In the glaucoma patients but not the control patients, CH but not CCT or other anterior segment parameters was associated with increased deformation of the optic nerve surface during transient elevations of IOP. (ClinicalTrials.gov number, NCT00328835.).

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The rebound tonometer cannot replace the Goldmann tonometer in the office setting given the wide limits of agreement between the two devices. Corneal rebound tonometer readings are influenced by CCT whereas scleral rebound tonometer readings are of no value.

ImportanceThere is paucity of data on prevalence and disease asymmetry of age-related macular degeneration (AMD), particularly the earlier stages, in the UK population.Objective and PurposeTo determine the prevalence of age-related macular degeneration in an elderly Caucasian UK population.DesignCross-sectional population study, 2002-2006.ParticipantsResidents in the study area of Bridlington aged 65 years and older.MethodsFull-ophthalmic examination was undertaken in 3549 participants, of eligible 6319 Caucasian population (response rate of 56%). Non-stereoscopic Colour fundus photographs (30°) were graded masked using a modified Rotterdam Classification for 3475 (98%) participants with gradable images. Prevalence for different AMD grades were calculated. Demographic details were analysed then integrated with the AMD gradings for full analysis. Prevalence rates for the different AMD Grades were calculated, as well as the age-specific prevalences.ResultsAMD prevalence in the worst eye were 38.5% grade 0, 41.4% grade 1, 12.8% grade 2, 2.8% grade 3, and 4.6% grade 4. Geographic atrophy (grade 4a) occurred in 2.5%, and neovascular AMD (grade 4b) in 1.8%. Prevalence increased with age such that grade 4 (advanced) AMD was 2.2% in the 65-69 years group, 15.8% for the 85-90, and 21.2% for over 90 years. There was significant asymmetry between the two eyes of individuals with advanced AMD (P<0.001), such that vision loss was unilateral. Persons with more advanced AMD grades were more likely to be dissatisfied with their vision.ConclusionsAdvanced AMD occurs more commonly in the UK Caucasian population than previously reported. Significant asymmetry between the two eyes occurs in individuals with unilateral advanced AMD so that visual impairment statistics do not represent true prevalence of advanced AMD. Persons with more advanced AMD were more likely to be dissatisfied with their vision.

The use of enlarged breath shields has been suggested as part of a wide range of infection control measures implemented during the COVID-19 pandemic. Breath shields have long been a standard feature of slit lamps and act as a physical barrier between the examiner and subject but there is an absence of evidence on their effectiveness in reducing droplet transmission and respiratory infections.SARS-CoV-2 shares many of the features of other respiratory viruses including SARS-CoV-1 and is thought to be commonly spread though respiratory droplets (>5 μm) and fomites [1]. Fomites are formed either from droplets settling on surfaces or through direct contamination from touching mucosal surfaces. Smaller aerosolised droplet nuclei (≤5 μm) can travel further and remain in air longer. They have been shown to carry viable virus particles in experimental conditions [2] but are not thought to be a common mode of transmission of COVID-19 [1]. The risk of transmission from tears is also thought to be low [3].We sought to examine the efficacy of facemasks and standard and augmented slit lamp breath shields using a breathing simulator. These have been described previously and generally comprise of a particle source, commonly a nebuliser attached to a bellows or air tank and a particle detector which can consist of a laser particle counter [4] or an impinger from which viral particles can be sampled from air, cultured in cells and detected as plaques [5]. Direct visual inspection of sprayed dye droplets has also been described as a way to test eye protection [6,7]. We experimented using nebulised fluorescein 2% but were unable to capture sufficient dye to determine the patterns of droplet distribution.We used a mouthpiece nebuliser (Galemed Corp, Taiwan) containing 5 ml of 0.9% saline as our particle source and attached it to a 500 ml paediatric bag valve mask that was manually compressed 12 times per minute to simulate normal adult tidal breathing. The device produces a range of particles from 1 to 25 μm with median mass aerodynamic diameter of 3.8 μm. We used a Met One A2400 optical particle counter (Hach Co, Loveland, CO) operating at a flow rate of one cubic foot per minute to detect particles that reached the eyepiece over a 1-min period. This was initially performed without any shielding, and then repeated with the standard (11 × 11 × 0.2 cm) and augmented (45 × 44 × 0.2 cm) acrylic shields attached to the slit lamp objective lens (Fig. 1). We then tested the effect of placing a fluid resistant surgical facemask (BARRIER 4313, Mölnlycke Healthcare, Sweden) over the nebuliser mouthpiece alone and in combination with the large shield. The slit lamp arm was offset to 60°throughout and each barrier was tested five times. Linear regression was used to determine the effect of shield type and particle size on particle count. All analyses were performed using Stata v14.With no shield in place, the mean log particle count was 3.59 (95% CI: 3.48-3.70). There was a significant reduction to 3.01 (95% CI: 2.90-3.13, p < 0.01) with the s...

IMPORTANCE Giant cell arteritis (GCA) is the most common vasculitis in adults and is associated with significant morbidity and mortality. Its incidence has been carefully studied in white populations, yet its relevance among other racial and ethnic groups is less well known. OBJECTIVE To examine the incidence of biopsy-proven GCA (BP-GCA) in a tertiary care center-based population with a sizeable proportion of black patients. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study identified all patients who underwent temporal artery biopsy (TAB) from July 1, 2007, through September 30, 2017, using the electronic medical record system at the Johns Hopkins Wilmer Eye Institute. Associations between self-reported race, sex, and age were explored and compared with all other patients attending the hospital over the same period. Data were analyzed from November 1, 2017, through July 31, 2018. MAIN OUTCOMES AND MEASURES Estimated incidence rates of BP-GCA in black and white patients. RESULTS Among 586 patients who underwent TAB (mean [SD] age, 70.5 [11.1] years; age range, 32-103 years; 423 [72.2%] women), 167 (28.5%) were black, 382 (65.2%) were white, and 37 (6.3%) were other or unknown. Of 573 individuals 50 years and older, 92 (16.1%) had BP-GCA; 14 were black (8.4% of all black patients undergoing testing) and 75 were white (19.6% of all white patients undergoing testing). Crude annual incidence rates for BP-GCA were 2.9 (95% CI, 1.3-5.5) per 100 000 for black and 4.2 (95% CI, 3.0-5.6) per 100 000 for white patients within the study population. Population-adjusted age-and sex-standardized incidence rates were 3.1 (95% CI, 1.0-5.2) and 3.6 (95% CI, 2.5-4.7) per 100 000 for black and white patients, respectively (difference, 0.5; 95% CI, −1.7 to 2.7; P = .70). The incidence rate ratio was 1.9 in women compared with men (95% CI, 1.1-3.4; P = .03) but was not significant in white compared with black patients (1.2; 95% CI, 0.6-2.4; P = .66). CONCLUSIONS AND RELEVANCE In our cohort, BP-GCA occurred more commonly in women, but rates were similar between races. These findings do not appear to support the conclusion that GCA occurs more frequently in white compared with black patients.

Transient elevation of IOP in adult eyes resulted in increases in disc area and linear disc dimensions, but not in retinal dimensions. The degree of enlargement appears to be less in patients with glaucoma than without and greater with increased corneal thickness. A multivariate model showed that the amount of disc area increase was inversely proportional to baseline disc area but was not related to glaucoma status or CCT. (ClinicalTrials.gov number, NCT00328835).

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