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Dunbar GE, Titus M, Stein JD, Meijome TE, Mian SI, Woodward MA. Patient-Reported Outcomes After Corneal Transplantation. Cornea 2021; 40:1316-1321. [PMID: 33758138 PMCID: PMC8418993 DOI: 10.1097/ico.0000000000002690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize vision-related quality of life after penetrating keratoplasty (PKP), deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK), and Descemet membrane endothelial keratoplasty (DMEK) using the National Eye Institute Visual Function Questionnaire (NEI-VFQ 9). METHODS Using the Sight Outcomes Research Collaborative ophthalmology electronic health record repository, questionnaire responses were obtained from 103 PKP patients, 24 DALK patients, 42 DSAEK patients, and 50 DMEK patients undergoing postoperative examination. No exclusions were made based on preoperative diagnosis, age, complications, or comorbidities. Associations between clinical characteristics and vision-related quality of life were analyzed using nonparametric and linear regression methods. RESULTS Patients were surveyed an average of 1.5 years postoperatively (range 24 d to 4.4 yrs). Participants who had undergone DALK, DMEK, DSAEK, and PKP had median composite VFQ scores of 77.8, 84.2, 76.1, and 70.6, respectively (P= 0.002). There were no significant differences in VFQ scores between patients treated with DMEK versus DSAEK (P = 0.440) or between patients treated with PKP versus DALK (P = 1.000). Higher postoperative acuities in the operative and fellow eyes were associated with higher VFQ scores (P < 0.001 and P < 0.001). When controlling for postoperative acuity by regression modeling, surgery type was not associated with patient-reported composite VFQ scores. CONCLUSIONS In this study, patient-reported vision-related quality of life was similar among DMEK and DSAEK participants and also among DALK and PKP participants. When controlling for postoperative acuity, vision-related quality of life was similar among all study participants, irrespective of the keratoplasty technique.
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Affiliation(s)
- Grace E. Dunbar
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | | | - Joshua D. Stein
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
- Center for Eye Policy and Innovation (CEPI), University of Michigan, Ann Arbor, Michigan, United States
| | - Tomas E. Meijome
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Shahzad I. Mian
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
| | - Maria A. Woodward
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, United States
- Center for Eye Policy and Innovation (CEPI), University of Michigan, Ann Arbor, Michigan, United States
- Institute for Healthcare Policy and Innovation (IHPI), University of Michigan, Ann Arbor, Michigan, United States
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Baim AD, Dunbar GE, Ahmad A. Evaluation and Management of Unilateral Congenital Ptosis in a Healthy Child. JAMA Ophthalmol 2017; 135:1444-1445. [PMID: 28910429 DOI: 10.1001/jamaophthalmol.2017.2593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adam D Baim
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Grace E Dunbar
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
| | - Amjad Ahmad
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago
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Abstract
Intraocular pressure, a major modifiable risk factor for glaucoma, has been shown to fluctuate throughout the day in patients with glaucoma. The detection and measurement of this fluctuation may help guide the clinical management of glaucomatous individuals. The Sensimed Triggerfish contact lens sensor (CLS), which has recently gained approval for marketing in the USA, is designed to detect intraocular pressure-related changes in an eye over a 24-hour period. This review will provide an overview of the Triggerfish CLS, as well as summarize current clinical data pertaining to the device. Overall, the current evidence suggests that the Triggerfish CLS is safe and well tolerated, and provides reproducible results. One challenge of using the Triggerfish CLS is that it may only provide data on relative changes in intraocular pressure rather than absolute intraocular pressure. In addition, its validity at estimating intraocular pressure compared to other methods is still controversial. Despite these limitations, recent studies suggest a myriad of potential indications for the Triggerfish CLS, including predicting glaucomatous progression and predicting efficacy of glaucoma treatment. With further research, the Triggerfish CLS may become a useful tool for eye care practitioners.
