Gavin Li

Purpose: To evaluate whether dry eye disease (DED) diagnosis may increase the subsequent risk of developing depression and anxiety. Methods: In this retrospective cohort study, Medicare beneficiaries aged 65 and older with a new diagnosis of DED, no prior history of depression and/or anxiety disorder, and continuous follow-up between 2011 and 2015 were identified from a 5% random sample of nationwide Medicare claims. Beneficiaries included in the DED cohort were matched to a non-DED cohort at a 1:4 ratio using propensity scores based on demographic factors and systemic comorbidities. Crude incidence rates and rate ratios for depression and anxiety were calculated. Multivariable Cox proportional hazards regression model was fit to evaluate the impact of demographic factors and dry eye on the risk of developing these conditions while adjusting for systemic comorbidities. Main Outcome Measures: Longitudinal incidence of depression and anxiety in DED versus non-DED groups. Results: The unadjusted incidence of depression was 30% higher [incidence rate ratio 1.30, 95% confidence interval (CI), 1.24‒1.36] in the DED cohort, and the unadjusted incidence of anxiety was 50% higher (incidence rate ratio 1.50, 95% CI, 1.41–1.58) compared with the non-DED group. The increased susceptibility to depression (adjusted hazard ratio 1.25, 95% CI, 1.19–1.31) and anxiety (adjusted hazard ratio 1.45, 95% CI, 1.37–1.54) because of DED remained significant after adjusting for demographic factors and systemic comorbidities. Conclusions: DED is an independent risk factor for developing depression and anxiety in the elderly.

Purpose: To investigate the intraoperative performance and lens fragmentation efficacy of a non-cavitating handheld lensectomy system in mild, moderate, and severe cataract. Setting: Ambulatory surgical centers. Design: Retrospective consecutive case series. Methods: 665 consecutive eyes underwent cataract surgery by 12 surgeons using a new handheld non-cavitating lensectomy system for nuclear fragmentations and extraction. Intraoperative measurements included surgical time, miLOOP pretreatment, and irrigation fluid use. Results: Of the 665 eyes, 38 (6%), 468 (70%), 126 (19%), and 33 (5%) were of grade 1, 2, 3, and 4 nuclear densities, respectively, as graded by the surgeon intraoperatively. Successful nuclear fragmentation, lens extraction, and cortical removal were achieved in all eyes. Total nucleus fragmentation and extraction times were 70.1 seconds, 100.3 seconds, 132.6 seconds, and 287.9 seconds for grades 1, 2, 3, and 4, respectively (P < .001). In addition, irrigation and aspiration cortical removal times were 64.1 seconds, 51.1 seconds, 48.5 seconds, and 59.0 seconds, respectively (P = .14). There was a low rate of capsular tear (3 cases in 665 surgeries, 0.45%) and no other emergent adverse events. Conclusions: The miCOR handheld non-cavitating lensectomy system demonstrated nuclear fragmentation and extraction in the absence of intraocular cavitation across all grades of nuclear densities.

Purpose: The purpose of this study was to investigate the impact of demographic characteristics and psychiatric comorbidity on the prevalence of dry eye disease in the American geriatric population. Methods: Data were collected from a 2011 nationwide sample of Medicare beneficiaries aged 65 years and older (N = 1,321,000). Age, sex, race/ethnicity, residential area, climate region, and income, along with psychiatric comorbidities including depression and anxiety, were collected. Multivariable logistic regression models were used to assess the relationship between demographic and psychiatric factors and the prevalence of dry eye disease. Results: Among 21,059 patients with clinically significant dry eye, women had higher odds of having dry eye compared with men [odds ratio (OR) 2.03, 95% confidence interval (1.97–2.10)]. Asian and Native American patients had increased odds of having dry eye compared with White patients [OR 1.85 (1.69–2.02) and OR 1.51 (1.19–1.93)], while Black patients were less likely to have dry eye [OR 0.83 (0.79–0.87)]. Patients aged 75 to 84 years and 85+ were more likely to have dry eye compared with those aged 65 to 74 years [OR 1.49 (0.45–1.53) and OR 1.54 (1.48–1.60)]. Having both depression and anxiety were associated with higher odds of having dry eye [OR 2.38 (2.22–2.55)] compared with having depression alone [OR 1.95 (1.86–2.04)] or anxiety alone [OR 2.22 (2.10–2.35)]. Conclusions: Significant racial and regional disparities in dry eye prevalence were found. Psychiatric association with dry eye varied with age, sex, race, and residence region. Further research is needed to comprehend the underlying mechanisms, implications, and to address disparities in the diagnosis and management of dry eye.

Understanding the association between ocular surface disease and glaucoma is important for improving adherence to treatment and introducing practical solutions. While topical antihypertensive medications for glaucoma are well tolerated according to short-term studies, there is little evidence on their long-term effects. Since they are often required for many years, the effects of these drops on the ocular surface become important in regard to quality of life and adherence. In this nonsystematic review performed in April 2022, we summarize what is known about the relationship between glaucoma and ocular surface disease. Specifically, we examine how each class of topical glaucoma drops affects the ocular surface. We then review the treatment of ocular surface disease for patients on topical glaucoma therapy. Finally, we discuss treatments that may reduce or eliminate the burden of topical medications.

Purpose. To evaluate whether unilateral crosslinking (CXL) and conservative follow-up of the fellow eye is an acceptable management strategy in patients with keratoconus (KC). Methods. Seventy-nine fellow eyes of KC subjects that initially underwent unilateral CXL were included. Thirty fellow eyes ultimately received CXL (group 1) whereas 49 fellow eyes were followed (group 2). Best spectacle corrected visual acuity (BSCVA) and corneal tomographic parameters were collected in all eyes preoperatively and at the last follow-up. Results. Subjects who received CXL in the fellow eye (group 1) were younger than subjects who did not (group 2, ). Group 1 eyes had higher baseline K1 ( ), K2 ( ), Km ( ), and Kmax ( ) compared to group 2 eyes. Amongst the 49 naïve fellow eyes (group 2), 19 eyes showed evidence of progression. Progressing naïve eyes had higher baseline K1, K2, Km, and Kmax ( ); progressors also had thinner pachymetry at the pupil, apex, and thinnest point ( ). Baseline values of K1 ≥ 43.5 Diopter (D), K2 > 45.1D, Km > 44.3D, K_max > 47.9D, astigmatism > 1.4D, pachymetry at the pupil μm, and thinnest pachymetry μm were tentative predictors of progression in the naïve fellow eye. Conclusions. Unilateral CXL with vigilant follow up of the fellow eye may be an acceptable management strategy in a subset of KC eyes.