OBJECTIVE:To determine if home environmental features (ie, lighting and home hazards) are associated with difficulties in instrumental activities of daily living (IADLs) in persons with glaucoma. DESIGN:Cross-sectional study. SETTINGS AND PARTICIPANTS:A total of 174 adults with suspect or primary glaucoma were recruited. METHODS:IADLs, fear of falling (FoF), and glaucoma quality of life (GQL) were assessed via questionnaire. FoF and GQL were prespecified as negative controls to assess discriminant/external validity, as they are not expected to be influenced specifically by in-home lighting or hazards. We classified IADL difficulty as a binary outcome (≥1 IADL difficulty vs none). Person-measure scores for FoF and GQL were calculated in logits using Rasch modeling. The home environment assessment for the visually impaired (HEAVI) tool assessed homes for the total number of hazards, frequency of hazards among graded items, and average home lighting. Multivariable logistic and linear regression models evaluated associations between home environmental measures with IADL difficulty and FoF and GQL scores, controlling for severity of visual field damage, age, race, sex, comorbidity, and polypharmacy. MAIN OUTCOME MEASURES:Association between home environmental features with difficulties in IADLs, FoF, and GQL. RESULTS:Better home lighting was associated with less difficulty completing IADL tasks (odds ratio [OR] = 0.88 per 0.1 log unit light increment, 95% CI = 0.77-1.00, P = .04). No association was found between the number of home hazards (OR = 0.97 per 10 additional hazard, 95% CI = 0.62-1.53, P = .89) or the frequency of home hazards among graded items (OR = 1.10 per 10% increment in hazard frequency, 95% CI = 0.65 to 1.86, P = .73) with IADL difficulty. No significant associations were noted between lighting levels, frequency or number of home hazards with FoF or GQL scores. CONCLUSION:Better home lighting was associated with less frequent difficulty with IADLs (but not FoF or GQL) in a cohort enriched for glaucoma; no associations were noted with any measure for home hazards. Lighting may be able to improve specific aspects of function in persons with glaucoma.

CLINICAL RELEVANCE:Age-related macular degeneration can lead to significant visual impairment in older individuals. These can significantly impact their day-to-day life, and understanding these limitations is crucial for healthcare providers. BACKGROUND:The aim of this work is to determine impairment of activities of daily living secondary to visual impairment caused by age-related macular degeneration in a South Indian population. METHODS:In this prospective cross-sectional study, the instrumental activities of daily living questionnaire was administered to participants with uniocular or binocular visual impairment due to age-related macular degeneration, and controls who did not have any significant ocular or retinal pathology. RESULTS:The study recruited 90 participants in each arm, where those with age-related macular degeneration were older. More participants with age-related macular degeneration (92.2%) had impairment with one or more activities of daily living as compared to controls (55.6%,p < 0.001). The age-related macular degeneration group faced a median of 4 (IQR 2-8) impairments and could perform 53.3% with difficulty, 39.4% with assistance and 7.3% activities could not be completed. In the age-related macular degeneration group, those with unilateral disease had 8.95-fold (p < 0.001) greater level of impairment, while those with bilateral disease has a 10.72-fold (p = 0.001) greater level of impairment as compared to controls. CONCLUSION:Visual impairment due to age-related macular degeneration has a significant impact on activities of daily living. The patients often need assistance in completing their activities. Care in age-related macular degeneration needs to involve rehabilitation and help in carrying out daily activities in addition to treatment for visual benefits.

