Study quantifies the effect of unreliable VF responses in healthy eyes

This observational, cross-sectional study examined how 3 reliability measures (false positives, false negatives and fixation losses) affect the global indices of visual field (VF) results in nonglaucomatous eyes.

Study design

Investigators included 830 adults (1,235 eyes) without visual impairment, glaucoma, significant cataract or major eye diseases from the population-based Singapore Chinese Eye Study.

Participants underwent a comprehensive ocular exam and VF testing with the Humphrey Field Analyzer II using the SITA Standard 24-2 program. The effects of false-negatives (FN), false-positives (FP) and fixation losses (FL) on mean deviation (MD) and pattern standard deviation (PSD) were analyzed using multivariable regression models.


Both FN and FP responses were independently associated with the MD and PSD, but in a nonlinear fashion.

An FN of greater than 15% had a larger effect on MD and PSD compared with lower FN frequencies (<15%). Likewise, a higher frequency of FP (≥15%) had a larger impact on MD than low frequencies of false answers (<15%). Lower FP frequencies had a negative association with PSD, but that association was not present at larger FP frequencies (≥15%).

FL had no significant associations with MD, and was only marginally associated with PSD.


These analyses were based on normal eyes, and the findings may not necessarily be the same in eyes with established VF defects. Because normal MD and PSD values represent a spread of values distributed around a mean, it is inaccurate to assume that all deviations from a normal baseline may be due to changes in reliability indices.

Clinical significance

Physicians typically rely on cutoff values for reliability indices to categorize a VF result as “reliable” or “unreliable”. However, these results show that “reliability” falls along a continuum. The findings will allow clinicians to better estimate to what degree the unreliable responses may affect the VF globally, at least in patients expected to have a normal VF and disc suspects.


Patients with JIA-associated uveitis often relapse after stopping immunomodulatory therapy

MAR 29, 2018


This retrospective study assessed outcomes and relapse rates among patients with juvenile idiopathic arthritis (JIA)-associated uveitis upon discontinuation of immunomodulatory therapy (IMT).

Study design

The authors identified medical records from 66 patients with JIA-associated uveitis who were treated at 2 institutions. The main outcome was time to relapse after starting IMT taper or stopping IMT.


Of 66 patients, 51 patients (77%) received corticosteroid-sparing IMT, either with a single agent or as combination therapy. The most common medications used were methotrexate (86%), followed by adalimumab (25%) and infliximab (24%). Seven patients were also on oral prednisone; 35 patients were on topical steroids.

During follow-up, 19 of 51 patients (37%) attempted IMT discontinuation. Approximately 68% relapsed at a median time of 288 days. Of note, 9 of 11 patients on TNF-alpha inhibitors relapsed after the medication was stopped.

The time to relapse was longer in patients who had remission as reason for discontinuation of medication compared with those who stopped therapy for reasons other than remission.


The study was limited by its small sample size and retrospective nature. The study was also underpowered to determine significant predictors of relapse. Reasons for IMT withdrawal were not listed. Various tapering strategies of the doctors included in the study.

Clinical significance

In patients on IMT for JIA-associated uveitis, the discontinuation of IMT, especially TNF-alpha inhibitors, was often unsuccessful. Physicians should closely monitor patients after discontinuation of therapy.

Blood Vessel Support and Prevention Package for Macular Degeneration Support

amd-4g2-email.gifA major problem with advanced Macular Degeneration is the growth of blood vessels in the eye. These unwanted blood vessels develop in the late stages of Age-Related Macular Degeneration (ARMD), also known as “wet” ARMD. Dr. Marc Grossman at Natural Eye Care has developed a package of supplements aimed at strengthening the retina and reducing the risk of new blood vessel growth.

New blood vessels obscure vision. Wet ARMD patients have few options. Doctors can sometimes zap the eye with lasers in an attempt to reduce the rate of future blood vessel growth. Oral drugs such as ranibizumab can help stop new blood vessels from developing. Injectable drugs are also aimed at stopping the extra blood vessel growth. All these options carry potential side effects and damage.

In consultation with their eye doctors, some wet AMD patients have tried research-based targeted nutrition. Certain vitamins, nutrients, homeopathics, and Traditional Chinese Medicine remedies are aimed at supporting the eyes. The AMD Package 4G2 contains nutrients to help strengthen the retina, and blood vessels, and reduce the risk of new unwanted blood vessel growth.

Contents of the ARMD Package

Advanced Eye and Vision Support Formula provides antioxidants for both eyes and total body health. Eye-specific nutrients include lutein, bilberry, special Chinese herbs, carrot root, and more.

Krill Oil Complex is an important source of omega-3 fatty acids.  Additionally, krill provides a treasured antioxidant for heart and vision health called “astaxanthin.” (LINK)

Vitamin D3 is for retinal and overall body support. Research has indicated this vitamin could reduce ARMD risk.1 Many Americans have low vitamin D due to indoor activities and less sunlight exposure in the winter. Vitamin D supports immunity, skeletal health, the heart, and cognition.

Dr. Grossman’s Blood Vessel Formula is designed to help prevent the growth of unwanted blood vessels. This wild-crafted herbal formula is based on a National Institutes of Health study.2 Includes ginkgo biloba, grape extract, cinnamon, ginseng and more. Click for ingredients.

See the AMD Package 4G2 in the Natural Eye Care Store.

