From the editors of Review of Ophthalmology:
AUGUST IS CHILDREN’S EYE HEALTH/SAFETY MONTH
In this issue: (click heading to view article)
DME Severity Correlates with Retinal Vascular Bed Area on Ultra-widefield FA
Researchers quantified retinal nonperfusion area and retinal vascular bed area (RVBA) in mm2
on ultra-widefield fluorescein angiography in eyes with diabetic macular edema and assessed the relationship with DME severity, as part of a prospective, observational case series.
Baseline ultra-widefield fluorescein angiography images of 40 eyes from 29 individuals with treatment-naive DME who participated in the DAVE study, which was completed in May 18, 2017, were stereographically projected at the Doheny Image Reading Center. Researchers automatically extracted the retinal vasculature to calculate RVBA. Two masked, certified graders manually delineated the nonperfusion area. The retinal vascular bed area and nonperfusion area in mm2
were automatically computed by adjusting for peripheral distortion, and then correlated with DME severity.
The global RVBA for the entire retina in eyes with DME was increased compared with healthy controls (54.7 ±16.6 mm2
vs. 37.2 ±9.9 mm2
0.001) and correlated with the severity of DME (p<
0.05). Retinal ischemia (nonperfusion area) was nonuniformly distributed and not related to DME extent (p>
Researchers determined that DME eyes had an increased RVBA compared with healthy controls. They added that DME severity appeared to be related to global RVBA, but not to retinal ischemia.
SOURCE: Fan W, Uji A, Wang K, et al. Severity of diabetic macular edema correlates with retinal vascular bed area on ultra-wide field fluorescein angiography. Retina 2019; July 26. [Epub ahead of print].
Total Donor Endothelial Viability After Endothelium-inward vs. Endothelium-outward Loading & Insertion in DMEK
Investigators compared endothelial cell density (ECD) and viability between two techniques used to prepare and insert Descemet’s membrane endothelial keratoplasty donor tissues. The first technique uses the naturally forming Descemet’s membrane scroll where the endothelial cells face outward; in the second technique, the DM is folded into thirds (trifold) with the endothelial cells facing inward.
Eighteen cadaveric corneas from nine donors (matched pairs) aided in the comparison of the two tissue-insertion techniques. In the scroll, investigators used the endothelium-outward technique with standard DMEK preparation, and inserted the naturally forming DM scroll into a Geuder Cartridge. In the trifold, they undertook the endothelium-inward technique; DMEK preparation involved folding the donor tissue into thirds before being pulled into the EndoGlide Ultrathin. In each case, the tissue was injected onto a glass slide. Investigators performed endothelial cell counting using microscopy preinjection and postinjection, and vital staining using calcein acetoxymethyl (AM) for quantitative cell viability analysis across the whole tissue. Here were some of the findings:
• Manual ECDs using direct microscopy didn’t demonstrate a statistically significant difference in ECD between the two injection techniques.
• Vital staining of the entire 8-mm diameter tissue yielded a significantly higher percentage of viable cells using the trifold, endothelium-inward technique (63.1 percent) compared with the scroll, endothelium-outward technique (41.5 percent) (p=0.013).
• Investigators found no difference in the pattern of cell loss between the two groups.
Investigators observed greater endothelial cell viability using the trifold, endothelium-inward technique compared with the scroll, endothelium-outward technique.
SOURCE: Chong EW, Bandeira F, Finn P, et al. Evaluation of total donor endothelial viability after endothelium-inward versus endothelium-outward loading and insertion in Descemet membrane endothelial keratoplasty. Cornea 2019; June 3. [Epub ahead of print].
Longitudinal Changes in the Peripapillary RNFL Thickness of Type 2 Diabetics
Scientists wrote that type 2 diabetes is expected to accelerate age-related peripapillary retinal nerve fiber layer loss, but limited information on the rate of reduction in pRNFL thickness in individuals with type 2 diabetes is available. As such, they looked at longitudinal changes in pRNFL thickness in individuals with type 2 diabetes, with or without diabetic retinopathy.
