Review of Ophthalmology Online



Vol. 22, #13  •   Monday, March 29, 2021


In this Issue:


Characteristics of Peripapillary Choroid in Unilateral NTG

Researchers compared the characteristics of the peripapillary choroid (PPC) between both eyes of patients with unilateral treatment-naïve normal tension glaucoma, as part of an observational case series.

Sixty-nine patients (138 eyes) with treatment-naive unilateral NTG were included. Researchers evaluated the characteristics of PPC vasculature by measuring PPC thickness and assessing the presence of parapapillary deep-layer microvasculature dropout (MvD). They measured PPC thickness by enhanced depth imaging optical coherence tomography, and assessed MvD using OCT angiography. The area and maximum radial width of β-zone parapapillary atrophy (PPA) were measured on infrared images using the built-in caliper tool of the Spectralis OCT.

Main outcome measures included between-eye differences in PPC thickness, MvD frequency, and the area and maximum width of β-zone PPA.

Here are some of the findings:
• Eyes with NTG had higher intraocular pressure, longer axial length, thinner PPC, larger area and maximum radial width of the β-zone PPA, and more frequent MvD (p<0.01 each) than contralateral healthy eyes.
• Multivariate conditional logistic regression analysis revealed that higher IOP, thinner PPC, larger maximum radial width of β-zone PPA and the presence of MvD were independently associated with risk of NTG (p<0.03 each).
• MvD location and retinal nerve fiber layer defect were topographically correlated in eyes with NTG.

Researchers wrote that PPC vasculature characteristics were significantly more compromised in patients’ NTG eye than in their contralateral healthy eyes.

SOURCE: Kim JA, Son DH, Lee EJ, et al. Intereye comparison of the characteristics of the peripapillary choroid in patients with unilateral normal tension glaucoma. Ophthalmol Glaucoma 2021; Mar 3. [Epub ahead of print].




Role of Intra- and Subretinal Fluid on Outcomes of nAMD Treatment

Investigators assessed the effect of fluid status at baseline (BL) and at the end of the loading phase (LP) of three different ranibizumab regimens: treat-and-extend (T&E); fixed bimonthly (FBM) injections; and pro re nata (PRN), in patients with neovascular age-related macular degeneration.

In this post hoc analysis of the In-Eye study, patients were randomized 1:1:1 to the three study arms and were treated accordingly. Investigators analyzed the presence and type of fluid, intraretinal fluid (IRF) or subretinal fluid (SRF), and anatomical and visual outcomes.

Main outcome measures included best-corrected visual acuity, the mean change from baseline BCVA, and the proportion of eyes gaining more than 15 letters or losing more than five letters. Morphological characteristics including the subtype of choroidal neovascular membrane and the development of atrophy and fibrosis were also evaluated.

Here were some of the findings:
• Patients with SRF at the loading phase had better visual outcomes than patients with IRF.
• The persistence of SRF didn’t affect the mean change from baseline BCVA among the three treatment regimens; however, in patients with IRF, the mean change from baseline BCVA was significantly lower in the FBM group.
• The presence of IRF at baseline and at the end of the loading phase was associated with the development of fibrosis at the end of the study; this result was contrary to that observed for patients with SRF.

Investigators reported that, while subretinal fluid was compatible with good visual and anatomical outcomes, intraretinal fluid led to worse results in patients with nAMD. They added that their results suggested patients with intraretinal fluid may have better outcomes when individualized treatment regimens are used (PRN or T&E) vs. a fixed bimonthly regimen.

SOURCE: Saenz-de-Viteri M, Recalde S, Fernandez-Robredo P, et al; In-Eye Study Group. Role of intraretinal and subretinal fluid on clinical and anatomical outcomes in patients with neovascular age-related macular degeneration treated with bimonthly, treat-and-extend and as-needed ranibizumab in the In-Eye study. Acta Ophthalmol 2021; Mar 15. [Epub ahead of print].


Long-term Outcomes of DSAEK for Bullous Keratopathy After Argon Laser Iridotomy

Scientists evaluated the long-term outcomes of Descemet’s stripping automated endothelial keratoplasty for bullous keratopathy secondary to argon laser iridotomy (BK-ALI), as part of a retrospective chart review.

Forty-five eyes from 41 consecutive patients with BK-ALI who underwent DSAEK from July 2007 to December 2013 were retrospectively analyzed. Best spectacle-corrected visual acuity, endothelial cell density (ECD) and any complications were investigated over a 10-year postoperative period.

Here were some of the findings:
• The mean BCVA improved from 0.80 logMAR (around 20/126) before DSAEK to 0.28 logMAR (around 20/38) at six months after DSAEK; the mean values showed an additional slight improvement between six months and 10 years after the surgery (p<0.01).
• The mean ECD decreased from 2,864 cells/mm2 at baseline to 2,269 cells/mm2 (20.8-percent loss) at six months post-DSAEK, and this decreasing trend continued throughout the 10 years after DSAEK (p<0.01).
• The mean ECD was 1,148 cells/mm2 (59.9-percent loss) after five years, and 568 cells/mm2 (80.2-percent loss) after 10 years.
• No graft deaths were observed throughout the 10-year period (five-year follow-up rate: 60 percent; 10-year follow-up rate: 20 percent).

Scientists found that the 10-year outcomes of DSAEK for BK-ALI were excellent, with a high graft survival rate.

