Glaucoma is the leading cause of irreversible blindness worldwide, with elevated intraocular pressure (IOP) as the only known modifiable risk factor. Trabecular meshwork (TM)-inducible myocilin (the MYOC gene) was the first to be identified and linked to juvenile and primary open-angle glaucoma. It has been suggested that mutations in the MYOC gene and the aggregation of mutant myocilin in the endoplasmic reticulum (ER) of TM may cause ER stress, resulting in a reduced outflow of aqueous humor and an increase in IOP. We selected 20 MYOC mutations with experimentally determined melting temperatures of mutated myocilin proteins. We included 40 published studies with at least one glaucoma patient with one of these 20 MYOC mutations and information on age at glaucoma diagnosis. Based on data from 458 patients, we found that a statistically significant but weak correlation was present between age and melting temperature based on various assumptions for age. We therefore conclude that genetic analysis of MYOC mutations alone cannot be used to accurately predict age at glaucoma diagnosis. However, it might be an important prognostic factor combined with other clinical factors for critical and early detection of glaucoma.

Purpose: The aim of the study was to evaluate the refractive outcomes of combined cataract surgery and vitrectomy compared to cataract surgery alone. Methods: This retrospective chart review study included two groups: (1) combined surgery in 103 eyes (101 patients) who underwent cataract surgery with posterior chamber intraocular lens (PCIOL) placement by a single cataract surgeon and vitrectomy by a single vitreoretinal surgeon at the same surgical setting; (2) cataract surgery alone by the same surgeon in 107 eyes (84 patients). Refractive outcomes and complications between the combined and cataract surgery alone group were compared. The predicted refractive error was compared to postoperative refractive outcomes in both groups, surgically induced astigmatism (SIA), intraoperative or postoperative complications of either cataract surgery or vitrectomy, and cystoid macular edema. Results: There was no statistically significant difference between predicted and actual postoperative refractive outcomes between the combined and cataract surgery alone groups (within ±0.5 diopters [D], p = 0.099; within ±1.0 D, p = 0.721). There was no difference in SIA refractive outcomes between the two groups (p = 0.509). The use of intraoperative gas for retina tamponade did not significantly affect postoperative refractive outcomes. Both cataract surgery and vitrectomy were successfully performed without unexpected complications from either procedure affecting the other. Discussion/Conclusion: Combined cataract surgery and vitrectomy allows excellent refractive outcomes equal to cataract surgery alone, allowing each procedure to be performed independently by separate anterior and posterior segment surgeons. Combined procedures can be performed in eyes with a variety of retinal indications and can include fluid-gas exchange with minimal risk of PCIOL malposition or change in targeted refraction.

Purpose: We report the longest follow-up to our knowledge of stable scleral fixation of a posterior chamber intraocular lens (PC IOL) with 10-0 polypropylene sutures. Methods: A retrospective review is presented of a case with more than 30 years’ follow-up after performing sutured scleral fixation with 10-0 polypropylene suture using 2 sutures tied together under a scleral flap. One suture was a cow-hitch looped around the haptic, and the other suture was passed through the sclera to create the scleral fixation. Results: The scleral fixation with 10-0 polypropylene suture knots for both haptics of the PC IOL allowed central optic positioning with excellent vision for more than 30 years without suture breakage. Conclusions: Polypropylene sutures for scleral fixation of PC IOLs remained stable for more than 30 years with central positioning of the PC IOL, without exposure of the fixation suture knots through the conjunctiva, and without suture breakage.

The Prevent Suicide Hawaiʻi Taskforce is a state, public, and private partnership of individuals, organizations, and community groups that leads statewide suicide prevention efforts in Hawaiʻi. The purpose of this evaluation was to identify the progress and barriers of the Taskforce to inform the upcoming 2025 Hawaiʻi Suicide Prevention Strategic Plan in the following areas: Hope, Help, Heal, Research and Evaluation, and Policy and Advocacy. Utilizing a sequential exploratory mixed-methods approach, 18 key informants were interviewed, followed by a 13-question survey sent to the Taskforce member listserv. Results were analyzed using qualitative coding techniques and descriptive statistics. Interview findings contained six themes: importance of community relationships, interconnection of suicide prevention efforts, progress in diversifying training, organizational challenges, adaptations to the COVID-19 pandemic, and funding challenges. Of the 34 survey respondents, most were involved in the area of Hope (91%). The respondents reported the area with most progress was Hope (87%), and the most important area to address was Help (41%). The majority (82%) of the respondents characterized the level of Taskforce communication as Excellent or Good. Interview and survey data corroborated each other and revealed new insights about the successes and barriers of the Taskforce and their progress in implementing the Strategic Plan. Recommendations included advocating for long-term funding for suicide prevention and building community relationships.

