Ophthalmology

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Contents
Volume 122, Number 5, May 2015

Editorial: The Importance of Peripheral Diabetic Retinopathy 869

Frederick L. Ferris, III, MD

Editorial: What Is Next in Amblyopia Treatment? 871

Creig Hoyt, MD, MA

Original Articles

A Randomized Trial of Levodopa as Treatment for Residual 874

Amblyopia in Older Children
Pediatric Eye Disease Investigator Group
Writing Committee: Michael X. Repka, MD, MBA, Raymond T. Kraker, MSPH,
Trevano W. Dean, MPH, Roy W. Beck, MD, PhD, R. Michael Siatkowski, MD,
Jonathan M. Holmes, BM, BCh, Cynthia L. Beauchamp, MD, Richard P. Golden, MD,
Aaron M. Miller, MD, MBA, Lisa C. Verderber, MD, David K. Wallace, MD, MPH
Children 7 to 12 years of age with residual amblyopia from strabismus, anisometropia, or both
did not demonstrate additional improvement in visual acuity when levodopa was added to
prescribed patching compared with patching alone.

Cataract Surgery Outcomes in Bangladeshi Children 882

Guy S. Negretti, MB, BChir, Tariq Ayoub, MB, BS, Sadeq Ahmed, FCPS,
Riton Deb, BOptom, MSc, Uttam Majumder, DOLV, OPTC, Johurul Jewel, MSS, MPH,
Mohamed Muhit, PhD, Clare E. Gilbert, FRCOphth, MD,
Richard J.C. Bowman, FRCOphth, MD
In this study of 407 Bangladeshis 8.8 years after pediatric cataract surgery, more than half had
presenting visual acuity <20/200, but 69% attended school, and better vision predicted
school attendance.
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On the cover: “Intra-ocular Foreign Body with Traumatic Cataract and Self-sealed
Wound” by Angela Chappell (Ophthalmology Department, Flinders Medical Centre,
Adelaide, South Australia) was the First Place winner in the Cross Categories category at
the 2014 Ophthalmic Photographers Society Scientific Exhibit (www.opsweb.org).
Equipment: Topcon TRC-50EX fundus camera - 50 degree view, Haag-Streit PBQ 900 Slit
Lamp, Nikon D300S Camera ISO 640.
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Changes in Lens Opacities on the Age-Related Eye Disease Study 888

Grading Scale Predict Progression to Cataract Surgery and
Vision Loss: Age-Related Eye Disease Study Report No. 34
Maanasa Indaram, MD, Elvira Agrón, MA, Traci E. Clemons, PhD, Robert D. Sperduto, MD,
Wai T. Wong, MD, PhD, Frederick L. Ferris, III, MD, Emily Y. Chew, MD, for the Age-Related
Eye Disease Study Research Group
Short-term, modest changes in lens opacity severity on the Age-Related Eye Disease Study
lens opacity scale may predict long-term clinically relevant outcomes. Worsening of severity
of opacities may be a potential surrogate outcome.

Intraocular Lens Power Selection after Radial Keratotomy: Topography, 897

Manual, and IOLMaster Keratometry Results Using Haigis Formulas
Harry S. Geggel, MD
Using IOLMaster keratometry values in the Haigis formula set for a targeted refraction of 1
diopter minimizes refractive surprises in patients who previously underwent radial keratotomy
and are undergoing routine cataract surgery.

Factors Affecting Visual Acuity after Cataract Surgery in Patients with 903
Retinitis Pigmentosa
Noriko Yoshida, MD, PhD, Yasuhiro Ikeda, MD, PhD, Yusuke Murakami, MD, PhD,
Shunji Nakatake, MD, Kota Fujiwara, MD, Shoji Notomi, MD, PhD,
Toshio Hisatomi, MD, PhD, Tatsuro Ishibashi, MD, PhD
Final best-corrected visual acuity improved after cataract surgery in approximately half of eyes
with retinitis pigmentosa. The preoperative ophthalmic examinations of Humphrey Field
Analyzer or optical coherence tomography are important parameters to assess postoperative
visual outcome.

Bowman Layer Transplantation to Reduce and Stabilize Progressive, 909

Advanced Keratoconus
Korine van Dijk, BSc, Vasilios S. Liarakos, MD, PhD, Jack Parker, MD, Lisanne Ham, PhD,
Jessica T. Lie, PhD, Esther A. Groeneveld-van Beek, MSc, Gerrit R.J. Melles, MD, PhD
In eyes with advanced keratoconus, Bowman layer transplantation may halt progression while
flattening the cornea. As such, penetrating or deep anterior lamellar keratoplasty may be
postponed or prevented, avoiding the attendant complications.

