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| Vol. 23, #11 • Monday, March 21, 2022 |
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MARCH IS WORKPLACE EYE WELLNESS MONTH
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A message from Review’s Chief Medical Editor, Mark H. Blecher, MD: Déjà vu all Over Again
You gotta love Yogi Berra. The absurdity of his quotes really resonates in the strange times we now live.
It’s spring again in the United States, the days get longer and the temperatures occasionally warmer. And, once again, the COVID numbers are crashing. I feel like I’ve been here before. And I, along with most of you, are looking forward to the return to normal life: ditching masks, resuming large gatherings, travel—everything. Yet, I feel a little uneasy as I recall last spring into summer which led us down a false path of hope. It’s true that we’re in a very different place this year. We’ve got multiple vaccines, multiple treatments, better understanding of the virus and, so far anyway, a milder variant to contend with. As we officially enter the endemic phase, we’re more comfortable with the possibility of ‘mild’ infections as long as hospitalizations remain low.
But I’m still uneasy.
Who could have predicted omicron? What does “mild” mean and do we really know that omicron is benign? I’m peering around every corner for the next shoe to drop in the COVID saga. And even if it really is “over,” the damage to our society will remain: a very different approach to work, a further weakening of civil society, changes in how we interact with each other. We won’t return to what we thought of as normal. It’ll be different. I’m still very happy to try to put all this behind us and move forward. What’s next, and who had “World War III” on their bingo card? I didn’t. As Roseanne Roseannadanna used to say on Saturday Night Live, “It’s always something.”
Mark H. Blecher, MD
Chief Medical Editor
Review of Ophthalmology
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Association of Angle-closure Extent & Anterior Segment Dimensions with IOP
Researchers investigated the association between the extent of iridotrabecular contact and other quantitative anterior-segment dimensions measured by swept-source optical coherence tomography (Casia SS-1000, Tomey) with intraocular pressure.
As part of a cross-sectional study, all subjects ≥50 years with no history of glaucoma, ocular surgery or trauma underwent SS-OCT imaging (eight equally spaced radial scans), Goldmann applanation tonometry and gonioscopy on the same day. Researchers measured:
• Iridotrabecular contact (ITC) index and area;
• total volume of trabeculo-iris space area (TISA 500 and 750);
• angle opening distance from the scleral spur (AOD 500 and 750);
• anterior chamber depth (ACD);
• volume, area and width;
• pupil diameter; lens vault; and
• iris volume.
They assessed the relationship between these metrics and IOP by locally weighted scatterplot smoothing (Lowess) regression with change-point analysis and generalized additive models adjusted for confounders.
A total of 2,027 right eyes of mostly Chinese Singaporeans (90 percent) were analyzed. Here are some of the findings:
• ITC index above a threshold of ~60 percent (CI, 34 to 92 percent) was significantly associated with higher IOP.
• Independent of the extent of ITC, ACD was significantly associated with higher IOP below a threshold of 2.5 mm (CI, 2.33 to 2.71 mm).
• Greater ITC index and shallower ACD had a joint association with IOP.
• A model including the ACD and ITC index was more predictive of IOP than a model considering these variables separately, particularly for women with gonioscopically closed angles (R2, 52.7 percent; p<0.05).
Researchers found that the extent of angle closure and the anterior chamber depth below a certain threshold had a significant joint association with IOP. They added that these parameters, as biometrical surrogates of mechanical obstruction of the aqueous outflow, may jointly contribute to elevated IOP, particularly in women with gonioscopic angle closure.
SOURCE: Porporato N, Chong R, Xu BY, et al. Angle closure extent, anterior segment dimensions and intraocular pressure. Br J Ophthalmol 2022; Mar 2. [Epub ahead of print].
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Association of Choroidal Thickness with RRD Repair
Investigators compared the choroidal thickness before and after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment repair, as part of a retrospective case series of RRD patients presenting between January 2015 and September 2020.
Subfoveal choroidal thickness (SFCT) and anatomical success were measured in post-PPV and fellow eyes at presentation, and at three and six months after PPV for RRD repair.
A total of 93 patients (59 percent male) with a mean age of 61.8 ±15.2 years were included. Here are some of the findings:
• Eighty-one patients were anatomically successful (group 1) while 12 re-detached (group 2).
• Mean SFCT of post-PPV eyes at presentation was 258.3 ±82 μm compared with 257.5 ±83.7 µm in fellow eyes (p=0.96).
• Group 2 presented with thicker SFCT than group 1 at baseline (309.2 ±56.2 vs. 250.7 ±82.8 μm; p=0.01).
• Both groups demonstrated a thinning trend throughout follow-up.
• At the six-month follow-up, the mean SFCT was 225.6 ±75.5 μm (p=0.05).
• Fellow eye SFCT was stable throughout follow-up (257 ±83.7 at baseline vs. 255 ±80.2 μm at six months).
Investigators reported that eyes with rhegmatogenous retinal detachment demonstrated thinning in the subfoveal choroidal thickness after vitrectomy surgery. Given that eyes with recurrent retinal detachment presented with thicker choroids at baseline, researchers suggest that thicker SFCT at presentation may play a role in retinal re-detachment.
SOURCE: Trivizki O, Eremenko R, Au A, et al. The association of choroidal thickness with rhegmatogenous retinal detachment repair. Retina 2022; Feb 25. [Epub ahead of print].
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Predictor of Meibomian Area Loss
Although meibography provides direct evidence of gland dropout in meibomian gland dysfunction, this specialized technique isn’t available in most clinics. Scientists aimed to determine which clinical ocular marker was most closely related to meibomian area loss.
