From the editors of Review of Ophthalmology:
FEBRUARY IS AGE-RELATED MACULAR
DEGENERATION AWARENESS MONTH
In this issue: (click heading to view article)
Pretreatment Measurements of Anterior Segment Parameters in Acute & Chronic PAC
Researchers compared pretreatment anterior segment parameters between eyes with acute primary angle closure and chronic primary angle closure, and identified the characteristics of eyes with APAC, as part of a retrospective study.
They measured pretreatment anterior chamber depth, iris convexity and pupil diameter in eyes with APAC and CPAC using anterior-segment OCT. And they evaluated the risk of APAC associated with anterior segment parameters using multiple logistic regression. Eyes with APAC were discriminated from eyes with CPAC using the receiver operating characteristic curve and area under the curve. The best cutoff for these variables was determined.
Thirty-four eyes with APAC and 60 eyes with CPAC were included. The mean intraocular pressure was 52.3 ±12.6 mmHg in APAC and 15.5 ±3.5 mmHg in CPAC (p<0.001). Here were some of the findings:
• Eyes with APAC had a shallower ACD (1.407 ±0.301 mm vs. 1.960 ±0.205 mm, p<0.001) and less IC (0.233 ±0.087 mm vs. 0.294 ±0.068 mm, p<0.001) than eyes with CPAC.
• In multivariate analyses, significant variables associated with APAC were ACD (p<0.001) and IC (p=0.001).
• The AUC was 0.931 for ACD and 0.742 for IC.
• The best cutoff was: for ACD, 1.699 mm (sensitivity 0.824, specificity 0.917); and for IC, 0.282 mm (sensitivity 0.853, specificity 0.533).
Researchers concluded that eyes with APAC had a shallower ACD and less IC than CPAC eyes, and that eyes with an ACD <1.7 mm might be at risk for APAC.
SOURCE: Yoshimizu S, Hirose F, Takagi S, et al. Comparison of pretreatment measurements of anterior segment parameters in eyes with acute and chronic primary angle closure. Jpn J Ophthalmol 2019; Jan 20. [Epub ahead of print].
CNV Activity by OCT Location & Quantification of Abnormal Fluid With Anti-VEGF for AMD
Investigators assessed optical coherence tomography leakage to help identify and quantify choroidal neovascularization-related fluid and changes after anti-vascular endothelial growth factor therapy in neovascular age-related macular degeneration eyes.
The prospective analysis of nAMD cases treated with 2 mg intravitreal aflibercept included eyes examined before, and one week and one month after a single injection. Investigators assessed best-corrected visual acuity using the Early Treatment Diabetic Retinopathy Study method. They acquired OCT leakage maps depicting low optical reflectivity (LOR) sites with OCT Cirrus AngioPlex, and correlated the LOR area ratio to retinal thickness and BCVA. Twenty-two eyes of 18 individuals with nAMD were included. Here were some of the findings:
• The LOR ratio of full retina scans and retinal pigment epithelium Bruch’s layers decreased from baseline to month one (p<0.05).
• Changes in retinal thickness and LOR ratio were positively correlated (p<0.05).
• BCVA correlated with outer segment layer LOR changes (rho=-0.53; p=0.014), and LOR was inferior in better responders (p=0.021).
• OCT leakage helped identify eyes with recurrent fluid in the external layers.
Investigators wrote that OCT leakage helped identify and quantify fluid related to CNV activity, that low optical reflectivity changes in outer segment layers correlated with functional outcomes and that increasing LOR in the external layers might be a marker of early recurrence. They suggested that combining OCT angiography and OCT leakage images enabled CNV morphology and activity analysis.
SOURCE: Farinha C, Santos T, Santos AR, et al. Optical coherence tomography leakage in neovascular age-related macular degeneration: Identification of choroidal neovascularization activity by location and quantification of abnormal fluid under anti-vascular endothelial growth factor therapy. Retina 2018; Jan. 24. [Epub ahead of print].
One-month IOP in MMC-augmented Trabeculectomy to Predict IOP Control in Chronic PACG
Scientists evaluated predictors of long-term intraocular pressure in chronic primary angle-closure glaucoma treated with primary trabeculectomy by systematically reviewing cases of CPACG treated with primary trabeculectomy.
The scleral flaps in all cases were sutured with two stitches in situ and two releasable sutures for a watertight environment under normal IOP conditions during surgery; mitomycin C was used in all eyes, and individuals were followed for two years. Digital massage of the bulbi and removal of releasable sutures were performed according to IOP and shapes of filtering blebs. Scientists recorded demographic data and clinical outcomes, and identified factors predicting long-term IOP. A total of 72 individuals (88 eyes) with a mean age of 58.51 ±10.60 years were included. Here are some of the findings from the study:
• The complete success rate was 89.77 percent after two years.
• IOP began to stabilize after seven days and reached its lowest point at one-month follow-ups.
