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Baltimore Highlands, MD, United States

The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins School of Medicine, located in Baltimore, Maryland, United States. It was founded using money from a bequest by philanthropist Johns Hopkins. The Johns Hopkins Hospital and the Johns Hopkins School of Medicine are the founding institutions of modern American medicine and are the birthplace of numerous traditions including rounds, residents and housestaff. Many medical specialties were formed at the Johns Hopkins Hospital, including neurosurgery, by Harvey Cushing; cardiac surgery by Alfred Blalock; pediatrics and child psychiatry, by Leo Kanner.The Johns Hopkins Hospital is widely regarded as one of the world's greatest hospitals. It was ranked by U.S. News & World Report as the best overall hospital in America for 21 consecutive years . In 2012 it was briefly supplanted by the Massachusetts General Hospital, but regained the top position in 2013, before moving to third place in 2014. Wikipedia.

Few longitudinal studies have examined how visual impairment affects mobility as people age. Data from the Salisbury Eye Evaluation Study, a population-based sample of 2,520 adults aged 65 years and older, were used to investigate the longitudinal association between visual impairment and mobility. Baseline, 2-year, 6-year, and 8-year visits occurred between 1993 and 2001. Mobility was assessed by measuring speeds on the following 3 tasks: walking up 7 steps, walking down 7 steps, and walking 4 m. Random-effects linear regression was used to model factors affecting speed. For each year of observation, speeds declined, and the visually impaired had significantly slower speeds than the non-visually impaired on all 3 tests after accounting for other covariates (βwalking up steps =-0.08 steps/second, 95% confidence interval (CI):-0.10,-0.06; βwalking down steps =-0.11 steps/second, 95% CI:-0.14,-0.08; and βwalking 4 m =-0.08 m/second, 95% CI:-0.10,-0.06). However, the interaction between years since baseline and visual impairment status was not significant, indicating that mobility speeds declined at a similar rate in the visually impaired and the non-visually impaired. These results suggest that the impact of visual impairment on speed is significant but does not change as people age. © 2013 The Author. Source

Matthaei M.,Wilmer Eye Institute
Investigative ophthalmology & visual science | Year: 2013

To investigate the endothelial gene expression profile in a Col8a2 Q455K mutant knock-in mouse model of early-onset Fuchs' endothelial corneal dystrophy (FECD) and identify potential targets that can be correlated to human late-onset FECD. Diseased or normal endothelial phenotypes were verified in 12-month-old homozygous Col8a2(Q455K/Q455K) mutant and wild-type mice by clinical confocal microscopy. An endothelial whole genome expression profile was generated by microarray-based analysis. Result validation was performed by real-time PCR. Endothelial COX2 and JUN expression was further studied in human late-onset FECD compared to normal samples. Microarray analysis demonstrated endothelial expression of 24,538 genes (162 up-regulated and 172 down-regulated targets) and identified affected gene ontology terms including Response to Stress, Protein Metabolic Process, Protein Folding, Regulation of Apoptosis, and Transporter Activity. Real-time PCR assessment confirmed increased Cox2 (P = 0.001) and Jun mRNA (P = 0.03) levels in Col8a2(Q455K/Q455K) mutant compared to wild-type mice. In human FECD samples, real-time PCR demonstrated a statistically significant increase in COX2 mRNA (P < 0.0001) and JUN mRNA (P = 0.002) and tissue microarray analysis showed increased endothelial COX2 (P = 0.02) and JUN protein (P = 0.04). The present study provides the first endothelial whole genome expression analysis in an animal model of FECD and represents a useful resource for future studies of the disease. In particular endothelial COX2 up-regulation warrants further investigation of its role in FECD. Source

Dagnelie G.,Wilmer Eye Institute
Investigative Ophthalmology and Visual Science | Year: 2013

When considering the burden of visual impairment on aging individuals and society at large, it is important to bear in mind that vision changes are a natural aspect of aging. In this article, we consider vision changes that are part of normal aging, the prevalence of abnormal vision changes caused by disorders of the visual system, and the anticipated incidence and impact of visual impairment as the US population ages. We then discuss the services available to reduce the impact of vision loss, and the extent to which those services can and should be improved, not only to be better prepared for the anticipated increase in low vision over the coming decades, but also to increase the awareness of interactions between visual impairment and comorbidities that are common among the elderly. Finally, we consider how to promote improved quality, availability, and acceptance of low vision care to lessen the impact of visual impairment on individuals, and its burden on society. © The Association for Research in Vision and Ophthalmology, Inc. Source

Pan Q.,Wilmer Eye Institute
The Cochrane database of systematic reviews | Year: 2013

