Objective: This study assessed the relationship of two structural tests, optic-disc photography and optical coherence tomography (OCT), and a functional test, standard achromatic perimetry (SAP), in the diagnosis of glaucoma. Methods: A retrospective review of charts from the database of a private glaucoma specialist and the glaucoma clinic of a tertiary hospital was done. The participants were longitudinally evaluated and had comprehensive eye examination, imaging, and functional testing. Optic-disc photographs, OCTs, and SAPs were interpreted and evaluated separately, and then correlated with each other by two glaucoma experts working individually. Sensitivities, specificities, and predictive values were obtained for each diagnostic test and in combination. Kappa statistics were used for interobserver agreement. Results: Three hundred sixty-seven eyes of 188 patients were included in the study. Fifty-eight patients were diagnosed as normal, 130 had glaucoma. OCT had the highest sensitivity and specificity at 70.7% and 76.6%, followed by SAP at 72.4% and 53.5% respectively. Optic-disc photos had the lowest sensitivity and specificity at 55.8% and 54.4% respectively, and the lowest interobserver agreement (kappa = 0.50-0.61). The predictive values of the 3 tests increased to 82% with good interobserver agreement (kappa = 0.68-0.78) when correlated with each other. Conclusion The correlation of structural and functional tests increased the accuracy of diagnosing glaucoma. These examinations offered complementary information and, when used in conjunction with comprehensive clinical evaluation, guided the clinician in the proper management of patients with glaucoma.
Glaucoma Optic Disk Tomography ; Optical Coherence Visual Fields

ACCORDING to the Department of Health (DOH), cancer ranks third among the leading causes of morbidity and mortality in the Philippines, after infectious and cardiovascular diseases.1 The DOH–Rizal Cancer Registry and the Philippine Cancer Society–Manila Cancer Registry listed breast cancer as the most commonly diagnosed type of cancer in 2006. The Cancer Institute of the University of the Philippines–Philippine General Hospital (UP-PGH) also reported breast cancer as the most common carcinoma seen at the outpatient clinic, with more than 10,000 cases each year. Although intraocular metastasis most frequently originates from the breast,2 it was once a rarity overall. Perls was the first to describe intraocular metastasis in 1872,3 and a subsequent article by Godtfredsen reported its incidence at 0.07%.4 However, post-mortem studies have shown that among patients who died of cancer, 12.2% had histopathologic evidence of intraocular metastases.5 This was supported by another study involving donor eyes with a prevalence of 12.6%.6 Two studies determined the frequency of intraocular metastases from breast carcinoma. Mewis and Young7 examined 250 patients with breast carcinoma and detected 67 (26.8%) positive cases. They also reported that 9% of patients who were asymptomatic also had intraocular metastases. Wiegel and colleagues performed a prospective screening program for 120 asymptomatic patients with disseminated breast carcinoma and found 6 (5%) with intraocular metastases.8 These studies showed that metastases to the eye may not be as rare as once thought.
Breast Neoplasm

OBJECTIVE: To identify the glaucoma clinical practice patterns among the members of the Philippine Glaucoma Society (PGS) from 2015 to 2016 using an online survey. METHODS: An online link was sent to each consenting PGS member which directed them to two poll sites. These sites asked questions about demographics and their preferred clinical practice patterns. Frequency and percent distributions were used to analyze the data. RESULTS: There was a high response rate from PGS members at 97% (42 out of 43 members). More than half of respondents (51%, n=22) defined glaucoma as glaucomatous optic neuropathy with an evident visual field loss. IOP was routinely measured by 90% (n=38) of the respondents with majority preferring to use the Goldmann applanation tonometer (GAT) (98%, n=41). Gonioscopy was done on all new patients by all PGS members but only 62% did regular gonioscopy on follow-up consultations. Most of the respondents relied on the 90D lens (88%) to assess the optic nerve. Visual field examination (VFE) was routinely requested by all respondents. Pachymetry and anterior segment optical coherence tomography (AS-OCT) were used sparingly at only 43% and 12% respectively. Appositional angle closure was addressed by performing laser iridotomy with majority of the respondents preferring a site that is covered by the upper eyelid (57%). Prostaglandin analogues were the top choice as first-line monotherapy for eyes with open-angle glaucoma. Majority of the respondents (55%) opted to do laser trabeculoplasty (LTP) as an adjunct to medical therapy. Mitomycin-C was the preferred intraoperative antimetabolite for trabeculectomy by 98% (n=41). Ahmed (71%, n=30) was the more favored glaucoma drainage device (GDD) by our respondents over Baerveldt (19%, n=8). CONCLUSION: This survey showed majority of the glaucoma practices of PGS members appear to adhere to the current clinical practice guidelines.
Philippines ; Glaucoma ; Tetrahymenina ; Surveys and Questionnaires

