Volume 20, Number 6Monday, February 3, 2020FEBRUARY IS AGE-RELATED MACULAR DEGENERATION AWARENESS MONTH In this issue: (click heading to view article)Six-Year Incidence & Risk Factors for AMD: The Handan Eye StudyResearchers described the six-year incidence of early and late age-related macular degeneration, and associated factors, in a large, rural Chinese population.The population-based, longitudinal study was conducted in rural China from 2006 to 2007. In total, 6,830 individuals ages 30 years or older participated. The six-year follow-up study was performed between 2012 and 2013. The modified Wisconsin Age-Related Maculopathy Grading System (WARMGS) protocol in the Blue Mountains Eye Study was used as the AMD grading standard. Excluding 509 deceased subjects, 5,394 (85.3 percent follow-up rate) completed the follow-up. Among them, 5,048 participants had gradable photographs of at least one eye at both exams. Here were some of the findings: • Over six years, the incidence of early AMD was 4.2 percent (CI, 3.8 to 4.7 percent) and of late AMD was 0.2 percent (CI, 0.2 to 0.3 percent). • In the multivariable analysis, the per-year increase in age (p<0.001; OR=1.06; CI, 1.04 to 1.07), male sex (p=0.006; OR=0.64; CI, 0.47 to 0.88) and per-millimeter increase in axial length (p=0.010; OR=0.78; CI, 0.63 to 0.94) at baseline was significantly associated with incident early AMD. • Early AMD wasn’t associated with systolic or diastolic blood pressure, hypertension, diabetes, history of stroke or heart disease, body mass index, total cholesterol, high- or low-density lipoprotein cholesterol, triglycerides, smoking status, refractive error or corneal curvature radius. • There were too few cases of late AMD for a valid statistical analysis of the risk factors. Researchers reported that, over six years, the incidence of early AMD was 4.2 percent (CI, 3.8 to 4.7 percent) and of late AMD was 0.2 percent (CI, 0.2 to 0.3 percent). They added that age, sex and axial length were relevant risk factors for early AMD in rural China. Source: Mao F, Yang X, Yang K, et al. Six-year incidence and risk factors for age-related macular degeneration in a rural Chinese population: The Handan eye study. Invest Ophthalmol Vis Sci 2019;2;60:15:4966-71. Use of Autologous Serum to Reverse Severe CL-induced Limbal Stem Cell DeficiencyInvestigators described the efficacy of autologous serum (AS) eye drops to reverse severe contact lens (CL)-induced limbal stem cell (LSC) deficiency (LSCD), as part of a prospective, uncontrolled, interventional case series. SOURCE: Yeh S-I, Chu T-W, Cheng H-C, et al. The use of autologous serum to reverse severe contact lens-induced limbal stem cell deficiency. Cornea 2020; Jan 26. [Epub ahead of print]. Researchers Use Smartphone App to Analyze Dry EyeA research team at Japan’s Juntendo University designed the DryEyeRhythm free mobile app with Apple’s ResearchKit to identify risk factors and characteristics of diagnosed and undiagnosed dry-eye disease. They say the study is among the first to use a crowdsourced smartphone application to collect epidemiological data for dry-eye disease, and the app documented symptoms, medical histories and lifestyle habits of the participants.The cross-sectional, crowdsourced research included an electronic informed consent step in the app. A total of 21,394 records were identified in the app’s database; 11,485 were duplicate records, and after removing user records outside of Japan or with incomplete data, a cohort of 4,454 participants were enrolled in the study. Of the 4,454 users, 899 participants (27.3 percent) had diagnosed dry eye and 2,395 participants (72.7 percent) had undiagnosed symptomatic dry eye; 2,972 participants (66.7 percent) were women; mean age was 27.9 ±12.6 years. Participants reported daily subjective symptoms, such as ocular itching, stress levels and headache; and filled out disease-specific questionnaires, such as the Ocular Surface Disease Index (100-point scale; scores 0 to 12 indicate normal; 13 to 22 mild; 23 to 32 moderate; 33 to 100 severe dry-eye symptoms) and the Zung Self-Rating Depression Scale (total of 20 items; total score ranging from 20 to 80; ≥40 highly suggestive of depression). Study participants