PURPOSE:To develop a consensus-based classification system and questionnaire for the standardized assessment and reporting of dysphotopsias following ophthalmic procedures. DESIGN:Systematic review and Delphi consensus process. PARTICIPANTS:Twenty ophthalmic specialists with expertise in glaucoma, cataract/refractive surgery, and cornea participated in this Delphi consensus survey. METHODS:A systematic literature search was conducted using Ovid MEDLINE and Embase to identify randomized controlled trials and observational studies reporting on dysphotopsias. Reported symptoms, assessment questionnaires, and individual question items were extracted to create a comprehensive list of potential classification items. These items were refined through iterative Delphi consensus surveys involving ophthalmic specialists, who evaluated each item for inclusion, exclusion, or rewording, and could propose the addition of new items. Consensus was defined a priori as ≥80% agreement among panelists. This iterative process allowed for progressive refinement of the classification system and continued until at least 80% of all proposed items achieved consensus. MAIN OUTCOME MEASURES:The proportion of ophthalmic specialists who chose to include or exclude specific dysphotopsia symptoms, and additional items of the questionnaire including baseline characteristics, environmental modifiers, quality of life, and attempted management strategies. RESULTS:Following the screening of 5,059 articles, 142 studies met inclusion criteria, identifying 34 unique dysphotopsia symptoms and 76 individual questionnaire items. Participants reached consensus on 53 of 63 items (84.1%) over two rounds of Delphi surveys. Items that did not meet inclusion or exclusion thresholds after the second round were excluded from the final classification system. The finalized classification system included 11 baseline clinical variables, 7 positive dysphotopsia symptoms (halos, glare/dazzle, starbursts, arcs, lines/streaks, ghosting, and flickering/shimmering), 1 negative dysphotopsia symptom (peripheral crescent/shadow), 5 environmental modifiers, 2 quality-of-life and mental health items, and 8 attempted interventions. These elements were consolidated into the DYsphotopsia Symptom Questionnaire and Outcomes (DYSQO) intended for clinical and research applications. CONCLUSION:A standardized classification system for the reporting of dysphotopsias following ophthalmic procedures was developed using the Delphi consensus process. The adoption of this tool in research and clinical practice may enhance the consistency, clarity, and quality of dysphotopsia reporting, enabling comparisons across interventions and enhancing evidence-based patient care.

PURPOSE:To characterize the time to maximum intraocular pressure (IOP) change after stopping and restarting topical prostaglandin analog (PGA) treatment using remote tonometry. DESIGN:A prospective single-site observational study. SUBJECTS:Patients with primary open-angle glaucoma or ocular hypertension treated with ≥4 weeks of PGA monotherapy, in whom the managing ophthalmologist ordered medication washout to assess the necessity of continued topical therapy. METHODS:Patients used a rebound home tonometer to obtain ≥4 daily measurements across 3 periods: "Baseline" (1 week while continuing PGA), "Washout" (4 weeks off therapy), and "Restart" (4 weeks while restarting PGA). Exponential decay functions were used to model IOP from "Baseline" through "Washout" and then from end of "Washout" through "Restart" to determine the time to 90% of maximum IOP change (plateau, T90%%). We evaluated the variation in T90% using multilevel models to account for the inclusion of both eyes from individual subjects. MAIN OUTCOME MEASURES:T90% for "Washout" and "Restart." RESULTS:Twenty subjects (34 eyes) successfully recorded multiple daily eye measurements for the 9-week study period. Mean (standard deviation) IOPs during the "Baseline," "Washout," and "Restart" periods were 15.6 (4.2) mmHg, 17.3 (5.0) mmHg, and 15.9 (4.7) mmHg, respectively. "Baseline" and "Restart" IOPs were significantly lower than "Washout" IOP (P < 0.001). T90% was significantly longer and more variable among subjects during Washout (median: 18.5 days; interquartile range 6.0-32.1 days) compared to Restart (2.2 days; 1.3-4.1 days, P < 0.001). CONCLUSIONS:Using remote tonometry, we identified a significantly longer T90% after stopping PGA drops than when they were restarted. The ranges of time to reach the IOP plateau were wide, often exceeding the standardized 4-week washout, and are relevant to clinical assessment of routine treatment effects and determination of accurate washout periods for clinical research studies. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

