By Brooke Strickland

This study, named the Multi-Ethnic Pediatric Eye Disease Study, was a cross sectional, population-based study that sought to determine the sex-and ethnicity-specific prevalence in color vision deficiency (CVD) for preschool age children that were Asian, black, Hispanic, or non-Hispanic white. There were a total of 5,960 kids included in the study, with ages ranging from 30 to 72 months old. A total of 4,177 were able to complete color vision testing (1265 black, 812 Asian, 1280 Hispanic, and 820 non-Hispanic white). To gather data, the children were tested using a color- vision-testing-made-easy color plate. Then, diagnostic confirmatory testing was done using Waggoner HRR Diagnostic Test color plates. They looked for prevalence of CVD in relation to age, ethnicity, and gender.

Results showed testability was 17% in children that were less than 37 months of age. It then increased to 57% for kids that were 37 to 48 months, then 89% in children 49 to 60 months of age, and 98% in children 61 to 72 months of age. The prevalence of CVD among boys was 1.4% for black, 3.1% for Asian, 2.6% for Hispanic, and 5.6% for non-Hispanic white children; the prevalence in girls was 0.0% to 0.5% for all ethnicities. The ethnic difference in CVD was statistically significant between black and non-Hispanic white children and between Hispanic and non-Hispanic white children. Most CVD cases for male children were either deutan (51%) or protan (34%), 32% were classified as mild, 15% as moderate, and 41% as severe. (1)

What to take away from the study: By age four, testability for CVD in preschool age kids is high. CVD incidences for preschool boys are different for each ethnicity, but the highest prevalence appears to be for non-Hispanic white children. Black children have the lowest occurrences of CVD.

1. Xie, John, Z., MD, PhD, Hornoch-Tarczy, Kristina, MD, DPhil, Lin, Jess, MS, Cotter, Susan, A., OD, MS, Torres, Mina, MS, Varma, Rohit, MD, MPH, Multi-Ethnic Pediatric Eye Disease Study Group. “Color Vision Deficiency in Preschool Children: The Multi-Ethnic Pediatric Eye Disease Study.” Ophthalmology. Published online April 3, 2014. Accessed April 5, 2014.


By Brooke Strickland

In this study, researchers looked at 988 culture-positive endophthalmitis samples that were collected in 911 eyes in a 25 year time period (1987-2011). The goal was to see what spectrum and susceptibility patterns were of pathogens responsible for culture-positive endophthalmitis referred to a single institution. They also wanted to identify any possible trends in both pathogens and antibiotic sensitivities in the 25 year time frame. The study was retrospective and laboratory-based. Susceptibility rates to a variety of antibiotics were calculated. To measure changes in spectrum or susceptibility over time, a chi-square test was used. The average patient was 67±18 years and 55% of the patients were female.

Results showed the most prevalent pathogens were coagulase-negative staphylococcus (39.4%), followed by Streptococcus viridans species (12.1%) and Staphylococcus aureus (11.1%). Gram-negative organisms and fungi accounted for 10.3% and 4.6% of all isolates. With the exception of two isolates, Enterococcus faecium and Nocardia exalbida, all the other 725 (99.7%) gram-positive bacteria tested were susceptible to vancomycin. There were 94 gram-negative organisms tested against ceftazidime, two were of intermediate sensitivity and six were resistant. For eight antibiotics, increasing microbial resistance over time was observed: cefazolin, cefotetan, cephalothin, clindamycin, erythromycin, methicillin/oxacillin, ampicillin, and ceftriaxone. For three antibiotics, increasing microbial susceptibility was observed: gentamicin, tobramycin, and imipenem. (1)

What to take away from the study: The most common cause of endophthalmitis is coagulase-negative staphylococcus. Vancomycin and ceftazidime were good choices for empiric antibiotic treatment. Although a statistically significant trend toward increasing microbial resistance against a variety of antibiotics including cephalosporins and methicillin was seen, decreasing microbial resistance against aminoglycosides and imipenem was detected.

1. Gentile, Ronald, C., MD, Shukla, Salil, MD, Shah, Mahendra, MS, Ritterband, David, C., MD, Engelbert, MD, PhD, Davis, Andrew, MD, Hu, Dan-Ning, MD. “Microbiological Spectrum and Antibiotic Sensitivity in Endophthalmitis: A 25-Year Review.” Ophthalmology. Published online April 3, 2014. Accessed April 4, 2014.


