Review of Ophthalmology Online



Vol. 23, #10  •   Monday, March 14, 2022


In this Issue:





Association of Initial OCTA Vessel Density Loss With Faster VF Loss in Glaucoma

Researchers evaluated the association between the rate of vessel density loss during initial follow-up and the rate of visual field loss during an extended follow-up period in glaucoma suspects and those with primary open-angle glaucoma.

This retrospective cohort study assessed 124 eyes (86 with POAG and 38 suspects) of 82 patients followed up at a tertiary glaucoma center for a mean of four years (CI, 3.9 to 4.1 years) from January 1, 2015, to February 29, 2020. Data analysis for the current study began in March 2021.

The rate of vessel density loss was derived from macular whole-image vessel density values from three optical coherence tomography angiography scans early during the study. The rate of VF loss was calculated from VF mean deviation during the follow-up period after the first OCTA visit. Linear mixed-effects models were used to estimate rates of change.

A total of 124 eyes from 82 patients were assessed. Here are some of the findings:
• The annual rate of vessel density change was -0.80 percent (CI, -0.88 to -0.72 percent) during a mean initial follow-up of 2.1 years (CI, 1.9 to 2.3 years).
• Eyes with annual rates of vessel density loss of -0.75 percent or greater (n=62) were categorized as fast progressors, and eyes with annual rates of less than -0.75 percent (n=62) were categorized as slow progressors.
• The annual rate of VF loss was -0.15 dB (CI, -0.29 to -0.01 dB) for slow OCTA progressors and -0.43 dB (CI, -0.58 to -0.29 dB) for fast OCTA progressors (difference, -0.28 dB; CI, -0.48 to -0.08 dB; p=.006).
• The fast OCTA progressor group was associated with faster overall rate of VF loss in a multivariable model after adjusting to include concurrent VF mean deviation rate (-0.17 dB; CI, -0.33 to -0.01 dB; p=.04).

Researchers wrote that faster vessel density loss during an initial follow-up period was associated with faster concurrent and subsequent rates of visual field loss during an extended period.

SOURCE: Nishida T, Moghimi S, Wu JH, et al. Association of initial optical coherence tomography angiography vessel density loss with faster visual field loss in glaucoma. JAMA Ophthalmol 2022; Feb 24. [Epub ahead of print].





OCT Predictors of Three-year Visual Outcomes for Type 3 MNV

Investigators identifed baseline optical coherence tomography predictors of the three-year visual outcome for type 3 (T3) macular neovascularization secondary to age-related macular degeneration treated by anti-vascular endothelial growth factor therapy.

The retrospective longitudinal study included 40 eyes of 30 patients affected by exudative treatment-naïve T3 MNV. Baseline best-corrected visual acuity and several baseline OCT features were assessed and included in the analysis. Univariate and multivariate analyses served to identify risk factors associated with three-year BCVA.

Main outcome measures included baseline OCT features associated with bad or good visual outcome of type 3 MNV treated by anti-VEGF injections.

Here are some of the findings:
• Mean baseline BCVA of 0.34 ±0.28 logMAR significantly decreased to 0.52 ±0.37 logMAR at the end of three-year follow-up (p=0.002).
• In the univariate analysis, the following baseline features were associated with the three-year BCVA outcome: o baseline BCVA (p=0.004);
   o foveal involvement of exudation (p=0.004); and
   o presence of subretinal fluid (SRF)(p=0.004).
• In the multivariate model, the following factors were associated with three-year BCVA outcomes:
   o baseline BCVA (p=0.032); o central macular thickness (p=0.036);
   o number of active T3 lesions (p=0.034); and
   o presence of SRF (p=0.008).
• Three-year BCVA was significantly lower in 19 eyes with SRF at baseline (0.69 ±0.42 logMAR) compared with 21 eyes without SRF (0.37 ±0.24 logMAR, p=0.004).

Investigators identified structural OCT features associated with BCVA outcomes after three-year treatment with anti-VEGF injections. They wrote that, unlike some previous findings on neovascular AMD, the presence of SRF at baseline was the most significant independent negative predictor of functional outcomes. They added that their strategy may be used to identify less favorable T3 patterns requiring a more intensive treatment.

SOURCE: Sacconi R, Forte P, Tombolini B, et al. Optical coherence tomography predictors of 3-year visual outcome for type 3 macular neovascularization. Ophthalmol Retina 2022; Feb 25. [Epub ahead of print].


Complimentary CME Education Videos



Utility of Epithelial Thickness Mapping in Refractive Surgery Evaluations

Scientists determined the value of corneal epithelial thickness maps for screening for refractive surgery candidacy, in a single refractive surgical practice.

They evaluated 100 consecutive patients who presented for refractive surgery screening. For each patient, screening was done by performing Scheimpflug tomography, and evaluating clinical data and patient history. A decision was independently made by two masked examiners on eligibility for LASIK, PRK, and SMILE. After examiners were shown patients' epithelial thickness maps derived from optical coherence tomography, they determined the percentage of patient cases that changed regarding surgical candidacy and ranking of surgical procedures from most to least favorable.

