Review of Ophthalmology Online



Vol. 22, #32  •   Monday, August 23, 2021


In this Issue:


A message from Review’s Chief Medical Editor, Mark H. Blecher, MD: Here We Go Again

I am, like most of you, totally over COVID. But as the cliché saying goes, “COVID isn’t over us,” which was mildly funny until it wasn’t. We had a small happy window of normalcy this spring when marginally successful vaccinations caused the infection rate to plummet. The sun started to shine again ... and then it was gone. The smug satisfaction the vaccinated among us enjoyed was crushed by the almost inconceivable reality of breaththrough infections that were not all mild. And it seemed we were again adrift, not knowing how this would play out or how we’d get back the progress we’d made toward the goal of moving beyond COVID. At least the mortality rate remained relatively low if you were vaccinated.

We need to learn to live with COVID and to continue to enjoy life under different terms. But what are the terms? We’re back to some of the same questions we had more than a year ago. Can we go maskless outdoors? Can we crowd together in a theater or a concert or even a restaurant? If we get sick, how long should we isolate or should we isolate at all? For me, modifying how I live my life to reflect the new reality isn’t the difficult part. It’s not knowing what the right answer is. I can adapt, but not in the absence of data, of certainty. I’m holding onto my faith in science, in the many brilliant people working every day to help us get ahead of this pandemic. I trust them, and will willingly accept the next advance against COVID. Our only chance of survival will depend on science, and a shared effort to take care of each other. I’m worried, however, since we failed the latter effort in the past year. We’ll see if we can belatedly learn that lesson—because we certainly need to.

Mark H. Blecher, MD
Chief Medical Editor
Review of Ophthalmology




Differentiating Diagnosed and Undiagnosed PACG and OAG

Researchers studied and compared factors contributing to the differentiation of diagnosed and undiagnosed primary angle-closure glaucoma and primary open-angle glaucoma in the same population, as part of a population-based survey.

All residents ages 40 years and older in Kumejima, Japan, were included. PACG and POAG were diagnosed according to the criteria of the International Society of Geographical and Epidemiological Ophthalmology. Factors contributing significantly to the differentiation of diagnosed and undiagnosed PACG and POAG were selected from various systemic, ocular, visual functional and fundus planimetric parameters using multivariate logistic regression analysis and compared between the two diseases.

Main outcome measures included factors contributing significantly to the differentiation of diagnosed and undiagnosed PACG and POAG.

Here are some of the findings:
• The prevalence rate of PACG was 2.2 percent, and the rate of POAG was 4 percent.
• 34.1 percent of PACG cases were previously diagnosed vs. 17.2 percent of POAG cases (p=0.004).
• Worse mean deviation on visual field testing (OR, 0.869; CI, 0.788 to 0.959; p=0.006) and the presence of signs suggestive of previous acute angle closure (OR, 4.35; range, 1.66 to 11.36; p=0.003) contributed to an established diagnosis of PACG at the time of screening.
• A greater vertical cup/disc ratio (3.74; range, 1.38 to 10.17; p=0.012) contributed with marginal significance to an established diagnosis of POAG at the time of screening.

Researchers wrote that PACG was more likely to have been previously diagnosed than POAG during a screening exam. They suggested that examination of the anterior segment and visual field may contribute more to the detection of PACG, and disc examination to the detection of POAG.

SOURCE: Iwase A, Sawaguchi S, Araie M. Differentiating diagnosed and undiagnosed primary angle-closure glaucoma and open-angle glaucoma: A population-based study. Ophthalmol Glaucoma 2021; Jul 30. [Epub ahead of print].


Complimentary CME Education Videos


Clinical Features and Treatment Outcomes of Inflammatory CNV

Investigators considered the long-term clinical features and treatment outcomes of patients with inflammatory choroidal neovascularization treated with intravitreal anti-vascular endothelial growth factor, as part of a retrospective, interventional, consecutive case series

They included 65 eyes of 65 patients with inflammatory CNV treated with anti-VEGF injections and followed up for at least 12 months. A retrospective chart review was conducted at a single tertiary referral center.

