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 correlate glycemic control, as expressed by HbA1c levels, to the change in macular thickness in diabetic patients who undergo phacoemulsification.

METHODS: This was a prospective cohort study done at the Cataract and Medical Retina Clinics of the University of the Philippines Department of Ophthalmology and Visual Sciences (UP-DOVS), Sentro Oftalmologico Jose Rizal (SOJR) of the Philippine General Hospital, University of the Philippines - Manila. Participants included 15 diabetic patients with mature cataracts that warranted lens extraction surgery via phacoemulsification by a senior resident of the UP-DOVS. Participants were screened using pre-determined inclusion and exclusion criteria. Pre-operative best corrected visual acuity (BCVA) was obtained for both eyes using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Pre-operative central macular thickness (CMT) was measured using the Cirrus Ocular Coherence Tomography (OCT) machine. Patients then underwent monocular phacoemulsification by their respective surgeons and instilled antibiotic and steroid drops as instructed. One month after surgery, BCVA and post-operative CMTwere measured. Blood was extracted and sent for determination of glycosylated hemoglobin (HbA1c) levels. Ttest was done to compare the mean CMT and BCVA at baseline and at 1 month after phacoemulsification in the study and control eyes. T-test was also used to compare the mean change in CMT in the study and control eyes. Simple correlation between HbA1c and CMT, as well as CMT and BCVA, was done using Pearson's R.

RESULTS: Neither mean baseline nor mean post-operative CMT between study and control eyes were statistically different  and p=0.1562). There was a statistically significant greater mean CMT in the study eye group (p=0.004). There was a mean change in CMT of 16.7 ± 18.5 ?m, and 1.8 ± 8.8 ?m in the group of control eyes (p=0.011). Mean HbA1c was 8.19%. No positive correlation was established between HbA1c and mean CMT in both study eyes (r=-0.312) and control eyes (r=-0.289). No correlation was established between BCVA and CMT (r=0.426).

CONCLUSION: In diabetics, eyes that undergo phacoemulsification gain a significant change in CMT but this may not necessarily result in macular edema and may not parallel the severity of diabetic retinopathy. We were not able to demonstrate correlation between CMT and HbA1c levels or CMT and BCVA.

Human ; Male ; Female ; Aged ; Middle Aged ; Macular Edema ; Diabetic Retinopathy ; Phacoemulsification ; Hemoglobin A, Glycosylated ; Ophthalmology ; Anti-bacterial Agents ; Cataract ; Retina ; Visual Acuity

OBJECTIVE: To report the causes of legal blindness in the Department of Health (DOH) Eye Center among working age group patients (16-64 years old) in 2014 and compare these figures to data from 2008.

METHODS: Data were collected from the DOH Eye Center records section. The charts of new patients seen at the general ophthalmology clinic in the years 2008 and 2014 were reviewed individually. Patients between 15 and 64 years old with best corrected visual acuity (BCVA) of 20/200 (6/60) or less in the better-seeing eye were included as subjects in the study. Patients who improved to better than 20/200 (6/60) with BCVA and any medical or surgical means were excluded from the study. Patients whose visual acuity could not be assessed for any reason or with reversible causes of blindness were also excluded from the study.

RESULTS: The DOH Eye Center general ophthalmology clinic had a total of 8,941 registered patients aged 15 to 64 years old during the period January 1 to December 31, 2014. Diabetic retinopathy/maculopathy together with pathologic myopia formed the largest category of irreversible legal blindness (BCVA of 20/200 or less on the better seeing eye) with a total of 26 (18%) patients for each. Retinitis pigmentosa and macular dystrophy under the hereditary retinal disorders formed the second largest cause of legal blindness with 17 (12%) followed by glaucomatous optic neuropathy from all kinds with 15 (10%). Together, these four entities comprised more than 58% of all causes of blindness in the working age group. Optic atrophy, comprised mostly of ethambutol toxic optic neuropathies (ETON), was responsible for 14 (10%) followed by congenital disorders and corneal disorders of the eye with 7 (5%) for each. Other conditions comprised of disorders of the neural cortex; this formed 6 (4%) eligible causes of legal blindness. Uveitic causes and retinal detachment also contributed 6 (4%) each to the pool of eligible cases of legal blindness. Other conditions were endophthalmitis, central retinal artery occlusion and clinically significant macular edema which collectively contributed 6% to the pool. In comparison, the main causes of eligible legal blindness in the DOH Eye Center in 2008 were glaucoma, which accounted for 21% and was the single leading cause of blindness, followed by diabetic retinopathy (16%), retinal detachment 11%), pathologic myopia and optic atrophy (10%).

