Review of Ophthalmology Online



Vol. 23, #14  •   Monday, April 11, 2022


In this Issue:




24-2 VF GPA & Progression of Glaucomatous Damage of Macula

Researchers studied 24-2 visual field Guided Progression Analysis (GPA) and detection of glaucomatous damage of the macula.

All eyes had at least four OCT and VF test dates over a period that ranged from 12 to 59 months. The 24-2 VF tests included two baseline tests and at least two follow-up tests. The two baseline tests were within an average of 5.6 days (median of seven days), and the last follow-up test occurred at least one year after the first baseline visit.

The commercial 24-2 GPA software characterized eyes as “Likely Progression” (LP) and “Possible Progression” (PP). Both were considered “progressing” for this analysis. For a reference standard (RS), three authors graded progression using strict criteria and a combination of a custom OCT progression report, and commercial 24-2 and 10-2 GPA reports for the same test dates as the GPA.

Here are some of the findings:
• The RS identified 10 of 70 eyes as progressing (14 percent) vs. no healthy control eyes.
• The 24-2 GPA identified as progressing 13 of the 70 patient eyes (PP or LP), but only correctly classified four (40 percent) of 10 RS progressors.
• All six of the RS progressors missed by the 24-2 GPA showed progression in the macula.
• The 24-2 GPA identified two of the 29 healthy control eyes as progressors, as well as nine patient eyes without progression, based upon the RS.

Researchers wrote that, in eyes with early glaucoma (i.e., 24-2 MD >-6dB), the 24-2 GPA missed progression seen with OCT and exhibited a relatively high rate of false positives. Furthermore, they added, regional progressing typically included the macula. They noted that the results suggested that including OCT and/or 10-2 visual fields should improve detection of progression.

SOURCE: Hood DC, La Bruna S, Tsamis E, et al. The 24-2 visual field guided progression analysis can miss progression of glaucomatous damage of the macula seen with OCT. Ophthalmol Glaucoma 2022; Mar 27. [Epub ahead of print].





Fundus Autofluorescence and En Face OCT Measurements of GA

Investigators evaluated the correlation between fundus autofluorescence (FAF) and en face spectral-domain optical coherence tomography measurements of geographic atrophy associated with age-related macular degeneration, as part of a retrospective, cross-sectional study.

A total of 270 eyes from 172 subjects with GA associated with AMD were included. Subjects with atrophic AMD with both FAF (Heidelberg HRA + Spectralis) and dense volume (128 B-scans over 6 x 6 mm) SD-OCT (Cirrus OCT) imaging were included in this retrospective analysis.

The borders of all areas of definite decreased autofluorescence (DDAF) corresponding to GA were manually outlined on FAF images by certified graders at the Doheny Image Reading Center (DIRC) using validated planimetric grading tools. In addition, GA was delineated automatically from en face OCT (at the level of the choroid) using instrument software (Cirrus v.6.2), and segmentation errors were manually corrected prior to computation of the GA area. FAF- and SD-OCT-derived measurements were correlated. Main outcome measures included correlation between SD-OCT and FAF measurements of GA area.

Here are some of the findings:
• The mean GA area measured from FAF images was 8.1 ±5.04 mm2, compared with an automated, uncorrected SD-OCT GA area of 6.82 ±3.84 mm2.
• Despite the presence of apparent OCT segmentation errors, a significant correlation was found between FAF and uncorrected SD-OCT measurements (r=0.80; p<0.001).
• Following manual correction of SD-OCT GA segmentation errors, the measured GA area increased to 7.29 ±4.18 mm2, and the correlation with the FAF-determined GA area significantly improved (r=0.98; p<0.001).

Investigators reported that SD-OCT-derived measurements of GA correlated well with areas of definite decreased autofluorescence obtained from fundus autofluorescence images. As such, they wrote that manual correction of SD-OCT segmentation errors can further improve this correlation.

SOURCE: Velaga SB, Nittala MG, Hariri A, et al. Correlation between fundus autofluorescence and en face optical coherence tomography measurements of geographic atrophy. Ophthalmol Retina 2022; Mar 22. [Epub ahead of print].





Long-term Astigmatic Changes Following Cataract Surgery

Scientists examined whether long-term corneal astigmatic changes after stabilization of surgically induced astigmatism (SIA) following cataract surgery differ among eyes having against-the-rule (ATR), with-the-rule (WTR) or oblique astigmatism.