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Microbial Keratitis in Los Angeles: The Doheny Eye Institute and 918
the Los Angeles County Hospital Experience
Daniel Sand, MD, Rosemary She, MD, Ira A. Shulman, MD, David S. Chen, BA,
Mathew Schur, BA, Hugo Y. Hsu, MD
A retrospective review of approximately 5 years of microbial keratitis cases from a tertiary care
referral center and a major county hospital in Southern California revealed no significant
differences between sensitivities to antibiotics.

Increased Tear Fluid Production as a Compensatory Response to 925

Meibomian Gland Loss: A Multicenter Cross-sectional Study
Reiko Arita, MD, PhD, Naoyuki Morishige, MD, PhD, Shizuka Koh, MD, PhD,
Rika Shirakawa, MD, Motoko Kawashima, MD, PhD, Tohru Sakimoto, MD, PhD,
Takashi Suzuki, MD, PhD, Kazuo Tsubota, MD, PhD
Tear fluid secretion increased to compensate for reduced meibomian gland function, but not
vice versa. Tear film homeostasis thus may operate in one direction, with the aqueous layer
compensating for deficiency of the oily layer.

Sarcoidosis in the National Veteran Population: Association of Ocular 934

Inflammation and Mortality
Andrea D. Birnbaum, MD, PhD, Dustin D. French, PhD, Mehdi Mirsaeidi, MD, MPH,
Sarah Wehrli, MD
Veterans with sarcoidosis and ocular inflammation have a decreased mortality rate when
compared with patients with only nonocular manifestations of the disease.

Efficacy and Safety of Intravenous Secukinumab in Noninfectious Uveitis 939

Requiring Steroid-Sparing Immunosuppressive Therapy
Erik Letko, MD, Steven Yeh, MD, C. Stephen Foster, MD, Uwe Pleyer, MD,
Mitchell Brigell, PhD, Cynthia L. Grosskreutz, MD, PhD, for the AIN457A2208 Study Group
Intravenous secukinumab achieved rapid clinical improvements in patients with active
noninfectious uveitis requiring corticosteroid-sparing immunosuppressive therapy. The
superiority of intravenous over subcutaneous administration indicates that intravenous dosing
may be needed to achieve therapeutic effect.

Peripheral Lesions Identified on Ultrawide Field Imaging Predict 949

Increased Risk of Diabetic Retinopathy Progression over 4 Years
Paolo S. Silva, MD, Jerry D. Cavallerano, OD, PhD, Nour Maya N. Haddad, MD,
Hanna Kwak, BS, Kelli H. Dyer, DO, Ahmed F. Omar, MD, Hasanain Shikari, MD,
Lloyd M. Aiello, MD, Jennifer K. Sun, MD, MPH, Lloyd Paul Aiello, MD, PhD
The presence of diabetic retinopathy lesions located predominantly peripheral to Early
Treatment Diabetic Retinopathy Study photographic fields predicted an increased risk for
retinopathy progression over 4 years, independent of baseline retinopathy severity and
hemoglobin A1c.

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Multimodal Characterization of Proliferative Diabetic Retinopathy 957

Reveals Alterations in Outer Retinal Function and Structure
Grace E. Boynton, BA, Maxwell S. Stem, MD, Leon Kwark, MSEE, Gregory R. Jackson, PhD,
Sina Farsiu, PhD, Thomas W. Gardner, MD, MS
This study characterized visual dysfunction in individuals with proliferative diabetic
retinopathy, including those who have received panretinal photocoagulation, and used
semiautomated retinal segmentation to evaluate retinal structure.

Aqueous Levels of Angiopoietin-like 4 and Semaphorin 3E Correlate with 968

Nonperfusion Area and Macular Volume in Diabetic Retinopathy
Soo Hyun Kwon, MD, Jae Pil Shin, MD, In Taek Kim, MD, Dong Ho Park, MD
ANGPTL4 levels are higher in patients with ischemic retinopathies, suggesting that
ANGPTL4 may hold promise as a novel target for diabetic macular edema treatments and as
a biomarker of ischemic-induced retinopathy, including diabetic retinopathy.

Retinal Nerve Fiber Layer Loss Is Associated with Urinary Albumin 976
Excretion in Patients with Type 2 Diabetes
Jin A Choi, MD, Sun-Hee Ko, MD, Yi Ryeung Park, MD, Dong-Hyun Jee, MD,
Seung-Hyun Ko, MD, Chan Kee Park, MD, PhD
Urinary albumin excretion was an independent risk factor for nerve fiber layer loss in type 2
diabetes without renal impairment. Careful examination of optic disc may be necessary in
type 2 diabetes patients exhibiting albuminuria.