CONCLUSION: The leading causes of legal blindness in 2014 were shared between diabetic retinopathy/maculopathy and pathologic myopia. In 2008, the single leading cause of legal blindness was glaucoma from all kinds, but after 6 years, it was overtaken by diabetic retinopathy and maculopathy. The decrease in blindness caused by glaucoma may be related to increased promotion of awareness of blindness due to glaucoma. 

Human ; Male ; Female ; Middle Aged ; Adult ; Adolescent ; Diabetic Retinopathy ; Macular Edema ; Ophthalmology ; Macular Degeneration ; Optic Nerve Diseases ; Myopia ; Retinal Artery Occlusion ; Retinitis Pigmentosa

OBJECTIVE: To compare the efficacy, refractive predictability, stability and safety of Small Incision Lenticule Extraction (SMILE) and Femtosecond Laser In-Situ Keratomileusis (F-LASIK) for the correction of myopia and astigmatism.

METHOD: This study was approved by the Institutional Review Committee of the St. Luke's Medical Center. A retrospective chart review was conducted at the Vision Laser Center of the St. Luke's Medical Center-Global City. All patients that underwent SMILE from January 2014 to July 2014, with adequate follow-up at 1 day, 1 week, 1 month, 3 months and 1 year, were included in the study. Age-matched and refraction-matched patients, who underwent F-LASIK from January 2012 to April 2014, were chosen as comparators. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), attempted refraction versus achieved refraction and adverse events at 1 day, 1 week, 1 month, 3 months and 1 year were compared postoperatively in both groups. Primary outcome measures were efficacy expressed as the percentage of eyes achieving UCVA of 20/25 or better during the postoperative follow-up, refractive predictability, safety and stability. 

RESULTS: Thirty-five eyes of 18 patients who underwent SMILE and 38 eyes of 19 patients who underwent FLASIK were included in the study. The mean preoperative spherical equivalent of both groups had no statistical difference, with -3.84 ± 1.31 D and -4.07 ± 1.39 D for SMILE and F-LASIK, respectively (p=0.801). At 1 week postoperatively, 51% and 97% achieved UCVA of 20/25 or better in the SMILE and F-LASIK groups. At 3 months, 97% had 20/25 vision or better for the SMILE group, while 100% had 20/25 vision or better for the F-LASIK group. At 1 year, both groups achieved 100% 20/25 or better vision. Three percent lost one line of BCVA in both groups at 1 year. Mean spherical equivalent (SE) between groups at 1 year showed no statistically significant difference (p=0.21), with 0.05 ± 0.18 D in the SMILE group and -0.1 ± 0.15 D in the F-LASIK group. No significant change in mean SE was observed within groups from 1 day to 1 year post op, p=0.166 for SMILE and p=0.226 for F-LASIK. At 1 year, 100% of the SMILE and F-LASIK groups were within ± 0.5 D of target refraction. No adverse events were noted in either group. 

CONCLUSION: SMILE was comparable to F-LASIK in terms of visual outcomes (efficacy, refractive predictability, stability) and safety for the treatment of myopia and astigmatism. However, a slight delay in visual improvement during the first week was observed in the SMILE group.

Human ; Male ; Female ; Adult ; Keratomileusis, Laser In Situ ; Astigmatism ; Eyeglasses ; Advisory Committees ; Myopia ; Visual Acuity ; Eye ; Outcome Assessment (health Care)

PURPOSE/OBJECTIVE: This study aims to determine the reliability of the "VisualFields Easy" application in detecting visual field loss among ophthalmology patients; and to determine the sensitivity, specificity, positive predictive and negative predictive values of this examination using the Humphrey Visual Field Analyzer as the gold standard.

