We studied sources of variation between countries in per-capita mortality from COVID-19 (caused by the SARS-CoV-2 virus). Potential predictors of per-capita coronavirus-related mortality in 200 countries by May 9, 2020 were examined, including age, gender, obesity prevalence, temperature, urbanization, smoking, duration of the outbreak, lockdowns, viral testing, contact-tracing policies, and public mask-wearing norms and policies. Multivariable linear regression analysis was performed. In univariate analysis, the prevalence of smoking, per-capita gross domestic product, urbanization, and colder average country temperature was positively associated with coronavirus-related mortality. In a multivariable analysis of 196 countries, the duration of the outbreak in the country, and the proportion of the population aged 60 years or older were positively associated with per-capita mortality, whereas duration of mask-wearing by the public was negatively associated with mortality (all P < 0.001). Obesity and less stringent international travel restrictions were independently associated with mortality in a model which controlled for testing policy. Viral testing policies and levels were not associated with mortality. Internal lockdown was associated with a nonsignificant 2.4% reduction in mortality each week (P = 0.83). The association of contact-tracing policy with mortality was not statistically significant (P = 0.06). In countries with cultural norms or government policies supporting public mask-wearing, per-capita coronavirus mortality increased on average by just 16.2% each week, as compared with 61.9% each week in remaining countries. Societal norms and government policies supporting the wearing of masks by the public, as well as international travel controls, are independently associated with lower per-capita mortality from COVID-19.

Glaucoma is one of the leading causes of blindness worldwide, and as the proportion of those over age 40 increases, so will the prevalence of glaucoma. The pathogenesis of primary open angle glaucoma (POAG) is unclear and multiple ocular risk factors have been proposed, including intraocular pressure, ocular perfusion pressure, ocular blood flow, myopia, central corneal thickness, and optic disc hemorrhages. The purpose of this review was to analyze the association between systemic vascular risk factors (including hypertension, diabetes, age, and migraine) and POAG, based on major epidemiological studies. Reports presenting the association between POAG and systemic vascular risk factors included a total of over 50,000 patients. Several epidemiological studies confirmed the importance of vascular risk factors, particularly hypertension and blood pressure dipping, in the pathogenesis and progression of glaucomatous optic neuropathy. We found that diabetes mellitus is associated with elevated intraocular pressure, but has no clear association with POAG. No significant correlation between migraine and POAG was found, however, the definition of migraine varied between studies.

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To the ancient Greeks, glaukos occasionally described diseased eyes, but more typically described healthy irides, which were glaucous (light blue, gray, or green). During the Hippocratic period, a pathologic glaukos pupil indicated a media opacity that was not dark. Although not emphasized by present-day ophthalmologists, the pupil in acute angle closure may appear somewhat green, as the mid-dilated pupil exposes the cataractous lens. The ancient Greeks would probably have described a (normal) green iris or (diseased) green pupil as glaukos. During the early Common Era, eye pain, a glaucous hue, pupil irregularities, and absence of light perception indicated a poor prognosis with couching. Galen associated the glaucous hue with a large, anterior, or hard crystalline lens. Medieval Arabic authors translated glaukos as zarqaa, which also commonly described light irides. Ibn Sina (otherwise known as Avicenna) wrote that the zarqaa hue could occur due to anterior prominence of the lens and could occur in an acquired manner. The disease defined by the glaucous pupil in antiquity is ultimately indeterminate, as the complete syndrome of acute angle closure was not described. Nonetheless, it is intriguing that the glaucous pupil connoted a poor prognosis, and came to be associated with a large, anterior, or hard crystalline lens.

Purpose To determine the association of strabismus surgery reoperation rates with adjustable or conventional sutures. Design Retrospective cross-sectional study. Methods Setting Review of a large national private insurance database. Study Population Adults age 18 to 89 having strabismus surgery between 2007 and 2011. Intervention Adjustable versus conventional suture strabismus surgery. Outcome Measure Reoperation rate in the first postoperative year. Results Overall, 526 of 6178 surgical patients had a reoperation (8.5%). Reoperations were performed after 8.1% of adjustable suture surgeries and after 8.6% of conventional suture surgeries (p=0.57). Of the 4357 horizontal muscle surgeries, reoperations were performed after 5.8% of adjustable suture surgeries, and after 7.8% of conventional suture surgeries (p=0.02). Of the 1072 vertical muscle surgeries, reoperations were performed after 15.2% of adjustable suture surgeries, and after 10.4% of conventional suture surgeries (p=0.05). Younger age (18 to 39 years) was associated with a lower reoperation rate (p ≤ 0.02). The significant multivariable predictors of reoperation for horizontal surgery were adjustable sutures (odds ratio, OR 0.69, 95% confidence interval 0.52 to 0.91), monocular deviation (OR 0.64), complex surgery (OR 1.63), and unilateral surgery on two horizontal muscles (OR 0.70, all p ≤ 0.01). Adjustable sutures were not significantly associated with reoperation rates after vertical muscle surgery (multivariable OR 1.45, p=0.07). Conclusions Adjustable sutures were associated with significantly fewer reoperations for horizontal muscle surgery. Adjustable sutures tended to be associated with more reoperations for vertical muscle surgery, but this observation was not statistically significant in the primary analysis after controlling for age.

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Averaging up to 4 preoperative IOP values improved postoperative IOP predictions. A high iris cross-sectional area or convex hull of the iris segments on AS-OCT was associated with lower postoperative IOP. These findings might help identify patients who are likely to have the largest IOP drop after cataract surgery.

Purpose To determine predictors of reoperation and abnormal binocularity outcomes (including amblyopia and diplopia) following pediatric strabismus surgery. Design Retrospective cross-sectional study. Methods Setting: Review of a national insurance database. Study population: Children under age 18 years having strabismus procedures between 2007 and 2013. Interventions: Adjustable or fixed suture strabismus surgery, or botulinum toxin injection. Outcome measures: Reoperation or diagnosis of abnormal binocularity in the first postoperative year. Results Of 11,115 children having strabismus procedures, 851 (7.7%) underwent reoperation. The reoperation rate was 7.4% for fixed suture surgeries, 9.6% for adjustable suture surgeries (p=0.18), and 44.9% for botulinum injections (p<0.001). Age under 2 years was associated with higher reoperation and abnormal binocularity rates (p<0.001). For horizontal strabismus, the postoperative abnormal binocularity rate was 12.8% for fixed suture surgery and 26.5% for botulinum injection (p=0.005). Reoperation rates tended to be higher with adjustable sutures (odds ratio [OR] 1.69, 95% confidence interval [CI] 0.94 to 3.03, p=0.08), or botulinum toxin injection (OR 10.36, 95% CI 5.75 to 18.66, p<0.001) and lower with 3- or 4-muscle surgery (p=0.001). Esotropia, hyperopia, and botulinum injection were independently associated with higher rates of postoperative abnormal binocularity (p<=0.005). For vertical surgeries, predictors of reoperation were adjustable suture use (OR 2.51, p=0.10) and superior oblique surgery (OR 2.36, p<0.001). Conclusions Adjustable sutures were not associated with a lower reoperation rate in children. Younger age, esotropia, hyperopia, and botulinum injection were associated with postoperative abnormal binocularity. Superior oblique surgery and botulinum injection were associated with higher rates of reoperation.