Scientists aimed to identify whether baseline characteristics of eyes with proliferative diabetic retinopathy were associated with better outcomes when treated with panretinal laser vs. ranibizumab in the DRCR.net Protocol S.
Participants had PDR, visual acuity of 20/320 or better, and no previous PRP. Eyes were randomized to PRP or intravitreous 0.5-mg ranibizumab. Here are some of the findings:
• Among 25 characteristics, none in PRP participants were associated with superior outcomes relative to ranibizumab-assigned participants.
• The relative benefit of ranibizu-mab over PRP in terms of change in VA appeared greater in participants with higher mean arterial pressure (p=0.03); without previous focal/grid laser (p=0.03); with neovascularization of the disc and elsewhere on clinical exam (p=0.04); and with more advanced PDR on photographs (p=0.02).
• For development of vision-impairing central-involved DME, the relative benefit of ranibizumab over PRP seemed greater among non-white participants (p=0.01) and those with higher mean arterial pressure (p=0.01).
Scientists wrote that no identified characteristics were associated with superior outcomes using PRP vs. ranibizumab. They added that their exploratory analyses provides additional support for the premise that ranibizumab might be a reasonable alternative to PRP for PDR over a two-year period.
Retina 2019; Feb. 18 [Epub ahead of print].
Bressler SB, Beaulieu WT, Glassman AR, et al.
The Sleep/Glaucoma Connection
Researchers from the Wilmer Eye Institute at Johns Hopkins University say that a patient’s sleep characteristics may play a role in the development of glaucoma.
In this cross-sectional study, the researchers included 6,784 glaucoma patients from the 2005 to 2008 National Health and Nutrition Examination Survey who were age 40 and above and who had completed a detailed sleep questionnaire. Participants were asked such questions as, “How much sleep do you usually get at night on weekdays or work days?” and “How long does it usually take you to fall asleep?” The questionnaire was set up to look at the following predictors:
• sleep duration;
• sleep latency;
• sleep disorders;
• sleep disturbances;
• sleep medication use; and
• daytime dysfunction due to sleepiness.
The outcomes included disc-defined glaucoma (either right or left disc demonstrating glaucoma) and visual field defects (VFD) assessed by frequency-doubling perimetry.
The investigators found that the odds of disc-defined glaucoma were three times higher among subjects who slept for ≥10 hours per night compared with those who slept seven hours per night. The odds of disc-defined glaucoma were two times higher among subjects who fell asleep in ≤9 minutes or ≥30 minutes, compared with 10 to 29 minutes. The odds of VFD were three times higher among subjects who slept for ≤3 hours per night, compared with seven hours per night. The odds of VFD were two times higher among subjects who had difficulty remembering things and three times higher among subjects who had difficulty working on a hobby due to daytime sleepiness compared with those without difficulty.
The researchers say there appear to be associations between glaucoma and abnormal sleep parameters, and that these abnormal sleep patterns may be a risk for, or consequence of, glaucoma.
J Glaucoma 2019;28:97-104
Qiu M, Ramulu P, Boland M.