By Brooke Strickland

In this cohort study (age-related eye disease study 2, report number 5), researchers were looking to assess the results of cataract surgery for patients with age-related macular degeneration. The study included 793 patients (1232 eyes) that had cataract surgery. The trial included information from a 5 year time span; it was a prospective, multicenter, randomized controlled trial that included nutritional supplements known to treat age-related macular degeneration (AMD).

Pre-op and post-op information was looked at. Clinical data and standardized red-reflex lens and fundus photos were taken at baseline and then annually thereafter. Researchers classified the photographs by a centralized reading center for cortical and posterior subcapsular lens opacities as well as the severity of their AMD. Main outcome measures included how best-corrected visual acuity (BCVA) changed after cataract surgery, compared to before surgery.

Researchers adjusted several factors after analyzing information: age at the time of surgery, gender, time between pre-op and post-op visits, and the type and severity of the cataract. After this information was adjusted, results were as follows: eyes with mild AMD gained 11.2 letters, eyes with moderate AMD gained 11.1 letters, eyes with severe AMD gained 8.7 letters, eyes with non-central geographic atrophy gained 8.9 letters, and eyes with advanced AMD (central geographic atrophy, neovascular disease, or both) gained 6.8 letters. The visual acuity gain across all AMD severity groups was statistically substantial from preoperative values. (1)

What to take away from the study: Vision improved significantly for patients with AMD that had cataract surgery.

1. Huynh, Nancy, MD, Nicholson, Benjamin, MD, Agrón, Elivra, MA, Clemons, Traci, PhD, Bressler, Susan, MD, Rosenfeld, Philip, MD, PhD, Chew, Emily, MD. Age-Related Eye Disease Study 2 Research Group, Writing Committee. “Visual Acuity After Cataract Surgery in Patients with Age-Related Macular Degeneration: Age-Related Eye Disease Study 2 Report Number 5.” Ophthalmology. Published online March 11, 2014. Accessed March 12, 2014.



By Brooke Strickland

In this case series study, researchers looked to define clinical, histopathologic, and radiologic features in patients with an enlarged infraorbital canal. Patients (a total of 14) were gathered from the databases of two hospitals: Moorfields Eye Hospital (London) and Royal Victorian Eye and Ear Hospital (Melbourne). Researchers conducted a retrospective, noncomparative review of the clinical notes, radiology, and histopathology. In addition, they studied medical literature for reports of enlarged infraorbital canals or nerves.

Out of the 14 patients, 10 were male and 4 were female. They were listed between age 29 and 76 and had been identified with proptosis, eyelid swelling or a mass (10/14), or periocular ache (5/14). In 6 of the patients, there was bilateral involvement. Four of the patients reported some reduction in ocular motility, but none had a decrease in visual function or facial sensation. The infraorbital canal was enlarged in 20 of the 28 orbits, with associated ipsilateral orbital changes in 19 of 20 (all 14 patients) and ipsilateral maxillary sinus changes in 12 of 20 (11 patients). Biopsy-proven chronic orbital inflammation was seen in all patients; this resembled reactive lymphoid hyperplasia (RLH) in 7 patients and immunoglobulin (Ig) G4–related sclerosing inflammation in 7 patients. Serum lgG4 was elevated in 6 of 7 patients and in half of the patients, clinical or histologically proven enlargement of cervical lymph nodes was seen. All patients received systemic corticosteroid therapy and responded positively; however, after treatment was stopped, some relapsed. One patient developed diffuse large B-cell lymphoma and subsequently leukemia, of which he later died 20 years after presentation. (1)

What to take away from the study: Patients with enlarged an infraorbital nerve and canal have a rare condition. This strongly suggests a diagnosis of RLH or IgG4-related disease, especially when ipsilateral extraocular muscle enlargement, sinus disease, or focal orbital disease is also manifested.

1. Hardy, Thomas, G., FRANZCO, MB, BS, McNab, Alan, A., FRANZCO, FRCOphth, DMedSc, Rose, Geoffrey, E., DSc, FRCS. “Enlargement of the Infraorbital Nerve: An Important Sign Associated with Orbital Reactive Lymphoid Hyperplasia or Immunoglobulin G4-Related Disease.” Ophthalmology. Manuscript no. 2013-415. Published online March 11, 2014. Accessed March 11, 2014.


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