Review of Ophthalmology Online



Vol. 22, #8  •   Monday, February 22, 2021


In this Issue:



Is Reading Performance Impaired in Glaucoma Patients with Preserved Central Vision?

Researchers aimed to determine whether patients with glaucoma with preserved central vision had impaired reading performance compared with healthy controls. The cross-sectional study included 35 patients with glaucoma and 32 similar-age controls with visual acuity better than 0.4 logMAR in both eyes.

Each participant had a detailed ophthalmological exam followed by a 5-chart reading performance test using a Portuguese version of the Minnesota Low Vision Reading Test (MNREAD). Correlation between reading performance (reading speed) and ocular parameters was investigated.

Participants had an average age of 63 ±12.6 years. Here were some of the findings:
• In the glaucoma group, mean deviation (MD) in the better eye was -6.29 ±6.36 dB and in the worse eye was -11.08 ±0.23 dB.
• No significant difference was found in age, gender, race, education, visual acuity or systemic comorbidities between groups.
• Participants with glaucoma had significantly slower reading speeds, with an average of 83.2 ±25.12 words per minute (wpm) compared with 102.29 ±29.57 wpm in controls (p=0.006); reading speed was slower for all five charts.
• The odds of glaucoma increased by 1.29 (CI, 1.07 to 1.56, p=0.009) for each 10 wpm decrease in average reading speed, with this relationship maintained after accounting for age, schooling and visual acuity.

Researchers found that patients with mild-to-moderate glaucoma had worse reading performance compared with similar-age controls, despite both having preserved central vision.

SOURCE: Ikeda MC, Bando AH, Hamada KU, et al. Is reading performance impaired in glaucoma patients with preserved central vision? J Glaucoma 2021; Feb 3. [Epub ahead of print].


Risk factors for Fellow Eye Treatment in Protocol T

Investigators identified risk factors for fellow eye treatment of diabetic retinopathy with vascular endothelial growth factor injections from the Diabetic Retinopathy Clinical Research Network (DRCR.Net) Protocol T trial, as part of a post hoc analysis of randomized clinical trial data.

Cox regression analysis was performed at 52 and 104 weeks to determine risk factors for treatment in 360 fellow eyes. Survival analysis was performed to determine mean time to treatment based upon medication used.

Here were some of the findings:
• Of 360 fellow eyes, 142 (39.4 percent) required treatment between weeks four and 104.
• Risk factors predicting a lower likelihood of year-one treatment included older subject age (HR=0.98; CI, 0.96 to 0.99; p=0.02) and higher baseline study eye ETDRS score (HR=0.98; CI, 0.97 to 0.99; p=0.04).
• Center-involving DME at baseline in the fellow eye was predictive of a higher treatment need at 52 weeks (HR=1.89; CI, 1.42 to 2.51, p<0.0001) and 104 weeks (HR=2.68; CI, 1.75 to 4.11, p<0.0001).
• Subjects treated in the study eye with aflibercept (HR=0.574; CI, 0.371 to 0.887, p=0.013) and ranibizumab (HR=0.58; CI, 0.36 to 0.94, p=0.03) were less likely to require first-year fellow eye injection than subjects treated with bevacizumab, although this difference was no longer statistically significant at week 104 (aflibercept HR=0.77; CI, 0.52 to 1.16; p=0.21; ranibizumab HR=0.66; CI, 0.43 to 1.00, p=0.05).
• Mean time to treatment was significantly shorter in the bevacizumab group (bevacizumab 25.83 weeks, aflibercept 38.75 weeks, ranibizumab 34.70 weeks (p=0.012)).

Investigators reported that bilateral treatment with intravitreal anti-VEGF injections was common during the Protocol T. They added that medication choice may impact on the risk of fellow-eye treatment.

SOURCE: Ness S, Green M, Loporchio D, et al. Risk factors for fellow eye treatment in protocol T. Graefes Arch Clin Exp Ophthalmol 2021; Feb 10. [Epub ahead of print].


Influence of Posterior Corneal Astigmatism Measurements on Toric IOL Implantation Outcomes

Scientists assessed whether the outcomes of toric intraocular lens implantation in eyes with oblique astigmatism could be improved by direct measurements of posterior corneal astigmatism using anterior-segment optical coherence tomography rather than just anterior corneal measurements alone.

In this retrospective case series, two toric IOL power calculation methods were compared: anterior corneal astigmatism in the keratometry group; and corneal astigmatism, determined by ray tracing through the measured anterior and posterior corneal surfaces, in the AS-OCT group. In 279 eyes of 232 patients, subgroup analysis was conducted for: with-the-rule (85 eyes in the keratometry group and 34 eyes in the AS-OCT group); against-the-rule (73/29 eyes); and oblique (26/32 eyes) astigmatism.

Here were some of the findings:
• In the WTR and ATR astigmatism groups:
   o uncorrected distance visual acuity was significantly better in the AS-OCT group than in the keratometry group (p=0.012 and p<0.001, Mann-Whitney test); and
   o residual astigmatism was significantly smaller in the AS-OCT group than in the keratometry group (p=0.037 and p<0.001).
• In eyes with oblique astigmatism, the uncorrected distance visual acuity (p=0.299) and residual astigmatism (p=0.373) of the keratometry and AS-OCT groups didn’t differ.

