From the editors of Review of Ophthalmology:
In this issue: (click heading to view article)
Prediction of BCVA With SS-OCT Parameters in Keratoconus
This study aimed to predict the best-corrected visual acuity based on swept-source optical coherence tomography parameters in eyes with keratoconus. Researchers retrospectively reviewed 135 eyes of 135 individuals with keratoconus (mean age: 31.9 ±12.4 years).
The average keratometry value was 48.68 ±5.44 D and the average BCVA was 0.20 ±0.36 logMAR (Snellen) (20/25). Researchers calculated 11 parameters using SS-OCT. Apart from the corneal height and elevation, researchers calculated all the other parameters from anterior and posterior corneal OCT data.
Subjects were divided into two groups: one for creating the prediction equation (86 eyes) and another for verifying the equation (49 eyes). In the prediction equation group, researchers analyzed individual correlations between the BCVA and SS-OCT parameters. They performed a stepwise multiple regression analysis, with the BCVA as a dependent variable and SS-OCT parameters as independent variables. Then, the accuracy of the prediction equation was verified in the verification group.
All parameters, except for age and total corneal cylinder, showed statistically significant correlations with BCVA (p<
0.0001). Using the stepwise multiple regression analysis, researchers selected two explanatory variables: root mean square of anterior corneal elevation (standardized regression coefficient: 1.221; p<
0.0001) and total coma aberration (standardized regression coefficient: -0.575; p=
0.001; adjusted R2
=0.546). The prediction was correct in 84.6 percent of eyes within ±1 line of Snellen BCVA.
Researchers concluded that using the equation derived from SS-OCT parameters is a promising method to predict visual function in individuals with keratoconus.
SOURCE: Esaka Y, Kojima T, Dogru M, et al. Prediction of best-corrected visual acuity with swept-source optical coherence tomography parameters in keratoconus. Cornea 2019; Jun 28. [Epub ahead of print].
Treat-and-extend vs. PRN Regimens of Ranibizumab & Aflibercept in nAMD
In a retrospective, observational study, investigators compared the treatment efficacy of anti-VEGF medications following pro re nata (monthly injections only in case of active disease) or treat-and-extend (progressive extension of treatment intervals up to 12 weeks depending on the clinical findings) treatment protocols in real-world conditions.
Individuals diagnosed with age-related macular degeneration and without pre-treatment undergoing routine anti-VEGF treatment in a Swiss eye clinic were included. Treatment was performed according to local practices, using ranibizumab or aflibercept and following T&E or PRN regimens. Investigators evaluated changes in logMAR and injection intervals (time between two injections) for specific treatment periods descriptively and using mixed models.
A total of 1,071 individuals with 1,332 treated eyes (722 PRN ranibizumab, 191 T&E ranibizumab, 419 T&E aflibercept) were included in the analyses. Here were some of the findings:
• At baseline, logMAR visual acuity was similar in both ranibizumab treatment groups (PRN: 0.63 ±0.43; T&E: 0.57 ±0.42).
• In the PRN ranibizumab group, logMAR acuity was about 0.1 lower for all time intervals in the initial and maintenance phases compared with baseline, indicating an improvement in VA.
• By comparison, acuity improved more strongly in the T&E ranibizumab group (16 to <22 months, - 0.19 [-0.23 to 0.15]) compared with baseline.
• Comparing T&E ranibizumab vs. T&E aflibercept groups, improvements in acuity were similar over time.
• In the maintenance phase, the rate of individuals with a clinically relevant improvement in visual acuity (>0.2 logMAR) was higher in both T&E groups compared with the ranibizumab/PRN group.
• Injection intervals in the maintenance phase in the T&E ranibizumab group gradually expanded over time, while in the T&E aflibercept group, injection intervals remained relatively stable.
Investigators determined that using ranibizumab according to a T&E protocol yielded a stronger improvement in logMAR acuity compared with a PRN protocol with longer injection intervals than T&E aflibercept. They added that this large real-world data assessment supported previous data on the superiority of T&E treatment.
SOURCE: Augsburger M, Sarra GM, Imesch P. Treat and extend versus pro re nata regimens of ranibizumab and aflibercept in neovascular age-related macular degeneration: A comparative study. Graefes Arch Clin Exp Ophthalmol 2019; June 29. [Epub ahead of print].
Characterizing Retinal-choroidal Anastomosis in MacTel 2 with OCTA
Scientists characterized structural and angiographic findings in macular telangiectasia Type 2 and examined associations with visual acuity. They retrospectively evaluated MacTel 2 patients with ophthalmologic exams including fundus photography, autofluorescence, spectral-domain optical coherence tomography and projection-resolved optical coherence tomography angiography.
A total of 43 eyes of 22 individuals had a mean age 63.9 ±10.3 years. Here were some of the findings:
• Six individuals had diabetes.
• Twenty-one eyes (48.8 percent) had retinal-choroidal anastomoses without any evidence of neovascularization extending laterally in a plane above or below the retinal pigment epithelium.
• No eyes had hemorrhages, lipids or signs of subretinal exudation.
• When present, an average of 55 ±33.7 individual RCAs were clustered primarily in temporal juxtafoveal region of involved eyes.
