Macular Degeneration: Chang A

Merani R, Hunyor AP, Playfair TJ, Chang A, Gregory-Roberts J, Hunyor AB, Azar D, Cumming RG. · Sydney Eye Hospital, University of Sydney, Australia. · Am J Ophthalmol. · Pubmed #17632068 No free full text.

Abstract: PURPOSE: To evaluate the management and outcomes of patients undergoing pars plana vitrectomy (PPV) for retained lens material after cataract surgery; and to evaluate risk factors for poor visual outcome, retinal detachment, raised intraocular pressure (IOP), and cystoid macular edema (CME). DESIGN: Retrospective interventional consecutive case series. METHODS: setting: Institutional and Clinical practice. study population: Patients with retained lens material after cataract surgery who underwent vitrectomy at Sydney Eye Hospital between July 1, 1998 and October 31, 2003. intervention: Standard three-port PPV/lensectomy. main outcome measures: Final best-corrected visual acuity (BCVA), retinal detachment, raised IOP, and CME. RESULTS: A total of 223 eyes of 223 patients were included, with a mean follow-up of 20.5 months after vitrectomy. Final BCVA was 6/12 or better in 159 patients (71.3%). Retinal detachment occurred in 20 patients (9%), with 11 diagnosed before or during vitrectomy, and nine occurring after vitrectomy. Ten patients (5.0%) developed raised IOP and 42 (23.2%) developed CME. Poor final visual acuity was associated with retinal detachment (P = .0026), and with poor visual acuity at presentation (P = .030). There was a significant association between retinal detachment and a long interval (>30 days) between cataract surgery and vitrectomy (P = .00047) and between retinal detachment and younger age (P = .0070). CONCLUSIONS: Visual acuity results in this study compared favorably with previously published reports. Although the overall rate of retinal detachment was low, it was significantly higher in those with a delayed interval between cataract surgery and vitrectomy, and was significantly associated with a poorer visual outcome.

Maberley DA, Hollands H, Chang A, Adilman S, Chakraborti B, Kliever G. · Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada. · Eye. · Pubmed #16456592 No free full text.

Abstract: PURPOSE: To ascertain the prevalence and primary causes of visual impairment in a sample of patients from Vancouver's downtown eastside (VDES). MATERIALS AND METHODS: A total of 200 patients seeking nonophthalmic medical care at the Vancouver Native Health Society (VNHS) clinic in Vancouver's inner city (downtown eastside) participated in this observational case-series study. For each participant, we obtained demographic information, a medical and ocular history, and performed a complete eye exam. The prevalence of visual disability using standard North American criteria was reported. Causes of visual loss were also reported based on Canadian National Institute for the Blind (CNIB) guidelines. RESULTS: A total of 200 patients participated in our study. The median age of our sample was 46 years, 69% were male. There were very high rates of comorbid medical conditions including HIV, Hepatitis B/C, IV drug use, and diabetes. The raw prevalence of visual disability based on best-corrected visual acuity (BCVA) was 500 per 10,000; this was over nine times greater than in the general Canadian population. The raw prevalence rate of 'presenting visual disability' based on presenting visual acuity (PVA) was 2400 per 10,000. Major causes of visual disability were cataract and retinal disease. Although age-related macular degeneration and diabetic retinopathy represent major causes of vision loss in North America, no cases were noted in our sample. CONCLUSION: The overall prevalence of visual disability was alarmingly high in this disadvantaged community. These results identify both ophthalmic disease and access to refraction and prescription spectacles as a significant health concern among people living in the VDES.

Chew H, Maberley DA, Ma P, Chang A, Maberley A. · Department of Ophthalmology, University of Toronto, Ontario, Canada. · Can J Ophthalmol. · Pubmed #15947808 links to  free full text

Abstract: BACKGROUND: The purpose of this study was to compare baseline clinical and socioeconomic features of patients undergoing self-funded photodynamic therapy (PDT) or government-funded subthreshold transpupillary thermotherapy (TTT) with a diode laser for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). METHODS: Between July 2000 and August 2001, 115 patients with subfoveal choroidal neovascularization secondary to AMD were offered PDT as an initial intervention. If individuals believed that they could not afford or did not want PDT, then TTT was offered. In masked fashion, leakage pattern and lesion size were determined retrospectively from pretreatment angiograms. Baseline visual acuity was determined with autorefraction and subsequent Snellen testing. The mean income of each treatment group was estimated from the average sex-specific income for each subject's postal code, based on the 1996 Canadian census data. The average education level for each subject's postal code was also determined. RESULTS: The patients who were not willing to pay for PDT had significantly worse macular disease before treatment (larger lesions and poorer visual acuity) and a significantly lower mean income than the patients who were willing to pay for PDT. INTERPRETATION: The severity of exudative choroidal neovascularization appears to be associated with lower socioeconomic status.

Maberley DA, Chew H, Ma P, Chang A, Hollands H, Maberley A. · Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada. · Can J Ophthalmol. · Pubmed #15947807 links to  free full text

Abstract: BACKGROUND: The purpose of this study was to compare photodynamic therapy (PDT) against subthreshold transpupillary thermotherapy (TTT) with a diode laser for subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD). METHODS: Patients with subfoveal choroidal neovascularization secondary to AMD were offered PDT as an initial intervention. If they declined PDT, then TTT was offered. RESULTS: We evaluated and followed 115 consecutive patients for an average of 1 year. The primary outcome measure was visual acuity, but the interventions were also compared on the basis of lesion size and angiographically determined lesion activity. Baseline comparisons between the 2 treatment groups showed significant differences in pretreatment visual acuity, lesion size, and lesion composition. Univariate analysis of outcomes demonstrated equivalence between the treatment groups in final lesion size, angiographic activity, and visual acuity. Multivariate analysis also demonstrated equivalence between the treatment groups in final visual acuity while controlling for age, pretreatment visual acuity, and lesion category. Predominantly classic lesions were associated with poorer visual outcomes. INTERPRETATION: The PDT and TTT groups were equivalent in terms of all outcome parameters evaluated.

Beaumont P, Lim CS, Chang A, Kang K. · <> · Arch Ophthalmol. · Pubmed #15477472 No free full text.

This publication has no abstract.

Zeldovich A, Beaumont P, Chang A, Kang K. · Sydney Retina Specialists, Sydney, New South Wales, Australia. · Clin Experiment Ophthalmol. · Pubmed #12213170 No free full text.

Abstract: A 37-year-old woman presented with flashes in her left eye and bilateral visual distortion. Fundal examination revealed a reticular 'fishnet' pattern of retinal pigmentation in both eyes consistent with reticular dystrophy of the retinal pigment epithelium. In the left eye there was a small haemorrhage and a shallow serous macular detachment. Fluorescein angiography demonstrated subfoveal choroidal neovascularization. Indocyanine green angiography (ICG) revealed more extensive involvement than fluorescein angiography, with small areas of intense hyperfluorescence amongst reticular areas of hypofluorescence. These changes, as interpreted in light of the known histopathological localization of ICG, are consistent with varying stages of dysfunction of the retinal pigment epithelium in this disease.