OBJECTIVE:To assess whether home environmental factors, including eyedrop storage location, local storage conditions (clutter, visual contrast, lighting), and trips to the storage room location, influence glaucoma medication adherence. DESIGN:Cross-sectional prospective study. PARTICIPANTS:A total of 93 community-dwelling adults with glaucoma aged ≥60 years with bilateral visual field damage from glaucoma. METHODS:Direct evaluation of the home and subsequent in-home monitoring of eyedrop nonadherence over a 7-day period using the Medication Event Monitoring System, which electronically recorded the date and time of eyedrop bottle openings. Room of medication storage (bedroom, bathroom, kitchen) and local conditions in the immediate area of eyedrop storage-lighting (measured in lux), clutter (graded via standardized rubric), and visual contrast (graded via standardized rubric)-were recorded. Trips to, and active time spent in, the eyedrop storage rooms were quantified using indoor positioning system technology, which continuously tracked participants' in-home movement. Multivariable multilevel logistic regression models identified environmental, clinical, and demographic factors contributing to weekly medication nonadherence, and nonadherence by time of day, and day of week. Other multivariable models assessed the relationship between time spent in, and transitions to, the eyedrop storage room and medication nonadherence. MAIN OUTCOME MEASURES:Medication Event Monitoring System-defined medication nonadherence (proportion of individual prescribed dose opportunities that were missed). RESULTS:Participants used 144 individual eyedrop medications, generating 1498 prescribed dose opportunities during the monitoring week. Overall, 15.3% of individual dose opportunities were missed. In multivariable analysis, kitchen storage (OR = 0.30, 95% CI: 0.11-0.86, P = .02) and bathroom storage (OR = 0.37, 95% CI: 0.14-0.95, P = .04) were associated with less nonadherence compared to bedroom storage. Evening medication doses had higher odds of nonadherence than morning doses (OR = 1.95, 95% CI: 1.25-3.03, P = .003). Lighting, clutter, and contrast of the medication storage area were not significantly associated with adherence, nor were active time spent in, or trips to, the room where medication was stored. CONCLUSIONS:Medication storage location and administration time significantly influence glaucoma medication adherence, while immediate environmental conditions around storage locations were less impactful. These findings suggest that integrating eyedrop medication routines with intentional spaces for medication storage, utilized early in the day, may improve adherence for older individuals with glaucoma.

Our objective is to investigate the association between prospectively-reported and retrospectively-reported falls data and the likelihood of subsequent falls in a cohort of patients with and without visual field loss. Retrospective falls data (self-reported) was collected at the baseline visit where participants reported if they experienced a fall in the preceding year and their level of fear of falling. Prospective falls data (i.e. falls, near falls, and injurious falls) was collected using fall calendars with participants recording falls daily. Participants reported falls and near-falls monthly over a 2-year period. Logistic regressions assessed whether baseline retrospective falls data was predictive of falls in year 1 and whether prospective falls data in year 1 was associated with falls in year 2. Models were controlled for age, gender, race, degree of visual field (VF) loss, comorbidities, and polypharmacy. Fallers in the first year of study, as judged by prospective falls data, were 2.4 times (Odds Ratio (OR)=2.41, p=0.003) more likely to report a fall in the second year compared to non-fallers in the first year. Those who prospectively-reported more than one fall (OR=5.74, p-value<0.001), a single injurious fall (months 0 to 12; OR=2.30, p-value=.03), and multiple injurious falls (months 0 to 12; OR= 4.28, p-value=0.025) in year one were significantly more likely to report a fall in the following year. Self-report of a fall in the year preceding the study and fear of falling at baseline did not predict reporting falls in the first study year. Prospectively-reported near-falls in the first year were associated with higher odds of falls in both the first (concurrent) study year (OR=3.49, p<0.001) and the subsequent second year (OR=3.14, p<0.001). Predictive capacity of retrospective and prospective data to identify those at risk of falls in subsequent years did not vary by visual field sensitivity. Prospectively-reported falls and near-falls are predictive of falls in subsequent years, while self-reported falls based on memory do not predict falls in subsequent years. These findings highlight the importance of prospective collection of falls data to accu­rately identify those at risk of falling who might benefit from fall prevention strategies. Clinical trial number: not applicable

