Review of Ophthalmology Online



Vol. 22, #40  •   Monday, September 27, 2021


In this Issue:


A message from Review’s Chief Medical Editor, Mark H. Blecher, MD: To Go or Not to Go

Back in the spring, when it seemed that we had turned a crucial corner in the fight against COVID, I encouraged you all to get out there and re-engage with the world. More specifically to re-engage with each other and to support the institutions that make our profession so successful. I encouraged you to attend a meeting in person. Some did, most didn’t. Presumably, those that didn’t continued to obtain news and education virtually as we had for the last 18 months. This virtual approach is useful—and possibly adequate—but not terribly gratifying, at least to me.

I attended the ASCRS meeting in Las Vegas. It was wonderful and felt good, and I came home safely. But we knew even then that the tide was turning. As we finish the summer of Delta, and enter the fall of the same name, how much will we be out there? Will we travel? Will we gather in large groups? The AAO is scheduled to meet in New Orleans in mid-November, which is still more than six weeks away. While the COVID rate in Louisiana has recently dropped, it’s still quite high, and hospitals are quite full. Though the Academy is making plans to gather more safely while in the Convention Center, that doesn’t help when you step off the plane or out the door, and takes a bit of the allure away from actually attending. Also, all this assumes that the city is fully recovered from Ida. I’m still planning on going but, as opposed to the spring when I encouraged all you vaccinated physicians to get out and go, I can’t be as vocal in my support. Attending will likely be more somber and cautious. I’d like to be wrong and have the situation much improved by then, but decisions are being made now and I completely understand if you decide to stay home.

Mark H. Blecher, MD
Chief Medical Editor
Review of Ophthalmology



Effect of Achieving Target IOP on VF Worsening

Researchers estimated the effect of achieving target intraocular pressure values on visual field worsening in a treated clinical population, as part of a retrospective analysis of longitudinal data.

A total of 2,852 eyes of 1,688 patients with glaucoma-related diagnoses treated in a tertiary care practice were included. All eyes had at least five reliable VF tests and five IOP measures on separate visits, along with at least one target IOP defined by a clinician on the first or second visit.

The primary dependent variable was the slope of the mean deviation over time (dB/year). The primary independent variable was mean target difference (measured IOP minus target IOP). Researchers created simple linear regression models and mixed-effects linear models to study the relationship between MD slope and mean target difference for individual eyes. In the mixed effects models, they included an interaction term to account for disease severity (mild/suspect, moderate or advanced) and a spline term (a special math function) to account for the differing effects of achieving target IOP (target difference ≤0) and failing to achieve target IOP (target difference >0).

Main outcome measures included rate of change in MD slope (changes in dB/year) per 1 mmHg change in target difference at different stages of glaucoma severity.

Here are some of the findings:
• Across all eyes, a simple linear regression model demonstrated that a 1 mmHg increase in target difference had a -0.018 dB/year (CI, -0.026 to -0.011; p<0.05) effect on MD slope.
• The mixed effects model showed that eyes with moderate disease that failed to achieve target IOP experienced the largest effects, with a 1-mmHg increase in target difference resulting in a 0.119 dB/year (CI, -0.168 to -0.070; p<0.05) worse MD slope.
• The effects of missing target IOP on VF worsening were much more pronounced than the effect of absolute level of IOP on VF worsening, where a 1 mmHg increase in IOP had a -0.004 dB/year (CI, -0.011 to 0.003; p>0.05) effect on the MD slope.

Researchers wrote that, in treated patients, failing to achieve target IOP was associated with more rapid VF worsening. They added that eyes with moderate glaucoma experienced the greatest VF worsening from failing to achieve target IOP.

SOURCE: Villasana GA, Bradley C, Ramulu P, et al. The effect of achieving target intraocular pressure on visual field worsening. Ophthalmology 2021; Sep 7. [Epub ahead of print].




Visual Outcomes & Morphologic Biomarkers of Vision Loss in DME Eyes Treated with Anti-VEGF Therapy

Investigators analyzed the morphological characteristics and long-term visual outcomes in eyes with diabetic retinopathy and diabetic macular edema treated with anti-vascular endothelial growth factor therapy, as part of a retrospective clinical cohort study.

