Review of Ophthalmology Online



Vol. 22, #36  •   Monday, August 30, 2021


In this Issue:




Lower Cognitive Function in Functionally & Structurally Severe Glaucoma: The LIGHT Study

Researchers aimed to determine whether functional and structural glaucoma damage was associated with cognitive function, as part of a cross-sectional analysis of 172 patients with glaucoma with a mean age of 70.6 years.

Functional glaucoma severity was evaluated according to the visual field mean deviation (severe, mean deviation ≤-12 dB; mild, mean deviation >-12 dB), and structural glaucoma severity was determined based on circumpapillary retinal nerve fiber layer thickness. The main outcome measure was cognitive impairment defined by a mini-mental state examination (MMSE) score of ≤26 and MMSE-blind score of ≤16.

Here are some of the findings:
• The prevalence of patients with cognitive impairment (MMSE score ≤26) was significantly higher in the severe glaucoma group (33.3 percent) than in the mild glaucoma group (15.7 percent; p=0.010).
• Similar results were obtained for MMSE-blind score of ≤16: 14.7 of the severe glaucoma group vs. 1.4 percent of the mild glaucoma group; p=0.003.
• Multivariable logistic regression analysis adjusted for potential confounders—including age, body mass index, education, visual acuity, hypertension, diabetes and depressive symptoms—indicated a higher odds ratio for cognitive impairment (MMSE score ≤26) in patients with severe glaucoma than in those with mild glaucoma (OR, 2.62; CI, 1.006 to 6.84; p=0.049) and in relation to a 10-μm thinning of the RNFL (OR, 1.42; CI, 1.05 to 1.93; p=0.025).

Researchers found that functional and structural glaucoma damage was significantly associated with lower cognitive function, independent of age and visual acuity in a glaucoma cohort.

SOURCE: Yoshikawa T, Obayashi K, Miyata K, et al. Lower cognitive function in patients with functionally and structurally severe glaucoma: The LIGHT Study. J Glaucoma 2021; Aug 12. [Epub ahead of print].


Complimentary CME Education Videos


Anti-VEGF Therapy in Treatment-naïve nAMD Diagnosed on OCTA: The REVEAL study

Investigators compared 12-month visual and anatomical outcomes of treatment-naïve neovascular age-related macular degeneration patients diagnosed by optical coherence tomography angiography compared with fluorescein angiography (FA)/indocyanine green angiography (ICGA) after anti-VEGF treatment in a real-world setting.

In a monocentric, observational, parallel-group study of nAMD patients diagnosed with either FA/ICGA or noninvasive OCTA methods, patients were treated with a fixed dosing regimen of intravitreal ranibizumab or aflibercept and followed up for 12 months. Primary outcomes were the 12 months functional (BCVA) and anatomical (CST reduction) gains between the two groups. The stratification of BCVA and CST gains by type of neovascular lesion and by anti-VEGF treatment was also assessed.

Here are some of the findings:
• Seventy-two patients received FA/ICGA for the initial diagnosis of nAMD while 73 received OCTA.
• Overall, the mean BCVA gain at 12 months was 11.5 ±9.6 letters.
• No statistically significant differences were found between the invasive and noninvasive imaging groups in BCVA gain (p=0.87) or CST reduction (p=0.76).
• No statistically significant outcome differences between different lesion types and the two drugs were observed.

Investigators reported, in a real-world setting, nAMD patients diagnosed with OCTA showed meaningful improvements in visual and anatomical parameters during 12 months of treatment, without significant differences from those diagnosed by invasive modalities.

SOURCE: Lupidi M, Schiavon S, Cerquaglia A, et al. Real-world outcomes of anti-VEGF therapy in treatment-naïve neovascular age-related macular degeneration diagnosed on OCT angiography: The REVEAL study. Acta Ophthalmol 2021; Aug 18. [Epub ahead of print].


Clinical, Morphological and Optical Correlates of Visual Function in FECD

Scientists studied the clinical, optical and morphological correlates of visual function in patients with Fuchs’ endothelial corneal dystrophy.

They analyzed case records for patients diagnosed with FECD between September 2019 and March 2020. The best-corrected visual acuity was recorded as decimal visual acuity and converted to the logarithm of the minimum angle of resolution units. Contrast sensitivity was measured with the Pelli-Robson contrast sensitivity test. Corneal alterations, including central corneal thickness, depression of the posterior cornea and corneal densitometry values, were evaluated using Scheimpflug images. Corneal epithelial thickness was measured by spectral-domain optical coherence tomography.