METHODS: This is an analytical study that enrolled subjects requiring visual field examination as part of the comprehensive evaluation of their ophthalmologic condition. Each subject was tested using the standard automated Humphrey Field Analyzer (Carl Zeiss Meditec, Inc., Germany) with the 30-2 Swedish Interactive Thresholding Algorithm (SITA) and the "VisualFields Easy" application (background = 10 cd / m2 ; size V target; 16-dB stimulus) loaded in an iPad 2 ver. 8.3. The print outs of each test were then interpreted independently by the principal investigator and verified by a glaucoma specialist as positive or negative for visual field defects and computation for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were done.

RESULTS: The study included 137 eyes of 77 patients, 52 (68%) females and 25 (32%) males, age ranging from 18 to 82 years with a mean (SD) of 58 (+ 14) years. The mean test duration for the standard Humphrey perimetry was 7 minutes 50 seconds (SD + 0.08s), and 3 minutes 21 seconds (SD + 0.01s) for the "VisualFields Easy". Correlations of False Positives and False Negatives between the 2 tests were p=0.02 and p=0.03 respectively and that there was no statistically significant difference between the reliability parameters of the two tests. There were a total of 74 positives and 63 negatives visual field defects for the Humphrey. These were considered as the True Positive (TP) and True Negative (TN) values. For the "VisualFields Easy", there were 67 positives and 70 negatives. The results of the "VisualFields Easy" were plotted against the Humphrey perimetry. Sensitivity was computed at 91% and specificity at 100%. Likewise the Positive Predictive Value (PPV) was computed to be 100% and the Negative Predictive Value (NPV) was computed at 90%.

CONCLUSION: The "VisualFields Easy" application is a quick, easily accessible and fairly reliable way of measuring visual field abnormalities, both for glaucoma and neuro-ophthalmology patients. The application is not intended to replace standard automated perimetry machines, but it may have a role in detecting, documenting and monitoring visual field defects in low resource settings where visual field tests are not available.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Visual Field Tests ; Visual Fields ; Ophthalmology ; Glaucoma ; Sensitivity And Specificity ; Tetrahymenina

OBJECTIVE: To determine if there is an agreement between keratometry readings and intraocular lens (IOL) power calculation using Haigis and Sanders, Retzlaff and Kraff theoretical (SRK/T) formulas obtained by iTrace® and IOLMaster®.

METHODS: A retrospective chart review of patients who underwent preoperative biometry using both IOLMaster® and iTrace® from January 2015 to July 2015 and satisfied the inclusion/exclusion criteria were included in the study. The average keratometry, cylinder power and predicted IOL power were computed accordingly. Agreement between devices was analyzed using Bland Altman.

RESULTS: A total of 70 eyes from 35 study participants were included in the analysis. The means of average keratometry values obtained from IOLMaster® and iTrace® were 43.9 ± 1.3 D and 43.6 ± 1.3 D respectively. The paired mean differences in the average keratometry and cylinder power between instruments were -0.3 ± 0.3 and 0.1 ± 0.4 respectively. There was a statistically significant difference in the proportion between the number of times there will be a need to change IOL power and the number of times IOL power will remain the same using the Haigis formula with a p value of <0.0005.

CONCLUSION: Average keratometry values, cylinder power and IOL calculation using the Haigis formula obtained by the two devices tested did not show agreement. There is agreement using the SRK/T formula. 

Human ; Male ; Female ; Adult ; Retrospective Studies ; Lenses, Intraocular ; Biometry ; Cornea

OBJECTIVE: To describe the demographic and clinical profile of patients who underwent refractive surgery screening.

METHODS: Medical records of patients who sought consult for refractive surgery from January 2010 to December 2014 at a refractive center were reviewed and analyzed. The preoperative clinical conditions, optical characteristics of myopes and hyperopes, refractive screening tests, and causes for disqualification were determined.

