From the editors of Review of Ophthalmology:
AUGUST IS CHILDREN’S EYE HEALTH AND SAFETY MONTH
In this issue: (click heading to view article)
Risk of Systemic Adverse Events Following Intravitreal Bevacizumab, Ranibizumab and Aflibercept in Routine Clinical Practice
Researchers wrote that intravitreal anti-VEGF pharmacotherapy plays a central role in the management of neovascular age-related macular degeneration, diabetic retinal disease and retinal venous occlusive disease. They added that, within clinical trials, rates of systemic serious adverse events following anti-VEGF treatment have been low; however, the comparative systemic safety profile of common anti-VEGF agents remains incompletely understood. The goal of this study was to compare the systemic safety of intravitreal bevacizumab, ranibizumab and aflibercept in real-world practice.
As part of the retrospective cohort study, researchers used a large U.S. administrative claims database of commercially insured and Medicare Advantage enrollees to identify adult cohorts receiving initial anti-VEGF injections for nAMD, DRD and RVO between January 1, 2007 and June 30, 2018. They included individuals with one year of insurance coverage prior to initial treatment.
Researchers compared predefined systemic outcomes between anti-VEGF agents occurring within 180 days of treatment initiation using propensity score-weighted Cox proportional hazards models.
Primary outcomes were acute myocardial infarction (MI), acute cerebrovascular disease (CVD), major bleeding and all-cause hospitalization. Here were some of the findings:
- A total of 87,844 individuals received initial anti-VEGF injections for nAMD, DRD and RVO (69,007, bevacizumab; 10,895, ranibizumab; and 7,942, aflibercept).
- Post-injection, 180-day event rates per 100 patients for MI, CVD, major bleeding and all-cause hospitalization were similar, respectively, for:
- bevacizumab (0.64, 0.59, 0.34 and 10.41);
- ranibizumab (0.62, 0.53, 0.40 and 9.44); and
- aflibercept (0.63, 0.60, 0.20 and 9.88).
- No differences were identified in the risk of MI, CVD, major bleeding or all-cause hospitalization when comparing the risk-adjusted effect of treatment initiation, with:
- bevacizumab vs. ranibizumab (all p>0.05):
- MI: HR: CI, 0.96 (0.74,1.25);
- CVD: 1.04 (0.78,1.38);
- Major bleeding: 0.85 (0.61,1.19); and
- All-cause hospitalization: 1.03 (0.96,1.10); or
- bevacizumab vs. aflibercept (all p>0.05):
- MI: HR: CI, 0.95 (0.68,1.33);
- CVD: 0.99 (0.71, 1.38);
- Major bleeding: 1.02 (0.60,1.74); and
- All-cause hospitalization: 1.01 (0.93,1.10); or
- aflibercept vs. ranibizumab (all p>0.05):
- MI: HR: CI, 0.91 (0.62,1.35);
- CVD: 1.12 (0.74,1.69);
- Major bleeding: 0.96 (0.53,1.73).
- All-cause hospitalization: 1.02 (0.92,1.13).
Researchers observed no differences in the risk of acute myocardial infarction, cerebrovascular disease, major bleeding or all-cause hospitalization following treatment initiation with intravitreal bevacizumab, ranibizumab or aflibercept during routine clinical practice.
SOURCE: Maloney MH, Payne SR, Herrin J, et al. Risk of systemic adverse events following intravitreal bevacizumab, ranibizumab, and aflibercept in routine clinical practice. Ophthalmology 2020; Aug. 8. [Epub ahead of print.]
Complimentary CME Education Videos
Visual Field Artifacts From Face Mask Use
Authors wrote that the coronavirus pandemic has had a profound impact on how glaucoma care is delivered—necessitating reduced clinic flow, social distancing, and use of face coverings by patients and staff. This case highlights the need to be aware of improperly fitted face masks as a cause of artifacts on standard automated perimetry.
A 32-year-old female underwent SAP with the 24-2 SITA Fast test of the Humphrey Field Analyzer while wearing an ear-loop surgical face mask. At the end of testing it was noted that the mask had ridden up on the individual’s face. Small amounts of condensate were noted on the perimeter lens.
SAP demonstrated good reliability indices, but in both eyes, a marked reduction in sensitivity inferiorly was noted. In addition, the Glaucoma Hemifield Test was outside normal limits. As a result, the staff made sure that the upper border of the patient’s mask was well-sealed, with the loops secured around the ears and the nasal strip of the mask pinched down. Visual fields were repeated and were found to be normal.
The authors wrote that poorly fitting face masks represent a new cause of visual field artifacts that may mimic pathological field defects. Without careful attention during testing, the cause of such artifacts may not be apparent, especially as reliability indices may be normal. The authors suggested that adjustments to the fit of face masks may help prevent fogging or mask slippage, and increase test reliability.
SOURCE: Young SL, Smith ML, Tatham AJ. Visual field artifacts from face mask use. J Glaucoma 2020; Jul 14. [Epub ahead of print].
OCTA Findings of Microvascular and Neural Changes in Primary Pulmonary Hypertension
Scientists evaluated microvascular and neural changes in primary pulmonary hypertension patients compared with healthy controls.
Forty-four eyes of 22 PPH patients were included in the observational clinical cohort study, while 44 eyes of 22 healthy participants were enrolled as controls. Optical coherence tomography angiography images were obtained from each participant using the RTVue XR Avanti device with AngioVue software 2.0.
Scientists found that the total macular-associated vessel density (VD), including the superficial and deep retina; and the optic disc-associated capillary density (CD), including that of the whole image, the CD inside the disc and the peripapillary region were significantly lower in the PPH group than the control group. A similar trend was found with the retinal nerve fiber layer thickness and the ganglion cell complex thickness, while the focal loss volume (FLV) and the global loss volume (GLV) were greater in the PPH group than in the control group.
