Evidence from a recent study suggests that Latinos in the United States may have a substantial unmet need for cataract surgery (UNCS).

The Los Angeles Latino Eye Study Group conducted a population-based, cross-sectional study on a total of 6,142 Latinos 40 years and older from six census tracts in Los Angeles County. Participants completed an in-home interview and a comprehensive eye examination that included assessment of lens opacification, using the slit lamp-based Lens Opacities Classification System II (LOCS II) and best-corrected visual acuity. Visually significant cataract was defined as any LOCS II grading ≥2, BCVA <20/40, cataract as the primary cause of vision impairment and self-reported vision of fair or worse. Because cataract surgery was not needed in everyone, participants with a visually significant cataract or prior cataract surgery in at least one eye composed the at-risk cohort needing cataract surgery. UNCS was defined as any person in the at-risk cohort who had at least one eye with a visually significant cataract.

Univariate and stepwise logistic regression analyses were used to identify predisposing, enabling, need and health behavior characteristics associated with UNCS. Outcome was measured by prevalence of visually significant cataract and odds ratios for factors associated with UNCS.

Of the participants who completed the interview and clinical examination, 118 (1.92 percent) had visually significant cataract in at least one eye. Of the 344 participants who have needed cataract surgery, 118 (34.3 percent) had UNCS. Independent factors associated with UNCS included health behavior: having last eye examination ≥five years ago compared with <one year ago (odds ratio, 3.76; 95 percent; confidence interval, 1.71-8.25), and enabling factors: being uninsured (OR, 2.79; CI, 1.30-5.19), income less than $20,000 (OR, 2.60; CI, 1.40-5.56) and self-reported barriers to eye care (OR, 2.41; CI, 1.14-5.13). The authors of the study suggested that because Latinos with specific health behavior and enabling characteristics were more likely to have UNCS, interventions aimed at modifying these characteristics may be beneficial in reducing the unmet need and thus reducing the burden of visual impairment related to cataract in the United States.

Ophthalmology 2009;116:2327-35.

Richter GM, Chung J, Azen SP


Bevacizumab and Ranibizumab Yield Same Efficacy

Early results of a head-to-head, randomized, double-masked, prospective, single-center controlled trial between bevacizumab (Avastin) and ranibizumab (Lucentis) show no difference in efficacy between the two treatments for choroidal neovascularizaton in the treatment of age-related macular degeneration. The trial, which took place at Boston Veterans Affairs Healthcare System, randomized the patients 2:1 to bevacizumab or ranibizumab. Each patient contributed one eye to the study. All subjects and investigators (except for the pharmacist responsible for study assignments) were masked to treatment arms. Visual acuity was checked via ETDRS chart. Patients were given bevacizumab or ranibizumab every month for the first three months, followed by optical coherence tomography-guided treatment, on a variable-dosing schedule. Main outcomes measured were VA and foveal thickness.

Twenty patients (13 bevacizumab and seven ranibizumab) completed the six-month follow-up. No subjects in either group lost more than 15 ETDRS letters. The average preoperative VA was 31.6 letters in the bevacizumab group and 30.4 letters in the ranibizumab group. At six months follow-up, mean vision was 46.4 letters in the bevacizumab group and 37.4 letters in the ranibizumab group. A two-tailed t-test failed to show statistical significance between the two groups. Patients in the bevacizumab group underwent an average of five injections, while patients in the ranibizumab group underwent a mean of four injections.

As this study conveys results of a small number of patients, further studies with larger sample sizes are needed in order to establish statistical significance.

Am J Ophthalmol 2009;148:875-82.

Subramanian ML, Ness S, Abedi G, et al.


Some Dry-Eye Patients May Need To Up the Dosage

Data from a recent study suggest that patients with severe dry eye may require more frequent dosing of topical cyclosporine 0.05% (Restasis) than just twice daily. The study was performed at the Massachusetts Eye and Ear Infirmary on a retrospectively identified cohort of patients with severe dry-eye disease who had shown inadequate response to at least a four-month course of treatment with twice-daily use of topical cyclosporine 0.05% but who showed significant improvement with more frequent dosing.

Twenty-two patients, including 13 patients with ocular graft-versus-host disease and nine patients with primary or secondary Sjögren's syndrome, were included. After a minimum of a two-month course of treatment with more frequent dosing of cyclosporine 0.05% (three times a day in seven patients and four times a day in 15 patients), overall dry-eye symptoms were improved in 15 patients (68.2 percent)—nine patients with ocular graft-versus-host disease and six patients with Sjögren's syndrome. Mean corneal fluorescein staining scores (National Eye Institute scale of 0-15) improved (decreased) from the baseline (precyclosporine use) by -3.5 (range, 0 to -7) in patients with ocular graft-versus-host disease (p≤0.0008) and -2.8 (range, 0 to -5) in patients with Sjögren's syndrome (p≤0.001).

After treatment with high-frequency use of cyclosporine 0.05%, the global physician assessment of dry-eye status was favorable (improved) in 16 patients (72.7 percent). Three patients (13.6 percent) reported new-onset symptoms of burning or irritation with the use of high-frequency dosing of topical cyclosporine. No other associated adverse effects were reported.

Cornea. 2009;28:1091-6.

Dastjerdi MH, Hamrah P, Dana R


EMGT Charts the Progression of Glaucoma

Six years after the Early Manifest Glaucoma Trial, the authors of the study have found that the median untreated rate of progression in three of the more common types of glaucoma corresponded to advancing from normal visual function to blindness in approximately 70 years, whereas on the basis of the mean rate, visual function would show the same deterioration in approximately 25 years.

The authors evaluated 118 control patients: 46 with high-tension glaucoma, 57 with normal-tension glaucoma and 15 with pseudoexfoliation glaucoma. They then followed a cohort of patients that was randomized into an untreated control group and then followed up to the time of progression, when treatment could then be initiated. To gauge progression, visual fields were tested every three months with the Humphrey 30-2 Full
Threshold test program. In order to measure outcome, linear regression analyses of the perimetric mean deviation values were performed, and the rate of progression was defined as the regression coefficient in decibels per year. Percentages of progressed eyes and time to progression were determined using EMGT event-based predetermined progression criteria derived from Glaucoma Change Probability Maps.

Results from the trial showed that the median and interquartile rates of visual function loss were -0.40 (1.05) dB/year overall, and -0.46 (1.61) in HTG, -0.22 (0.65) in NTG and -1.13 (6.13) in PEXG. Thus, interpatient variability was large. Mean rates were considerably higher than medians: -1.08 dB/year overall; -1.31 in HTG; -0.36 in NTG and -3.13 in PEXG. Differences in median visual function progression rates among groups were statistically significant (NTG vs. HTG, p=0.003; PEXG vs. non-PEXG, p<0.001). Progression was considerably and significantly faster in older patients than in younger ones (p=0.002). By six years, 68 percent of patients had progressed overall, 74 percent of those with HTG, 56 percent of those with NTG and 93 percent of those with PEXG (p=0.012). Median time to progression also differed considerably among groups: 19.5 months for those with PEXG; 44.8 months for HTG and 61.1 months for those with NTG (p<0.0001).

Ophthalmology 2009;116:2271-6.

Heijl A, Bengtsson B, Hyman L