig Maximilians University of Munich | Kampik A.,Ludwig Maximilians University of Munich | And 3 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Vitreomacular adhesion can lead to pathologic traction and macular hole. The standard treatment for severe, symptomatic vitreomacular adhesion is vitrectomy. Ocriplasmin is a recombinant protease with activity against fibronectin and laminin, components of the vitreoretinal interface. METHODS: We conducted two multicenter, randomized, double-blind, phase 3 clinical trials to compare a single intravitreal injection of ocriplasmin (125 μg) with a placebo injection in patients with symptomatic vitreomacular adhesion. The primary end point was resolution of vitreomacular adhesion at day 28. Secondary end points were total posterior vitreous detachment and nonsurgical closure of a macular hole at 28 days, avoidance of vitrectomy, and change in best-corrected visual acuity. RESULTS: Overall, 652 eyes were treated: 464 with ocriplasmin and 188 with placebo. Vitreomacular adhesion resolved in 26.5% of ocriplasmin-injected eyes and in 10.1% of placebo-injected eyes (P<0.001). Total posterior vitreous detachment was more prevalent among the eyes treated with ocriplasmin than among those injected with placebo (13.4% vs. 3.7%, P<0.001). Nonsurgical closure of macular holes was achieved in 40.6% of ocriplasmin-injected eyes, as compared with 10.6% of placebo-injected eyes (P<0.001). The best-corrected visual acuity was more likely to improve by a gain of at least three lines on the eye chart with ocriplasmin than with placebo. Ocular adverse events (e.g., vitreous floaters, photopsia, or injection-related eye pain - all self-reported - or conjunctival hemorrhage) occurred in 68.4% of ocriplasmin-injected eyes and in 53.5% of placebo-injected eyes (P<0.001), and the incidence of serious ocular adverse events was similar in the two groups (P = 0.26). CONCLUSIONS: Intravitreal injection of the vitreolytic agent ocriplasmin resolved vitreomacular traction and closed macular holes in significantly more patients than did injection of placebo and was associated with a higher incidence of ocular adverse events, which were mainly transient. (Funded by ThromboGenics; ClinicalTrials.gov numbers, NCT00781859 and NCT00798317.) Copyright © 2012 Massachusetts Medical Society.

Baskin D.E.,Wills Eye Institute
Current Opinion in Ophthalmology | Year: 2010

Purpose of Review: Because optical coherence tomography (OCT) has developed quite rapidly in recent years, the purpose of this review is to synthesize much of the recent literature on the use of OCT in the diagnosis and management of diabetic macular edema (DME). Recent Findings: OCT has become increasingly utilized in clinical management and in research protocols in the approach to DME. Spectral domain OCT has given clinicians and researchers an even greater pathophysiologic understanding of DME. Summary: OCT has now added another quantitative dimension in the assessment of DME and could lead to better visual outcomes via earlier detection and more targeted therapeutic approaches. Arguably, OCT is the single most important diagnostic and prognostic tool in the management of DME. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Eagle Jr. R.C.,Wills Eye Institute | Eagle Jr. R.C.,Thomas Jefferson University
Eye (Basingstoke) | Year: 2013

Primary cancers of the eye are rare. These include uveal melanoma, a tumor that preferentially affects the choroid of light-eyed, fair-skinned Europeans, and the pediatric retinal neoplasm retinoblastoma, which is slightly more common worldwide. Uveal melanoma kills about half of affected patients. Most succumb to hepatic metastases, which are unresponsive to current therapy. Factors indicative of poor prognosis include tumor size, ciliary body involvement, epithelioid cells, extraocular extension, lymphocytic and melanophagic infiltration, mitotic activity, vascular mimicry patterns, and most importantly, the detection of monosomy 3 and class 2 gene expression profile in tumor cells using special tests. Most retinoblastomas are caused by sporadic somatic mutations in the RB1 gene, but about one-third arise in infants with germline mutations. The latter tend to develop earlier, are often bilateral and are transmissible to offspring as an autosomal dominant trait. Retinoblastoma displays varying degrees of differentiation including Homer Wright and Flexner-Wintersteiner rosettes and photoreceptor differentiation (fleurettes). Rosettes are more common in eyes enucleated from very young infants. Tumors composed entirely of fleurettes (retinoma/retinocytoma) are thought to be retinoblastoma precursors, and like retinoblastoma, harbor mutations in both copies of the RB1 gene. Retinoblastoma is a major cancer treatment success story in developed countries where most deaths are caused by secondary tumors in germline mutation carriers. High-risk histopathological features that are an indication for adjuvant chemotherapy include massive uveal invasion and retrolaminar optic nerve invasion. Eye-sparing therapies including brachyradiotherapy and systemic and intra-arterial chemotherapy have reduced the number of eyes with retinoblastoma requiring enucleation in recent years. © 2013 Macmillan Publishers Limited All rights reserved.

Rapuano C.J.,Wills Eye Institute
Current Opinion in Ophthalmology | Year: 2010

PURPOSE OF REVIEW: To discuss the primary types of lesions most amenable to excimer laser phototherapeutic keratectomy (PTK) and the specific techniques to best treat each of these disorders. RECENT FINDINGS: Elevated and anterior stromal lesions respond best to PTK. PTK can also be used to effectively treat recurrent erosions. Smoothing agents and intraoperative mitomycin C can be helpful for certain disorders. SUMMARY: The preoperative evaluation is very important in order to establish whether the eye is a good candidate for excimer laser PTK. Careful slit lamp evaluation and ancillary testing can not only determine how good a candidate they are but just as importantly, the best surgical approach. Surgeons and patients need to understand the limitations of PTK for proper informed consent. PTK is a minimally invasive procedure that is often successful in delaying or avoiding more aggressive corneal surgeries. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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