• Right-angle veins were seen in all 21 eyes with RCAs, and hyperpigmentation was present in 18 (p<
0.001 for both).
• Scientists found a conical collection of hyperreflective material spanning from Bruch’s membrane past external limiting membrane of ≥200-μm basal diameter in 21 eyes and labeled it as outer retinal hyperreflective lesion.
• Retinal-choroidal anastomoses occurred in clusters, often within the outer retinal hyperreflective lesion.
• The outer retinal hyperreflective lesion colocalized with focal thinning of the outer nuclear layer and was surrounded by a larger defect in the ellipsoid zone.
• The presence of diabetes (p=
0.015), outer retinal hyperreflective lesion (p=
0.006), RCA (p=
0.005) and ellipsoid zone defect extent (p<
0.001) were associated with decreased visual acuity.
Scientists wrote that retinal-choroidal anastomoses occurred in eyes with MacTel 2 without signs of exudation. In addition, they reported that retinal-choroidal anastomoses occurred in numerous clusters, particularly in the temporal juxtafoveal macula; and that diabetes, ellipsoid zone defect extent, RCAs and the outer retinal hyperreflective lesion predicted poorer vision in MacTel 2.
SOURCE: Breazzano MP, Yannuzzi LA, Spaide RF. Characterizing retinal-choroidal anastomosis in macular telangiectasia type 2 with optical coherence tomography angiography. Retina 2019; Jun 25. [Epub ahead of print].
Gonioscopy-assisted Transluminal Trabeculotomy for Steroid-induced Glaucoma
Researchers evaluated the efficacy of gonioscopy-assisted transluminal trabeculotomy for lowering the intraocular pressure in steroid-induced glaucoma. They performed a retrospective chart review of all GATT procedures performed on individuals with a predominant diagnosis of steroid-induced glaucoma between March 1, 2016, and March 30, 2018, at the University of Michigan.
Primary outcome measures included IOP, the number of IOP-lowering medications prescribed and the topical steroid dosing over the duration of follow up. A total of 13 individuals with steroid-induced glaucoma underwent the GATT procedure. Here were some of the findings:
• A significant reduction in the mean IOP was found at all postoperative visits.
• The average IOP decreased by 16.4 mmHg (55 percent) to 19.5 mmHg (63 percent) between three and 24 months postoperatively.
• By 24 months, all individuals had a reduction in IOP of >20 percent.
• The number of glaucoma medications decreased significantly from an average of 3.1 medications preoperatively to an average of 0.8 medications at last follow-up.
• The majority of individuals (>67 percent) required continued use of steroids at all postoperative visits. The most common postoperative complication was a transient hyphema (38 percent).
• No individuals required a repeat glaucoma surgery or anterior chamber washout.
Researchers wrote that their small case series suggested that GATT was an effective and safe surgical technique to decrease IOP and decrease medication burden in individuals with predominantly steroid-induced glaucoma. To their knowledge, this was the first study looking specifically at the efficacy of GATT for this condition.
Source: Boese EA, Shah M. Gonioscopy-assisted transluminal trabeculotomy (GATT) is an effective procedure for steroid-induced glaucoma. J Glaucoma. 2019; Jun 27. [Epub ahead of print].
Zeiss Receives FDA Clearance for CLARUS 700
Zeiss announced it received FDA 510(K) clearance for the CLARUS 700 high-definition, ultra-widefield imaging system. The system has true color and a complete range of fundus imaging modalities, including fluorescein angiography. The system’s high-resolution and high contrast FA images enable clinicians to capture minute details from the macula in early phases to the periphery in late phases of disease, the company says. Zeiss adds that the device captures images that closely resemble the natural coloration of the fundus as it appears under direct clinical observation. Learn more.
Survey: Retina Specialists Positively Impact Treatment for Macular Degeneration Patients
A new survey from Health Union finds that people with macular degeneration who regularly see a retina or macular degeneration specialist for care have more satisfaction with their health-care professional relationships and treatment plans, and have a better grasp of their condition than those who regularly see other health-care providers. Of the survey's 461 respondents, 51 percent said they see a retina specialist or macular degeneration specialist most often for their condition. The findings from the survey, titled “Macular Degeneration in America 2019,” support the launch of Health Union’s MacularDegeneration.net, a condition-specific online community. Read more.
Bausch + Lomb Launches Ocuvite Eye Performance Vitamins
Bausch + Lomb announced the U.S. launch of Ocuvite Eye Performance, an eye vitamin supplement formulated with seven nutrients that the company says help strengthen the macula. B+L says the product contains high levels of lutein and zeaxanthin, the two carotenoid pigments naturally found in the eye; omega-3’s to help support healthy tears and a healthy retina; zinc to help regulate immune function in the eye; vitamins C and E, antioxidants key to eye health; and vitamin D, an antioxidant to help prevent inflammation. Read more.
New Company Offers Dry-eye Device Arrangement
Startup company Physician Partnered Products says it will make available Johnson & Johnson Vision’s LipiFlow system for practices, including mentoring programs and collateral support, without the practice having to make a capital investment in the device. The company adds that it provides training in dry-eye treatment with the instrument, as well as ongoing education and support for billing, coding and marketing. Learn more.
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