were classified as having no symptomatic dry eye (defined as an OSDI total score <13) or having symptomatic dry eye (OSDI ≥13). The symptomatic dry-eye group was further divided into diagnosed and undiagnosed symptomatic dry eye. The researchers used multivariate-adjusted logistic regression analysis to identify risk factors. They found that risk factors for symptomatic dry eye included younger age, female sex, allergic rhinitis, mental health disorders, digital device screen exposure time and contact lens wear. For undiagnosed symptomatic dry eye, associated risk factors included younger age, male sex, absence of a collagen disease, mental health disorders, ophthalmic surgery and contact lens wear. The researchers say that one of the advantages of using an app to conduct clinical research is the potential for unlimited participation and no geographical restrictions or participation cost. They add that the identification of associated risk factors offers valuable information that might help to inform targeted health promotion strategies and/or opportunistic screening among those with a greater propensity of developing dry-eye disease, as well as risk factor reduction or modification strategies. SOURCE: Inomata T, Iwagami M, Kakamura M, et al. Characteristics and risk factors associated with diagnosed and undiagnosed symptomatic dry eye using a smartphone application. JAMA Ophth 2020;138:1:58-68. HORIZON Trial: Early Postoperative IOP Following Cataract SurgeryIn a sub-analysis of data from the the Ivantis-sponsored HORIZON trial, researchers compared early postoperative IOP in individuals who underwent cataract surgery alone with those who underwent cataract surgery combined with implantation of Ivantis’ Hydrus Microstent. The trial included 26 U.S. and 12 international sites.Included were subjects with mild or moderate primary open-angle glaucoma and visually significant cataract with mean modified diurnal IOP between 22 and 34 mmHg after washout of IOP-lowering medications. A total of 556 subjects were randomized in a 2:1 ratio to undergo cataract surgery alone / no microstent (NMS) vs. cataract surgery with placement of the Hydrus Microstent. All eyes were washed out of IOP-lowering medications prior to surgery and remained unmedicated until surgery. No IOP-lowering prophylaxis was used postoperatively. Comprehensive eye exams were conducted on postoperative day one, week one and month one. Postoperative IOP >40 mmHg was the primary outcome. Incidence of IOP rise >10 mmHg above baseline unmedicated IOP and mean IOP were analyzed as secondary outcomes. A total of 369 eyes were randomized to the HMS group, and 187 eyes were randomized to the cataract surgery alone group. The HMS and NMS groups didn’t differ with respect to baseline demographic or ocular characteristics. • On POD1, the incidence of IOP spikes defined as IOP >40 mmHg was significantly higher at 14.4 percent in the NMS group, compared with 1.4 percent in the Hydrus group (p<0.001). • The incidence of IOP rise ≥10 mmHg relative to baseline on POD1 was also significantly higher in the NMS than in the Hydrus group (22.5 vs. 3 percent, p<0.001). • IOP in the NMS group was significantly higher than in the Hydrus group (27.6 vs. 17 mmHg, p<0.001). • In multivariable logistic regression analysis, higher baseline IOP predicted higher odds of POD1 IOP spikes >40 mmHg, while presence of the Hydrus was associated with a lower likelihood of postoperative IOP spike. Researchers found that the addition of a Hydrus Microstent at the time of cataract surgery lowered the risk of markedly elevated IOP in the early postoperative period in glaucoma patients. SOURCE: Zebardast N, Zheng C, Jampel H, et al. Effect of a Schlemm’s canal microstent on early post-operative IOP following cataract surgery: An analysis of the HORIZON randomized controlled trial. Opthalmology 2019; Jan 22. [Epub ahead of print]. BRIEFLY B+L & Clearside Announce Positive Phase III Data on Xipere ProQR Receives FDA Rare Pediatric Disease Designation for QR-421a Aldeyra Appoints Dr. Karpecki to Advisory Board Glauconix Promotes Southern to CEO Review of Ophthalmology® Online is published by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073. |