Volume 12, Number 21
Monday, May 21, 2012


In this issue: (click heading to view article)
######### A New Method of Staging and Detecting Glaucomatous Damage

######### Link Between Cataract and Cataract Extraction to AMD
######### Inflammatory Back Pain and Anterior Uveitis
######### Smoking and Risk of Age-Related Cataract
######### Briefly



A New Method of Staging and Detecting Glaucomatous Damage

To present and evaluate a new combined index of structure and function (CSFI) for staging and detecting glaucomatous damage, researchers conducted this observational study of 333 glaucomatous eyes (295 with perimetric glaucoma and 38 with preperimetric glaucoma) and 330 eyes of healthy subjects.

They tested all eyes with standard automated perimetry and spectral domain optical coherence tomography within 6 months. Additionally, they obtained estimates of the number of retinal ganglion cells (RGCs) from standard automated perimetry and spectral domain optical coherence tomography and they used a weighted averaging scheme to obtain a final estimate of the number of RGCs for each eye. The study researchers calculated CSFI as the percent loss of RGCs obtained by subtracting estimated from expected RGC numbers and evaluated the performance of the CSFI for discriminating glaucoma from normal eyes and the different stages of disease by receiver operating characteristic curves.

The mean CSFI, representing the mean estimated percent loss of RGCs, was 41% and 17% in the perimetric and preperimetric groups, respectively (p< .001), the researchers reported. They found that they were both significantly higher than the mean CSFI in the healthy group (p< .001). Moreover, the CSFI had larger receiver operating characteristic curve areas than isolated indexes of structure and function for detecting perimetric and preperimetric glaucoma and differentiating among early, moderate, and advanced stages of visual field loss.

To conclude, an index combining structure and function performed better than isolated structural and functional measures for detection of perimetric and preperimetric glaucoma as well as for discriminating different stages of the disease.

SOURCE: Medeiros FA, Lisboa R, Weinreb RN, et al. A combined index of structure and function for staging glaucomatous damage. Arch Ophthalmol. 2012; May 14. [Epub ahead of print].

Link Between Cataract and Cataract Extraction to AMD

This longitudinal, population-based study examined the associations of cataract and cataract surgery with early and late age-related macular degeneration (AMD) over a 20-year interval and included participants of the Beaver Dam Eye Study.

Persons aged 43 to 86 years participated in the baseline examination in 1988–1990 and were followed up at 5-year intervals after the baseline examination. Examinations consisted of ocular examination with lens and fundus photography, medical history, measurements of blood pressure, height, and weight. Values of risk variables were updated, and incidences of early and late AMD were calculated for each 5-year interval. Additionally, odds ratios were computed using discrete linear logistic regression modeling with generalized estimating equation methods to account for correlation between the eyes and multiple intervals. The main outcome measure was AMD.

After adjusting for age and sex, neither cataract nor cataract surgery was associated with increased odds for developing early AMD. Further adjusting for high-risk gene alleles (CFH and ARMS2) and other possible risk factors did not materially affect the odds ratio (OR). However, cataract surgery was associated with incidence of late AMD (OR 1.93; 95% confidence interval [CI], 1.28–2.90). This OR was not materially altered by further adjusting for high-risk alleles (CFH Y402H, ARMS2) or other risk factors. Furthermore, the OR for late AMD was higher for cataract surgery performed 5 or more years prior compared with less than 5 years prior.

These data strongly support the past findings of an association of cataract surgery with late AMD independent of other risk factors, including high-risk genetic status, and suggest the importance of considering these findings when counseling patients regarding cataract surgery. These findings should provide further impetus for the search for measures to prevent or delay the development of age-related cataract.

SOURCE:Klein BE, Howard KP, Lee KE, et al. The relationship of cataract and cataract extraction to age-related macular degeneration: the Beaver Dam Eye Study. Ophthalmol. 2012; May 14. [Epub ahead of print].


Inflammatory Back Pain and Anterior Uveitis

Investigators in the following retrospective cohort study sought to determine the prevalence of inflammatory back pain in an anterior uveitis cohort.

They recruited patients with anterior uveitis from the clinic of an ophthalmologist to complete a survey between March and December 2008. They classified patients with inflammatory back pain if they had ≥2 positive responses to 4 validated inflammatory back pain questions: presence of morning stiffness >30 minutes in duration; improvement in back pain with exercise but not with rest; awakening from back pain during the second half of the night only; and presence of alternating buttock pain. They also assessed disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Finally, they measured impact of disease on quality of life using the EuroQOL (EQ-5D) questionnaire. Twenty-five patients underwent further rheumatologic examination.

The investigators noted that 141 of 167 patients (84.4%) completed the survey and classified 66 of 141 patients (46.8%) to have inflammatory back pain. Mean BASDAI (4.2, SD 2.41) and EQ-5D scores (0.73, SD 0.21) were lower than patients with no inflammatory back pain (0.82, SD 0.16, p = .0048). In the subgroup that underwent rheumatologic assessment, a classification of inflammatory back pain was 92% sensitive and 67% specific for a diagnosis of inflammatory back pain.

In conclusion, the prevalence of inflammatory back pain in a cohort of anterior uveitis patients was found to be 46.8%. Patients with inflammatory back pain had worse quality of life than those without. Ophthalmologists may use these questions on back pain to select patients classified to have inflammatory back pain to refer for early rheumatologic assessment.

