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BackgroundThe potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors.MethodsData for this study came from the five-site Longitudinal Research on Aging Drivers (LongROAD) project. Participants were active drivers, age 65-79 years at enrollment, and patients at one of the 5 participating sites. Medication names and doses were obtained at baseline based on the "brown-bag review" method. Medications were coded using the American Hospital Formulary Service system. Driving data were collected by a GPS accelerometer installed in the study participants' main vehicles.ResultsMedication data were available for 2949 (98.6%) of the 2990 participants, and 2898 (96.9% of all participants) had both medication data and at least 30 recorded days of driving. The median number of medications taken per study participant was seven, with a range of 0-51. Total number of medications was significantly associated with a higher rapid deceleration rate. Certain medication classes were significantly associated with other driving outcomes, including central nervous system agents (more speeding events), hormones and gastrointestinal medications (more rapid decelerations), electrolytes (fewer rapid decelerations), and antihistamines (greater right to left turn ratio).ConclusionsOlder adult drivers are taking large quantities of prescription and non-prescription medications that may affect their driving safety. Certain medication classes are associated with potentially adverse driving patterns, such as speeding and rapid decelerations, while others are associated with potentially protective maneuvers, such as right hand turning. Further research is warranted to identify and mitigate potential adverse effects of such medications on driving safety in older adults.

BACKGROUND: Potentially Inappropriate Medication (PIM) use has been studied in a variety of older adult populations across the world. We sought to examine the prevalence and correlates of PIM use in older drivers. METHODS: We applied the American Geriatrics Society 2015 Beers Criteria to baseline data collected from the brown-bag review of medications for participants of the Longitudinal Research on Aging Drivers (LongROAD) study to examine the prevalence and correlates of PIM use in a geographically diverse, community-dwelling sample of older drivers (n = 2949). Proportions of participants who used one or more PIMs according to the American Geriatrics Society 2015 Beers Criteria, and estimated odds ratios (ORs) and 95% confidence intervals (CIs) of PIM use associated with participant characteristics were calculated. RESULTS: Overall, 18.5% of the older drivers studied used one or more PIM. The most commonly used therapeutic category of PIM was benzodiazepines (accounting for 16.6% of the total PIMs identified), followed by nonbenzodiazepine hypnotics (15.2%), antidepressants (15.2%), and first-generation antihistamines (10.5%). Compared to older drivers on four or fewer medications, the adjusted ORs of PIM use were 2.43 (95% CI 1.68-3.51) for those on 5-7 medications, 4.19 (95% CI 2.95-5.93) for those on 8-11 medications, and 8.01 (95% CI 5.71-11.23) for those on ≥12 medications. Older drivers who were female, white, or living in urban areas were at significantly heightened risk of PIM use. CONCLUSION: About one in five older drivers uses PIMs. Commonly used PIMs are medications known to impair driving ability and increase crash risk. Implementation of evidence-based interventions to reduce PIM use in older drivers may confer both health and safety benefits. TRIAL REGISTRATION: Not applicable.

PurposeMethodsResultsConclusionTo investigate the long-term outcomes of XEN-45 implantation for glaucoma secondary to Fuchs uveitis syndrome (FUS), juvenile idiopathic arthritis (JIA)-related anterior uveitis and intermediate uveitis (IU).This retrospective study evaluated 19 eyes with FUS, 10 eyes with JIA, and nine eyes with IU that underwent XEN-45 Gel Stent implantation. The primary outcome measure was 3-year surgical success, defined as a ≥20% reduction in intraocular pressure (IOP), with a target IOP of 6–21 mmHg. Success was considered complete when IOP control was achieved without glaucoma medication or surgery other than needling and qualified when medication and/or incisional bleb revision were allowed for IOP control. The secondary outcome measures included IOP changes and revision and complication rates.The 3-year complete success rate was 49% and 67% in the FUS and IU groups, respectively, both significantly higher than the 20% rate in the JIA group (p = 0.01 and 0.02, respectively, log-rank test). The qualified success rate was also significantly higher in the FUS and IU groups than in the JIA group. Significantly more medications were reintroduced in the JIA group within the first year, and the JIA group did not achieve a significantly lower median IOP at the 2- and 3-year visits, contrary to the FUS and IU groups. The bleb revision and secondary glaucoma surgery rates were similar among all groups.XEN-45 demonstrates a favourable safety and efficacy profile for glaucoma secondary to FUS and IU. However, its efficacy is significantly poor for JIA-related uveitic glaucoma. [ABSTRACT FROM AUTHOR]