Importance:Dual sensory impairment-that is, concurrent hearing and vision impairment-is common in aging populations. Individuals with dual sensory impairment face unique social and functional challenges, but the benefit of conventional rehabilitation in addressing these challenges is not well researched. Objective:To determine the association between hearing impairment and the likelihood of achieving a clinically meaningful functional improvement following vision rehabilitation. Design, Setting, and Participants:This was a cross-sectional analysis of data collected by the Low Vision Rehabilitation Outcomes Study, a prospective cohort study on clinical outcomes of vision rehabilitation. Data were included from outpatient low vision rehabilitation services provided at 28 clinical centers across the US between April 2008 and May 2011. The analyses included 611 adults with vision impairment and available self-reported hearing status. Of these, 407 had complete postrehabilitation follow-up data. Data were analyzed from July 2024 to March 2025. Exposure:Self-reported hearing impairment status at baseline (normal hearing vs hearing impairment). Main Outcomes and Measures:The primary outcome was the improvement in general capability as measured by the Activity Inventory before and after rehabilitation, computed using the method of successive dichotomizations. Rehabilitation was considered effective if the improvement reached a minimum clinically important difference (MCID). Multivariable logistic regression was used to evaluate the association between hearing impairment and achieving MCID. Covariates included age, sex, visual, psychological, physical, and cognitive status. Results:Among the 611 participants (mean [SD; range] age, 73 [15.3; 19-101] years; 403 [66%] female), 358 had normal hearing and 253 had self-reported hearing impairment. Baseline ability did not differ by hearing status (β, -0.08; 95% CI, -0.56 to 0.41; P = .75). However, a smaller proportion of participants with hearing impairment achieved MCID following vision rehabilitation (39/169 [23%] vs 74/238 [31%]; odds ratio [OR], 0.58; 95% CI, 0.34-0.95; P = .03); this association was not attenuated by possession of hearing aid (17/74 [23%] vs 21/95 [22%]). In addition to better hearing status, participants with severe vision impairment (OR, 3.32; 95% CI, 1.2-11.86; P = .04) and higher depressive symptoms (OR, 1.38 per logit increase; 95% CI, 1.17-1.63; P < .001) were more likely to achieve MCID. Conclusions and Relevance:In this study, self-reported hearing impairment was associated with reduced likelihood of functional improvement following vision rehabilitation. These findings support the need for interdisciplinary efforts in rehabilitation programs to better serve individuals with dual sensory impairment.

center dot PURPOSE: To examine the cross-sectional and longitudinal associations between visual impairment (VI) and falls in United States older adults. DESIGN: Retrospective cross-sectional and cohort study. center dot METHODS: This study utilized data from the National Health and Aging Trends Study 2021 and 2022. Participants were Medicare beneficiaries > 71 years. Exposures were any VI- defined as distance or near VI ( > 0.3 log- MAR), or contrast sensitivity (CS) impairment ( < 1.55 logCS)-and changes in distance visual acuity ([DVA], logMAR/y), near visual acuity ([NVA], logMAR/y), or CS (logCS/y). Outcomes were self-reported falls in the past 12 months. center dot RESULTS: 2822 participants were included in the analysis. At baseline, adults with any VI had greater rates of falls (rate ratio = 1.16, 95% CI = 1.04-1.30) and multiple falls (rate ratio = 1.23, 95% CI = 1.01-1.49) than peers without VI. In longitudinal analysis, adults with any VI at baseline did not have a greater risk of falls or multiple falls in the following year compared to peers without VI; only worse CS (hazard ratio [HR] = 1.03, 95% CI = 1.01-1.06, per 0.1 logCS worse) and DVA (HR = 1.11, 95% CI = 1.04-1.18, per 0.1 logMAR worse) were associated with a greater risk of falls and multiple falls, respectively. However, in other models, change in NVA (HR = 1.04, 95% CI = 1.01-1.08, per 0.1 logMAR worse/y) was associated with greater fall risk over the follow-up period. Further, change in CS (HR = 1.11, 95% CI = 1.05-1.18, per 0.1 logCS worse/y) was associated with a greater risk of multiple falls, while changes in DVA and NVA were not. center dot CONCLUSIONS: Older United States adults with VI are more likely to experience a fall, with various components of their vision influencing the fall risk.

