Objective To assess the relationship between vitamin D status and diabetic retinopathy Methods A clinic-based, cross-sectional study was conducted at Emory University. A total of 221 subjects were classified into five groups based on diabetes status and retinopathy findings: no diabetes or ocular disease (n = 47), no diabetes with ocular disease (n = 51), diabetes with no background diabetic retinopathy (No BDR; n = 41), nonproliferative diabetic retinopathy (NPDR; n = 40), and proliferative diabetic retinopathy (PDR; n = 42). Key exclusion criteria included type 1 diabetes and those taking > 1000 IU vitamin D daily. Subjects underwent dilated fundoscopic examination and were tested for hemoglobin A1c, serum creatinine, and 25-hydroxy-vitamin D (25(OH)D) between December 2009 and March 2010. Results Between the groups, there was no statistical difference in age, race, sex, or multivitamin use. Diabetic subjects had lower 25(OH)D levels than non-diabetic subjects (22.9 ng/ml versus 30.3 ng/ml, p<0.001). The mean 25(OH)D levels were as follows: No diabetes or ocular disease = 31.9 ng/ml, No diabetes with ocular disease = 28.8 ng/ml, No BDR = 24.3 ng/ml, NPDR = 23.6 ng/ml, PDR = 21.1 ng/ml. Univariate analysis of the 25(OH)D levels demonstrated statistical significance between the study groups, race, body mass index, multivitamin use, hemoglobin A1c, serum creatinine, and estimated glomerular filtration rate. In a multivariate linear model with all potential confounders, only multivitamin use remained significant (p<0.001). Conclusions This study suggests that diabetic subjects, especially those with PDR, have lower 25(OH)D levels than those without diabetes.

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Objective-To compare contact lenses and intraocular lenses (IOLs) for the optical correction of unilateral aphakia during infancy.Methods-In a randomized, multicenter (12 sites) clinical trial, 114 infants with a unilateral congenital cataract were assigned to undergo cataract surgery either with or without IOL implantation. Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL had their aphakia treated with a contact lens Main Outcome Measures-Grating acuity at 12 months of age and HOTV visual acuity at 4.5 years of age Results-Enrollment began in December 2004 and was completed in January 2009. The median age at the time of cataract surgery was 1.8 months. Fifty patients were 4-6 weeks of age at the time of enrollment, 32 patients were between 49 days and 3 months of age and the remaining 32 children were 3 to 7 months of age. Fifty-seven children were randomized to each treatment group with either IOL placement or aphakia. The eyes with cataracts had shorter axial lengths and steeper corneas on average than the fellow eyes.Conclusions-The optimal optical treatment of aphakia in infants is unknown. IATS was designed to provide empirical evidence whether optical treatment with an IOL or a contact lens following unilateral cataract surgery during infancy is associated with a better visual outcome.

Objective To evaluate the characteristics of strabismus in infants who underwent cataract surgery with and without intraocular lens (IOL) implantation. Design Secondary outcome analysis in a prospective, randomized clinical trial Participants The Infant Aphakia Treatment Study (IATS) is a randomized, multicenter (n = 12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with a unilateral congenital cataract. Intervention Infants underwent cataract surgery with or without placement of an IOL. Main Outcome Measures The proportion of patients who developed strabismus during the first 12 months of follow-up was calculated using the life-table method, and compared across treatment groups and age strata using a log-rank test. Results Strabismus developed within the first 12 months of follow-up in 38 (life table estimate: 66.7%) pseudophakic infants and 42 (life table estimate: 74.5%) infants treated with contact lenses (p=0.59). The younger cohort (< 49 days) at the time of surgery developed less strabismus (29 of 50, life table estimate: 58.0%) than the older cohort (≥ 49 days) (51 of 64, life table estimate: 80.0%) (p<0.01). Conclusions Intraocular lens placement does not prevent the early development of strabismus following congenital cataract surgery. However, strabismus was less likely to develop in infants whose cataract was removed at an earlier age.

Objective To assess whether outcomes of strabismus surgery are improved by using the adjustable suture technique and to determine which subgroups of strabismus patients benefit most from the adjustable suture technique. Design A retrospective chart review. Participants Five hundred thirty-five adults who had strabismus surgery between 1989–2010. Methods Success was defined as ≤10 prism diopters (PD) for horizontal deviations and ≤2 PD for vertical deviations. Differences in the proportion of successful strabismus surgery were analyzed using a chi-square test with an alpha of 0.05. Main outcome measures Ocular alignment in primary position at a 7-day to 12-week follow-up examination. Results 491 patients met the inclusion criteria (adjustable suture, n=305; non-adjustable, n=186). The success rates for non-adjustable and adjustable groups were 61.3% and 74.8% respectively (χ2=9.91, p=0.0016). Adjustable suture use was particularly beneficial for patients undergoing a reoperation for childhood strabismus (success rate: non-adjustable, 42.4%; adjustable, 65.7% p=0.0268; n=100). The differences in outcomes were not statistically significant for patients with childhood strabismus undergoing a primary surgery (non-adjustable, 65.0%; adjustable, 81.4% p=0.1354; n=90) or with thyroid orbitopathy (non-adjustable, 76.7%; adjustable, 74.1% p=0.8204; n=57). Conclusions Strabismus surgery using adjustable sutures was associated with improved short-term ocular alignment compared to strabismus surgery without the use of adjustable sutures. Adjustable sutures were most beneficial for patients undergoing reoperations for childhood strabismus.