RESULTS: A total of 1215 patients who sought consult for refractive surgery had a mean age of 36.45 ± 11.60 years. Seven hundred ten (58.44%) were females and 860 (70.78%) were Filipinos. Nine hundred eighty eight (81%) were myopes. The mean manifest refractive spherical equivalent (MRSE) for myopic patients was -4.41D±2.98 with mean uncorrected distance vision (UCDVA) of 20/400 (logMAR 1.26) and mean best-corrected distance vision (BCDVA) of 20/20 (logMAR 0.02). For hyperopic patients, the mean MRSE was +1.33D±3.76 with mean UCDVA of 20/40 (logMAR 0.33) and mean BCDVA of 20/20 (logMAR 0.001). Reasons for disqualification from undergoing a refractive procedure included thin cornea (5.27%), irregular corneal topography (2.39%), steep cornea (0.78%), high refractive errors (0.41%), optic nerve (0.41%), and retina (0.25%) pathologies.

CONCLUSION: Patients who underwent screening for refractive surgery were young, mostly female, with myopic refractive errors. LASIK remained the most popular refractive surgery procedure. 

Human ; Male ; Female ; Adult ; Keratomileusis, Laser In Situ ; Corneal Topography ; Hyperopia ; Myopia ; Refractive Errors ; Optic Nerve ; Retina ; Cornea ;

OBJECTIVE: To evaluate the visual and refractive outcomes of LASIK, PRK, phakic IOL, and Supracor as treatment for errors of refraction, including presbyopia, performed at a private eye center.

METHODS: This is a retrospective, single-center, single-surgeon study that reviewed the surgical outcomes of patients who underwent LASIK, PRK, phakic IOL, and Supracor from January 2010 to December 2014. Main outcome measures were postoperative uncorrected and corrected distance, intermediate, and near visual acuity (for Supracor), and mean manifest-refraction spherical equivalent (MRSE) of patients who had at least 1 month follow up. Complications and enhancements were analyzed independently.

RESULTS: Data were analyzed from 1,366 eyes of 771 patients. LASIK was the most commonly performed procedure (68%), followed by PRK (18.3%), Supracor (10.2%), and phakic IOL (3.7%). The postoperative mean MRSE at 1 month for LASIK, PRK, and phakic IOL were -0.08 ± 0.36, +0.06 ± 0.52 and -0.11 ± 0.44, respectively. The mean postoperative logMAR uncorrected distance visual acuity (UDVA) at 1 month for LASIK, PRK, and phakic IOL were 0.02 ± 0.10, 0.07 ± 0.12, 0.001 ± 0.09, respectively. In the Supracor group, the mean preoperative and postoperative spherical equivalent were +1.12 ± 0.8 and -0.76 ± 0.62, respectively. The mean postoperative logMAR UDVA and uncorrected near visual acuity (UNVA) for Supracor were 0.24 ± 0.19 and 0.02 ± 0.08, respectively. The most common postoperative complication was symptomatic dry eye (13%). Regression and off-target outcomes occurred in 24 (1.8%) and 13 eyes (1%), respectively. Overall enhancement rate was 2%.

CONCLUSION: LASIK remained to be the most common refractive procedure, with femtosecond laser-created flap becoming the norm. Refractive and visual outcomes showed good efficacy with all the refractive procedures. Complication and enhancement rates were low.

Human ; Adult ; Keratomileusis, Laser In Situ ; Presbyopia ; Visual Acuity ; Eye ; Surgeons ; Postoperative Complications ; Outcome Assessment (health Care)

OBJECTIVE: To determine the range of macular pigment optical density (MPOD) levels in healthy Filipino adults using both the MPS II and the macuscope and to investigate whether age and sex were related to inter-subject variations in MPOD.

METHODS: This was a prospective, cross sectional study of 168 healthy Filipino patients who underwent heterochromic filter photometry to measure macular pigment levels using the MPS II and the macuscope. The MPOD levels were averaged per age group and analyzed as to variations among age and gender.

RESULTS: One hundred thirty (130) and thirty-eight (38) patients underwent MPS II and macuscope testing respectively. The mean MPOD level for MPS II was 0.39(±0.16) and for macuscope 0.27(±0.07). MPOD values were similar across all age groups and gender, but they were lower when measured with the macuscope.

CONCLUSIONS: MPOD levels measured among healthy Filipino adults were lower with the macuscope compared to the MPS II. These differences should take into consideration the differences in apparatus and techniques of measurement.

Human ; Male ; Female ; Adult ; Macular Pigment ; Cross-sectional Studies ; Prospective Studies ; Photometry