Here are some of the findings:
• Candidacy for corneal refractive surgery changed in 16 percent of patients after evaluation of epithelial thickness maps, with 10 percent of patients screened in and 6 percent screened out.
• Chosen surgery changed for 16 percent of patients, and the ranking of surgical procedures from most to least favorable changed for 25 percent of patients.
• Eleven percent of patients gained eligibility for LASIK while 8 percent lost eligibility for LASIK.
• No significant difference was found between the evaluations of the two examiners.

Scientists found that epithelial thickness mapping derived from OCT imaging of the cornea altered candidacy for corneal refractive surgery as well as choice of surgery in a substantial percentage of patients, and was determined to be a valuable tool for screening evaluations. Overall, scientists wrote, the use of epithelial thickness maps resulted in screening for corneal refractive surgery in a slightly larger percentage of patients.

SOURCE: Asroui L, Dupps WJ, Randleman JB. Determining the utility of epithelial thickness mapping in refractive surgery evaluations. Am J Ophthalmol 2022; Mar 2. [Epub ahead of print].


Foveal Thickness Fluctuation in Anti-VEGF Treatment for BRVO

Branch retinal vein occlusion causes macular edema that can be controlled with anti-vascular endothelial growth factor treatments. However, these treatments are not curative, necessitating additional anti-VEGF treatments at recurrences. Long-term results, optimal anti-VEGF treatment regimens and the comprehensive effects of ME recurrences are largely unknown, researchers wrote. Thus, they aimed to examine the effects of foveal thickness fluctuation (FTF) on visual and morphologic outcomes following anti-VEGF treatments for BRVO-ME administered via a pro re nata regimen.

The retrospective, observational case series analyzed 309 treatment-naïve patients (309 eyes) with BRVO-ME between 2012 and 2021, at a multicenter retinal practice.

FT was assessed via optical coherence tomography at each study visit.

Researchers evaluated the logMAR best-corrected visual acuity and defect length of the foveal ellipsoid zone (EZ) band via OCT.

Here are some of the findings:
• At baseline, the mean logMAR BCVA was 0.30 ±0.30 and the mean FT was 503 ±162 μm.
• The number of anti-VEGF injections for BRVO-ME was 5.8 ±4.6 during the mean follow-up period (50.6 ±22.2 months).
• At the final exam, the mean logMAR BCVA and FT values were significantly improved compared with the baseline.
• Multiple regression analyses showed that age, baseline logMAR BCVA and FTF were significantly associated with the final logMAR BCVA (β=0.20, 0.35 and 0.30, respectively).
• FTF (divided into groups 0 to 3 in ascending order of FTF) was significantly associated with the logMAR BCVA and the defect length of the foveal EZ band at the final exam.
• The defect lengths of the foveal EZ band were longitudinally shortened in groups 0 to 1, and were slightly prolonged in groups 2 to 3.
• The logMAR BCVA maintained improvements in groups 0 to 1, and worsened slightly in groups 2 to 3.

Researchers found that FTF was significantly associated with visual acuity and foveal photoreceptor status. They suggested that identifying the characteristics of eyes with a larger FTF and controlling FTF more strictly may improve the morphologic and functional prognosis of eyes with BRVO.

SOURCE: Nagasato D, Muraoka Y, Tanabe M, et al. Foveal thickness fluctuation in anti-vascular endothelial growth factor treatment for branch retinal vein occlusion: A long-term study. Ophthalmol Retina 2022; Feb 23. [Epub ahead of print].




Industry News

Allergy-Fighting Contact Lens Approved

Most soft contact lenses aim to be minimally disruptive to the ocular surface, but Johnson & Johnson says its new daily-disposable lens, the Acuvue Theravision, takes an active role: releasing an antihistamine to fight allergy. The lens, which just received FDA approval, contains 19 µg of the antihistamine ketotifen. Patients who experience ocular itch due to allergic conjunctivitis can get relief as quickly as three minutes after insertion, with a potential effect lasting up to 12 hours, according to the company. The lens may be worn for longer than 12 hours for vision correction. It’s available in powers of -12 D to +6 D, with no toric component, so patients can have no more than 1 D of astigmatism in order to use it. Read more.

New World Medical Updates Streamline Surgical System Status

New World Medical announced its glaucoma surgical offering, called the Streamline Surgical System, received FDA 510k clearance October 8, 2021, which prompted a “limited soft launch” that included commencing Phase IV clinical studies. The viscocanalostomy device is designed to create goniotomies in the trabecular meshwork and deliver small amounts of viscoelastic into Schlemm’s canal in one step, either alone or in combination with cataract surgery. Learn more about the company.

Lensar Announces FDA Progress for Ally

Lensar announced the FDA accepted its Ally Adaptive Cataract Treatment System 510(k) submission for substantive review. The company plans to submit an additional 510(k) application seeking clearance for phacoemulsification features within the integrated Ally system later in the year. Read more.

Prevent Blindness Holds 17th Annual Advocacy Event

Prevent Blindness held its 17th annual Eyes on Capitol Hill advocacy day virtually March 1 to 2. The program provided patients, caregivers, allied personnel and medical professionals direct access to their elected officials. Learn more.

Lumithera Acquires Diopsys

Electrophysiology-device maker Diopsys is now a wholly-owned subsidiary of Lumithera. Read more.


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