Visual Impairment and Blindness Avoided with Ranibizumab in 982

Hispanic and Non-Hispanic Whites with Diabetic Macular Edema in
the United States
Rohit Varma, MD, MPH, Neil M. Bressler, MD, Quan V. Doan, PharmD, Mark Danese, PhD,
Chantal M. Dolan, PhD, Abraham Lee, BA, Adam Turpcu, PhD
Monthly treatment with ranibizumab 0.3 mg was estimated to reduce the incidence of visual
impairment and blindness substantially in non-Hispanic and Hispanic white patients in the
United States with central-involved diabetic macular edema.

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Darapladib, a Lipoprotein-Associated Phospholipase A2 Inhibitor, 990

in Diabetic Macular Edema: A 3-Month Placebo-Controlled Study
Giovanni Staurenghi, MD, Li Ye, MS, Mindy H. Magee, PhD, Ronald P. Danis, MD,
John Wurzelmann, MD, MPH, Peter Adamson, PhD, Megan M. McLaughlin, MS, for the
Darapladib DME Study Group
This prospective, multicenter, randomized, double-masked, placebo-controlled phase IIa study
investigated the potential of lipoprotein-associated phospholipase A2 inhibition as a novel
mechanism to reduce edema and improve vision in center-involved diabetic macular edema.

Genetics and Disease Expression in the CNGA3 Form of Achromatopsia: 997

Steps on the Path to Gene Therapy
Lina Zelinger, PhD, Artur V. Cideciyan, PhD, Susanne Kohl, PhD,
Sharon B. Schwartz, MS, CGC, Ada Rosenmann, MD, PhD, Dalia Eli, PhD,
Alexander Sumaroka, PhD, Alejandro J. Roman, MS, Xunda Luo, MD, PhD,
Cassondra Brown, BS, Boris Rosin, MD, PhD, Anat Blumenfeld, PhD, Bernd Wissinger, PhD,
Samuel G. Jacobson, MD, PhD, Eyal Banin, MD, PhD, Dror Sharon, PhD
We identified CNGA3 and CNGB3 mutations in 49 achromatopsia families and show that
CNGA3 is the most common achromatopsia gene in the Israeli and Palestinian populations.
Retinal structure revealed persistent but abnormal foveal cones.

Outcomes after Intravitreal Bevacizumab versus Laser Photocoagulation 1008

for Retinopathy of Prematurity: A 5-Year Retrospective Analysis
Christopher K. Hwang, MD, PhD, G. Baker Hubbard, MD, Amy K. Hutchinson, MD,
Scott R. Lambert, MD
Both intravitreal bevacizumab (IVB) and panretinal photocoagulation (PRP) treated
type 1 retinopathy of prematurity (ROP) effectively with low complication rates. Zone 1 ROP
was associated with high myopia after treatment with either IVB or PRP.

Efficacy and Toxicity of Second-Course Ophthalmic Artery 1016

Chemosurgery for Retinoblastoma
Jasmine H. Francis, MD, David H. Abramson, MD, Y. Pierre Gobin, MD, Brian P. Marr, MD,
Irwin Tendler, BS, Scott E. Brodie, MD, PhD, Ira J. Dunkel, MD
Eyes with recurrent tumor after initial ophthalmic artery chemosurgery can be salvaged with
second-course ophthalmic artery chemosurgery, although ocular survival is worse for eyes with
vitreous seeds.

Early Subclinical Macular Edema in Eyes with Uveal Melanoma: 1023

Association with Future Cystoid Macular Edema
Arman Mashayekhi, MD, Etienne Schönbach, MD, Carol L. Shields, MD, Jerry A. Shields, MD
Subclinical macular edema is a common early finding in eyes with uveal melanoma. This
finding is associated with larger initial tumor size and is predictive of future development of
cystoid macular edema after plaque radiotherapy.

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Local Anesthetic Agents for Vitreoretinal Surgery: No Advantage to 1030

Mixing Solutions
V.V. Jaichandran, DA, Rajiv Raman, MS, DNB, Laxmi Gella, MPhil,
Tarun Sharma, MD, MBA
This study found that 0.5% bupivacaine used as a local anesthetic agent for vitreoretinal surgery
performed better than a mixture of 2% lidocaine combined with 0.5% bupivacaine solution.

Threat to Fixation at Diagnosis and Lifetime Risk of Visual Impairment in 1034

Open-Angle Glaucoma
Dorothea Peters, MD, Boel Bengtsson, PhD, Anders Heijl, MD, PhD
In this study, threat to fixation at diagnosis was not an independent risk factor for developing
glaucoma blindness or central vision loss after adjusting for differences in disease severity stage
at the time of diagnosis.