A total of 164 eyes of 63 healthy individuals, and 101 individuals with type 2 diabetes (49 people without DR, and 52 people with mild-to-moderate nonproliferative DR) were enrolled in the prospective, longitudinal, observational study betwen Jan. 2, 2013, and Feb. 27, 2015. Participants were followed for three years, and the peripapillary mean and sector RNFL thickness were measured at one-year intervals. Scientists estimated the mean rate of pRNFL loss using a linear mixed model and compared it among the three groups. Follow-up was completed on March 16, 2018, and data was analyzed from April 2, 2018, through July 27, 2018.
Main outcomes and measures included the rate of reduction in pRNFL thickness in individuals with type 2 diabetes. A total of 164 participants (88 women [53.7 percent]; mean age: 58.2 ±8.7 years) were included in the study analysis. The mean age of the control group was 56.5 ±9.3 years (39 women [61.9 percent]); the non-DR group, 59.1 ±9.4 years (26 women [53.1 percent]); and the NPDR group, 59.4 ±11 years (23 women [44.2 percent]). Here were some of the findings:
• The mean duration of type 2 diabetes was 7.1 ±4.4 years in the non-DR group and 13.2 ±8.4 years in the NPDR group.
• The baseline mean pRNFL thickness was 96.2 ±11 μm in the control group, 93.5 ±6.4 μm in the non-DR group and 90.4 ±7.9 μm in the NPDR group.
• During three years of follow-up, these values decreased to 95 ±9.2 μm in the control group, 90.3 ±6.4 in the non-DR group and 86.6 ±7.9 μm in the NPDR group.
• In a linear mixed model, the estimated mean pRNFL loss was -0.92 μm/y in the non-DR group (p<
0.001) and -1.16 μm/y in the NPDR group (p<
0.001), which was 2.9-fold (CI, 1.1 to 14.8; p=
0.003) and 3.3-fold (CI, 1.4 to 18; p<
0.001) greater, respectively, than that of the control group (-0.35 μm/y; p=
Scientists observed a progressive reduction of pRNFL thickness in healthy controls and individuals with type 2 diabetes without and with DR; however, type 2 diabetes was associated with a greater loss of pRNFL, regardless of whether DR was present. Scientists wrote that the findings suggested that pRNFL loss might occur in people with type 2 diabetes even in the absence of DR progression.
SOURCE: Lim HB, Shin Y, Lee MW, et al. Longitudinal changes in the peripapillary retinal nerve fiber layer thickness of patients with type 2 diabetes. JAMA Ophthalmol 2019; Jul 25. [Epub ahead of print].
AREDS2 Report 20: Prevalence, Risk and Genetic Association of Reticular Pseudodrusen in AMD
Researchers determined the prevalence of reticular pseudodrusen (RPD) in eyes with age-related macular degeneration to assess the role of RPD as an independent risk factor for late AMD development, and evaluated genetic associations with RPD, as part of a prospective cohort study. Participants included individuals with intermediate AMD in one or both eyes enrolled in the Age-Related Eye Disease Study 2 (AREDS2).
Fundus autofluorescence images from a subset of AREDS2 participants were evaluated at annual visits for presence of RPD. Six SNPs: rs10490924 (ARMS2), rs1061170 (CFH), rs2230199 (C3), rs116503776, rs114254831 (C2/CFB) and rs943080 (VEGF-A) and genetic risk scores (GRS) were assessed for associations with RPD. Development of late AMD, defined as geographic atrophy or neovascular AMD (NVAMD) was identified. Researchers conducted multivariate repeated measures logistic regression.
Main outcome measures included prevalence of RPD, the odds ratio of late AMD development and genetic associations of RPD. FAF images were evaluated for 5,021 eyes (2,516 participants). RPD was seen in 1,186 (24 percent of eyes, 29 percent of participants). Here were some of the findings:
• RPD prevalence varied with baseline AREDS AMD severity level for the eye: 6 percent in early AMD (n=458), 26 percent in intermediate AMD (n=2606), 36 percent in GA (n=682) and 19 percent in NVAMD (n=1246).
• The mean age of participants with RPD was 79 ±SD 7 years compared with 75 ±SD 8 years in those without (p<
• RPD was more common in females (65 percent RPD vs. 53 percent no RPD).