PRÉCIS:Discrepancy between objective measures of functioning and self-reported quality of life is predicted by depressive symptoms, females, and advanced field loss, while significant variability between these measures remains unexplained. PURPOSE:To determine the degree to which functional metrics and self-reported quality of life agree in glaucoma, and identify factors associated with discrepancies between the two. PATIENTS AND METHODS:Individuals with glaucoma or suspected glaucoma (n=227) were evaluated. Subjective functioning was assessed with the Glaucoma Quality-of-Life-15 (GQL-15) questionnaire. Objective metrics of functioning included balance (total sway), gait (cadence), and reading speed, which were compiled into a z- scored composite measure of function. Discrepancy scores were defined as the difference between composite functioning and GQL-15 z -scores. Linear regression models were computed to identify patient-level and neighborhood-level factors associated with discrepancies between objective functioning and self-reported quality of life. RESULTS:Composite functioning and GQL-15 z -scores were poorly correlated (the Pearson coefficient r =0.15, P =0.024). In multivariable analyses, positive discrepancy (greater function than self-report) was associated with female gender (β=0.53, P <0.001), depressive symptoms (β=0.19, P <0.001), and greater visual field damage (β=0.28, P =0.001). The multivariable model, including gender, depressive symptoms, and visual field sensitivity, accounted for 20% of the variance in discrepancy scores. CONCLUSIONS:Female gender, depressive symptoms, and greater visual field damage are associated with greater subjective vision-related disability than predicted by objective functional impairment. The overall ability of the studied measures to predict agreement between function and self-report was poor, highlighting the complexity of both self-reported impairment and functional evaluation.

Low vision adversely impacts daily activities, particularly reading. However, quantifying text accessibility for different levels of low vision is challenging, leading to product designs that often overlook the vision status of low vision readers. In this paper, we bridge the gap between computer vision and low vision fields by introducing a text accessibility assessment pipeline called VI-OCR (short for Visually Impaired Optical Character Recognition), based on state-of-the-art OCR models. VI-OCR mimics human text recognition ability under specified levels of visual acuity and contrast sensitivity loss, to estimate whether text of a given size would be recognizable for a low vision human reader. We benchmarked specialized OCR models and vision-language models in replicating text recognition performances with visual acuity and contrast sensitivity deficits across three reading tasks: letter acuity using ETDRS charts, word acuity using MNREAD charts, and scene text recognition using complex real-life images. Comparing model performance to that of normal vision participants on degraded texts revealed major issues in some models including limited generalizability across reading tasks, difficulties dealing with severe contrast reduction, and overperforming rather than mimicking human observers. However, robust human-like performance of winning models such as Qwen2.5-VL and GPT supports the feasibility of VI-OCR in assessing text accessibility.

OBJECTIVE:To examine the association between visual impairment (VI) and (1) homebound status, (2) presence of home hazards, and (3) utilization of home-based long-term services and supports (LTSS) among older adults. DESIGN:Longitudinal and cross-sectional analyses using National Health and Aging Trends Study (NHATS) data (2021-2023). SUBJECTS:A total of 3022 Medicare beneficiaries aged ≥71 years (mean age 78.8 years, 55.3% female) with complete data on homebound status and visual function. METHODS:VI was defined as impairment in distance visual acuity or near visual acuity (<0.3 logMAR), or in contrast sensitivity (<1.55 logCS). Homebound status was classified as homebound, semi-homebound, or non-homebound based on frequency and difficulty leaving home. Home hazards (peeling paint, broken furniture, flooring damage, and tripping hazards) were documented during in-home visits. LTSS utilization encompassed assistive devices, home modifications, transportation services, senior housing, meal delivery, paid care, and high-burden family caregiving. Regression models (logistic and Cox proportional hazards) assessed cross-sectional and longitudinal relationships between VI - its presence, severity, and rate of decline - and outcomes. MAIN OUTCOME MEASURES:Presence or transition to homebound or semi-homebound status, presence of home safety hazards, and utilization of home-based LTSS. RESULTS:Among 3,022 participants (mean age 78.8 years, 55.3% female), 5.7% were homebound, and 14.4% semi-homebound. The presence of any VI was associated with a higher likelihood of both being (OR = 1.52, 95% CI: 1.17-1.98, P = .002) and becoming homebound or semi-homebound (HR = 1.35, 95% CI: 1.04-1.74, P = .02). Participants meeting all three VI criteria had an even higher risk (HR = 1.86, 95% CI: 1.35-2.58, P < .001). Individuals with VI were more likely to have home hazards (OR = 1.88, 95% CI: 1.32-2.69, P = .001) and utilize home-based LTSS (OR = 1.35, 95% CI: 1.10-1.66, p = 0.005). CONCLUSIONS:VI is a significant risk factor for being and becoming homebound in older adults, with increasing severity and breadth of VI compounding this risk. Individuals with VI also face greater home hazards and require more home-based LTSS, suggesting challenges maintaining home safety and functionality as they become more confined to the home. Early vision interventions, comprehensive home safety assessments, and targeted LTSS may be important preventive strategies for maintaining independence in visually impaired older adults.