Background: Epiretinal proliferation (ERP) is an extension of preretinal tissue, creating a thin, semi-translucent layer of fibrous tissue on the retina. ERP has been recently associated with degenerative lamellar macular holes (DLMH) and full-thickness macular holes (FTMH). The proposed surgery for patients has been vitrectomy and ERM peeling, but there is no consensus on whether DLMH is a stable condition or should be resolved with surgical treatment. The purpose was to investigate optical coherence tomography (OCT) changes and visual outcomes of degenerative LMH and FTMH secondary to ERP after pars plana vitrectomy (PPV) and internal limiting membrane (ILM) peeling. Methods: This retrospective case series evaluated 14 eyes with DLMH and eight eyes with FTMH. All 22 eyes were associated with ERP and treated with PPV with ILM peeling. Best-corrected visual acuity (BCVA, in logMAR), OCT findings, including presence of foveal bump and ellipsoid zone integrity, were documented. Wilcoxon signed-rank tests were used for numerical data. Statistical significance was based on a value of p < 0.05. Results: Among the 14 DLMH cases, the mean Snellen equivalent VA was 20/75 at baseline; 20/59 at the 4–12-month postoperative period; and 20/56 at the final follow-up visit. For the eight FTMH cases, the mean Snellen equivalent VA was 20/94 at baseline; 20/45 at the 4–12-month postoperative period; and 20/38 at the final follow-up visit. Compared to baseline VA, FTMH cases demonstrated a statistically significant improvement in the 4–12-month postoperative VA (p < 0.05) and in the final postoperative VA (p < 0.05). Among all cases, a strong correlation was observed between baseline logMAR and change in logMAR from baseline to final follow-up (R² = 0.671). Conclusion: This study demonstrated that surgical intervention led to improved visual and anatomic outcomes in patients with DLMH and FTMH, with a correlation between baseline VA and postoperative visual outcomes. The results suggest that patients with worse preoperative VA experienced the greatest benefit in visual outcome from PPV and ILM peeling. Future studies would look at the timing of when to ideally intervene to improve anatomic and visual outcomes.

Background: Formal assessment of What Matters in end-of-life care is often done in medical settings through legal forms. Past research indicates that Native Hawaiians are less likely to complete these forms than Whites. The purpose of this study was to explore health care preferences among Native Hawaiian elders and to identify cultural themes that may impact quality care at end of life. Objective: To explore What Matters to Native Hawaiian elders, as culture likely impacts health care and end-of-life preferences. Design: A secondary analysis of qualitative data collected through a multiyear interview project in Hawai'i. Setting/Participants: Twenty participants age 60+ living in rural Hawai'i. Measurement: Deductive coding was informed by guidelines on What Matters according to the Institute of Healthcare Improvement's 4Ms Framework. Inductive coding identified themes specific to Native Hawaiian elders as part of their culture. Results: Themes suggest the criticality of: (1) incorporating cultural traditions into health care routines; (2) involving family in health and end-of-life decisions; (3) supporting home-based care at the end of life; and (4) building strong patient-provider relationships. Conclusion: Although findings parallel preferences expressed in other populations, the data provide additional insights into the preferences of Native Hawaiian elders anticipating end-of-life care. Recommendations for culturally competent care include: (1) develop relationships with Native Hawaiian patients well before end-of-life care is needed to facilitate discussions of care preferences; (2) work collaboratively with the patient and the patient's defined family; (3) ask about cultural practices and engage traditional healers as directed by the patient; and (4) provide services in patients' homes and communities.