Study participants were followed for 60.6 ±42.8 (range: 16 to 160) months. Mean age was 33.4 ±10.8 years, and mean refractive error was -3.94 ±1.35 D in spherical equivalent. Final best-corrected visual acuity was 0.21 ±0.20 logMAR (around 20/32) after treatment. Patients were treated with bevacizumab (76.9 percent), ranibizumab (4.6 percent), aflibercept (3.1 percent) and drug combinations (15.4 percent). Here are some of the findings:
• Systemic corticosteroid or immunosuppressant use wasn’t correlated with visual outcome, required number of anti-VEGF injections or recurrence.
• Commonly occurring optical coherence tomography features included:
   o ellipsoid zone disruption;
   o choroidal hypertransmission;
   o retinal pigment epithelium atrophy (RPEA) or absence;
   o intraretinal hyperreflective foci (HRF);
   o choroidal vessel engorgement;
   o focal choroidal excavation; and
   o irregular vascular loops (on OCT angiography).
• RPEA after treatment (β=0.238, p=.036) and BCVA (β=0.267, p=.029) showed significant correlation with final BCVA.
• Twenty-eight patients (43.1 percent) experienced recurrence; intraretinal HRF after treatment was the single risk factor for recurrence (OR, 2.712; p=.031).

Investigators found that inflammatory CNV recurrence showed higher rates over time after anti-VEGF treatment than previously reported, even though the overall visual outcome was good. They also reported that baseline BCVA and RPEA after treatment were significant predictors of visual outcome, and that intraretinal HRF after anti-VEGF treatment may indicate a heightened risk of recurrence.

SOURCE: Kim M, Lee J, Park YG, et al. Long-term analysis of clinical features and treatment outcomes of inflammatory choroidal neovascularization. Am J Ophthalmol 2021; Jul 20. [Epub ahead of print].


Femtosecond LASIK for Correction of Low and High Myopic Astigmatism

Scientists compared the efficacy and safety of femtosecond LASIK (FS-LASIK) for the refractive correction of patients with low (<1.5 D) vs. high (≥1.5 D) myopic astigmatism.

The retrospective observational study included 841 eyes of 825 eligible patients treated with FS-LASIK for the correction of simple or compound myopic astigmatism. Outcome measures included residual error, best-corrected and uncorrected distance visual acuity (BCVA and UCVA), and efficacy and safety three months after the primary procedure or the retreatment.

Here are some of the findings:
• Of 841 eyes, 432 (51.37 percent) had <1.5 D (group 1) and 409 (48.63 percent) had ≥1.5 D (group 2) preoperative myopic astigmatism.
• The efficacy index of primary treatment was 0.94 ±0.18 in group 1 and 0.89 ±0.22 in group 2 (p=0.001).
• Of 138 eyes (16.41 percent) retreated due to dissatisfaction related to residual refractive error, 28 belonged to group 1 (6.5 percent) and 110 (26.9 percent) to group 2 (p<0.001).
• Following retreatment, small but statistically significant differences in the residual mean postoperative cylinder (-0.08 ±0.24 vs -0.27 ±0.46 D; p=0.001) and UCVA (1.11 vs. 0.96, p=0.0001) were detected for groups 1 and 2, respectively.
• No statistically significant differences were found in the safety and efficacy indices.

Scientists concluded that, following FS-LASIK, eyes with myopic astigmatism ≥1.5 D had approximately a four times greater chance of undergoing retreatment due to dissatisfaction caused by residual refractive error compared with eyes with myopic astigmatism <1.5 D. However, they added that the clinical results after retreatment were highly satisfactory and comparable in both groups.

SOURCE: Cañones-Zafra R, Katsanos A, Garcia-Gonzalez M, et al. Femtosecond LASIK for the correction of low and high myopic astigmatism. Int Ophthalmol 2021; Aug 9. [Epub ahead of print].


GA Characteristics Using Fluorescence Lifetime Imaging Ophthalmoscopy

Researchers wrote that short foveal fluorescence lifetimes (fFLTs) in geographic atrophy are typically found in eyes with foveal sparing disease but may also occur in eyes without foveal sparing disease. They investigated whether short fFLTs could serve as a functional biomarker for disease progression in geographic atrophy.

Thirty-three eyes were followed over four to six years. Foveal sparing was assessed using fluorescence lifetime imaging ophthalmoscopy, optical coherence tomography, fundus autofluorescence and macular pigment optical density.