SOURCE: Chan CC, Inriq T, Molloy CB, et al. Prevalence of inflammatory back pain in a cohort of patients with anterior uveitis. Am J Ophthalmol. 2012;153(6):1025–1030.



Smoking and Risk of Age-Related Cataract

The authors of the following study conducted a meta-analysis to evaluate the relationship between smoking and age-related cataract. They identified eligible studies via both computer searches and reviewing the references lists of the key articles.

They also calculated the summary relative risk ratio (RR) or odds ratio (OR) and 95% confidence interval (CI). Additionally, the authors pooled study-specific risk estimates using a random-effects model and performed meta-regression to assess for heterogeneity by several covariates and subgroup analysis on ARC types.

A total of 13 prospective cohort and eight case-control studies met their inclusion criteria. The study authors found that ever smoking was statistically significant associated with increased risk of ARC among cohort studies (OR, 1.41; 95% CI, 1.23–1.62) and case-control studies (OR, 1.57; 95% CI, 1.20–2.07). Furthermore, in subgroup analysis, ever smoking exhibited a positive relationship with nuclear cataract (OR, 1.66; 95% CI, 1.46–1.89) and a marginally significant relationship with posterior subcapsular cataract (OR, 1.43; 95% CI, 0.99–2.07) in cohort studies. The authors found similar results in case-control studies (nuclear cataract, OR, 1.86; 95% CI, 1.47–2.36; posterior subcapsular cataract OR 1.60; 95% CI, 0.97-2.65). Current smokers were at higher risk of ARC than past smokers. They observed no association between smoking and cortical cataract.

The overall current literature suggested that smoking was associated with increased risk of ARC, especially nuclear cataract (NC). Further efforts should be made to confirm these findings and clarify the underlying biological mechanisms.

SOURCE: Ye J, He J, Wang C, et al. Smoking and risk of age-related cataract: a meta-analysis. Invest Ophthalmol Vis Sci. 2012; May 17. [Epub ahead of print].



  • CARDHOLDER SWEEPSTAKES A CELEBRATION OF CARECREDIT'S 25TH ANNIVERSARY. CareCredit is commemorating its 25th anniversary with the 25 Years of Caring Sweepstakes, which celebrates the millions of patients who have chosen to use CareCredit as a payment option to get care. Cardholders will learn about the sweepstakes, which runs April 15 through May 31, 2012, through mail, e-mail, online and other outlets. CareCredit cardholders in good standing will automatically be entered for a chance to win the Grand Prize of $25,000 or one of 25 First Prizes of $1,000. Cardholders who use their CareCredit healthcare credit card during the Sweepstakes at any practice that accepts the program will receive an additional entry. Cardholders can also visit www.carecredit.com/25 to play the “Scratch & Match” game for their chance to instantly win various prizes. No purchase is necessary to participate; click here for official rules.
  • COOPERVISION INTRODUCES NEW DAILY DISPOSABLE LENS FOR PRESBYOPES. CooperVision Inc. has launched Proclear 1 day multifocal daily disposable lenses. The lenses are manufactured with PC Technology, a unique lens material that attracts and maintains moisture, thus reducing dryness and feature sphere powers from +6.00 to –10.00 (0.50 steps after –6.00); a base curve of 8.7 mm; and a diameter of 14.2 mm. Proclear 1 day multifocal daily disposable lenses are designed with a single power profile that can accommodate patients up to +2.50 ADD power. The lens will be launched initially in the United States, Canada, Australia, New Zealand, and in a number of European countries. Visit the company's website for additional information.
  • ADVANCED LOTEPREDNOL ETABONATE GEL FORMULATION MAY OFFER NEW HOPE FOR OCULAR INFLAMMATION; BARR NAMED GLOBAL PRESIDENT OF BAUSCH + LOMB SURGICAL. According to Bausch + Lomb, its new loteprednoletabonate (LE) gel formulation demonstrated safety and efficacy for the treatment of ocular inflammation after cataract surgery, according to clinical findings presented on May 10th at the 2012 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting. According to two multi-center, randomized, double-masked clinical studies, significantly more patients treated with loteprednol etabonate gel had complete resolution of anterior chamber cells and no pain at day 8 and through the end of the study (day 18) compared with patients treated with vehicle. Most drug-related ocular adverse eventswere mild in severity and resolved without treatment. No serious adverse events were reported. A pre-clinical study also presented at ARVO demonstrated that drug particles do not settle within the gel formulation, thereby eliminating the need to shake the product before use. Get more information at www.bausch.com.

    In other company news, a recent press release states that Bausch + Lomb has named John Barr Global President of its Surgical business. In this capacity, Barr will oversee the company's full suite of ophthalmic surgical products, intraocular lenses and delivery systems. Immediately prior to joining Bausch + Lomb, Barr was President and CEO of AGA Medical, a pioneer of minimally invasive devices to treat structural heart defects and vascular abnormalities.
  • MAZZO ANNOUNCES RETIREMENT FROM AMO. After leading AMO for the past 10 years, Jim Mazzo is retiring from his position as President at the end of 2012 and will be replaced by Mr. Murthy Simhambhatla, from Abbott Corporate. An engineer by training, Murthy held a succession of management positions at Guidant and joined Abbott through the acquisition of that business. He and Jim will work together over the next several months to ensure a smooth transition.


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