Anterior corneal astigmatism of 390 eyes of 390 patients (130 eyes each having ATR, WTR and oblique astigmatism) who underwent phacoemulsification with a horizontal clear corneal or scleral incision, and 390 eyes of 390 controls without surgery were examined using an auto-keratometer on the day that SIA stabilized (baseline) and at ≥8 years post-baseline. Changes in corneal astigmatism during the ≥8 years post-baseline were broken out to vertical/horizontal (Rx) and oblique astigmatism components (Ry) and compared among baseline types of astigmatism, as well as among eyes with and without surgery.

Here are some of the findings:
• The mean corneal astigmatic changes (Rx and Ry) showed an ATR shift of 0.2 to 0.3 D during the ≥8 years post baseline, which didn’t differ significantly among the ATR, WTR, and oblique astigmatism groups in eyes with and without surgery.
• In the ATR, WTR and oblique groups, the mean Rx and Ry didn’t differ significantly between eyes with and without surgery.
• Double angle plots revealed an equivalent degree of ATR change in the ATR, WTR, and oblique groups between eyes with and without surgery.

Scientists determined that long-term corneal astigmatic changes towards ATR astigmatism occurred to a similar extent in eyes having ATR, WTR and oblique astigmatism, and were comparable to eyes with and without surgery, suggesting that astigmatism type need not be considered when planning astigmatism correction.

SOURCE: Hayashi K, Sasaki H, Hirata A, et al. Comparison of long-term astigmatic changes following cataract surgery among types of corneal astigmatism. Br J Ophthalmol 2022; Mar 17. [Epub ahead of print].


Complimentary CME Education Videos



Brolucizumab for Pre-treated Patients with CNV & Signs of Tachyphylaxis to Aflibercept and Bevacizumab

Researchers wrote that treatment of choroidal neovascularization due to age-related macular degeneration is challenging since an increasing number of patients show reduced morphological response to conventional treatment with intravitreal injections. This study tested the hypothesis that the newly introduced anti-VEGF antibody brolucizumab shows promising results in pre-treated patients, as well as in cases of tachyphylaxis to aflibercept or bevacizumab.

Thirty-six eyes of 34 patients with a history of at least 10 anti-VEGF injections as well as persistent retinal fluid following the past five monthly injections with aflibercept and bevacizumab, prior to first treatment with brolucizumab, were included. Morphological and functional treatment responses were compared before and after switching to brolucizumab.

Here are some of the findings:
• Mean best-corrected visual acuity didn’t significantly change after treatment with brolucizumab.
• Central retinal thickness significantly decreased four weeks after treatment with brolucizumab from 340.36 to 282.22 µm (p<0.001), as well as pigment epithelial detachment from 346.73 to 280.47 µm (p<0.001).
• In 24 eyes (66.67 percent), complete resolution of intra- and subretinal fluid was observed after a single dose of brolucizumab.
• No serious adverse events, such as intraocular inflammation and retinal vasculitis, were reported after a single injection of brolucizumab.

Researchers reported that brolucizumab was effective not only in treatment-naïve patients, as shown in HAWK and Harrier trials, but also in pre-treated patients. They added that the data also suggested that brolucizumab was effective in patients with signs of tachyphylaxis to other anti-VEGF agents.

SOURCE: Boltz A, Radunsky K, Weingessel B, et al. Brolucizumab for pre-treated patients with choroidal neovascularization and signs of tachyphylaxis to aflibercept and bevacizumab. Graefes Arch Clin Exp Ophthalmol 2022; Mar 29. [Epub ahead of print].




Industry News

Alcon Introduces Systane iLux² MGD Thermal Pulsation System

Alcon introduced the Systane iLux2 Meibomian Gland Dysfunction Thermal Pulsation System with new imaging technology to capture infrared photos and HD video of the meibomian glands. The handheld device enables patients to view their meibomian glands and treatment through infrared imaging and HD video of the procedure, the company says. Learn more.

Haag-Streit Introduces Slit Lamp Imaging System

Haag-Streit announced its Imaging Module 910, which the company says generates high-quality images while enabling clinicians to concentrate on examining their patients. Imaging is ready with the turn of a knob, requires no software and needs only the press of a button to capture images. Haag-Streit says the module is equipped with an improved camera sensor and optics, features that ensure high illumination and an image selection algorithm that chooses the best image possible. Learn more.

