Volume 12, Number 11
Monday, March 12, 2012


In this issue: (click heading to view article)
######### Identification of Risk Factors for Cortical, Nuclear, Posterior Subcapsular and Mixed Lens Opacities

######### Asymmetry in Hemifield Macular Thickness: An Early Indicator of Glaucomatous Change
######### Visual Outcomes Following Phacoemulsification Cataract Surgery in Diabetic Patients
######### Correlations Among Various Functional and Morphological Tests in Resolved CSC
######### Briefly




Identification of Risk Factors for Cortical, Nuclear, Posterior Subcapsular and Mixed Lens Opacities

The following population-based, cross-sectional study sought to identify sociodemographic and biological risk factors associated with having cortical, nuclear, posterior subcapsular (PSC) and mixed lens opacities.

A total of 5,945 Latinos aged ≥40 years from 6 census tracts in Los Angeles underwent an interview and detailed eye examination, including best-corrected visual acuity and slit lamp assessment of lens opacities using the Lens Opacities Classification System II. Univariate and stepwise logistic regression analyses were used to identify independent risk factors associated with each type of lens opacity. Odds ratio for sociodemographic and biological risk factors associated with cortical only, nuclear only, PSC only and mixed lens opacities were the main outcome measures.

It was reported that of the 5,945 participants with gradable lenses, 468 had cortical only lens opacities, 217 had nuclear only lens opacities, 27 had PSC only opacities and 364 had mixed lens opacities. It was also noted that older age, higher hemoglobin A1c and history of diabetes mellitus were independent risk factors for cortical only lens opacities and that higher systolic blood pressure and history of diabetes were independent risk factors for PSC lens opacities. Additionally, older age, myopic refractive error, history of diabetes, higher systolic blood pressure, female gender and presence of large drusen were independent risk factors for mixed lens opacities.

The modifiable and non-modifiable risk factors identified in this study provide insight into the mechanisms related to the development of lens opacification. Improved glycemic control, smoking cessation and prevention and blood pressure control may help to reduce the risk of having lens opacities and their associated vision loss.

SOURCE: Richter GM, Torres M, Choudhury F, et al; Los Angeles Latino Eye Study Group. Risk factors for cortical, nuclear, posterior subcapsular, and mixed lens opacities: the Los Angeles Latino Eye Study. Ophthalmol. 2012;119(3):547–554.

Asymmetry in Hemifield Macular Thickness: An Early Indicator of Glaucomatous Change

Researchers investigated whether asymmetry in hemifield macular thickness can serve as an early indicator of glaucomatous structural damage using spectral domain optical coherence tomography. They determined that evaluation of asymmetry in hemifield macular thickness may serve as an assessment tool in the early diagnosis of glaucoma.

They defined five zones in the macular thickness map and each zone included reciprocal areas in the superior and inferior hemifield. The researchers measured differences in average retinal thickness (DRT) between corresponding regional pairs in each of the five zones in 50 healthy eyes. They defined an abnormality as the DRT value lying outside the 95% confidence intervals and considered an eye to yield an “abnormal macular hemifield test” (MHT) if abnormality was evident in any zone. They also determined the sensitivity and specificity for glaucoma detection of MHT and average circumpapillary retinal nerve fiber layer (cRNFL) classification.

They included a total of 114 healthy, 103 glaucoma-suspect and 74 glaucomatous eyes and reported that overall, 5.8%, 36.9%, 88.4% and 77.4% of the eyes of the healthy, glaucoma-suspect (GS), early glaucoma (EG) and advanced glaucoma (AG) groups yielded abnormal MHT results, respectively. In EG eyes, the study researchers found that the sensitivity of an abnormal MHT result was significantly greater than that of abnormal average cRNFL classification (p=0.008). They also observed that in the GS and AG groups, the sensitivity did not significantly differ between an abnormal MHT result and an average cRNFL classification (p=0.880, 0.180). Compared with sectoral cRNFL thickness measurements, MHT showed a similar level of diagnostic performance. Specificity was not different between an abnormal MHT result and an average cRNFL classification (p=0.687).