SOURCE: Ye Y, Mori N, Kobayashi A, et al. Long-term outcomes of Descemet stripping automated endothelial keratoplasty for bullous keratopathy after argon laser iridotomy. Jpn J Ophthalmol 2021; Mar 16. [Epub ahead of print].


Relationship Between Multilayered CNV & Choriocapillaris Flow Deficits in AMD

Researchers used optical coherence tomography angiography to test the hypothesis that more complex, multilayered choroidal neovascular membranes in age-related macular degeneration were associated with worse flow deficits (FD) in the choriocapillaris.

A retrospective, cross-sectional study included 29 eyes of 29 subjects with neovascular AMD. En face choriocapillaris images were compensated for signal attenuation using the structural optical OCT slab and signal normalization based on a cohort of healthy subjects. Researchers binarized the choriocapillaris using local Phansalkar and global MinError(I) methods, FD count/density; and mean FD size in the area outside the CNV, in the 200-µm annulus surrounding the CNV and in the area outside the annulus. They used projection-resolved OCTA to quantify CNV complexity, including highest CNV flow height, number of flow layers and flow layer thickness. Researchers assessed the relationship between CNV complexity and choriocapillaris FD using Spearman correlations.

Here are some of the findings:
• The highest CNV flow signal significantly correlated with lower FD count (p<0.01), higher FD density (p<0.05) and higher mean FD size (p<0.05) in the area outside the annulus and the CNV, using Phansalkar and MinError(I).
• Within the annulus, CNV complexity wasn’t consistently correlated with choriocapillaris defects.

Researchers determined that CNV vascular complexity was correlated with choriocapillaris FD outside the CNV area, providing evidence for the importance of choriocapillaris dysfunction in neovascular AMD, as well as the potential role of choroidal ischemia in the pathogenesis of complex CNV membranes.

SOURCE: Nesper PL, Ong JX, Fawzi AA. Exploring the relationship between multilayered choroidal neovascularization and choriocapillaris flow deficits in AMD. Invest Ophthalmol Vis Sci 2021; Mar 1. [Epub ahead of print.]




Industry News

Rayner RayOne EMV IOL Receives FDA Approval

Rayner has received U.S. Food and Drug Administration approval for it's non-diffractive RayOne EMV IOL, which the company calls, "An effective solution for patients when diffractive IOLs may be cost-prohibitive or if there are concerns about dysphotopsia." The company adds that the lens was developed in collaboration with Australian surgeon Professor Graham Barrett, president of the Australasian Society of Cataract & Refractive Surgeons.
Dr. Mariano Royo, director of ophthalmology at the Hospital San Rafael in Madrid and director of the Ophthalmic Institute of Madrid, performed a study of 22 eyes of 11 patients implanted with RayOne EMV measured at six months postop. Dr. Royo reported that 100 percent of the patients achieved spectacle independence in the distance and intermediate range. The average reading add at 33 cm was reported to be +1.5 D, and one in three patients had functional near vision without the need for spectacles.1
Patient outcomes for RayOne EMV can be tracked using RayPRO, a free contactless telehealth solution that collects three years’ worth of patient reported outcomes after cataract or refractive surgery. To request clinical results from Dr. Royo's study, more information on RayOne EMV or an evaluation, contact: You can also visit the company website at
1. Data on file. Rayner.


Lineage Presents More Data on OpRegen for Dry AMD with GA

Lineage Cell Therapeutics announced new interim results from its ongoing, 24-patient Phase I/IIa clinical study of its lead product candidate, OpRegen, an investigational cell therapy administering allogeneic retinal pigment epithelium cells to the subretinal space for the treatment of dry age-related macular degeneration with geographic atrophy. Overall, 75 percent of cohort 4 patients’ treated eyes were at or above baseline visual acuity at their last assessment, based on per protocol-scheduled visits ranging from three months to >2 years post-transplant. Improvements in best-corrected visual acuity reached up to +19 letters on an EDTRS chart. Learn more.



ProQR Announces Results from QR-421a Trial

ProQR Therapeutics announced results from a planned analysis of its Phase I/II Stellar trial of QR-421a in adults with Usher syndrome and non-syndromic retinitis pigmentosa due to USH2A exon 13 mutations. In the trial, the company says that QR-421a demonstrated benefits on multiple measures of vision, including visual acuity, visual fields and optical coherence tomography retinal imaging after a single dose. QR-421a was observed to be well-tolerated with no serious adverse events, the company says. Read more.



SemaThera Enters Into Research Collaboration & Exclusive License Agreement with Roche

SemaThera announced the signing of a multi-year research collaboration and licensing agreement with Roche. The partnership will focus on developing SemaThera’s new class of biologicals for the treatment of diabetic retinopathy and other ischemic retinal diseases. SemaThera holds exclusive rights to various technologies in which Semaphorin 3A is involved in neo-angiogenesis, senescence and neuronal regeneration. Read more.

New Website Supports AMD Patients

The American Macular Degeneration Foundation, BrightFocus Foundation, MD Support, Prevent Blindness and The SupportSight Foundation launched AMD Central, an online resource that “provides information and tools from leading advocacy organizations to support age-related macular degeneration patients and the caregiver community.” Learn more.



Complimentary CME Education Videos




Prevent Blindness Names April as Women’s Eye Health and Safety Month

Prevent Blindness Named April as Women’s Eye Health and Safety Month to raise awareness on the fact that women are at higher risk for most eye diseases, and provide free information on topics ranging from possible vision changes during pregnancy to the safe use of eye cosmetics. Read more.





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