First Installment of Video Journal of Cataract, Refractive, & Glaucoma Surgery Now Available

The new video journal, titled “Great Lectures!” is now available. The videos feature lectures from Dr. Ehud Assia from Israel who gave the ESCRS Binkhorst Lecture; Mr. Richard Packard from England who gave the Choyce Lecture to the UKISCRS; and Dr. Michael Snyder who recently delivered the Kelman Lecture at the 2021 AAO meeting.
The VJCRGS is in its 38th year of “providing the highest quality of education to anterior segment surgeons around the world.” It’s a free member benefit of virtually every cataract society, and a new one is released quarterly. View the lectures free of charge.

Genentech Study Looks at Underrepresented Patient Populations

Genentech launched the Elevatum trial of Vabysmo in specific patient populations with diabetic macular edema. The company says that Black, Hispanic, Latin-American and Indigenous people are disproportionately affected by diabetes, and are at higher risk of developing diabetic macular edema yet are underrepresented in clinical trials, so Genentech designed this Phase IV, multicenter, open-label, single-arm trial to study Vabysmo in these populations.

Allergan Announces Topline Results for New Vuity Regimen

The presbyopia drop Vuity (pilocarpine HCl ophthalmic solution) 1.25% is already approved for q.d. dosing, but Allergan recently announced it’s now investigating the potential of a b.i.d. regimen with the Phase III VIRGO trial. The company says the trial met its primary efficacy endpoint, improving near vision without compromising distance vision on day 14. Read more.

Quest Adds DR Screening in Collaboration with IRIS

Quest Diagnostics announced a collaboration with IRIS (Intelligent Retinal Imaging Systems) to deliver diabetic retinal imaging services through designated Quest patient service centers across the United States. Read more.

Foundation Fighting Blindness Offers Two New Podcasts

Foundation Fighting Blindness released two new Eye on the Cure Podcasts. Episodes 20 features Nancy Holekamp, MD, who discusses new therapies for wet and dry age-related macular degeneration, and emerging treatments for inherited retinal diseases. Episode 21 features jazz singer Katriona Taylor’s journey with Stargardt’s disease. Listen to the podcasts.

Outlook Submits BLA to FDA for ONS-5010

Outlook Therapeutics submitted its Biologics License Application to the FDA for investigational therapy ONS-5010 which, if approved, will be branded as Lytenava (bevacizumab-vikg), for the treatment of wet age-related macular degeneration. Read more.

Staar Announces ASCRS Program

Staar Surgical announced its program at the American Society of Cataract and Refractive Surgery annual meeting (April 22 to 26) Washington, D.C. View the lineup.

Lensar Unveils ASCRS Activities

Lensar will take part in the following activities at the ASCRS annual meeting:
• Experts meeting: discussion of developments in laser cataract surgery
• Ally in the booth: The device is presented on the show floor
• Podium presentation from James D. Lehmann, MD: A study on the Lensar system’s automated cataract density feature. Learn more about the study.

BVI Announces ASCRS Activities

BVI Medical announced its ASCRS lineup, including opportunities to meet the leadership team, hands-on experience, demo stations and an “Innovision Corner” to share ideas. Learn more.

New Appointments

• Amydis appointed Robert N. Weinreb, MD, as chair of its scientific advisory board. Dr. Weinreb is the Distinguished Professor and Chair of Ophthalmology at the University of California San Diego, and Director of the Shiley Eye Institute and Hamilton Glaucoma Center. Read more.
• Nanoscope Therapeutics appointed new members to its clinical and scientific advisory board:
   o Arshad Khanani, MD, MA, managing partner, director of clinical research, and director of fellowship at Sierra Eye Associates, Reno, Nevada;
   o Eleonora Lad, MD, PhD, associate professor of ophthalmology, Duke University Medical Center; and
   o Charles Wykoff, MD, PhD, director of research at Retina Consultants of Texas and the Greater Houston Retina Research Foundation.
• OcuTerra appointed Majid Anderesi, MD, as vice president of clinical and medical affairs. Dr. Anderesi previously served as Global Medical Affairs Director for the Novartis ophthalmology franchise. Read more.

First Patient Dosed in Ocugen’s Phase I/II Gene Therapy Trial

Ocugen announced the first patient was dosed in the Phase I/II clinical trial of OCU400, a modifier gene therapy candidate for the treatment of retinitis pigmentosa resulting from mutations in the nuclear receptor subfamily 2 group E member 3 (NR2E3) and Rhodopsin (RHO) genes. Read more.

Zeiss Innovation Day Discusses Clinical Insights

Zeiss held an “Innovation Day” on April 7 in which experts discussed the Zeiss Medical Ecosystem’s support of a digital environment and “efficient management of data.” Read more.










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