Review of Ophthalmology Online



Vol. 23, #13  •   Monday, April 4, 2022


In this Issue:




Diagnostic Accuracy of AI in Glaucoma Screening and Clinical Practice

Researchers wrote that AI has been shown as a potential diagnostic tool for glaucoma detection through imaging modalities, though it has yet to be deployed in clinical practice. This meta-analysis determined overall AI performance for glaucoma diagnosis and identified potential factors affecting implementation.

The researchers searched databases (Embase, Medline, Web of Science and Scopus) for studies that developed or investigated the use of AI for glaucoma detection using fundus and OCT images. A bivariate random-effects model was used to determine the summary estimates for diagnostic outcomes. The PRISMA-DTA extension was followed, and the QUADAS-2 tool was used for bias and applicability assessment.

Seventy-nine articles met inclusion criteria, with a subset of 66 containing adequate data for quantitative analysis. The pooled AUC across all studies for glaucoma detection was 96.3 percent, with a sensitivity of 92 percent (CI, 89 to 94) and specificity of 94 percent (CI, 92 to 95). The pooled AUC on fundus images was was 96.2 percent, and the pooled AUC on OCT images was 96 percent. Mixed datasets and external data validation had unsatisfactory diagnostic outcomes.

Researchers concluded that, while AI has the potential to revolutionize glaucoma care, the findings of their meta-analysis highlighted that before such algorithms can be implemented into clinical care, a number of issues need to be addressed. They wrote that many factors were found to affect AI’s diagnostic performance, with substantial heterogeneity across studies. They recommended implementing a standard diagnostic protocol for grading, and implementing external data validation and analysis across different ethnicity groups.

SOURCE: Chaurasia AK, Greatbatch CJ, Hewitt AW. Diagnostic accuracy of artificial intelligence in glaucoma screening and clinical practice. J Glaucoma. 2022; Mar 18. [Epub ahead of print].





Vitrectomy for Diabetic Complications: A Pooled Analysis

Investigators reported updated clinical outcomes in subjects undergoing pars plana vitrectomy using modern techniques and equipment for the treatment of proliferative diabetic retinopathy-related complications.

The pooled analysis included five randomized clinical trials conducted at the same institution, and study and control subjects from the trials.

A total of 943 subjects prospectively underwent small-gauge PPV with anti-vascular endothelial growth factor pretreatment for PDR-related complications and completed six-month follow up.

Here are some of the findings:
• One hundred eighty-four patients (19.5 percent) achieved 20/50 or better acuity, and 652 patients (69.1 percent) achieved 20/200 or better acuity at six months.
• The vision improved or remained stable in 901 patients (95.5 percent), and 11 patients (1.2 percent) developed no light perception at six months.
• Intraoperative complications occurred in 343 cases (36.4 percent) of cases, and 199 cases (21.1 percent) experienced a postoperative complication.
• The most common postoperative complication was vitreous hemorrhage in 124 cases (62.3 percent of all complications).
• Unplanned secondary PPV was necessary in 86 cases (9.1 percent).

Investigators wrote that clinical outcomes in patients undergoing PPV for PDR-related complications compared favorably to those reported prior to small-gauge PPV and anti-VEGF pretreatment.

SOURCE: Rush RB, Rush SW, Reinauer RM, et al. Vitrectomy for diabetic complications: A pooled analysis of randomized controlled trials utilizing modern techniques and equipment. Retina 2022; Mar 8. [Epub ahead of print].





Corneal Sweep Test for Diagnosis of Recurrent Corneal Erosion

Scientists evaluated the incidence and epidemiology of recurrent corneal erosion within a clinical population using standard diagnostic techniques and a new technique called the corneal sweep test (CST).

A retrospective chart review was conducted on 58 eyes of 51 patients with the diagnosis of recurrent corneal erosion (RCE) from July 2018 to June 2020. All underwent a thorough history and physical exam. The CST was performed as a confirmatory test and on any patient who lacked visible corneal pathology.

Here are some of the findings:
• The CST was necessary on 49 of 58 eyes to help confirm the diagnosis of a corneal erosion.
• Among them, 34 had an occult corneal erosion, which is defined as having a normal-appearing cornea on slit lamp exam but found to have loose corneal epithelium with the CST.
• Clear corneal cataract surgery (28 eyes, 48.2 percent) was the most common presumed mechanism of injury, with 20 (71.4 percent) developing symptoms only after cataract surgery.
• All 20 eyes had an erosion located directly over a clear corneal cataract incision.

Scientists wrote that the corneal sweep test is a new and effective technique to help diagnose corneal erosions in the absence of visible corneal findings. They added that clear corneal cataract surgery is an important risk factor to consider given that the incision can be the source for an erosion. Furthermore, scientists wrote, using the corneal sweep test could lead to a shift in the way clinicians approach recurrent corneal erosions and patients with a persistent ocular pain syndrome.

