Review of Ophthalmology Online



Vol. 20, #44   •   Monday, October 19, 2020


In this Issue:


Visit Adherence & VA Outcomes in DME: Analysis of DRCRnet Protocol T

Researchers quantified the association between visit adherence and visual acuity in diabetic macular edema, as part of a secondary analysis of the two-year DRCRnet Protocol T study of 656 individuals.

Individuals were required to have one visit every four weeks in the first year, then variable four-to-16-week interval visits in the second year. Visit adherence was measured as:
• number of missed visits;
• average (average days) and longest (maximum days) visit interval;
• average (average missed days) and longest (maximum missed days) unintended visit interval; and
• visit constancy (percentage of three-month periods with at least one visit).

Average and maximum missed days were categorized as on time (0 days), late (>0 to 60 days) and very late (>60 days).

The primary outcome was change in ETDRS VA between baseline and last attended visit using multivariate linear regression models controlling for: age; gender; race; ethnicity; treatment arm; baseline VA; hemoglobin A1c; insulin use; and number of lasers and injections.

Here were some of the findings:
• The mean number of missed visits was 1.7.
• A total of 616 (94 percent) individuals had 100 percent visit constancy.
• A total of 331 (51 percent) individuals were on time; 171 (26 percent) were late; and 154 (23 percent) very late in average missed days.
• Maximum missed days ranged from zero to 696 days.
• Adjusted, each missed visit was associated with 0.3-letter decrease (CI, 0.6 to 0.1, p=0.02); being very late in average and maximum missed days saw -4.2 letters (CI, -6.4, -2, p<0.001) and -4 letters (CI, -6.1 to -1.9, p<0.001), respectively, than on time.
• Those that averaged >4 days missed per attended visit saw 4.6 letters worse (CI, -7.3, -2, p<0.001).

Researchers concluded that visit adherence was associated with better visual acuity outcomes in DME patients.

SOURCE: Ramakrishnan MS, Yu Y, VanderBeek BL. Visit adherence and visual acuity outcomes in patients with diabetic macular edema: A secondary analysis of DRCRnet Protocol T. Graefes Arch Clin Exp Ophthalmol 2020 ; Sep 30. [Epub ahead of print].


Complimentary CME Education Videos


Detecting Morphologic DME Patterns Using OCT-based Deep Learning

Investigators developed a deep learning model to detect morphologic patterns of diabetic macular edema based on optical coherence tomography images.

In the training set, 12,365 OCT images were extracted from a public dataset and an ophthalmic center. A total of 656 OCT images was extracted from another ophthalmic center for external validation. The presence or absence of three OCT patterns of DME—including diffused retinal thickening (DRT), cystoid macular edema (CME) and serous retinal detachment (SRD)—were labeled with one or zero, respectively. A DL model was trained to detect three OCT patterns of DME. An occlusion test was applied for visualization of the DL model.

• Applying a five-fold cross-validation method in internal validation:
   o the area under the receiver operating characteristic curve for detection of three OCT patterns (i.e., DRT, CME and SRD) was: 0.971, 0.974, and 0.994, respectively;
   o accuracy was 93 percent, 95.1 percent and 98.8 percent, respectively; and
   o sensitivity was 93.5 percent, 94.5 percent and 96.7 percent, respectively; and
   o specificity was 92.3 percent, 95.6 percent and 99.3 percent, respectively.
• In external validation:
   o the AUC was: 0.970, 0.997, and 0.997, respectively;
   o accuracy was 90.2 percent, 95.4 percent and 95.9 percent, respectively;
   o sensitivity was 80.1 percent, 93.4 percent and 94.9 percent, respectively; and
   o specificity was 97.6 percent, 97.2 percent, and 96.5 percent, respectively.
• The occlusion test showed that the DL model could successfully identify the pathologic regions most critical for detection.

Investigators wrote that their DL model demonstrated high accuracy and transparency in detecting OCT patterns of DME. The results emphasized the potential of artificial intelligence to aid clinical decision-making processes for DME patients.

SOURCE: Wu Q, Zhang B, Hu Y, et al. Detection of morphologic patterns of diabetic macular edema using a deep learning approach based on optical coherence tomography images. Retina 2020; Oct 1. [Epub ahead of print].


Complimentary CME Education Videos


Factors Associated with Favorable Laser Trabeculoplasty Response

Scientists examined a large clinical registry to assess factors associated with laser trabeculoplasty responses, as part of a retrospective cohort study. The population included LTP patients in the Intelligent Research in Sight (IRIS) Registry, 2013-2018.

IRIS Registry data were extracted if eyes had a procedural code for LTP and a glaucoma diagnosis. Eyes were excluded if LTP laterality or baseline IOP couldn’t be determined. Following LTP, “nonresponders” were those with <20 percent IOP reduction after eight weeks, and “responders” were those with >20 percent IOP reduction.

The main outcome measures included proportion of responders and odds ratios of pre-LTP factors associated with being a nonresponder.