Abstract In a multicenter study of newly diagnosed ALS patients without a reported family history of ALS, we are prospectively investigating whether markers of oxidative stress (OS) are associated with disease progression. Methods utilize an extensive structured telephone interview ascertaining environmental, lifestyle, dietary and psychological risk factors associated with OS. Detailed assessments were performed at baseline and at 3-6 month intervals during the ensuing 30 months. Our biorepository includes DNA, plasma, urine, and skin. Three hundred and fifty-five patients were recruited. Subjects were enrolled over a 36-month period at 16 sites. To meet the target number of subjects, the recruitment period was prolonged and additional sites were included. Results showed that demographic and disease characteristics were similar between 477 eligible/non-enrolled and enrolled patients, the only difference being type of health insurance among enrolled patients. Sites were divided into three groups by the number of enrolled subjects. Comparing these three groups, the Columbia site had fewer definite ALS diagnoses. This is the first prospective, interdisciplinary, in-depth, multicenter epidemiological investigation of OS related to ALS progression and has been accomplished by an aggressive recruitment process. The baseline demographic and disease features of the study sample are now fully characterized.

Purpose: Artificial intelligence (AI)-tools hold great potential to compensate for missing resources in health-care systems but often fail to be implemented in clinical routine. Intriguingly, no-code and low-code technologies allow clinicians to develop Artificial intelligence (AI)-tools without requiring in-depth programming knowledge. Clinician-driven projects allow to adequately identify and address real clinical needs and, therefore, hold superior potential for clinical implementation. In this light, this study aimed for the clinician-driven development of a tool capable of measuring corneal lesions relative to total corneal surface area and eliminating inaccuracies in two-dimensional measurements by three-dimensional fitting of the corneal surface. Methods: Standard slit-lamp photographs using a blue-light filter after fluorescein instillation taken during clinical routine were used to train a fully convolutional network to automatically detect the corneal white-to-white distance, the total fluorescent area and the total erosive area. Based on these values, the algorithm calculates the affected area relative to total corneal surface area and fits the area on a three-dimensional representation of the corneal surface. Results: The developed algorithm reached dice scores >0.9 for an automated measurement of the relative lesion size. Furthermore, only 25% of conventional manual measurements were within a ± 10% range of the ground truth. Conclusions: The developed algorithm is capable of reliably providing exact values for corneal lesion sizes. Additionally, three-dimensional modeling of the corneal surface is essential for an accurate measurement of lesion sizes. Besides telemedicine applications, this approach harbors great potential for clinical trials where exact quantitative and observer-independent measurements are essential. [ABSTRACT FROM AUTHOR]

Objectives: To investigate whether phakia affects the outcome of XEN-45 gel stent implantation in the treatment of pseudoexfoliative glaucoma (PXG). Methods: A retrospective, comparative cohort study of 30 phakic and 55 pseudophakic PXG patients who received the XEN-45 gel stent at a tertiary centre. The primary outcome measure was two-year success defined as a ≥20% lowering of intraocular pressure (IOP) and a target IOP of 6–21 mmHg. Success was complete without and qualified irrespective of antiglaucoma medication use. Further glaucoma surgery other than needling was regarded as a failure. The secondary outcome measures included changes in IOP, revision and complication rates. Results: The complete two-year success rates were 70% and 59% in the phakic and pseudophakic groups, respectively (p = 0.75, log-rank test), and the qualified rates were 80% and 72%, respectively (p = 0.89). The median IOP reduction from baseline was 54% in phakic, and 46% in pseudophakic eyes. While needling rates were similar, the incidence of early incisional bleb revisions was significantly higher in the phakic eyes (13% vs. 0% within 3 months; p = 0.0098, chi-square). Increasing after a year, significantly more pseudophakic eyes failed due to secondary glaucoma surgery (16% vs. 0%; p = 0.0191). Conclusions: The XEN-45 gel stent offers equally effective IOP control for both phakic and pseudophakic patients. However, the onset of bleb revisions and the necessity for secondary glaucoma surgery differed significantly between the groups. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the changes in retinal arterial architecture after treatment with voretigene neparvovec in patients with retinal dystrophy caused by bi‐allelic mutations in the RPE65 gene. Methods: Sixteen eyes treated with voretigene neparvovec at the University Eye Clinic in Tuebingen, Germany, underwent adaptive optics ophthalmoscopy (AO) imaging at baseline and 2 weeks, 1, 3, 6 and 12 months after treatment. Follow‐up was performed in six eyes of four patients. For each eye, five different positions at arterial vessels were selected and the wall‐to‐lumen ratio (WLR), the lumen diameter (LD) and the wall cross‐sectional area (WCSA) were measured by the manufacturer's software over the observational period. Results: Vast retinal atrophy dominated all gained AO images. WLR fluctuated in the observation period without statistically significant change. LD and WCSA changed significantly after 2 weeks from the baseline examination and returned to values similar to baseline thereafter. There were no signs of inflammation such as macrophages or perivascular accumulated fluid visible. Conclusion: AO imaging of the retinal vessels in RPE65‐associated retinal dystrophies (IRD) is challenging. There was no change in the retinal arterial vasculature over the observation period of 12 months that would indicate inflammatory changes. Decrease of the LD and WCSA shortly after treatment might be caused by the perioperative prednisolone intake. AO of retinal vessels can be used as a diagnostic module to complement monitoring the disease and effects of genetic treatments if the acquisition is possible in selected cases. [ABSTRACT FROM AUTHOR]

