Researchers from Johns Hopkins University, Baltimore, conducted a one-year study to develop, implement and evaluate a replicable community-based screening intervention with the hope of improving glaucoma and other eye-disease detection and follow-up care in high-risk populations in the United States.

This prospective study is ongoing, but researchers released the one-year findings. The study focuses on African Americans over 50 years of age at multiple inner-city community sites in Baltimore. The screening examination uses a sequential referral approach and assesses presenting visual acuity, best-corrected VA, digital fundus imaging, visual field testing and measurement of intraocular pressure.

Of the 901 individuals screened between January 2015 and October 2015, subjects were mostly African Americans (94.9 percent) with a mean age of 64.3 years. Among them, 356 participants (39.5 percent) were referred for a definitive eye examination, and 107 (11.9 percent) required prescription glasses.

The most common reasons for referral were an ungradable fundus image (39.3 percent of those referred), best-corrected VA less than 20/40 (14.6 percent), and ungradable autorefraction (11.8 percent). Among those referred for definitive examination, 153 people (43 percent) attended their scheduled examination. The most common diagnoses at the definitive examination were glaucoma and cataract (51 and 40 percent, respectively).

After one year of the ongoing study, a large proportion of individuals screened required ophthalmic services. To reach and encourage these individuals to attend screenings and follow-up examinations, researchers say that programs could develop innovative strategies and approaches.

Am J Ophthalmol 2017;180:18-28.
Zhao D, Guallar E, Gajwani P, et al.

Classification of Fluorescein Breakup Patterns
In a cross-sectional study, researchers from Kyoto, Japan, investigated the relationship between fluorescein breakup patterns and clinical manifestations in dry-eye cases.

Researchers looked at 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years). FBUPs were categorized into one of the following five types: area (AB, n=19); spot (SB, n=22); line (LB, n=24); dimple (DB, n=19); and random (RB, n=22 eyes). They also examined dry-eye-related symptoms using the visual analog scale (100 mm=maximum); tear meniscus radius; tear film lipid layer interference grade (grades 1–5, 1=best) and spread grade (grades 1–4, 1=best); tear film noninvasive breakup time; fluorescein breakup time; corneal epithelial damage score (15 points=maximum); ocular surface epithelial damage score (9 points=maximum); and the Schirmer I test.

In all FBUPs, eye dryness and fatigue were the worst symptoms. Symptoms specific to different types included: for AB, sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge; for SB, heavy eyelids; and for LB, foreign-body sensation. Statistically significant differences (p<0.05) were found in: tear meniscus radius (AB vs. SB, AB vs. DB, AB vs. RB, and LB vs. RB); tear film lipid layer interference grade (AB vs. all other FBUPs, LB vs. SB, and LB vs. DB); tear film lipid layer spread grade (AB vs. all other FBUPs); fluorescein breakup time (AB vs. LB, AB vs. DB, AB vs. RB, SB vs. DB, SB vs. RB; LB vs. RB, and DB vs. RB). Significant differences were also found in noninvasive breakup time (AB vs. all other FBUPs, SB vs. DB, SB vs. RB, and LB vs. RB); corneal epithelial damage score (AB vs. all other FBUPs, LB vs. SB, LB vs. DB, and LB vs. RB); ocular surface epithelial damage score (AB vs. SB, AB vs. LB, AB vs. DB, LB vs, SB, LB vs. DB, and LB vs. RB); and Schirmer I test (AB vs. SB, AB vs. DB, and AB vs. LB).

Researchers say that the five different fluorescein breakup patterns reflect different pathophysiologies.

Am J Ophthalmol 2017;180:72-85.
Yokoi N, Georgiev G, Kato H, et al.