Association between SNPs of Metalloproteinases and Prostaglandin 1040

F2a Receptor Genes and Latanoprost Response in Open-Angle
Glaucoma
Fernando Ussa, MD, PhD, Itziar Fernandez, PhD, Maria Brion, MD, PhD,
Angel Carracedo, MD, PhD, Francisco Blazquez, MD, MSc, Maria T. Garcia, MSc,
Ana Sanchez-Jara, MD, PhD, Lourdes De Juan-Marcos, MD, PhD,
Soledad Jimenez-Carmona, MD, PhD, Jose R. Juberias, MD, PhD,
Jose M. Martinez-de-la-Casa, MD, PhD, Jose C. Pastor, MD, PhD
New evidence suggests that the response to latanoprost may be affected by polymorphisms of
the genes coding for prostaglandin F2a and metalloproteinase-1 receptors in a Spanish
population with primary open-angle glaucoma.

A Quantitative Analysis of the Relationship between Medicare Payment 1049

and Service Volume for Glaucoma Procedures from 2005 through 2009
Dan Gong, BA, Lin Jun, MD, PhD, James C. Tsai, MD, MBA
Using a fixed-effects regression model to calculate payment-volume elasticity, this study found
that many glaucoma procedures analyzed do not have significant associations between
changes in Medicare payment and service volume.

The Incidence and Clinical Characteristics of Adult-Onset 1056

Convergence Insufficiency
Rafif Ghadban, MD, Jennifer M. Martinez, MD, Nancy N. Diehl, BS, Brian G. Mohney, MD
Adult-onset convergence insufficiency is a common form of adult strabismus generally
diagnosed beyond the sixth decade of life. Although the near exodeviation progressed for
many patients, most were treated successfully with prism spectacles.

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Reports

Factors Underlying Different Myopia Prevalence between 1060

Middle- and Low-income Provinces in China
Zhongqiang Zhou, MD, PhD, Xiaochen Ma, PhD, Hongmei Yi, PhD, Xiaopeng Pang, PhD,
Yaojiang Shi, PhD, Qianyun Chen, MS, Mirjam E. Meltzer, PhD, Carlos Price-Sanchez,
Mingguang He, MD, PhD, Scott Rozelle, PhD, Ian Morgan, PhD,
Nathan Congdon, MD, MPH

The Early Treatment in Diabetic Retinopathy Study Chart Compared 1062

with the Tumbling-E and Landolt-C
Maxwell P. Treacy, MIEI, FRCOphth, Tara P. Hurst, PhD, Marcus Conway, BSc,
Emma S. Duignan, MRCSI, Borislav D. Dimitrov, PhD, Nicholas Brennan, BSc, MBBCh,
Lorraine Cassidy, FRCOphth

Characteristics that Predict Ophthalmic Knowledge among 1063

Ophthalmology Residents
Suzanne W. van Landingham, MD, Divya Srikumaran, MD, Aazim A. Siddiqui, BS,
Bonnielin Swenor, MPH, PhD, Pradeep Y. Ramulu, MD, PhD

Correspondence (available at www.aaojournal.org/current) e28

Re: Cursiefen et al.: Aganirsen antisense oligonucleotide eye

drops inhibit keratitis-induced corneal neovascularization and reduce
need for transplantation: the I-CAN study
(Ophthalmology 2014;121:1683-92)
Eduardo M. Rocha, MD, PhD, Luis Fernando Nominato, MD, Peter S. Reinach, PhD

Author reply
Claus Cursiefen, MD, PhD, Eric Viaud, PhD

Re: Chang et al.: Cost evaluation of surgical and pharmaceutical

options in treatment for vitreomacular adhesions and macular
holes (Ophthalmology 2014;121:1720-6)
Rodrigo Abreu-Gonzalez, MD, FEBO, Pedro Serrano-Aguilar, MD, PhD

Author reply
Jonathan S. Chang, MD, William E. Smiddy, MD

(Continued)
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Re: Thompson: Three kinds of lies (Ophthalmology

2014;121:1315-6)
Marc Biarnés, MPH, PhD

Author reply
John T. Thompson, MD

Re: Srikumaran et al.: Long-term outcomes of Boston type 1

keratoprosthesis implantation: a retrospective multicenter cohort
(Ophthalmology 2014;121:2159-64)
Shraddha Pawan Sureka, MBBS, MS, Rohit R. Modi, MBBS, MS,
Srikant K. Sahu, MBBS, MS

Author reply
Divya Srikumaran, MD, Beatriz Munoz, MS, Esen Karamursel Akpek, MD

Corrigendum 1065

Pictures & Perspectives

Juvenile Xanthogranuloma 870

Krishna R. Surapaneni, MD, Angeline L. Wang, MD, Cathy N. Burkat, MD

Blastomycosis in the Eyelid of a Native Chicagoan 1015

Paul O. Phelps, MD, Zach Seagrave, MD, Kenya M. Williams, MD

Conjunctival Intraepithelial Neoplasia 1039

Krishna R. Surapaneni, MD, Sarah M. Nehls, MD, Heather D. Potter, MD

The journal’s Guide for Authors and Guide for Reviewers are
available at www.aaojournal.org.