Scientists concluded that incorporation of posterior corneal astigmatism measured with AS-OCT significantly improved the outcomes of toric IOL implantation in eyes with WTR and ATR astigmatism, but not in eyes with oblique astigmatism.

SOURCE: Nakano S, Iida M, Hasegawa Y, et al. Influence of posterior corneal astigmatism on the outcomes of toric intraocular lens implantation in eyes with oblique astigmatism. Jpn J Ophthalmol 2021; Jan 28. [Epub ahead of print.]


Evaluating Treatment Response of Aflibercept in Wet AMD Using OCTA

Researchers used optical coherence tomography angiography to measure the change in size (mm2) and density (flow index) of choroidal neovascular membranes from baseline to week 52 of treatment-naïve wet age-related macular degeneration patients receiving intravitreal aflibercept injections (IAI).

Patients were treated with IAI at baseline, months one and two, and then every other month for a total of 12 months. Along with clinical exam and best-corrected visual acuity, OCTA 6- and 3-mm scans were acquired at every visit between May 2017 and January 2019. Data from baseline, week 12 and week 52 were analyzed prospectively and included in the final analysis.

Twenty-five eyes from 23 patients were included in the study. Here were some of the findings:
• The mean BCVA at baseline and week 52 increased from 20/125 to 20/80, respectively (p<0.001).
• The mean central subfield thickness at baseline and week 52 decreased from 330.48 to 222.40 μm, respectively (p<0.001).
• Seventeen patients (18 eyes) completed all protocol-based 6 × 6 mm and 3 × 3 mm OCTA scans. In this subgroup:
   o 6-mm OCTA scans revealed that the mean size of choroidal neovascular membranes before and after IAI was 1.21 mm2 and 0.56 mm2, respectively (p<0.001);
   o 3-mm OCTA scans at baseline and week 52 demonstrated a decrease in mean size of the choroidal neovascular membranes from 0.89 to 0.37 mm2, respectively (p<0.001).
• The 6-mm perfusion density map revealed no difference at either time point.

Researchers found that OCTA provided a useful approach for monitoring and evaluating the treatment of intravitreal aflibercept for choroidal neovascular membranes. They added that mean size of choroidal neovascular membranes could be identified by 3- or 6-mm scans, but without machine learning, it required extensive segmentation. While reproducibility and clear delineation of choroidal neovascular membranes in wet AMD using OCTA was challenging, OCTA offered the ability to monitor choroidal neovascular membrane size changes during treatment, and may offer another biomarker to assist in assessing treatment response.

SOURCE: Sodhi SK, Trimboli C, Kalaichandran S, et al. A proof of concept study to evaluate the treatment response of aflibercept in wARMD using OCT-A (Canada study). Int Ophthalmol 2021; Feb 7. [Epub ahead of print.]




Industry News

New World Medical’s KDB Glide Now Available

New World Medical announced the commercial launch of the KDB Glide device for advanced excisional goniotomy treatment of glaucoma. The device, which was registered with the FDA in October 2020, features a proprietary ramp that facilitates lifting and stretching of the trabecular meshwork, along with dual blades to penetrate the trabecular meshwork and create parallel incisions for controlled excision. The company says the new features on the device include a rounded heel, tapered sides and a smaller footplate to offer optimal interface with Schlemm’s canal. Read more.



Trefoil Begins Second Phase II STORM Trial with Regenerative FECD Treatment

Trefoil Therapeutics began a Phase II clinical trial of its engineered Fibroblast Growth Factor-1, TTHX1114, to evaluate its safety and efficacy as a regenerative treatment for patients with Fuchs’ endothelial corneal dystrophy. The STORM study, the second clinical trial of TTHX1114, is designed to assess the therapy’s potential to enhance corneal recovery and improve visual acuity in FECD patients undergoing techniques known as Descemetorhexis Without Endothelial Keratoplasty, which is also known as Descemet’s Stripping Only, for their disease. Read more.



Gyroscope Announces Interim Data from Phase I/II FOCUS Trial

Gyroscope Therapeutics announced interim safety, protein expression and biomarker data from the ongoing open-label Phase I/II FOCUS clinical trial of its investigational gene therapy, GT005, in patients with geographic atrophy secondary to age-related macular degeneration. The company says that interim results show GT005 is well-tolerated and results in sustained increases in vitreous complement factor I levels in the majority of patients, as well as decreases in the downstream complement proteins associated with overactivation of the complement system. Read more.

RegenxBio Announces Interim Phase I/IIa Data of RGX-314

RegenxBio reported at the Angiogenesis, Exudation, and Degeneration 2021 conference additional interim data from cohorts 4 and 5 of its RGX-314 Phase I/IIa trial for the treatment of wet age-related macular degeneration, and cohort 3 of its Long-Term Follow-Up (LTFU) study. The company says that patients in cohorts 4 and 5 at 1.5 years after administration of RGX-314 demonstrated stable visual acuity, as well as decreased central retinal thickness. Read more.



Complimentary CME Education Videos




Alcon Announces OTC Availability of Pataday

Alcon announced that Pataday Once Daily Relief Extra Strength (olopatadine hydrochloride ophthalmic solution 0.7%) is now available in-store and online at U.S. retailers, following its 2020 approval by the FDA for sale over-the-counter. Read more.












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