• Preoperative and early postoperative high or low IOPs didn’t affect long-term effects (p>0.05).
• Scientists found a positive correlation between postoperative IOPs at one-month and two-year follow-ups (r=0.64, p<0.001).
Scientists reported that, in CPACG patients undergoing primary trabeculectomies, scleral flaps sutured watertightly with two stitches in situ and two releasable sutures under normal IOP conditions, could ensure controllable, effective and safe treatment of CPACG. They found that preoperative and early postoperative high or low IOP didn’t affect long-term effects and suggested that one-month postoperative IOP could be used as a predictor of long-term IOP control.
SOURCE: Zuo C, Lin S, Wu K, et al. One-month IOP in mitomycin C-augmented trabeculectomy can predict long-term IOP control in chronic primary angle-closure glaucoma. Int Ophthalmol 2019; Jan 24. [Epub ahead of print].
OCT-based Diagnostic Criteria for Myopic Maculopathy Staging
Researchers evaluated whether distance vision impairment (VI)(LogMAR) >0.30), or near VI (NVI) (logMAR 0.32 to 1.30 at 40 cm with <0.30 at 3 m) independently predicted health-related quality of life (HRQoL), and estimated its societal impact.
The National Eye Survey of Trinidad and Tobago was a population-based, cross-sectional eye survey using multistage, cluster random sampling with probability-proportionate-to-size methods in adults aged >40 years.
Responders rated general health level in the five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) of the EQ-5D 5-level instrument. Multivariable regression analyses with robust standard error estimation explored the relationship between utility score and presenting vision. The main outcome measure included utility value and Quality Adjusted Life Year (QALY) loss by vision category. A total of 62.4 percent (2,658/4,263) of adults queried completed the EQ-5D-5L. Mean age was 58.4 (SD 11.8, range 40 to 103) years and 56.3 percent were female. Here were some of the findings:
• Blindness had the largest independent effect on utility coefficient, at -0.140 (CI, -0.092 to -0.192), with mean utility value of 0.727 (CI, 0.671 to 0.784), and a mean EQ-VAS score of 69.9 (CI, 62.0 to 77.8).
• Near VI was also independently associated with utility loss of -0.012 (CI, 0.004 to -0.021).
• Independent predictors of utility <1 included female sex, older age, being uninsured, lower educational attainment, ethnicity and multiple medical co-morbidities.
• A hypothetical person, experiencing onset of a stable vision state at 40 years, would be expected to accrue lifetime loss of 0.45 QALYs for near VI, 0.72 QALYs for mild VI, 1.64 QALYs for moderate VI, 3.30 QALYs for severe VI and 5.13 QALYs for blindness.
• VI caused 762.3 QALYs lost per 100,000 population per year, of which 36.5 percent were attributed to near VI, exceeding the equivalent QALY loss from stroke (307 QALYs), depression (284 QALYs) or arthritis (522 QALYs).
• Ninety-one percent (694.9/762.3) of VI-related QALY loss was potentially avoidable.
Researchers reported that this was the first population-based survey to identify that both distance and near VI independently reduced HRQoL. They wrote that the estimated QALY loss highlighted the societal importance of efforts to address all degrees of avoidable VI.
SOURCE: Braithwaite T, Bailey H, Bartholomew D, et al. Impact of vision loss on health-related quality of life in Trinidad and Tobago. Ophthalmology 2019; Jan 28. [Epub ahead of print].
Janssen & MeiraGTx to Develop Gene Therapies for Inherited Retinal Diseases
The Janssen Pharmaceutical Companies of Johnson & Johnson announced a worldwide collaboration and license agreement with MeiraGTx Holdings to develop, manufacture and commercialize its clinical-stage inherited retinal disease portfolio, including leading product candidates for achromatopsia caused by mutations in CNGB3 or CNGA3, and X-linked retinitis pigmentosa. The companies also have formed a research collaboration to explore targets for other inherited retinal diseases and develop adeno-associated virus manufacturing technology. Read more.
Lutronic Initiates Preclinical Trial of R:Gen Laser for Treatment of Dry AMD
Lutronic Vision announced it initiated a preclinical trial to determine the optimal setting for its R:Gen laser to treat the dry form of age-related macular degeneration. The company is aiming to bring to market its fully integrated laser platform designed to safely and precisely target the retinal pigment epithelium to regenerate and restore its function. Read more.
Apellis Appoints Lackner as SVP, Head of Europe
Apellis Pharmaceuticals announced the appointment of Thomas Lackner as senior vice president, head of Europe. Previously, Lackner was responsible for developing the global commercial strategy and launch organization for Prothena Biosciences in Europe. In his new role, he will build out the launch organization for its lead product candidate APL-2 in Europe as the company expands operations with two clinical programs in Phase III trials: DERBY & OAKS for the treatment of geographic atrophy and PEGASUS for the treatment of paroxysmal nocturnal hemoglobinuria. Read more.
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