Here are some of the findings:
• Eyes with foveal sparing exhibited shorter fFLTs compared to eyes without foveal sparing.
• Short fFLTs (<600 ps) were measured in all eyes with foveal sparing and half of the eyes without foveal sparing.
• Eyes with foveal sparing showed a greater increase in fFLTs per year (+39/+30 ps [SSC/LSC]) in foveal sparing vs. +29/+22 ps [SSC/LSC] in non-foveal sparing).
• BCVA correlated significantly with fFLTs (p=0.018 and p=0.005 for SSC/LSC).
• MPOD measurements correlated significantly with fFLTs but not in all spectral channels (p=0.018 to 0.077).

Researchers determined that, in GA, shorter foveal fluorescence lifetimes were associated with foveal sparing and also were observed in eyes without foveal sparing. They added that longitudinal data suggested that shorter fFLT features in eyes with loss of foveal sparing represented an earlier stage of disease and may increase risk of visual acuity loss.

SOURCE: Lincke JB, Dysli C, Jaggi D, et al. Longitudinal foveal fluorescence lifetime characteristics in geographic atrophy using fluorescence lifetime imaging ophthalmoscopy (FLIO). Retina 2021; Jul 17. [Epub ahead of print].




Industry News

Novartis Announces Results from Phase III Trials of Beovu

Novartis announced results from two Phase III clinical trials assessing Beovu (brolucizumab) 6 mg versus aflibercept 2 mg in patients with diabetic macular edema. The company says that results from year two (week 100) of KITE demonstrated that most patients who completed an initial 12-week cycle following a loading phase were maintained on a 12- or 16-week dosing interval through the end of the study. As previously reported, KITE met its primary endpoint of non-inferiority to aflibercept in best-corrected visual acuity from baseline at year one (week 52). Another Beovu study, KINGFISHER, met its primary endpoint of non-inferiority to aflibercept in change in BCVA from baseline at year one (week 52) when dosed every four weeks. Both trials demonstrated an overall well-tolerated safety profile, the company says. Read more.


Alcon Launches New Monthly Contact Lens

For the population of contact lens wearers who prefer reusable over daily disposable lenses, Alcon says its newest offering, Total30, is intended to offer a level of comfort that’s as good on the last day of wear as on the first.
Total30 is made from a new material called lehfilcon A that has a 55 percent water content at the core and up to 100 percent at the surface—the same water gradient concept of the company’s Dailies Total1 and Precision1 product lines— which Alcon says enhances its moisture, oxygen transmission and comfort. It’s also coated with a new copolymer that the company says resists adhesion of bacteria, proteins and lipids to help ensure comfort and safety, while also promoting water retention.
The company says that studies show the lens surface is able to remain intact through a 30-day regimen of daily cleaning, disinfecting and storing. The lenses will be available in sphere powers of -12 D to +8 D beginning in September 2021. The company has also previously noted that toric and multifocal options are slated for future product line extensions. Learn more.



Metrovision Receives FDA Clearance for MonPackONE

Metrovision received FDA clearance for its MonPackONE Vision Monitor for vision electrophysiology applications, including ganzfeld flash ERG and VEP, pattern ERG and VEP, multifocal ERG and VEP, and sensory EOG. Compatible with ISCEV standards for vision electrophysiology, the monitor’s design combines a central LCD panel with an LED backlight surrounded by peripheral panels illuminated with LEDs. The result is constant luminance and elimination of luminance artifacts generated by standard LCD monitors, Metrovision says. The device is able to perform dark- and light-adapted full-field perimetry. Other capabilities include dark adaptometry, FST, pupillometry and vision electrophysiology testing. Learn more.



Dr. Donnenfeld Named America’s Best Eye Doctor by Newsweek

Garden City, New York, surgeon Eric D. Donnenfeld was named America’s Best Eye Doctor 2021 by Newsweek. Surgeons were ranked on quality of care, continuity of care and the quality of technology they use at their practices. Read more.

Visus Adds Investigational Glaucoma & AMD Therapies to Portfolio

Visus Therapeutics entered into a worldwide exclusive licensing agreement with Cella Therapeutics to develop an array of investigational ophthalmic therapies to treat glaucoma and age-related macular degeneration. The company also announced a worldwide exclusive licensing agreement with DelSiTech, a provider of biodegradable, silica-based, controlled-release materials, to develop novel drug delivery technology to help optimize ophthalmic therapies. Read more.

Aequus and reVision to Collaborate

Aequus Pharmaceuticals and reVision Therapeutics say they will collaborate on the development of a therapy for Stargardt’s disease. Read more.


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