Cortical amyloid burden is associated with neuronal and vascular abnormalities. The retina shares significant structural and physiological similarities with the brain. This study assessed the association of retinal microstructural and microvascular signs with cortical amyloid burden in the prospective Atherosclerosis Risk in Communities-Positron Emission Tomography study. One hundred and twenty-four participants without a diagnosis of dementia underwent florbetapir PET (2011-13) and optical coherence tomography and optical coherence tomography angiography imaging (2017-19). Retinal nerve fibre thickness, total macular thickness and the ganglion cell-inner plexiform layer thickness were derived from the optical coherence tomography scan. Vessel density and the foveal avascular zone were measured on the 3 × 3 mm2 optical coherence tomography angiography scan. Amyloid burden, defined by global cortical standardized uptake value ratio, was treated as a dichotomous (standardized uptake value ratio > 1.2) and continuous outcome measure in logistic and robust linear regression models, respectively. Only lower intermediate capillary plexus vessel density [β (95% confidence interval) = -0.05 (-0.12, -0.01)] was significantly associated with increased continuous amyloid standardized uptake value ratio but not elevated dichotomous amyloid burden independently of demographic, genetic and vascular risk factors. No other retinal measure showed a significant association. Microvascular signs may accompany greater amyloid burden in late life in individuals without dementia.

Purpose: To investigate the relationship between baseline visual field (VF) severity and rates of visual field loss with changes in quality of life (QoL) and fear of falling (FoF) in adults with glaucoma. Methods: Prospective cohort study, including participants from the Falls In Glaucoma Study. Quality of life and FoF were assessed annually using the Glaucoma Quality of Life-15 Questionnaire, and the University of Illinois at Chicago FoF Questionnaire, respectively, with higher Rasch-analyzed scores (in logits) indicating better QoL and greater FoF. Mean deviation (MD) values of each eye were collected, with better-eye MD taken as the primary exposure. Change rates in better-eye MD, QoL, and FoF were computed using linear regression. Separate regression models were employed to explore the relationship between baseline better-eye MD and its rate of change with rates of change in QoL and FoF. Results: The mean (standard deviation) rate of change in better-eye MD was-0.08 dB/year (0.5), rate of QoL change was-0.08 logits/year (0.4), and rate of FoF change was 0.16 logits/year (0.7). At baseline, better-eye MD (per dB worse) was significantly associated with worse baseline QoL (13 =-0.10 logits [95% confidence interval [CI]:-0.13,-0.08]) and greater FoF (13 = 0.06 logits [95% CI: 0.01, 0.10]). Baseline better-eye MD was associated with no significant change in QoL (-0.004 logits/year, 95% CI:-0.02, 0.01) or FoF (-0.0001 logits/year, 95% CI:-0.02, 0.02) over time. Change rates in better-eye MD showed significant associations with faster increases in FoF over time (13 = 0.26 logits/year [95% CI: 0.06, 0.45]; per dB loss/year), but not with changes in QoL (P = 0.79). Conclusions: Patients with glaucoma generally showed worsening of QoL and FoF over time, though the degree of change was modest and not related to the degree of damage at baseline. Faster rates of better-eye MD change alone were associated with faster increases in FoF. Further studies are needed to evaluate the reasons (visual and nonvisual) for changes in QoL and functionality over time and find ways in which QoL and mobility can be improved for those with VF damage. Financial Disclosures: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. Ophthalmology Glaucoma 2025;8:63-72 (c) 2024 by the American Academy of Ophthalmology