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Affiliation(s)
- Grace E Dunbar
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Bailey Yuguan Shen
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Ahmad A Aref
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Bavinger JC, Dunbar GE, Stem MS, Blachley TS, Kwark L, Farsiu S, Jackson GR, Gardner TW. The Effects of Diabetic Retinopathy and Pan-Retinal Photocoagulation on Photoreceptor Cell Function as Assessed by Dark Adaptometry. Invest Ophthalmol Vis Sci 2016; 57:208-17. [PMID: 26803796 PMCID: PMC4877135 DOI: 10.1167/iovs.15-17281] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The pathophysiology of vision loss in persons with diabetic retinopathy (DR) is complex and incompletely defined. We hypothesized that retinal pigment epithelium (RPE) and rod and cone photoreceptor dysfunction, as measured by dark adaptometry, would increase with severity of DR, and that pan-retinal photocoagulation (PRP) would exacerbate this dysfunction. Methods Dark adaptation (DA) was measured in subjects with diabetes mellitus and healthy controls. Dark adaptation was measured at 5° superior to the fovea following a flash bleach, and the data were analyzed to yield cone and rod sensitivity curves. Retinal layer thicknesses were quantified using spectral-domain optical coherence tomography (OCT). Results The sample consisted of 23 controls and 73 diabetic subjects. Subjects with moderate nonproliferative diabetic retinopathy (NPDR) exhibited significant impairment of rod recovery rate compared with control subjects (P = 0.04). Cone sensitivity was impaired in subjects with proliferative diabetic retinopathy (PDR) (type 1 diabetes mellitus [T1DM]: P = 0.0047; type 2 diabetes mellitus [T2DM]: P < 0.001). Subjects with untreated PDR compared with subjects treated with PRP exhibited similar rod recovery rates and cone sensitivities. Thinner RPE as assessed by OCT was associated with slower rod recovery and lower cone sensitivity, and thinner photoreceptor inner segment/outer segment layer was associated with lower cone sensitivity. Conclusions The results suggest that RPE and photoreceptor cell dysfunction, as assessed by cone sensitivity level and rod- and RPE-mediated dark adaptation, progresses with worsening DR, and rod recovery dysfunction occurs earlier than cone dysfunction. Function was preserved following PRP. The findings suggest multiple defects in retinoid function and provide potential points to improve visual function in persons with PDR.
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Affiliation(s)
- J Clay Bavinger
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Grace E Dunbar
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Maxwell S Stem
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Taylor S Blachley
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
| | - Leon Kwark
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States
| | - Sina Farsiu
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, United States 3Department of Biomedical Engineering, Duke University, Durham, North Carolina, United States
| | | | - Thomas W Gardner
- Department of Ophthalmology and Visual Sciences W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, Michigan, United States
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Stem MS, Dunbar GE, Jackson GR, Farsiu S, Pop-Busui R, Gardner TW. Glucose variability and inner retinal sensory neuropathy in persons with type 1 diabetes mellitus. Eye (Lond) 2016; 30:825-32. [PMID: 27034201 DOI: 10.1038/eye.2016.48] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/27/2016] [Indexed: 01/05/2023] Open
Abstract
PurposeTo quantify early neuroretinal alterations in patients with type 1 diabetes mellitus (T1DM) and to assess whether glycemic variability contributes to alterations in neuroretinal structure or function.MethodsThirty patients with T1DM and 51 controls underwent comprehensive ophthalmic examination and assessment of retinal function or structure with frequency doubling perimetry (FDP), contrast sensitivity, dark adaptation, fundus photography, and optical coherence tomography (OCT). Diabetic participants wore a subcutaneous continuous glucose monitor for 5 days, from which makers of glycemic variability including the low blood glucose index (LGBI) and area under the curve (AUC) for hypoglycemia were derived.ResultsSixteen patients had no diabetic retinopathy (DR), and 14 had mild or moderate DR. Log contrast sensitivity for the DM group was significantly reduced (mean±SD=1.63±0.06) compared with controls (1.77±0.13, P<0.001). OCT analysis revealed that the inner temporal inner nuclear layer (INL) was thinner in patients with T1DM (34.9±2.8 μm) compared with controls (36.5±2.9 μm) (P=0.023), although this effect lost statistical significance after application of the Bonferroni correction for multiple comparisons. Both markers of glycemic variability, the AUC for hypoglycemia (R=-0.458, P=0.006) and LGBI (R=-0.473, P=0.004), were negatively correlated with inner temporal INL thickness.ConclusionsPatients with T1DM and no to moderate DR exhibit alterations in inner retinal structure and function. Increased glycemic variability correlates with retinal thinning on OCT imaging, suggesting that fluctuations in blood glucose may contribute to neurodegeneration.
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Affiliation(s)
- M S Stem
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - G E Dunbar
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | | | - S Farsiu
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, USA
| | - R Pop-Busui
- Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - T W Gardner
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
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