A total of 107 eyes of 61 patients (18 male and 43 female) with FECD were retrospectively investigated. Here are some of the findings:
• The Spearman rank correlation coefficient showed moderate correlation between BCVA and contrast sensitivity (ρ=-0.66, p<0.001), with some patients maintaining relatively good BCVA but having reduced contrast sensitivity.
• Logistic regression analysis demonstrated that age, central corneal thickness, depression of the posterior cornea and epithelial thickening were negatively associated with contrast sensitivity but not with BCVA.

Scientists wrote that contrast sensitivity is a useful tool for assessing visual dysfunction and should be incorporated into the assessment protocol of patients with FECD. They added that alterations in the cornea, including central corneal thickness, depression of the posterior cornea and epithelial thickening, might be objective parameters that can help the clinician in grading the severity of the disease and tracking its progression.

SOURCE: Okumura N, Padmanaban V, Balaji J, et al. Clinical, morphological, and optical correlates of visual function in patients with Fuchs endothelial corneal dystrophy. Cornea 2021; Aug 6. [Epub ahead of print].


Genetic Associations of Anti-VEGF Therapy Response in AMD

Researchers assessed the association of all reported common polymorphisms in anti-vascular endothelial growth factor therapy response and identified potential clinically useful biomarkers for anti-VEGF therapy response in patients with age-related macular degeneration.

They searched the Embase, PubMed and Web of Science databases in English, and the China National Knowledge Infrastructure, WanFang and VIP databases in Chinese for pharmacogenetics studies on anti-VEGF therapy response in AMD. Odds ratios with 95 percent confidence intervals were calculated using the random effects model.

Among the 10,468 records yielded by the literature search, 33 articles that met the eligibility criteria were included in the meta-analysis. Nine single-nucleotide polymorphisms (SNP) in four genes were observed to be associated with the anti-VEGF therapy response in AMD patients.
• The following SNPs were associated with good anti-VEGF therapy responses:
   o rs1120063 in the HTRA1 gene;
   o rs10490924 in the age-related maculopathy susceptibility (ARMS2) gene;
   o rs1061170 in the complement factor H (CFH) gene; and
   o rs323085 in the OR52B4 gene.
• The following SNPs were associated with poor anti-VEGF therapy response in the AMD patients:
   o rs800292, rs1410996 and rs1329428 in the CFH gene; and
   o rs4910623 and rs10158937 in the OR52B4 gene.

Researchers wrote that nine SNPs of four genes were indicated to be significantly associated with the anti-VEGF therapy response in the samples. They added that further studies based on various ethnicities and large sample sizes are warranted to strengthen the evidence found in the present study.

SOURCE: Wang Z, Zou M, Chen A, et al. Genetic associations of anti-vascular endothelial growth factor therapy response in age-related macular degeneration: a systematic review and meta-analysis. Acta Ophthalmol 2021; Aug 17. [Epub ahead of print].




Industry News

Regeneron Announces Positive Topline Phase II Data

Regeneron Pharmaceuticals announced that an ongoing Phase II proof-of-concept trial evaluating an investigational 8 mg dose of aflibercept met its primary safety endpoint, with no new safety signals observed compared to the currently-approved 2 mg dose of Eylea (aflibercept) Injection in patients with wet age-related macular degeneration. In this small trial involving 106 patients, a higher proportion of patients in the aflibercept 8 mg group had no retinal fluid (43.4 percent, n=23/53) compared to patients treated with Eylea 2 mg (26.4 percent, n=14/53) (p=0.067) at week 16, the primary efficacy endpoint. At this timepoint patients had received three initial doses (administered at weeks 0, 4 and 8), after which dosing was extended. Read more.


Sight Sciences Announces Publication of Standalone Omni Outcomes

A study in Clinical Ophthalmology found that the standalone use of Sight Sciences’ Omni surgical system (i.e., not used in conjunction with cataract surgery) in mild to moderate open-angle glaucoma resulted in statistically significant reductions in both IOP and IOP-lowering medication use at two years. The study was a single-center, open-label study conducted in Germany. Sight Sciences provided financial assistance to support writing, preparation, and publication of the manuscript, and the lead author received grants from the company. Omni is FDA-cleared and CE-marked for canaloplasty followed by trabeculotomy to reduce intraocular pressure in adult patients with primary open-angle glaucoma. Sight Sciences says it intends to further develop the surgical system and to seek regulatory clearance for expanded indications. Read more.




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