They included subjects with a long-term follow-up and evidence of resolved DME in at least one visit (study visit) after five years of follow-up following the initiation of anti-VEGF therapy. At the study visit, structural OCT scans were reviewed for qualitative features reflecting a distress of the neuroretina or retinal pigment epithelium. A quantitative topographical assessment of the inner and outer retinal thicknesses was also provided.

Sixty-one eyes (50 patients) were included and divided into two subgroups according to the visual acuity at the study visit, yielding a group of 24 eyes with a VA <20/40 ("poor/intermediate vision" group), and 37 eyes with a VA ≥20/40 ("good vision" group). Here are some of the findings:
• The external limiting membrane (ELM) and RPE bands were more frequently disrupted/absent in the poor/intermediate vision group (p=0.003 and p=0.019).
• Disorganization of retinal inner layers was more prevalent in the "poor/intermediate vision" group (p=0.013).
• Foveal and parafoveal outer retinal thicknesses were reduced in poor/intermediate vision eyes (p=0.022 and p=0.044).
• Multivariate stepwise linear regression analysis demonstrated that VA was associated with appearance of the RPE and ELM (p<0.0001 and p=0.048, respectively), and foveal and parafoveal outer retinal thicknesses (p=0.046 and p=0.035, respectively).

Investigators found that modifications in the outer retina and RPE represented OCT biomarkers of long-term visual outcomes in eyes with DME treated with anti-VEGF.

SOURCE: Borrelli E, Grosso D, Barresi C, et al. Long-term visual outcomes and morphologic biomarkers of vision loss in eyes with diabetic macular edema treated with anti-VEGF therapy. Am J Ophthalmol 2021; Sep 9. [Epub ahead of print].



Rates of Myopia Development in Young Chinese Schoolchildren During COVID Outbreak

Scientists evaluated changes in the development of myopia in young Chinese schoolchildren during the outbreak of COVID-19 in an observational study.

Two groups of students from 12 primary schools in Guangzhou, China, were prospectively enrolled and monitored from grade 2 to 3. Comparisons between the exposure and non-exposure groups were made to evaluate any association between environmental changes during the COVID-19 outbreak period and development of myopia. The exposure group received complete eye exams in November and December 2019, and November and December 2020. The non-exposure group received exams in November and December 2018, and November and December 2019.

Main outcomes and measures included changes in cycloplegic spherical equivalent refraction (SER), axial length (AL) elongation and myopia incidence from grade 2 to 3.

Among the 2,679 eligible students in grade 2 (mean age: 7.76 ±0.32 years; 1,422 [53.1 percent] male), 2,114 (1,060 in the non-exposure group and 1,054 in the exposure group) were reexamined in grade 3. Here are some of the findings:
• Compared with the period from November and December 2018, to November and December 2019, the shift of SER, AL elongation and myopia incidence from grade 2 to 3 from November and December 2019, to November and December 2020 was 0.36D greater (CI, 0.32 to 0.41; p<0.001), 0.08 mm faster (CI, 0.06 to 0.10; p<0.001) and 7.9 percent higher (CI, 5.1 to 10.6 percent; p<0.001), respectively.
• In grade 3 students, the prevalence of myopia increased from 13.3 percent (141 of 1,060 students) in November and December 2019, to 20.8 percent (219 of 1054 students) in November and December 2020 (difference [CI], 7.5 percent [4.3 to 10.7]; p<0.001); the proportion of children without myopia and with SER greater than -0.50 D and less than or equal to +0.50 D increased from 31.1 percent (286 of 919 students) to 49 percent (409 of 835 students)(difference [CI], 17.9 percent [13.3 to 22.4]; p<0.001).

Scientists determined that development of myopia increased during the COVID-19 outbreak period in young schoolchildren in China. Consequently, they added, myopia prevalence and the proportion of children without myopia who were at risk of developing myopia increased. They suggested that future studies would be needed to investigate long-term changes in myopia development after the COVID-19 pandemic.

SOURCE: Hu Y, Zhao F, Ding X, et al. Rates of myopia development in young Chinese schoolchildren during the outbreak of COVID-19. JAMA Ophthalmol 2021; Sep 16. [Epub ahead of print].


Complimentary CME Education Videos


Intravitreal Pharmacotherapies for DME: A Report by the American Academy of Ophthalmology

Authors reviewed evidence on the safety and efficacy of current anti-vascular endothelial growth factor and intravitreal corticosteroid pharmacotherapies for the treatment of diabetic macular edema.