PURPOSE:To compare the early exposure and surgical revision rates between a new synthetic tissue substitute (CorNeat EverPatch) with that of human donor cornea after placement onto the scleral surface during ophthalmic surgery and study the biomaterial properties of the synthetic patch material. DESIGN:Retrospective comparison study and biomaterial analyses of new and explanted synthetic patch material. PARTICIPANTS:All consecutive patients who underwent ophthalmic surgery with implantation of the CorNeat EverPatch at the Wilmer Eye Institute (occurring from February through August 2024) and a comparison group who underwent ophthalmic surgery with implantation of irradiated donor cornea, matched 1:2 with patients receiving EverPatch for age, type of glaucoma, and surgeon. METHODS:Retrospective review of clinical electronic medical records of patients who underwent surgery at the Wilmer Eye Institute. Materials characterization of EverPatch, including morphologic features, surface roughness, wettability, thermal stability, elemental analysis, and physical properties. MAIN OUTCOME MEASURES:Early exposure (within 5 months of surgery) and surgical revision rates after CorNeat EverPatch or irradiated human donor cornea implantation during ophthalmic surgery. RESULTS:Thirty patients undergoing ophthalmic surgery in 2024 received EverPatch implantation during primary tube shunt placement (n = 27), tube shunt revision (n = 2), or covering of exposed suture used for scleral fixation of an intraocular lens (n = 1). During the early postoperative period, the rate of EverPatch exposure was 48.3% and the rate of surgical revision was 27.9%. In case-matched control participants (n = 58), the rate of patch graft exposure was 1.7% (P < 0.0001) and the rate of surgical revision was 1.7% (P < 0.0001). EverPatch devices constituted a randomly aligned fibrous mesh with an average fiber diameter of 1.36 ± 0.78 μm, surface roughness of 1.3 ± 0.1 μm, pore size of 3.7 ± 0.4 μm2, and percent porosity of 37 ± 3%. Explanted EverPatch devices demonstrated varying degrees of tissue integration with significantly increased wettability and changes in thermal stability and elemental composition. CONCLUSIONS:The rate of early conjunctival complications leading to exposure of the CorNeat EverPatch was higher than that of irradiated human donor corneal patch grafts. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

PURPOSE:To assess the clinical outcomes of Hydrus Microstent implantation with cataract extraction for the treatment of open-angle glaucoma (OAG) over a maximum of 4 years. DESIGN:A retrospective, single-center, single-arm, longitudinal cohort study. SUBJECTS:Three hundred eight patients (464 eyes) with OAG who underwent Hydrus Microstent implantation with cataract extraction between February 2019 and December 2021, followed for a median of 2.0 (interquartile range [IQR], 1.3-2.8) years. METHODS:Medical records were reviewed to collect demographic and clinical data. After assessment for Gaussian distribution, mean and standard deviation (SD) or median and IQR were calculated. Change from baseline was calculated with mixed-effects models and expressed as mean change and standard error. MAIN OUTCOME MEASURES:(1) Intraocular pressure (IOP); (2) number of glaucoma medications; (3) need for additional glaucoma procedures; and (4) rate of glaucoma progression, calculated using mean deviation (MD) from standard automated perimetry and OCT peripapillary retinal nerve fiber layer (RNFL) thickness. RESULTS:Among 308 patients, 60.7% (n = 187) were White, and 50.6% (n = 156) were female. The median age was 74 (IQR, 68-78) years. Most eyes had mild (63.8%) or moderate (23.9%) OAG. Of 464 eyes, 99 (21.4%) had undergone prior procedures for glaucoma. At baseline, the mean (±SD) IOP was 16.0 ± 3.7 mmHg while taking 1.9 ± 1.1 glaucoma medications. After Hydrus implantation, a sustained reduction was observed in mean IOP [mean change ± standard error]: -1.9 ± 0.3 at 6 months (P < 0.0001), -1.2 ± 0.2 at 1 year (P < 0.0001), -1.2 ± 0.2 at 2 years (P < 0.0001), -1.6 ± 0.3 at 3 years (P < 0.0001), and -1.2 ± 0.7 at 4 years (P = 0.02). Glaucoma medications were reduced by 1.2 ± 0.1 at 6 months (P < 0.0001), 1.1 ± 0.1 at 1 year (P < 0.0001), 1.0 ± 0.1 at 2 years (P < 0.0001), 0.9 ± 0.1 at 3 years (P < 0.0001), and 0.5 ± 0.2 at 4 years (P = 0.03). Only 14 eyes (3.2%) required additional glaucoma procedures. Compared to the lookback period, the rates of visual field MD and RNFL loss decreased in the postoperative period by 0.18 ± 0.08 dB/year (-0.18 ± 0.02 vs. 0.004 ± 0.08 dB/year, P = 0.02) and 0.51 ± 0.29 μm/year (-0.47 ± 0.12 vs. 0.04 ± 0.21 μm/year, P = 0.07), respectively. CONCLUSIONS:In this nontrial setting, cataract surgery with Hydrus Microstent implantation was associated with sustained reductions in IOP, glaucoma medication burden, and disease progression rate. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Objective: Characteristics of individuals with angle closure may be useful in targeted screening of family members. Here, we assess if findings gathered during examination and imaging of patients with a known angle- closure diagnosis (probands) could better determine the risk of angle closure in the patients' siblings. Design: Cross-sectional study of patients with known angle closure and their siblings. Participants: South Indian patients (probands) 30 years and older with open angles, primary angle-closure suspect (PACS), or primary angle closure/primary angle-closure glaucoma (PAC/PACG) and a biological sibling age 30 years or older (n = 292 proband/sibling pairs). Methods: Demographic data, relevant ocular history, and a comprehensive ophthalmic examination with anterior segment OCT (AS-OCT) were obtained. Three clinically relevant models were created to analyze the contribution of specific proband factors in predicting sibling angle-closure diagnosis, using demographic (age, sex), ocular examination (gonioscopy, optic nerve examination, visual acuity, intraocular pressure), and AS-OCT features to improve prediction beyond proband diagnosis alone evaluated by log likelihood ratio testing and statistical comparison of receiver operating characteristics (ROCs). Main Outcome Measures: Sibling angle-closure diagnostic accuracy. Results: Demographic and ocular examination metrics did not improve the prediction of sibling angle closure for all 3 outcomes (sibling diagnosis: (1) PACS/PAC/PACG vs. OA, (2) PAC/PACG vs. PACS/OA, and (3) PAC/ PACG vs. PACS), adding no model improvement when compared to diagnosis alone. Models adding AS-OCT metrics to the prior model including proband diagnosis, demographics, and ocular examination measures led to significantly improved prediction of 2 of the 3 angle-closure outcomes. Specifically, improvement was noted via likelihood ratio testing for prediction of PAC/PACG vs. PACS/OA (P = 0.01) or PAC/PACG vs. PACS (P = 0.001). For all 3 angle-closure outcomes, ROC comparisons demonstrated significant improvement in area under the curve (AUC) between the 3 models predicting sibling outcomes, demonstrating an increase in AUC with each successive nested model across all 3 sibling angle-closure outcomes. Conclusions: Structural features of eyes with angle closure may assist in stratifying the risk of angle closure in patients' siblings. Further studies should consider evaluating this approach to achieve more targeted screenings.

