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Re: Meuer et al.: The epidemiology of vitreoretinal interface abnormalities as detected by spectral-domain optical coherence tomography: the Beaver Dam Eye Study (Ophthalmology 2015;122:787-95)
Correspondence Re: Meuer et al.: The epidemiology of vitreoretinal interface abnormalities as detected by spectral-domain optical coherence tomography: the Beaver Dam Eye Study (Ophthalmology 2015;122:787-95) The article by Meuer et al1 reports that epiretinal membranes were absent in 19% of those having had cataract extraction, and present in 33%, with a P value of <0.0001. This is a stunning finding and seems to indicate that cataract extraction is not as benign a procedure as it seems generally thought to be. The authors do not comment on whether this was merely a function of age, or seemed to be related to the surgery. TO THE EDITOR:
GEORGE L. SPAETH, MD Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania Financial Disclosure(s): The authors made the following disclosure(s): G.L.S.: Consultant e Pfizer; Expert testimony e Transcend; Lecture fees e Allergan; Royalties e Elsevier; Development of educational presentations e Merck Correspondence: George L. Spaeth, MD, Wills Eye Hospital, 840 Walnut Street, Jefferson Medical College, Philadelphia, PA 19107. E-mail: [email protected].
The Beaver Dam Eye Study was supported by National Institutes of Health grant no. EY06594 (B.E.K.K. and R.K.) and by an unrestricted grant from Research to Prevent Blindness, New York, New York. The National Eye Institute provided funding for entire study including collection and analyses of data; Research to Prevent Blindness provided additional support for data analyses. The sponsors or funding organizations had no role in the design or conduct of this research. Correspondence: Ronald Klein, MD, MPH, University of Wisconsin School of Medicine and Public Health, Department of Ophthalmology and Visual Sciences, 610 N. Walnut Street, 4th Floor WARF, Madison, WI 53726-2336. E-mail: [email protected].
Reference 1. Meuer SM, Myers CE, Klein BE, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectraldomain optical coherence tomography: the Beaver Dam Eye Study. Ophthalmology 2015;122:787–95.
Re: Jiang et al.: Optic nerve head changes after short-term intraocular pressure elevation in acute primary angle-closure suspects (Ophthalmology 2015;122:730-7) The article by Jiang et al1 in the April 2015 issue of Ophthalmology is beautifully done. The authors are to be congratulated for commenting that the rim width “decreased” rather than the rim getting “thinner.” Thickness and width are not synonymous. The optic nerve head has both width and thickness, or narrowness and thinness. The “cup” of the optic nerve can become deeper (i.e., a change in thickness) or wider (i.e., a change in the lateral direction, not the anterioreposterior direction). The finding that width of the neural retinal rim becomes narrower in response to short-term elevations of intraocular pressure is a powerful commentary on the plasticity of the optic nerve head. Unfortunately, the authors did not repeat the evaluation and the configuration of the optic nerve head to determine whether the nerve returned to its pre-elevation configuration after the intraocular pressure returned to normal. There is much evidence of this type of reversibility of change, but its occurrence seems not to be well accepted or understood. More information about that is important in furthering knowledge about the relationship between intraocular pressure and optic disc structure. TO THE EDITOR:
Reference 1. Meuer SM, Myers CE, Klein BE, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectraldomain optical coherence tomography: the Beaver Dam Eye Study. Ophthalmology 2015;122:787–95. 1 REPLY: In our study, the original frequencies of epiretinal membranes reported were crude (33% in eyes with cataract surgery vs 19% in eyes without cataract surgery). When the frequencies of epiretinal membranes were adjusted for age, there was little change (33% vs 21%) and the age-adjusted P value remained at <0.001. Because these data are cross-sectional, we cannot infer the temporal relationship of the association from these data, that is, which is antecedent and which is consequent.
