Bimatoprost showed greater effi-cacy in lowering intraocular pressure when compared to other prostaglandin analogs latanoprost and travoprost, according to a new meta-analysis.
Clinical trials published up to July 2006 were used for the study, with the inclusion criteria being prospective, randomized, controlled clinical trials; patients with primary open-angle glaucoma or ocular hypertension; and pros-taglandin monotherapy, without system-ic/ocular medications or laser/surgery that could affect IOP within the past three months. The Jadad scoring system was used to assess quality, with potential bias eliminated through intensive statistical and independent reviews of publications. The main outcome measures were efficacy assessed by IOP (taken at 8 a.m., noon,
4 p.m. and 8 p.m.), change at three months from baseline and tolerability assessed by the incidence of conjunctival hyperemia.
Eight trials were identified (n=1,610 pa-tients). IOP change from baseline was statistically significantly greater with bimatoprost, compared with latanoprost at all time points:
8 a.m.: weighted mean (WM)=0.50 mmHg, p=0.05, 95 percent confidence intervals (CIs) 0.01 to 0.99; noon: WM=1.17 mmHg, p<0.001, 95 percent CI 0.68 to 1.66; 4 p.m.: WM=0.78 mmHg, p=0.003, 95 percent CI 0.26 to 1.29; 8 p.m.: WM=0.67 mmHg, p=0.04, 95 percent CI 0.02 to 1.32. It was also greater than travoprost during the daytime (8 a.m.: WM=1.02 mmHg, p=0.004, 95 percent CI 0.32 to 1.72; noon: WM=0.86 mmHg, p=0.02, 95 percent CI 0.12 to 1.59). Latanoprost and travoprost were comparable in reducing IOP at all time points (p¡Ü0.82).
Despite bimatoprost¡¯s greater ability to re-duce IOP, findings also showed the incidence of hyperemia was less with latanoprost and travoprost (latanoprost vs. bimatoprost: relative risk=0.59, p<0.001, 95 percent CI 0.50 to 0.69; travoprost vs. bimatoprost: relative risk=0.84, p=0.05, 95 percent CI 0.70 to 1.00).
(J Glaucoma 2008;17:667-73)
Aptel F, Cucherat M, Denis P.
MICS Yields Better Results for the Cornea Than SICS
Coaxial clear corneal microin-cision cataract surgery can be more beneficial than coaxial small-incision cataract surgery, say researchers in
A study evaluated 120 eyes of 60 patients scheduled for phacoemulsification. In order to compare changes in corneal topography and in regular and irregular astigmatism after MICS and SICS, the
Of the eyes observed, 60 had MICS (2 mm), and the 60 contralateral eyes had SICS (2.65 mm). The mean induced corneal astigmatism was significantly less in the MICS group than in the SICS group (p¡Ü0.0495) one week postoperatively and subsequently. The average difference mapped on videokeratography showed focal corneal flattening corresponding to the incision and coupled steepening around the flattened area two days postoperatively in both groups. The flattening and steepening gradually reduced to virtually the preoperative shape after eight weeks, but the changes were significantly less in the MICS group than in the SICS group. Of the irregular astigmatic components, higher-order irregularity was significantly less in the MICS group than in the SICS group up to two weeks postoperatively (p¡Ü0.0470).
Results showed induced astigmatism, focal wound-related flattening of the peripheral cornea and corneal surface irregularity were significantly less after coaxial MICS than after SICS.
(J Cataract Refract Surg 2009;35:233-9)
Hayashi K, Yoshida M, Hayashi H.
LASIK Discontent May Be Linked to Depression
Preoperative depression in patients could ultimately lead to dissatisfaction with their LASIK procedures, reports a recent study.
To better understand the 5 percent postoperative dissatisfaction rate, the
Patients were stratified by their visual quality rating after LASIK as highly satisfied, satisfied or less satisfied and by their depression scale score into low, medium and high groups. A proportional odds model was developed to compare the visual quality rating between the three depression groups one and six months post LASIK.
Results showed an uncorrected visual acuity of at least 20/20 was achieved in 88.6 percent of eyes. Patients with higher levels of depressive symptoms had three times higher odds (95 percent confidence interval [CI], 1.2 to 7.4) of being less satisfied than those with low levels of depressive symptoms one month after LASIK (p¡Ü0.02) and 2.5 times higher odds (95 percent CI, 1.0 to 6.5) of being less satisfied at six months (p¡Ü0.06).
In the end, preoperative depressive symptoms proved to be a significant contributor to pa-tient dissatisfaction with visual quality after the procedure.