Here were some of the findings:
• A total of 263,480 eyes were included, with mean age 71.4 ±11.7 years.
• Mean baseline IOP was 19.1 ±5 mmHg, and mean number of pre-LTP medications was 2.1 ±1.5.
• Response rate was 36.9 percent overall and 68.8 percent for those with baseline IOP >24 mmHg.
• Higher baseline IOP was associated with reduced odds of nonresponse (OR=0.60, p<0.0001 for a 3-mmHg increase).
• Angle recession, uveitis and aphakia increased the odds of a nonresponse (Respective ORs: 2.46, 1.50 [both p<0.0001]; and 1.55 [p=0.0259]).
• In nonresponders with at least one medication at baseline, 76.3 percent of eyes had fewer medications postoperatively.

Scientists reported that lower baseline IOP, angle recession, uveitis and aphakia were associated with increased odds of nonresponse. They added that future studies that analyze LTP responder survival and implementation lags could help optimize resources in glaucoma therapy.

SOURCE: Chang TC, Parrish RK, Fujino D, et al. Factors associated with favorable laser trabeculoplasty response: IRIS Registry Analysis. Am J Ophthalmol 2020; Oct 10. [Epub ahead of print].


How Cataract Surgery Rate Affects Angle Closure Prevalence

Researchers estimated the effects of cataract surgical rates on the prevalence of primary angle-closure glaucoma in a Chinese population. Participants ages 50 years and older from the Liwan Eye Study were included as the study sample.

Researchers evaluated occludable angle (OA) as a surrogate of PACG using static gonioscopy, and they measured anterior chamber depth (ACD) before dilation using A-mode ultrasound. They used random sampling to generate 50 cohorts with sample size of 200 for each predefined cataract surgical rate of 2,000, 4,000, 6,000, 8,000, 10,000 and 12,000 per million people, according to the multinomial distribution. Researchers calculated the mean ACD and OA rates of each cohort. They used logistic function models of nonlinear least-squares estimation to predict the prevalence of OA.

Data of the right eye from 1,280 participants were included. Here were some of the findings:
• The prevalence of cataract surgery was 2.27 percent and OA was 11.3 percent.
• In the cohorts with the following cataract surgical rates, the projected prevalence of OA was:
   o 2,000: 11.4 percent (CI, 10.8 to 12 percent);
   o 4,000: 11.2 percent (CI, 10.6 to 11.9 percent);
   o 6,000: 10.9 percent (CI, 10.3 to 11.6 percent);
   o 8,000: 11.4 percent (CI, 10.8 to 12.1 percent);
   o 10,000: 10.8 percent (CI, 10.2 to 11.4 percent); and
   o 12,000: 10.1 percent (CI, 9.46 to 10.7 percent).
• The OA rates decreased remarkably as CSR increased for those ages 70 years and older.

Researchers wrote that an increase in CSR may be associated with a decrease in OA prevalence, especially in an older population. They added that cataract surgery should be performed at an appropriate time for individuals in their late 60s to 70s with significant cataracts.

SOURCE: Jin G, Wang L, Scheetz J, et al. How does cataract surgery rate affect angle closure prevalence. J Glaucoma 2020 Oct 7. [Epub ahead of print].






Industry News

New World Medical Registers KDB Glide for Goniotomy

New World Medical announced FDA registration of the KDB Glide as a class 1 medical device, designed to give surgeons a refined, precise experience performing excisional goniotomy for treatment of glaucoma. The company says the device improves on the successful Kahook Dual Blade technology by adding features such as a rounded heel, tapered sides and a smaller footplate in order to optimally interface with Schlemm’s canal for precise excision with the instrument's dual blades, even in variable anatomy. Read more.



Bausch Health Licenses Eyenovia's Investigational Treatment

Bausch Health Companies and Eyenovia announced that an affiliate of Bausch Health acquired an exclusive license in the United States and Canada for the development and commercialization of an investigational microdose formulation of atropine ophthalmic solution, which is being investigated for the reduction of pediatric myopia progression in children ages 3 to12. This investigational formulation of atropine is delivered with Eyenovia's proprietary Optejet dispenser technology. Read more.



Prevent Blindness Names Jobson’s Ferrara Person of Vision Award Recipient

Prevent Blindness has chosen Marc Ferrara, CEO of information services, Jobson Medical Information, as the recipient of the 2021 Prevent Blindness Person of Vision Award. The award will be presented on May 26, 2021, at the Prevent Blindness Person of Vision Dinner in New York City in conjunction with Vision Expo East. All proceeds will go to support the sight-saving programs from Prevent Blindness.
The Prevent Blindness Person of Vision Award recognizes an individual or organization whose inspired outlook champions healthy vision and its importance for a healthy life. Ferrara has worked at Jobson Publishing for more than 30 years. In 1989, he was named editor-in-chief of 20/20 magazine and was later named publisher of the magazine. Later, he helped launch Sightstreet, one of the optical industry's initial ventures in web-related initiatives, and later managed VisionWeb, the industry's leading wholesale portal. Ferrara served as president of JHI's worldwide Optical Group since 2005, with wide-ranging responsibilities including 20/20, Frames Data, Vision Monday, Review of Optometry, Review of Ophthalmology, Jobson Research, Jobson Internet Solutions and Jobson's international business in Europe, Latin America and Asia. At Prevent Blindness, Ferrara has served on various committees, including as chair of the 2017 Person of Vision Committee, honoring Marge Axelrad, senior vice president, editorial director at Vision Monday/Jobson Optical Group. He has also volunteered for numerous Prevent Blindness events, including the annual Swing Fore Sight golf outings. Read more.




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