One hundred participants ages 18 to 65 years were recruited. Measurements of the right eye and its upper eyelid included:
• noninvasive tear breakup time;
• bulbar and limbal redness scores;
• blepharitis score;
• lipid layer thickness;
• number of parallel conjunctival folds;
• tear osmolarity;
• corneal fluorescein staining;
• phenol red thread test;
• lid margin score;
• meibography; and
• in vivo confocal microscopy.
Participants also completed the Ocular Surface Disease Index questionnaire. Scientists determined the relationship between the measurements using the Spearman correlation. The receiver operating characteristic curve and area under the ROC curve were used to determine the cutoff value of clinical markers.
Here are some of the findings:
• Significant correlations were found between meibomian area and lid margin score (r=-0.47; p<0.01), and meibomian tortuosity and lid signs of blepharitis (r=-0.32, p<0.01).
• Area under the ROC curve analysis revealed that a lid margin score of ≥1.70 detected meibomian area loss, with a sensitivity of 0.58 and a specificity of 0.86.
• Significant correlations were found between meibomian area and orifice area at 30 μm depth (r=-0.25, p=0.01).
Scientists found that the lid margin score was most closely related to the meibomian area and was the best predictor of undiagnosed meibomian area loss.
SOURCE: Zhou N, Edwards K, Colorado LH, et al. Lid margin score is the strongest predictor of meibomian area loss. Cornea 2022; Mar 5. [Epub ahead of print].
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Complimentary CME Education Videos
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MNV Lesion Type and Vision Outcomes in AMD: Post Hoc Analysis of HARBOR
Researchers characterized the relationships between Consensus on Neovascular Age-Related Macular Degeneration Nomenclature (CONAN) Study Group classifications of macular neovascularization (MNV) and visual responses to ranibizumab in patients with neovascular age-related macular degeneration.
This post hoc analysis of the Phase III HARBOR trial of ranibizumab in nAMD included analyses of:
• ranibizumab-treated eyes with baseline multimodal imaging data;
• baseline MNV;
• subretinal and/or intraretinal fluid at screening, baseline or week 1; and
• spectral-domain optical coherence tomography images through month 24 (n=700).
Mean best-corrected visual acuity over time and mean BCVA change at months 12 and 24 were compared between eyes with type 1, type 2/mixed type 1 and 2 (type 2/M), and any type 3 MNV at baseline.
Here are some of the findings:
• At baseline, 263 eyes (37.6 percent) had type 1, 287 eyes (41 percent) had type 2/M, and 150 eyes (21.4 percent) had any type 3 lesions.
• Type 1 eyes had the best mean BCVA at baseline (59; CI, 57.7 to 60.3 letters) and month 24 BCVA (67.7; CI, 65.8 to 69.6 letters).
• Type 2/M eyes had the worst mean BCVA (50; CI, 48.6 to 51.4 letters) and month 24 BCVA (60.8; CI, 58.7 to 62.9 letters).
• Mean BCVA gains at month 24 were most pronounced for type 2/M eyes (10.8; CI, 8.9 to 12.7 letters), and similar for type 1 (8.7; CI, 6.9 to 10.5 letters) and any type 3 eyes (8.3; CI, 6.3 to 10.3 letters).
Researchers found that differences in BCVA outcomes between CONAN lesion type subgroups supported the use of an anatomic classification system to characterize MNV and prognosticate visual responses to anti-vascular endothelial growth factor therapy for nAMD.
SOURCE: Freund KB, Staurenghi G, Jung JJ, et al. Macular neovascularization lesion type and vision outcomes in neovascular age-related macular degeneration: Post hoc analysis of HARBOR. Graefes Arch Clin Exp Ophthalmol 2022; Mar 3. [Epub ahead of print].
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Industry News
Apellis Reports 18-month Pegcetacoplan Findings
Apellis Pharmaceuticals announced longer-term data from the Phase III DERBY and OAKS studies. The company says the data shows that intravitreal pegcetacoplan, an investigational, targeted C3 therapy, continued to reduce geographic atrophy lesion growth and demonstrate a “favorable” safety profile at month 18 for the treatment of GA secondary to age-related macular degeneration. The data will be included in the New Drug Application that the company plans to submit to the FDA in the second quarter of 2022, Apellis says. Read more.
Ocuphire Completes Enrollment in ZETA-1
Ocuphire Pharma completed enrollment of 103 diabetic patients with moderately severe to severe, non-proliferative diabetic retinopathy or mild proliferative diabetic retinopathy in ZETA-1, a Phase IIb trial evaluating the efficacy and safety of APX3330 for the treatment of diabetic retinopathy. Read more.
Glaukos Launches Phase II
Glaukos has launched a Phase II clinical program for its third-generation iLink corneal cross-linking therapy for keratoconus. The company says the therapy “builds upon Glaukos’ first-generation iLink Epi-off therapy and second-generation investigational iLink Epi-on therapy.” Read more.
Lineage’s OpRegen Phase I/IIa Results to Be Reported at ARVO Meeting
Lineage Cell Therapeutics announced that full results from a Phase I/IIa clinical study of RG6501 (OpRegen), a retinal pigment epithelium cell transplant therapy in development for the treatment of dry age-related macular degeneration, will be presented at the Association for Research in Vision and Ophthalmology annual meeting to be held May 1 to 4, at the Colorado Convention Center in Denver. Read more.
Personnel Moves
Visus Therapeutics, which is currently developing Brimochol, a topical drug to temporarily alleviate presbyopia, appointed Julia Williams as vice president of clinical and medical affairs. Williams previously worked at Aerie Pharmaceuticals, Allergan, Bausch + Lomb and Heidelberg Engineering. Read more.
Oyster Point recently announced that William J. Link, PhD, is retiring from the company’s board of directors, effective March 17, 2022. Dr. Link will continue to serve as a consultant to the company. Read more.
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