SOURCE: Um TW, Sung KR, Wollstein G, et al. Asymmetry in hemifield macular thickness as an early indicator of glaucomatous change. Invest Ophthlamol Vis Sci. 2012;53(3):1139–1144.


Visual Outcomes Following Phacoemulsification Cataract Surgery in Diabetic Patients

Australian investigators assessed cataract surgery visual outcomes 12 months postoperatively in patients with diabetes, with or without diabetic retinopathy (DR), compared to patents without diabetes.

They followed 1,192 cataract surgical patients aged ≥65 for 12 months postoperatively and took standardized pre- and postoperative pinhole logMAR visual acuity (VA) measurements. Additionally, they determined mean VA improvement by comparing VA after 12 months to preoperative VA.

According to the investigators, of 1,192 surgical patients, 324 (27.2%) had diabetes, of whom, 136 (42.0%) had DR and after adjusting for age, gender, diabetes duration and preoperative pinhole VA, the average VA gained 12 months after surgery was 10.8 letters among 868 patients without diabetes, 10.6 letters among 188 patients with diabetes but no DR, 10.0 letters among 95 patients with DR but no past laser treatment, and no letters among 41 patients with DR plus past laser treatment (p<0.0001, compared to the other three groups). Moreover, they associated diabetes duration ≥20 years with mean VA gain of 3 fewer letters than duration <10 years (7 versus 10 letters, p=0.023), after adjusting for age, gender, DR and preoperative pinhole VA.

Cataract surgery improved VA by an average two lines for patients both with and without diabetes, or with DR but no past laser treatment, the investigators concluded. No significant VA improvement was evident for patients who had preoperative DR and laser therapy.

SOURCE: Fong CS, Mitchell P, Rochtchina E, et al. Visual outcomes 12 months after phacoemulsification cataract surgery in patients with diabetes. Acta Ophthalmol. 2012;90(2):173–178.


Correlations Among Various Functional and Morphological Tests in Resolved CSC

The authors of this Korean study aimed to find the explanatory parameters for best-corrected visual acuity (BCVA) and microperimetry (MP) in resolved central serous chorioretinopathy (CSC).

They retrospectively analyzed 33 eyes from 33 patients correlated BCVA and MP with parameters from various functional and morphological tests. They also correlated MP with parameters from various functional and morphological tests and measured the mean MP sensitivities at fovea 2° and 4°, retinal thickness and degree of defect at the photoreceptor inner and outer segment junction (IS/OS) of the spectral-domain optical coherent tomography (SD-OCT) image, normalized coefficient of variation of grey scale at the fovea in the short wavelength and near infrared fundus autofluroescence image, P1 amplitude and latency, and N1 amplitude and latency of multifocal elecroretinography at ring 1 (R1). The authors also used Spearman correlations and multiple linear regression analysis for analysis of correlation between functional and morphological characteristics.

They noted that the mean BCVA was 0.19 ± 0.23 (logarithm of the minimum angle of resolution [logMAR]) and that the mean MP at 2° was 12.79 ± 4.47 dB. BCVA correlated with MP at 2° (p=–0.491, p=0.004) and had a significant association with the IS/OS defect and center point thickness (CPT) (BCVA=0.413+0.31xIS/OS defect–0.002xCPT; p<0.001, R=0.739, R²=0.546). Furthermore, retinal sensitivity measured by MP at the fovea (2°) had a significant association with the IS/OS defect and N1 latency at R1 (MP at 2°=19.350–9.116xIS/OS defect –0.324xN1 latency at R1; p<0.001, R=0.804, R²=0.647). To conclude, the visual function of eyes with resolved CSC was suboptimal and was better explained when various parameters showing retinal status were combined and interpreted together.

SOURCE: Kim SW, Oh J, Huh K. Correlations among various functional and morphological tests in resolved central serous chorioretinopathy. Br J Ophthalmol. 2012;96(3):350–355.