STACY M. MEUER, BS BARBARA E.K. KLEIN, MD, MPH CHELSEA E. MYERS, MSTAT RONALD KLEIN, MD, MPH Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
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GEORGE L. SPAETH, MD Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania Financial Disclosure(s): The authors made the following disclosures: G.L.S.: Consultant e Pfizer; Expert testimony e Transcend; Lecture fees e Pfizer; Royalties e Elsevier; Development of educational presentations e Merck; Travel expenses e Allergan
GEORGE L. SPAETH, MD Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania Financial Disclosure(s): The authors made the following disclosure(s): G.L.S.: Consultant e Pfizer; Expert testimony e Transcend; Lecture fees e Allergan; Royalties e Elsevier; Development of educational presentations e Merck Correspondence: George L. Spaeth, MD, Wills Eye Hospital, 840 Walnut Street, Jefferson Medical College, Philadelphia, PA 19107. E-mail: [email protected].
The Beaver Dam Eye Study was supported by National Institutes of Health grant no. EY06594 (B.E.K.K. and R.K.) and by an unrestricted grant from Research to Prevent Blindness, New York, New York. The National Eye Institute provided funding for entire study including collection and analyses of data; Research to Prevent Blindness provided additional support for data analyses. The sponsors or funding organizations had no role in the design or conduct of this research. Correspondence: Ronald Klein, MD, MPH, University of Wisconsin School of Medicine and Public Health, Department of Ophthalmology and Visual Sciences, 610 N. Walnut Street, 4th Floor WARF, Madison, WI 53726-2336. E-mail: [email protected].
Reference 1. Meuer SM, Myers CE, Klein BE, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectraldomain optical coherence tomography: the Beaver Dam Eye Study. Ophthalmology 2015;122:787–95.
Re: Jiang et al.: Optic nerve head changes after short-term intraocular pressure elevation in acute primary angle-closure suspects (Ophthalmology 2015;122:730-7) The article by Jiang et al1 in the April 2015 issue of Ophthalmology is beautifully done. The authors are to be congratulated for commenting that the rim width “decreased” rather than the rim getting “thinner.” Thickness and width are not synonymous. The optic nerve head has both width and thickness, or narrowness and thinness. The “cup” of the optic nerve can become deeper (i.e., a change in thickness) or wider (i.e., a change in the lateral direction, not the anterioreposterior direction). The finding that width of the neural retinal rim becomes narrower in response to short-term elevations of intraocular pressure is a powerful commentary on the plasticity of the optic nerve head. Unfortunately, the authors did not repeat the evaluation and the configuration of the optic nerve head to determine whether the nerve returned to its pre-elevation configuration after the intraocular pressure returned to normal. There is much evidence of this type of reversibility of change, but its occurrence seems not to be well accepted or understood. More information about that is important in furthering knowledge about the relationship between intraocular pressure and optic disc structure. TO THE EDITOR:
Reference 1. Meuer SM, Myers CE, Klein BE, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectraldomain optical coherence tomography: the Beaver Dam Eye Study. Ophthalmology 2015;122:787–95. 1 REPLY: In our study, the original frequencies of epiretinal membranes reported were crude (33% in eyes with cataract surgery vs 19% in eyes without cataract surgery). When the frequencies of epiretinal membranes were adjusted for age, there was little change (33% vs 21%) and the age-adjusted P value remained at <0.001. Because these data are cross-sectional, we cannot infer the temporal relationship of the association from these data, that is, which is antecedent and which is consequent.
STACY M. MEUER, BS BARBARA E.K. KLEIN, MD, MPH CHELSEA E. MYERS, MSTAT RONALD KLEIN, MD, MPH Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.
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GEORGE L. SPAETH, MD Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania Financial Disclosure(s): The authors made the following disclosures: G.L.S.: Consultant e Pfizer; Expert testimony e Transcend; Lecture fees e Pfizer; Royalties e Elsevier; Development of educational presentations e Merck; Travel expenses e Allergan