Literature searches were last conducted on May 13, 2020, in the PubMed database with no date restrictions and limited to articles published in English. The combined searches yielded 230 citations, of which 108 were reviewed in full text. Of these, 31 were deemed appropriate for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist.

Only the 21 articles with level I evidence were included in this assessment. Here are some of the findings:
• Seventeen articles provided level I evidence for one or more anti-VEGF pharmacotherapies, including ranibizumab (14), aflibercept (5), and bevacizumab (2) alone or in combination with other treatments for DME.
• Level I evidence was identified in seven articles on intravitreal corticosteroid therapy for treatment of DME: triamcinolone (1); dexamethasone (4); and fluocinolone acetonide (2).

The authors wrote that a review of the available literature indicated that intravitreal injections of anti-VEGF agents and corticosteroids were effective treatments for DME. They also found that elevated intraocular pressure and cataract progression were important potential complications of corticosteroid therapy. However, they suggested that further evidence would be required to assess the comparative efficacy of these therapies. Further, the authors noted, given the limited high-quality comparative efficacy data, choice of therapy must be individualized for each patient, and broad therapeutic access for patients is critical to maximize outcomes.

SOURCE: Ehlers JP, Yeh S, Maguire MG, et al. Intravitreal pharmacotherapies for diabetic macular edema: A Report by the American Academy of Ophthalmology. Ophthalmology 2021; Aug 23. [Epub ahead of print].




Industry News

Novartis Acquires Arctos Medical, Expands Optogenetics

Novartis acquired Arctos Medical, adding a pre-clinical optogenetics-based AAV gene therapy program and Arctos’ proprietary technology to its ophthalmology portfolio. Arctos developed its technology as a potential method for treating inherited retinal dystrophies and diseases that involve photoreceptor loss, such as age-related macular degeneration. Read more.


RD Fund Launches Opus to Advance Gene Therapy Treatments for Blinding Conditions

The Retinal Degeneration Fund, the venture arm of the Foundation Fighting Blindness, announced the launch of Opus Genetics, a patient-focused gene therapy company developing therapies for orphan inherited retinal diseases. The $19 million in seed financing was led by the RD Fund with participation from the Manning Family Foundation and Bios Partners. The company’s lead programs are licensed from the University of Pennsylvania and will focus on treatments to address mutations in genes that cause different forms of Leber’s congenital amaurosis. Opus’ lead program, OPGx-001, is designed to address mutations in the LCA5 gene, which encodes the lebercilin protein. Read more.



Zeiss Introduces Innovations to Zeiss Medical Ecosystem

At Zeiss Innovation Week, Sept. 21 to 23, Zeiss Medical Technology was expected to introduce integrated solutions to the Zeiss Medical Ecosystem, connecting devices, data and applications that will help maximize clinical efficiency and performance. View the advancements.



Prevent Blindness Declares First Inflammatory Eye Disease Awareness Week

In an effort to educate the public on the various forms of Inflammatory Eye Disease (IED), Prevent Blindness declared September 27 to October 3, as the first Inflammatory Eye Disease Awareness Week. As part of this initiative, Prevent Blindness created a dedicated webpage providing detailed information on IED, downloadable fact sheets in English and Spanish, and resources for eye care. Learn more.

Aerie Announces Appointment of Interim Executive Chair, and Departure of Chairman and CEO

Effective September 17, Aerie Pharmaceuticals’ board of directors appointed Benjamin F. McGraw, III, Pharm.D. as its interim executive chairman of the board of directors and began a search for a new chief executive officer; Vicente Anido, PhD. no longer serves as the chairman and chief executive officer or as a director of the company. Read more.

Foundation Fighting Blindness to Jointly Host Online CME Webinar

The Foundation Fighting Blindness will host an online continuing medical education (CME and COPE) course October 26, at 7 p.m. Eastern. During the one-hour webinar, Marco Zarbin, MD, PhD, Rutgers-New Jersey Medical School, will review, compare and contrast different forms of macular degeneration such as age-related macular degeneration (wet, dry and GA), Stargardt’s disease, Best disease and cone-rod dystrophies. The webinar is being supported by an educational grant from Apellis Pharmaceuticals. Register here.


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