OBJECTIVES: To compare the rate of progression of visual field loss in mean defect (MD) decibels (dB)/year in primary open angle glaucoma (POAG) versus primary angle closure glaucoma (PACG) patients managed in a tertiary hospital and to assess the impact of baseline age, baseline MD, and intraocular pressure (IOP) on the rate of progression of visual field loss. METHODS: This was a retrospective review of medical records of patients who were seen at the Glaucoma Clinic of a tertiary hospital from August to October 2018. The following data were recorded: diagnosis, number of reliable automated visual fields (AVFs), number of years followed, baseline age, baseline MD, MD of all subsequent AVFs, IOP at the time of each test, and IOP-lowering interventions. Rate of visual field progression expressed in dB/year was calculated using linear regression analysis. T–test was done to compare the baseline data and rates of progression of visual field loss between the POAG and PACG cohorts. Correlation using Pearson’s r and multivariate analyses were performed to evaluate the effect of baseline age, baseline MD, and IOP on rate of progression of visual field loss. RESULTS: The mean rates of progression of visual field loss in POAG and PACG eyes were 0.12 ± 0.68 dB/year and 0.10 ± 0.59 dB/year, respectively (p=0.8525). Despite treatment, 4.35% of the study eyes were identified as fast progressors while 1.09% were catastrophic progressors. In the POAG group (n=33), laser treatment was negatively correlated with rate of progression of visual field loss (r= -0.5072, p=0.0026). Multivariate analysis showed that baseline MD (p=0.017), mean IOP on follow–up (p=0.020), and laser treatment (p=0.004) were significant factorsaffecting the rate of progression of visual field loss in POAG eyes. In the PACG group (n=59), both baseline MD (r= -0.2798, p=0.0318) and mean IOP on follow–up (r= 0.368, p=0.0041) correlated with rate of progression of visual field loss. Only mean IOP on follow–up was found to be significant on multivariate analysis. CONCLUSION: While most glaucoma patients managed in a tertiary hospital have a slow rate of progression of visual field loss, a few were still identified as fast and catastrophic progressors. Factors associated with rate of progression of visual field loss were baseline MD, mean IOP on follow–up, and laser treatment for POAG, and mean IOP on follow–up for PACG.
Visual Fields ; Visual Field Tests ; Vision Disorders ; Glaucoma

OBJECTIVE: To compare the visual, refractive, and patient-reported outcomes of eyes implanted with one of 3 trifocal intraocular lenses (IOLs). METHODS: This is a cross-sectional, comparative, non-interventional study wherein subjects implanted with FineVision Micro F, AT LISA tri 839MP or AcrySof IQ PanOptix trifocal IOL after phacoemulsification were recruited. Manifest refraction, uncorrected and corrected visual acuity (VA) at distance, intermediate and near vision, contrast sensitivity, modulated transfer function (MTF) values and questionnaire answers were compared among the 3 groups using analysis of variance (ANOVA). RESULTS: Fifty-seven (57) eyes were included in the study: 21 eyes with FineVision (group A), 21 eyes with LISA tri (group B), and 15 eyes with PanOptix IOL (group C). The post-operative mean manifest spherical equivalent was -0.01D, -0.07D, and 0.05D, respectively (p=0.083). Uncorrected distance VA and best-corrected distance VA were similar among the groups. Groups A and C had better uncorrected and corrected intermediate VA at 80 cm and at 60 cm compared to group B. Group A had significantly better uncorrected near visual acuity than groups B and C (p=0.032). Mesopic contrast sensitivity testing showed group C had higher contrast sensitivities without glare in at the spatial frequency of 6 CPD (p=0.038) and with glare at 3 CPD (p=0.039) and at 12 CPD (p=0.009). MTF average height analysis showed that the group A had significantly superior resolution in far targets compared to groups B and C (p=0.001). At near targets, groups A and C had better resolutions compared to group B (p=0.017). There was no significant difference in patient satisfaction for far, intermediate and near VA among the groups. CONCLUSION: Eyes implanted with any of the 3 trifocal IOL designs achieved excellent uncorrected and bestcorrected distance, intermediate and near vision. FineVision and PanOptix provided significantly better intermediate vision than LISA tri at both 80 cm and 60 cm testing distance. FineVision had better near visual outcomes than PanOptix and LISA tri. Patient satisfaction was high in all 3 trifocal IOLS
Lenses, Intraocular ; Vision, Ocular