Corneal hysteresis as a potential glaucoma biomarker

MAR 27, 2018


In this prospective observational trial, investigators explored whether corneal hysteresis (CH) could be used as a biomarker for identifying patients at risk for developing glaucoma.

Study design

The cohort comprised 199 glaucoma suspects (287 eyes) who were followed for an average of 3.9 years. All eyes had normal visual fields and CH measurements taken at baseline. Development of glaucoma was defined as 3 consecutive abnormal standard automated perimetry tests during follow-up.


Repeatable visual field (VF) defects developed in 54 eyes (19%) eyes during follow-up. All eyes in this group had significantly lower CH measurement at baseline compared with those who did not develop VF defects (9.5 mm Hg vs 10.2 mm Hg, P=0.012).

A multivariate analysis revealed that each 1-mm Hg drop in baseline CH was associated with a 21% increased risk of developing glaucoma during follow-up.


This study failed to identify IOP as a risk factor for glaucoma. The authors believe this is due to the observational rather than interventional design, and participants were treated at the discretion of the attending ophthalmologist during follow-up.

Clinical significance

Previous studies have already identified decreased CH as a risk factor for worsening glaucoma and faster VF progression among individuals with glaucoma. This study shows that CH is an independent risk factor for the development of glaucoma among glaucoma suspects.

Integrating CH will help clinicians better stratify glaucoma suspects and perhaps lower the threshold for treatment, thereby allowing us to take a more proactive approach while the nerve is still healthy.

Lasik Correction

To undergo Lasik correction, you need to make necessary preparations for the procedure.


What you can expect before, during and after the surgery may depend to a large extent on your doctor. As part of your preparation for the Lasik correction, you need to make a firm decision if you will go through with the Lasik surgery. You need evaluation by your eye doctor to know if you are a good candidate for Lasik correction before you sign the waiver. Before you undergo Lasik correction you should stop wearing contact lenses. You should switch to wearing glasses full-time prior to lasik correction for at least 2 to 4 weeks. This is because the contact lens can change the shape of your cornea. Leaving your contact lenses out for several weeks will enable the cornea to assume its natural shape which is essential for the surgery.

In Lasik correction procedure during surgery, you will be made to lie down on a reclining chair. A numbing eye drop will be placed in your eye. A ring will be placed in your eye and very high pressures will be applied to create suction to the cornea. You will experience dimness of vision and some discomfort. A cutting instrument called microkeratome is attached to the suction ring. The blade will cut a flap in the cornea. This is essential for the Lasik correction procedure. The microkeratome and the suction ring are then removed. A laser light will help your eye get focused. When your eye is in the correct position, the doctor will start the laser treatment. After the pulses of the laser energy vaporize the corneal tissue, the flap is put back into position. A shield is placed over the eye as part of the Lasik correction procedure to serve as protection.

After the Lasik correction procedure, your eye may feel some discomfort. Rubbing your eye could dislodge the flap, so prevent from doing so. The symptoms should improve after a few days. If you experience severe pain after a few days of Lasik correction then you should contact your doctor immediately. See your doctor within 24 to 48 hours after Lasik correction. Your doctor will remove the eye shield, test your vision and examine the eye. You may use drops to prevent infection. And you may be advised to use artificial tears to lubricate the eye. Contact lens should not be use used in the operated eye even if your vision is hazy.

Houman Ahdieh, MD
Lehigh Valley Center for Sight

Week in review: Zombie cells, firearm injuries, eye-tooth connection

MAR 30, 2018

By Anni Griswold

Comprehensive Ophthalmology, Pediatric Ophth/Strabismus, Retina/Vitreous

A weekly roundup of ophthalmic news from around the web.

week-in-review-zombie-cells-firearm-injuries-eye-tooth-connection-1.jpgThe retina’s immune cell population can spring back after nearing extinction, according to a mouse study by scientists at the National Eye Institute. Therapies that harness this resilience could potentially curb inflammation and slow damage from retinitis pigmentosa or AMD, experts predict. NEI

A novel ocular insert could coax the cornea to absorb more antibiotics than ever before, say researchers at Valencia’s CEU Cardenal Herrera University. The bioadhesive polymer fits under the eyelid and infuses the cornea with controlled doses of moxifloxacin. The insert outperformed eyedrops and creams in rabbits, but has yet to be tested in humans. Science Daily

Firearms disproportionally injure the eyes of boys, teens and blacks, according to findings reported this week at the American Association for Pediatric Ophthalmology and Strabismus meeting. Scientists sifted through 6 years’ worth of records from the National Trauma Data Bank—including 1,972 gun injuries—and found that while most children survive the blast, many lose vision and more than half sustain severe brain damage. Healio

In the hunt for possible sources of AMD, a surprising culprit has emerged: periodontal disease.
A poster presented this week at the American Association for Dental Research meeting shows that the invasive bacteria underlying chronic periodontitis, Porphyromonas gingivalis, can invade human retinal-pigment epithelial cells and produces AMD-like features when injected into the mouse retina. EurekAlert!

The Keck School of Medicine has appointed a new chair of ophthalmology. Narsing Rao, MD, an expert on uveitis and ophthalmic pathology, replaces interim chair Thomas C. Lee, MD, and assumes the responsibilities of Rohit Varma, MD, MPH, who led the department from 2014 through 2017. USC