Purpose:Uncorrected visual impairment (VI) significantly impacts life quality and exacerbates age-related health issues. Social determinants of health (SDOH) are associated with uncorrected VI, but quantitative evidence is limited. This study investigated the link between SDOH and uncorrected VI among aging adults to identify disparities and improve vision care. Methods:We used data from the Atherosclerosis Risk in Communities (ARIC) study visits 4 and 6 and the ancillary Eye Determinants of Cognition (EyeDOC) study. We included subjects who were >70 years old and extracted their sex, race, residence, household income, education level, having an eye doctor, health insurance status, and Area Deprivation Index (ADI) and vision outcomes. Uncorrected VI was categorized into uncorrected distance (UDVI) or near visual impairment (UNVI). Associations between SDOH indicators and VI were evaluated using logistic regressions. Results:Among 967 adults (mean ± SD age, 78.6 ± 4.35 years; 37.9% male), UDVI was found in 293 and UNVI in 186. Living in Jackson, MS, was associated with lower odds for UNVI (adjusted odds ratio [aOR] = 0.36; 95% CI, 0.20-0.65). Higher odds for UNVI were associated with male sex (aOR = 2.01; 95% CI, 1.41-2.87), low educational attainment (aOR for not completing high school = 2.32; 95% CI, 1.37-3.92; aOR for high school only = 1.92; 95% CI, 1.26-2.92), no eye doctor (aOR = 1.58; 95% CI, 1.05-2.39), and having government health insurance only (aOR = 1.48; 95% CI, 1.00-2.17). Associations between SDOH factors and UDVI were weaker or non-existent. Conclusions:This study links SDOH factors to uncorrected VI among older adults. Translational Relevance:SDOH should be considered when designing interventions to reduce VI in vulnerable communities.