• The odds ratio adjusted for baseline age, gender, race, educational status, smoking and AMD severity level for 1,710 eyes at risk of developing late AMD at the next annual visit was 2.42 (CI, 1.80, 3.24, p<
0.001) for GA and 1.21 (CI, 0.87 to 1.7; p=
0.26) for NVAMD.
• RPD presence was significantly associated, at a Bonferroni-adjusted significance level of 0.007, with higher GRS (p<
0.0001) and ARMS2 risk alleles (rs10490924; p<
0.0001); and, at a nominal level, with C3 risk alleles (rs2231099; p=
0.04) and CFH risk alleles (rs1061170; p=
0.048 for homozygotes).
Researchers found that participants with RPD had an increased risk of progression to GA but not NVAMD. ARMS2 risk alleles and higher GRS were associated with the presence of RPD. Researchers wrote that the findings suggested that RPD were an important risk marker and should be included in classification systems used for patient prognosis.
Source: Domalpally A, Agron E, Pak JW, et al. Prevalence, risk and genetic association of reticular pseudodrusen in age-related macular degeneration. AREDS2 Report 20. Ophthalmology 2019; July 19. [Epub ahead of print].
B+L Introduces FreeFlow and Starts Excimer Trial
Bausch + Lomb announced the launch of the FreeFlow infusion system for retina surgery. The new offering allows for a higher level of infusion flow compared to previous generation infusion lines to support the efficient vitreous removal provided by the company’s Bi-Blade dual port vitrectomy cutters and Vitesse hypersonic vitrectomy system, both designed for use with the Stellaris Elite vision enhancement system.
In the FreeFlow infusion system, the infusion line goes over the top of the trocar cannula rather than inside of it, significantly increasing the size of the inner lumen and allowing surgeons to increase inflow by 40 percent, the company says. Read more.
B+L also recently announced that it’s initiated the first in a series of U.S. clinical trials to evaluate the safety and efficacy of the Technolas Teneo 317 (model 2) excimer laser for vision correction surgery for myopia and myopic astigmatism. The trial is a multicenter, prospective, open-label, non-randomized study. Participants in the study will undergo safety and efficacy evaluation when refractive stability has been achieved (study endpoint). Read more.
Johnson & Johnson Vision Launches New Surgical Vision Experience Center
Johnson & Johnson Vision launched the Surgical Vision Experience Center at the Johnson & Johnson Institute in Jacksonville, Florida. The company says that the center will serve as Johnson & Johnson Vision’s premier physical training space and laboratory setting for various experiential educational programs offering hands-on, in-depth training for practicing ophthalmic surgeons, ophthalmology residents and optometrists. Training will cover best practices for personalized approaches to intraocular lens selection for cataract procedures, as well as training on topo-integrated, wavefront-guided LASIK procedures. The curriculum will span the company’s full line of products and equipment for cataract and refractive surgery, along with ocular surface health. Read more
Help for CyPass Micro Stent Patients
If you’ve got patients with Alcon CyPass glaucoma stents in their eyes that need revision, Microsurgical Technologies says its new instrument, the 19g Ahmed Micro Stent Cutter, might be of use. MST developed the cutter in collaboration with Toronto surgeon Ike Ahmed, MD, and says the unique design of the instrument enables surgeons to approach a stent coaxially, grasp and trim a stent in a single step using only one hand and make a clean cut of the stent’s proximal end. Read more.
Hillrom Introduces Retinal Imager
Hillrom introduced the Welch Allyn RetinaVue 700 Imager handheld retinal camera as part of the RetinaVue Care Delivery Model, enabling remote ophthalmologists to diagnose diabetic retinopathy in individuals with diabetes during routine primary care office visits. The imager is the first handheld camera capable of capturing high-quality retinal images in a fully automated fashion in pupils as small as 2.5 mm, according to the company. With a 60-degree field of view and image-quality assessment algorithm, the imager enables users to efficiently review up to 75 percent more retinal area compared with cameras with a standard 45-degree field of view, the company says. The device includes Hillrom's HIPAA/HITECH-compliant RetinaVue Network, featuring encryption of data in transit and at rest, along with secure client-server authentication. Read more.
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