OBJECTIVE: To compare the presence and severity of meibomian gland (MG) dysfunction among eyes of female subjects with and without eyelid margin tattoos using infrared meibography and colored photographs. METHODS: This is a cross-sectional, descriptive study that involved 38 Filipino females with and without eyelid margin tattoos. Infrared meibography was performed on the upper and lower eyelids of each eye to assess total or partial MG dropout. Colored photographs were taken to evaluate vascularity, irregularity, thickening of the lid margins, and plugging of MG orifices. Severity of MG dysfunction (MGD) was assessed using Arita’s MGD proposed grading scale. Independent t-test was used to compare MG dropout and other lid margin parameters between the two groups. Prevalence ratio and prevalence odds ratio were calculated to measure the likelihood of MGD among eyes with eyelid tattoos. RESULTS: Seventy-four (74) eyes were included in the study (36 in the tattoo group and 38 in the control group). Scores for abnormal vascularity, irregularity, and thickening of the lid margins were significantly higher in the tattoo group compared to the control group (p<0.0000001). However, plugging of gland orifices scores between the two groups were found to be similar (upper eyelid: p=0.65; lower eyelid: p=0.91). Total MG dropout was significantly greater in the tattoo group (upper eyelid: -1.11 ± 0.82; lower eyelid: 1.37 ± 0.75) compared to the control group (upper eyelid: 0.53 ± 0.83; lower eyelid: 0.45 ± 0.76) (upper eyelid: p=0.003; lower eyelid: p=0.000001) for the upper and lower eyelid, respectively). Analysis of total MG dropout between the two groups showed a prevalence ratio of 2.13. CONCLUSION: Eyelid margin tattoos are associated with several eyelid margin abnormalities and increase the risk of meibomian gland droupout.
Meibomian Gland Dysfunction ; Tattooing ; Margins of Excision

OBJECTIVE: To describe the visual and clinical outcomes of 3 patients with sympathetic ophthalmia treated with a combination of systemic steroids and methotrexate. METHODS: This was a small, descriptive case series. RESULTS: We reported 3 cases of post-traumatic sympathetic ophthalmia treated with steroids and methotrexate. Two patients had inciting eyes with no light perception on presentation, while one had a best-corrected visual acuity (BCVA) of counting fingers. The initial BCVA of the sympathizing eyes ranged from 20/20 to 20/50. Control of ocular inflammation was achieved using methotrexate (12.5 to 15 mg weekly) in addition to oral steroids and topical therapy. The final BCVA of the sympathizing eyes ranged from 20/20 to 20/30, indicating that good visual outcomes were attainable with steroids and methotrexate as part of the maintenance regimen. None of the patients developed adverse side-effects from methotrexate. CONCLUSION: This small case series demonstrated the effectiveness and safety of methotrexate for control of intraocular inflammation in sympathetic ophthalmia.
Ophthalmia, Sympathetic ; Methotrexate ; Panuveitis ; Steroids

