The Los Angeles Latino Eye Study is a population-based cross-sectional study of 6,357 Latinos age 40 years and older from six census tracts in Los Angeles. A door-to-door census located self-identified Latinos, who were then invited to participate in both a home interview and a clinic examination. The majority of participants were female (58 percent). Average age was 54.9 ±10.8 years. Nearly 95 percent were of Mexican-American ancestry.

The overall prevalence for visual impairment (BCVA of £ 20/40 in the better eye) was 3 percent (n = 182); range: 0.9 percent (40-49 years) to 27.8 percent (³80 years).

The overall prevalence for blindness (BCVA £ 20/200 in the better eye) was 0.4 percent (n = 26); range: 0.2 percent (40-49 years) to 4.2 percent (³ 80 years). Visual impairment increased with age (P < 0.0001) and was greater in  women (P = 0.02).

Independent risk indicators (odds ratio [95 percent confidence interval]) for visual impairment were:
• Age 70-79 years (2.8 [1.3-5.8]) or ³80 years (8.7 [3.9-19.6]);
• History of ocular disease (3.2 [2.1-4.8]);
• Being unemployed (3.3 [1.7-6.3]);
• Diabetes (2.2 [1.5-3.2]);
• Being separated/divorced (1.8 [1.0-3.1]); and
• Being widowed (2.8 [1.8-4.4]).

Participants with ³12 years of education (0.5 [0.3-0.8]) were less likely to be visually impaired.

Outcomes showed rates of visual impairment and blindness in Latinos are high, especially in older individuals. Researchers suggest that better education and employment may decrease the burden of visual impairment in Latinos.
(Ophthalmology 2004;111:1132-1140)
Varma R, Ying-Lai M, Klein R, Azen S, The Los Angeles Latino Eye Study Group

Phase-I Results Promising for the Implantable Miniature Telescope
Researchers at four centers in the United States have been involved in a Phase I clinical trial of the visual prosthetic device, the Implantable Miniature Telescope, designed by Isaac Lipshitz, MD. The study was conducted under an investigational device exemption granted by the U.S. Food and Drug Administration.

In this prospective, multicenter Phase-I trial, investigators implanted the IMT in one eye of 14 patients age 60 or older with significant bilateral central vision impairment from late-stage age-related macular degeneration. Participants had bilateral geographic atrophy or disciform scar AMD, cataract and BCVA between 20/80 and 20/400. Researchers conducted preop and postop evaluation of distance and near BCVA, endothelial cell density and quality of life as measured on the Activities of Daily Life scale.

At 12 months postop, 10 of 13 patients (77 percent) gained two or more lines of either distance or near BCVA. Eight of 13 patients (62 percent) gained three or more lines in either distance or near BCVA. Mean endothelial cell density decreased by 13 percent. All adverse events (primarily late intraocular inflammation) resolved without sequelae. Activities of Daily Life scores improved in the majority of patients.

Authors note that a Phase-II/III trial is in progress.
(Am J Ophthalmol 2004;137:993-1001)
Lane S, Kuppermann B, Fine I, Hamill M, Gordon J, Chuck R, Hoffman R, Packer M, Koch D

MMC Shows No Effect on Ahmed Valve Implantation
Mitomycin C did not increase the short- or intermediate-term success rates of Ahmed Glaucoma Valve implantation in a multicenter, prospective, randomized clinical trial conducted in Brazil, the United Kingdom, Canada and the United States.

Sixty eyes of 60 patients with uncontrolled glaucoma requiring glaucoma drainage device implantation were enrolled and randomized to receive intraoperative MMC (0.5 mg/ml for five minutes) (n = 34) or balanced salt solution (n = 26) during implantation surgery. There were no significant differences in gender, race, mean age, lens status, type of glaucoma or mean number of previous glaucoma surgeries.

Researchers defined surgical success according to two different criteria: 1) postop IOP between 6 and 21 mmHg, with or without antiglaucoma medications; and 2) IOP reduction of at least 30 percent relative to preoperative values. Cases classified as failures were those in eyes requiring additional glaucoma surgery, that developed phthisis or that showed loss of light perception.

Mean follow-up was 12.3 months. Considering the first criterion for success (IOP between 6 and 21 mmHg), Kaplan-Meier survival analysis showed a probability of success of 59 percent (at 18 months) for the MMC group and 61 percent for the control group. Considering IOP reduction of at least 30 percent, Kaplan-Meier survival analysis showed a probability of success of 62 percent for the MMC group and 67 percent for the control group.

At 15 days postop, the mean IOP didn't differ significantly between the MMC and control eyes. Mean numbers of postop antiglaucoma medications were similar in MMC-treated eyes and controls. Researchers found no significant difference in the incidences of postop complications in both groups.
(Ophthalmology 2004;111:1071-1076)
Costa V, Azuara-Blanco A, Netland P, Lesk M, Arcieri E

Vitrectomy for Lens Fragments
Patients undergoing vitrectomy for retained lens fragments often develop delayed visual loss, say investigators in North Carolina. They recommend long-term surveillance of these patients.

A retrospective, noncomparative, interventional case series revealed 42 consecutive patients who had undergone vitrectomy for retained lens fragments by a single surgeon, with a minimum of six months' follow-up. The mean and median age of patients was 73 years. Fifty-five percent were female and 95 percent were white.

Ninety-five percent of eyes had significant anterior segment inflammation at the time of presentation. Corneal edema or folds were present in 67 percent of eyes and lenticular fragments in the anterior chamber were present in 48 percent. An IOL had been placed at the time of cataract surgery in 81 percent of eyes, with posterior chamber IOLs in 52 percent of eyes.

The interval between cataract surgery and vitrectomy varied based on joint patient-surgeon decision. The surgeon performed vitrectomy within a week of cataract surgery in 54 percent of eyes, with 21 percent of these done on the day after cataract surgery.

Investigators report that while 67 percent of eyes achieved a postop visual acuity of 20/40 or better at three months, 17 percent had events during follow-up that resulted in loss of vision to less than 20/40. Final BCVA of 20/40 or better was achieved in half of the eyes. Retinal detachment occurred in 17 percent, and 21 percent of eyes required long-term therapy for glaucoma.
(Retina 2004;24:363-367)
Greven C, Piccione K