Purpose/Aim of the study: Studies in mouse models have suggested a role for the cellular prion protein in iron metabolism of the eye. Here we have investigated whether iron metabolism affects the expression of prion protein in humans. Patients presenting to the department of ophthalmology of the Medical University of Graz for reasons unrelated to prion diseases were enrolled. Parameters of iron metabolism, including ferritin and soluble transferrin receptor were measured by routine laboratory tests. Serum prion protein was determined by enzyme-linked immunosorbent assay. Surface prion protein on CD14+ monocytes and CD4+ T cells was analyzed by fluorescence activated cell sorting. 95 patients were enrolled. Soluble transferrin receptor correlated significantly with prion protein levels on CD14+POM1+ monocytes (P =.001, r = −0.7) and on CD4+POM1+ T cells (P =.01, r = −0.62). Our findings suggest a connection between the physiological function of the prion protein and iron metabolism in humans. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo investigate the efficacy and safety of the Preserflo MicroShunt (PMS) in treating glaucoma secondary to different uveitic glaucoma (UG) types in a European population.This study evaluated consecutive eyes with UG that received the PMS. The primary outcome measure was 12-month surgical success (≥20% IOP reduction, target IOP of 6–21 mmHg). Complete success was considered without IOP-lowering medication or additional surgery other than needling. Qualified success A was considered regardless of medication use, and qualified success B regardless of medication and/or incisional bleb revision. The secondary outcome measures included revision and complication rates.Twenty-five eyes (viral group: 10 with Fuchs uveitis syndrome and six with herpetic uveitis; juvenile idiopathic arthritis (JIA) group: nine with JIA-related uveitis) were included. The 12-month complete success rate was significantly higher in the viral group than in the JIA group (69% vs 11%; p = 0.0059, log-rank test). The qualified success rates in the viral and JIA groups were 75% and 22% for category A (p = 0.029) and 94% and 56% for category B (p = 0.0237), respectively. Among the viral and JIA groups, 13% and 11% required medication, respectively. Incisional bleb revisions were conducted within 12 months in 25% and 78%, respectively (p = 0.0131, log-rank test). Complications were self-limiting, with no uveitic activity observed.The PMS is safe and effective for glaucoma secondary to viral anterior uveitis. Conversely, it is moderately effective in eyes with JIA-related UG, with a high probability of bleb fibrosis development. [ABSTRACT FROM AUTHOR]

Purpose: To describe the clinical course and treatment response of a case of Acute Zonal Occult Outer Retinopathy (AZOOR)., Methods: This is an observational case report. The examinations included ophthalmic examination, longitudinal multimodal imaging, visual field testing, electrophysiological recordings, serologic analyses and whole genome sequencing., Results: In this report, the authors present the case of an otherwise healthy 33-year-old female with bilateral AZOOR manifestation. Other possible causes of the observed retinal lesions were ruled out by extensive diagnostic work-up. Treatment with oral prednisolone therapy led to temporal disease control but progression was observed after prednisolone discontinuation. A tapered oral prednisolone therapy in combination with adalimumab initiation prevented further progression for at least 21 months., Conclusion: Diagnosis of AZOOR is frequently complicated by the unspecific symptoms of the disease and significant number of differential diagnoses. Complete diagnostic work-up is important to rule out other etiologies. Due to the lack of randomized controlled trials, therapeutic decisions obligatorily rely on empiric treatment decisions in combination with frequent follow-up examinations., Competing Interests: Conflict of interest: Laura Kühlewein: Financial support for research from Novartis, Rhythm Therapeutics, Tistou and Charlotte Kerstan Foundation, none related to this work. No conflicts of interest for this publication. Katarina Stingl: Consultant for Novartis, ProQR, ViGeneron, Santen, Janssen, with all fees paid to Center for Ophthalmology, University of Tuebingen to support research. No conflicts of interest for this publication. None of the other authors declare a conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Opthalmic Communications Society, Inc.)