=Theoretically, autologous serum eye drops (AS) have a potential advantage over traditional therapies based on the assumption that ASserve not only as a lacrimal substitute to provide lubrication, but also contain other biochemical components mimicking natural tears more closely. The application of AS in dry eye treatment has gained popularity as a second-line therapy in the treatment of dry eye.Published studies on the subject indicate that autologous serum could be an effective treatment for dry eye. To evaluate the efficacy and safety of AS compared to artificial tears for treating dry eye. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 3),Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE,(January 1950 to April 2013), EMBASE (January 1980 to April 2013), Latin American and Caribbean Literature on Health Sciences(LILACS) (January 1982 to April 2013), themetaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov(www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We also searched the Science Citation Index Expanded database (September 2013) and reference lists of included studies. We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 15 April 2013. We included randomized controlled trials (RCTs) in which AS was compared to artificial tears in the treatment of dry eye in adults. Two review authors independently screened all titles and abstracts and assessed full-text articles of potentially eligible trials. Two review authors extracted data and assessed the methodological quality and characteristics of the included trials.We contacted investigators for missing data. For both primary and secondary outcomes, we reported mean differences with corresponding 95% confidence intervals(CIs) for continuous outcomes. We identified four eligible RCTs in which AS was compared with artificial tear treatment or saline in individuals (n = 72 participants)with dry eye of various etiologies (Sjögren's syndrome-related dry eye, non-Sjögren's syndrome dry eye and postoperative dry eye induced by laser-assisted in situ keratomileusis (LASIK)). The quality of the evidence provided by these trials was variable. A majority of the risk of bias domains were judged to have an unclear risk of bias in two trials owing to insufficient reporting of trial characteristics.One trial was considered to have a low risk of bias for most domains while another was considered to have a high risk of bias for most domains. Incomplete outcome reporting and heterogeneity in the participant populations and follow-up periods prevented the inclusion of these trials in a summary meta-analysis. For the primary outcome, improvement in participant-reported symptoms at one month, one trial (12 participants) showed no difference in participant-reported symptoms between 20% AS and artificial tears. Based on the results of two trials in 32 participants, 20% AS may provide some improvement in participant-reported symptoms compared to traditional artificial tears after two weeks of treatment. One trial also showed positive results with a mean difference in tear breakup time (TBUT) of 2.00 seconds (95% CI 0.99 to 3.01 seconds) between 20% AS and artificial tears after two weeks, which were not similar to findings from the other trials. Based on all other objective clinical assessments included in this review, AS was not associated with improvements in aqueous tear production measured by Schirmer's test (two trials, 33 participants), ocular surface condition with fluorescein (four trials, 72 participants) or Rose Bengal staining (three trials, 60 participants), and epithelial metaplasia by impression cytology compared to artificial tears (one trial, 12 participants). Data on adverse effects were not reported by three of the included studies. In one study, there were no serious adverse events reported with the collection of and treatment with AS. Overall there was inconsistency in the possible benefits of AS in improving participant-reported symptoms and TBUT and lack of effect based on other objective clinical measures. Well-planned, large, high-quality RCTs are warranted, in different severities of dry eye and using standardized questionnaires to measure participant-reported outcomes and objective clinical tests as well as objective biomarkers to assess the benefit of AS therapy for dry eye. Source

Arevalo J.F.,Wilmer Eye Institute
Current Opinion in Ophthalmology | Year: 2014

Purpose of review To review the current management and recent changes in treatment paradigm for diabetic macular edema (DME). Recent findings During the review period (1 year), several prospective studies analyzed the beneficial effect of anti-vascular endothelial growth factor agents in the management of DME. An exploratory analysis concluded that intravitreal ranibizumab appears to be associated with a reduced risk of diabetic retinopathy worsening. A randomized, controlled, multicenter, double-masked, parallel-group, 12-month trial to evaluate a dexamethasone intravitreal implant (DEX implant) combined with laser photocoagulation compared with laser alone for treatment of DME concluded that there was no significant between-group difference at month 12. A multicenter, prospective, observational study found that in eyes with diabetic retinopathy without concurrent central-involved DME, presence of noncentral-involved DME immediately prior to cataract surgery or history of DME treatment may increase the risk of developing central-involved macular edema after cataract extraction. Another randomized trial to evaluate whether intravitreal ranibizumab injection at cataract surgery prevents postoperative DME concluded that intravitreal ranibizumab injection at cataract surgery may prevent the postoperative worsening of macular edema. Summary The results of clinical trials have shown the superiority of some of these anti-vascular endothelial growth factor agents to laser therapy. However, with the availability of several of these newer agents, it may be difficult to individualize treatment options, especially if DME patients respond differently to various therapies. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

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