Scientists concluded that OCTA can detect changes in retinal and CD thicknesses, and in the ONH in PPH patients. They added that parameters such as macular-associated VD, optic disc-associated CD, RNFL, GCC, FLV and GLV may offer evidence for early detection of microvascular and neural impairments in individuals with PPH.
SOURCE: Gu S, Li Z, Zhang Y, et al. Optical coherence tomography angiography (OCTA) findings of microvascular and neural changes in primary pulmonary hypertension. Retina 2020; Aug. 5. [Epub ahead of print.]
Vitreous Levels of VEGF, Stromal Cell-derived Factor-1α & Angiopoietin-like Protein 2 in Active PDR
Researchers determined the vitreous levels of vascular endothelial growth factor, stromal cell-derived factor-1α (SDF-1α) and angiopoietin-like protein 2 (ANGPTL2) in individuals with active proliferative diabetic retinopathy, and assessed their contributions to different clinical presentations of active PDR.
The case-control study included 31 eyes with active PDR and 10 eyes with idiopathic macular hole as controls. Eyes with active PDR were divided into three subgroups: vitreous hemorrhage (VH), tractional retinal detachment (TRD) caused by active fibrovascular membrane (FVM), and coexistence of VH and TRD with FVM. Vitreous samples obtained during vitrectomy were analyzed for concentrations of VEGF, SDF-1α and ANGPTL2.
Here were some of the findings:
- Vitreous level of the following were significantly higher in eyes with active PDR than in controls):
- VEGF (2,021 [168 to 6,550] pg/ml vs. 110.1 [74.5 to 236] pg/ml)(p<0.001);
- SDF-1α (517 [194 to 1,044] pg/ml vs. 388 [320 to 535] pg/ml)(p=0.002); and
- ANGPTL2 (725 [131 to 1,590] ng/ml vs. 196 [75.9 to 437] ng/ml)(p<0.001).
- The concentrations in each active PDR subgroup were also significantly higher than in the control group (p<0.05).
- The vitreous level of ANGPTL2 was significantly higher in eyes with TRD caused by FVM (1,033 ±401 ng/ml) than in eyes with VH (561 ±237 ng/ml)(p=0.008).
Researchers reported that high levels of SDF-1α, ANGPTL2 and particularly VEGF appeared to be associated with PDR. They wrote that, since the vitreous levels of ANGPTL2 tended to be higher in eyes with active fibrovascular tractional detachment, vitreous levels of this chemokine seemed to be affected by the clinical presentation of vascularly active PDR eyes.
SOURCE: Keles A, Sonmez K, Erol YO, et al. Vitreous levels of vascular endothelial growth factor, stromal cell-derived factor-1α, and angiopoietin-like protein 2 in patients with active proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2020; Aug. 19. [Epub ahead of print].
BVI Launches IPure Monofocal IOL in United States
BVI entered the U.S. intraocular lens market with IPure, what the company describes as the first and only pre-loaded aspheric monofocal IOL available in one- and three-piece designs for individuals undergoing cataract surgery. The company says IPure's aspheric optic design is designed to provide high-contrast and high-quality vision in various light conditions while maintaining natural corneal depth of focus for individuals undergoing cataract surgery. It offers a disposable, pre-loaded injector to optimize the implantation of the IOL. Read more.
Frinzi Joins CorneaGen Board as Executive Chair
CorneaGen announced Tom Frinzi joined the company’s board as executive chair. Frinzi recently retired from his position as worldwide president of Johnson & Johnson Vision-Surgical, which includes an ophthalmology portfolio across the areas of cataracts, refractive surgery and dry eye. Read more.
Infuse Contact Lens Now Available
Hot on the heels of Bausch + Lomb's announcement of the FDA's approval of its new Infuse contact lens, the company now says the lens is available for sale. The company says the lens's unique material was designed to be as minimally disruptive to the tear film as possible. The material, kalifilcon A, has a Dk/t of 134 and a 55% water content.
Infuse is available in powers of -12 D to +6 D, with 0.5-D steps in the -12 D to -6 D range and 0.25-D steps thereafter. Learn more.
Haag-Streit Offers New CO:RE Surgical Chair
Haag-Streit USA says it’s aiming to optimize ergonomics for surgeons. To that end, the company collaborated with Michael E. Snyder, MD, of the Cincinnati Eye Institute and other ophthalmologists, as well as the product design firm Zukunplan to engineer its new doctor-inspired CO:RE Surgical Chair. Read more.
CooperVision Upgrades OptiExpert App
If you or someone at your practice fits toric or multifocal contact lenses, CooperVision upgraded its OptiExpert app—a free, multifunctional lens-fitting tool. The company says the app features a more efficient prescription calculator and other features delivered through an intuitive design. Read more.
J&J Vision Offers New Acuvue Services & Resources as Part of Contact Lens Health Week
Johnson & Johnson Vision announced the availability of tools and resources for eye care practitioners to enhance the contact lens experience, in conjunction with Contact Lens Health Week, which is sponsored by the Centers for Disease Control and Prevention. Learn more.
Journal Offers Free Anterior Segment Surgical Videos as Member Benefit
The Video Journal of Cataract, Refractive, and Glaucoma Surgery offers free anterior segment surgical videos as a member benefit of organizations such as the AAO, ASCRS and ESCRS. The journal’s editorial board consists of Graham Barrett, MD (in cataract); Michael Snyder, MD (in iris reconstruction); Ike Ahmed, MD (in glaucoma); and George Waring IV, MD (in refractive). View the journal’s latest Table of Contents.
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