OBJECTIVE: To determine the incidence of contrast-induced nephropathy (CIN) among patients undergoing fundus fluorescein angiography (FFA) METHODS: One hundred fifty-nine (159) patients from the Ophthalmology out-patient department were enrolled in this prospective, observational study. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were measured within 7 days before and 48 to 72 hours after FFA. Subjects were stratified into low-, intermediate-, and high-risk groups for developing CIN according to baseline eGFR. CIN was defined by an increase in SCr by more than 25% or by 0.5 mg/dL within 72 hours of intravascular administration of contrast media. The incidence of CIN, changes in SCr levels, and changes in eGFR were analyzed. RESULTS: Of the 144 subjects who completed the study, 106 (73.6%) were females, 105 (72.9 %) were diabetics, and 57 (39.6%) had elevated baseline SCr. Four (4 or 2.8%) patients developed CIN after FFA, all of whom had normal baseline SCr and were stratified as low-risks. Overall, there were no significant changes in the means of SCr (1.18 ± 0.56 vs 1.16 ± 0.52, p = 0.13) and eGFR (64.53 ± 26.05 vs 64.94 ± 24.88, p = 0.64) before and after FFA. In the low-risk group, the means of SCr and eGFR remained unchanged after FFA (p = 0.06 and p = 0.15, respectively). In the intermediate-risk group, no significant change was appreciated in SCr levels (p = 0.07) however a significant improvement in eGFR (p = 0.006) was seen. Interestingly, a significant decrease in SCr levels (p = 0.004) as well as a significant improvement in eGFR (p = 0.02) was noted after FFA in the high-risk group. CONCLUSION: The incidence of CIN among patients undergoing FFA in our cohort was 2.8%. There was no prolonged or serious worsening of renal function based on SCr and eGFR before and after FFA overall, and among low-, moderate-, and high-risk groups.
Creatinine ; Glomerular Filtration Rate ; Contrast Media ; Incidence ; Fluorescein Angiography ; Acute Kidney Injury ; Drug-Related Side Effects and Adverse Reactions

OBJECTIVE: To compare the different intraocular lens (IOL) calculation formulas available on the American Society of Cataract and Refractive Surgery (ASCRS) IOL power calculator website among Asian eyes with previous corneal refractive surgery. METHODS: A retrospective cohort study of 84 eyes in 68 Asian patients who had phacoemulsification with previous LASIK or photorefractive keratectomy (PRK) was done. Using the post-phacoemulsification manifest refraction spherical equivalent (MRSE) as target refraction, IOL prediction error (PE) for each formula was calculated as the implanted minus the predicted IOL power. Refractive PE was determined by calculating that 1 diopter (D) of IOL PE produces 0.7 D of refractive error at the spectacle plane. RESULTS: Comparing the Shammas, Haigis-L, Barrett True-K No History, ASCRS Average IOL Power No History, Barrett True-K, and ASCRS Average IOL Power with Change in Manifest Refraction (ΔMR), the mean IOL PEs ranged from -0.23 to -0.62 D, with the Barrett True-K having the lowest PE. The median refractive PEs for all formulas were similar at 0.35 D, except for the Haigis-L at 0.53 D. The ASCRS average with ΔMR had a statistically higher percentage of eyes within 0.5 D of target refraction versus other formulas (p<0.05). The Haigis-L IOL PE and refractive PE were significantly higher than the Barrett True-K (p<0.001), and the ASCRS average with ΔMR (p<0.001) respectively. The ASCRS average with ΔMR produced a significantly smaller variance of IOL PE (p<0.05). CONCLUSION: Accounting for PEs and variance, the ASCRS average IOL power with ΔMR is recommended, followed by the ASCRS average IOL power No History if without historical data.
Keratomileusis, Laser In Situ

OBJECTIVE: This study aimed to calculate and compare the costs of different brands of ocular hypotensive eye drops available in the Philippines. METHODS: This was a single-center research conducted at a local laboratory. Triplicate samples of 21 different brands of locally-available ocular hypotensive drops were tested. The mass of ten drops, total usable mass, number of drops per bottle, and mass of 200-µL aliquots were measured for each sample. These were used to calculate for the total usable bottle volume, drop volume, and number of drops per milliliter of each sample. Lastly, the daily, monthly, and annual costs were computed and compared. RESULTS: Available brands of β-blockers were the most affordable options for topical glaucoma therapy, with costs ranging from Php1,838 to 8,472 per year. Innovator brands of α-agonists and carbonic anhydrase inhibitors were the most expensive, with annual costs ranging from Php7,641 to 24,295 and Php7,361 to 25,327, respectively. Fixed-combination preparations, with yearly costs ranging from Php4,307 to 22,200, were generally more costeffective than individual preparations. The cost of topical anti-glaucoma therapy can amount up to 3.3 to 66.9% of a minimum-wage earner’s annual income depending on the number and combination of drugs being used. CONCLUSIONS: The price range of ocular hypotensive eye drops available in the Philippines is wide. Cost of therapy is an important consideration for patients who acquire medications through out-of-pocket expenditure. Optimization of bottle designs and volumes is crucial to maximize the cost-effectiveness of eye drop solutions. Information on the cost of therapy should be available to both patients and physicians.
Glaucoma ; Tetrahymenina ; Eye ; Ophthalmic Solutions ; Costs and Cost Analysis