(J Cataract Refract Surg 2009;35:341-6)
Morse JS,
360-degree SLT Improves on 180-degree SLT Treatment
A study suggests that 360-de-gree selective laser trabeculoplasty may work better for achieving smaller IOP fluctuations than treatment with 180-degree SLT.
In order to determine and compare the effect of 180 and 360 degrees of SLT treatment as a primary therapy on the intervisit IOP fluctuation in pat-ients, the study used retrospective chart reviews of patients with ocular hypertension and primary open-angle glaucoma who received SLT as primary therapy without any subsequent medical or surgical intervention. IOP before SLT and post-laser IOP at all visits during the follow-up period of months six to 24 were determined. The standard deviation (SD) of the mean
IOP was used as a surrogate for IOP fluctuation.
The study treated 41 eyes with SLT¡ª19 eyes in the 180-degree group and 22 eyes in the 360-degree group. The mean reduction in IOP at two years was 28 percent in the 180-degree group and 35 percent in the 360-degree group. After SLT, the 360-degree group had a lower IOP fluctuation compared with the 180-degree group over the follow-up period of months six to 24.
The percentage of eyes with intervisit IOP fluctuation SD ¡Ü2 mmHg during the same follow-up period was significantly greater in the 360-degree SLT treatment group (86 percent) than in the 180-degree SLT treatment group (52 percent) (p=0.03). The odds of achieving IOP fluctuation ¡Ü2 mmHg were 5.7 times greater with 360 degrees than with 180-degree SLT during the follow-up period of months six to 24.
(J Glaucoma 2009;18:157-60)
Prasad N, Murthy S, Dagianis JJ,
Cataract Surgery Doesn¡¯t Affect AMD Progression
Cataract surgery provides no direct risk for the progression of advanced AMD, according to research from the Age-Related Eye Disease Study.
The AREDS conducted a multicenter, controlled, randomized clinical trial on 4,572 participants (8,050 eyes). The trial evaluated the development of advanced AMD¡ªeither neovascular AMD or geographic atrophy¡ªwith the use of annual fundus photographs. History of cataract surgery was as-sessed every six months. Cox proportional hazard models with time-dep-endent covariates were conducted for NV AMD and GA separately. The main outcome measures were NV AMD, GA and central GA (CGA, involving the center of the macula).
The Cox proportional hazards model of right eyes showed nonsignificant hazard ratios of 1.20 (95 percent CI, 0.82 to 1.75) for NV AMD; 0.80 (95 percent CI, 0.61 to 1.06) for GA; and 0.87 (95 percent CI, 0.64 to 1.18) for CGA. Similar results were ob-tained for left eyes: 1.07 (95 percent CI, 0.72 to 1.58) for NV AMD; 0.94 (95 percent CI, 0.71 to 1.25) for GA; and 0.86 (95 percent CI, 0.63 to 1.19) for CGA. For participants with ad-vanced AMD in one eye (AREDS category 4), the hazard ratios for fellow eyes were 1.08 (95 percent CI, 0.65 to 1.72) for NV AMD and 0.98 (95 percent CI, 0.64 to 1.49) for CGA.
Results showed no clear effect of cataract surgery on the risk of progression to advanced AMD.
(Ophthalmology 2009;116:297-303)
Chew EY,
Slowing DR Could Reduce Medicare Expenditures
Delaying the progression of diabetic retinopathy could decrease Medicare expenditures, according to new research.
In an attempt to estimate the amount of DR-related expenditures in the United States, retrospective data was analyzed using the 1997 through 2004 5-percent Medicare claims data. A case-control design was used. Eli-gible beneficiaries were 65 or older and without major ophthalmic conditions (cataract, cataract surgery or macular degeneration) during the study period. Controls had diabetes but no evidence of diabetic retinopathy. There were two diabetic retinopathy case groups: beneficiaries with nonproliferative diabetic retinopathy (NPDR) and beneficiaries with proliferative diabetic retinopathy (PDR).
Analyses quantified annual Medicare payments for case and control groups.
The research identified a total of 178,383 controls, 33,735 NPDR cases and 6,138 PDR cases. After adjusting for age, sex and race, annual average Medicare payments for all care types were significantly higher for case groups compared to the control group, as were average payments for ophthalmic care only (all p<0.0001). In addition, average payments for all care and for ophthalmic care were substantially higher for PDR cases compared to NPDR cases, nonetheless demonstrating substantial expenditures associated with DR¡ªonly part of which is associated with ophthalmic care.
(Retina 2009;29:199-206)
Schmier JK, Covert DW, Lau EC, Matthews GP.