  • EYEGATE PHARMA COMMENCES PHASE I STUDY OF EGP-437 FOR NON-NECROTIZING ANTERIOR SCLERITIS. EyeGate Pharma has begun enrolling patients with anterior scleritis into a Phase I study evaluating the safety and effectiveness of its lead product, EGP-437 (a late-stage asset with multiple indications for inflammatory ocular indications). According to the company, the randomized, double-masked, placebo-controlled study will evaluate the safety and tolerability of three ocular iontophoresis dose levels of EGP-437 (dexamethasone phosphate ophthalmic solution 40 mg/mL) in subjects with non-infectious, non-necrotizing anterior scleritis. EGP-437 will be administered using the EyeGate II Ocular Drug Delivery System: a non-invasive, iontophoretic drug delivery technology and the study design allows for a preliminary assessment of the efficacy for single and repeat treatment at three different dose levels. Click here to learn more.
  • SARCODE ENROLLS LAST PATIENT IN PHASE 3 DRY EYE STUDY. SARcode Bioscience, Inc. has completed patient enrollment in its first pivotal Phase 3 clinical study (OPUS-1) of SAR 1118 ophthalmic solution. SAR 1118 is a first-in-class small-molecule integrin antagonist that inhibits T-cell inflammation by blocking the binding of two key surface proteins (LFA-1 and ICAM-1) that mediate the chronic inflammatory cascade associated with dry eye disease. OPUS-1 is a randomized, double-masked study evaluating the safety and efficacy of SAR 1118 5.0% ophthalmic solution compared to placebo over a 12-week period. A total of 588 patients with dry eye disease have been enrolled at 13 clinical sites across the United States. In related news, the United States Adopted Name (USAN) Council and the World Health Organization's International Nonproprietary Names (INN) program have adopted “lifitegrast” as the nonproprietary name for SAR 1118. To learn more, visit www.sarcode.com.
  • OASIS IRIS EXPANDER NOW ON THE MARKET. OASIS Medical, Inc. has reported the introduction of the OASIS Iris Expander, a 7.0-mm diameter polypropylene ring that expands and maintains access and visibility throughout the surgical procedure. OASIS says the disposable device, now available for purchase online, is indicated in cases where Miosis and Intraoperative Floppy Iris Syndrome is present. Visit oasismedical.com for further information.
  • B+L ACQUIRES RIGHTS TO NOVEL PLATFORM TECHNOLOGY. In a recent press release, Bausch + Lomb announced that it has acquired the rights to a novel platform technology for treating posterior segment diseases of the eye.
  • THROMBOGENICS OPENS NEW U.S. HEADQUARTERS. ThromboGenics NV announced the opening of its new U.S. headquarters in Iselin, New Jersey, led by Dr. David Pearson, Head of U.S. Country Operations. The company has been growing its U.S. team in recent months, building its marketing, medical, commercial, market access and regulatory expertise ahead of its planned launch of its lead product ocriplasmin. ThromboGenics intends to resubmit a BLA for the product in the United States before the end of April 2012 and expects the product to be granted Priority Review by the FDA. Read more here.
  • EYLEA INJECTION APPROVED IN AUSTRALIA FOR THE TREATMENT OF AMD. Regeneron Pharmaceuticals, Inc. and Bayer HealthCare recently announced that Bayer HealthCare has received approval from the Australian Therapeutic Good Administration (TGA) for EYLEA (aflibercept) injection for the treatment of patients with neovascular age-related macular degeneration (AMD) at a recommended dose of 2 mg via intravitreal injection per month for three consecutive months, followed by 2 mg via intravitreal injection every two months. Bayer Healthcare plans to launch the drug in Australia in the second half of 2012. Additional information is available at www.regeneron.com.


Review of Ophthalmology® Online is published by the Professional Publications Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073.

To subscribe to other JMI newsletters or to manage your subscription, click here.

To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.

To ensure delivery, please be sure to add reviewophth@jobsonmail.com to your address book or safe senders list.

Click here if you do not want to receive future emails from Review of Ophthalmology Online.

Advertising: For information on advertising in this e-mail newsletter or other creative advertising opportunities with Review of Ophthalmology, please contact publisher Rick Bay, or sales managers James Henne or Michele Barrett.

News: To submit news or contact the editor, send an e-mail, or FAX your news to 610.492.1049