SOURCE: Kim ME, Kim DB. Implementation of the corneal sweep test in the diagnosis of recurrent corneal erosion: A 2-year retrospective study. Cornea 2022; Mar 17. [Epub ahead of print].


Complimentary CME Education Videos



Laser & Anti-VEGF Treatment for Drusenoid PED in AMD

Researchers investigated the 24-month primary endpoint outcomes of drusenoid pigment epithelial detachment (dPED) after laser and intravitreal anti-VEGF treatment following a 12-month interim safety analysis.

Twenty-one patients with treatment-naïve bilateral intermediate AMD with dPED and visual acuity ≤83 letters (Snellen 20/23) were enrolled. The subject eye received low-energy Pascal laser (532 nm) treatment, and the fellow eye was used as the control. Intravitreal injections were administered at three-month intervals from baseline to 12 months. Treatment outcomes, safety and development of advanced AMD lesions were analyzed.

Here are some of the findings:
• Mean drusen area and dPED height were significantly reduced (17.3 ±2.7 percent vs. 112.8 ±3.1 percent, p<0.001 and 11.8 ±4.7 percent vs. 119.1 ±4.6 percent, p<0.001, respectively).
• Mean BCVA improved (5.11 ±1.35 vs. 0.83 ±1.03 letters, p=0.014) in study eyes compared to those in the control eyes.
• Development of parafoveal iRORA (nGA) (67 percent, 12 of 18 eyes) and cRORA (GA) (22 percent, four of 18 eyes) was observed in study eyes.
• Three cases of iRORA and cRORA were observed in control eyes (17 percent, three of 18 eyes; p=0.010 and p=0.791, respectively).

Researchers wrote that laser and anti-VEGF treatment may be a potential treatment option for intermediate AMD with dPED. However, they added, the relatively high rate of secondary iRORA and cRORA development suggested that long-term follow-up is necessary to clarify the safety and efficacy of the treatment.

SOURCE: Kim MS, Ryoo NK, Park KH. Laser and anti-vascular endothelial growth factor treatment for drusenoid pigment epithelial detachment in age-related macular degeneration: 24-month outcomes. Graefes Arch Clin Exp Ophthalmol 2022; Mar 21. [Epub ahead of print].




Industry News

B+L and Clearside Launch Xipere

Bausch + Lomb and Clearside Biomedical announced the U.S. commercial launch of Xipere (triamcinolone acetonide injectable suspension), the first and only therapy approved by the FDA for suprachoroidal use for the treatment of macular edema associated with uveitis. Read more.

Icare USA Introduces iCare Home2

Icare USA announced FDA 510(k) clearance for its next-generation self-tonometer, the iCare Home2. The compay says the tonometer is designed for additional ease of use in measuring patients’ real-world intraocular pressure outside of normal clinic hours. A smart light guide and interactive display screen means most patients can utilize the iCare Home2 on their own, the device’s maker adds. iCare Home2’s new design enables IOP measurements to be taken while the patient is supine, reclined or sitting, iCare says. Learn more.

New Dry-eye Treatment Approved

Olympic Ophthalmics announced that the FDA has granted 510(K) approval for the company’s second-generation iTEAR100 device, a prescription neuromodulation therapy to acutely increase tear production in adult patients over a 30-day period. Read more.

Surgeons Implant First U.S. AccuraSee IOPCL

The first AccuraSee Intraocular Pseudophakic Contact Lens (IOPCL) to improve near vision in patients with macular degeneration was recently implanted as part of the company’s IDE study. The lens implant is placed on top of an existing posterior chamber intraocular lens implant in patients who have had previous cataract surgery, to help magnify images using areas of the retina not affected by macular degeneration. Read more.

STAAR Announces FDA Nod of EVO Visian ICL Lens

STAAR Surgical Company announced the FDA granted approval of the EVO/EVO+ Visian Implantable Collamer Lens for the correction of myopia and myopia with astigmatism. The lens has a central artificial hole that was added to improve aqueous humor circulation in the eye. This eliminates the need for a preoperative peripheral laser iridotomy or intraoperative peripheral iridectomy, which the company says simplifies the surgical procedure and significantly reduces the complications associated with iridotomy. Read more.

Prevent Blindness Declares April as Women’s Eye Health and Safety Awareness Month

Prevent Blindness declared April as Women’s Eye Health and Safety Awareness Month. A recent report, “The Lancet Global Health Commission on Global Eye Health: Vision Beyond 2020,” found a gender imbalance in which women are at higher risk of vision impairment and blindness than men can be attributed to demographic and social factors. Read more.

Luneau Launches as “Visionix”

Luneau Technology Group announced it will take on “Visionix” as its official global name beginning March 31. “Optovue” will transition to a product brand for Visionix’s OCT and OCTA line. Read more.




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