Volume 12, Number 25
Monday, June 18, 2012

In this issue: (click heading to view article)
######### Results of Multimodal Imaging of Dry AMD
######### Detection of Early Exudative AMD with OCT
######### Longitudinal Changes in Anterior Chamber Configuration in Eyes with OAG and Associated Factors
######### A Closer Look at Management and Outcomes of Cataract in Children
######### Briefly




Results of Multimodal Imaging of Dry AMD

This study sought to explain the clinical significance of near-infrared reflectance (NIR), blue fundus autofluorescence (FAF) and near-infrared autofluorescence (NIA) in dry age-related macular degeneration (AMD) by correlation with fluorescein angiography (FA) and cross-sectional spectral domain optical coherence tomography (SD OCT).

A total of 110 eyes (62 patients, mean age: 64 ± 8 years) diagnosed with dry AMD between January 2010 and December 2010, which underwent NIR (Λ = 830 nm), FAF and FA (excitation Λ = 488 nm; emission Λ > 500 nm), NIA (excitation Λ = 787 nm; emission Λ > 800 nm), and simultaneous SD OCT scanning using a combined confocal scanning laser ophthalmoscope/SD OCT device (Spectralis HRA + OCT; Heidelberg Engineering) were examined.

Drusen showed variable increased/decreased NIR, FAF, NIA and FA, which corresponded to variable increased/decreased thickness of the retinal pigment epithelium (RPE) and possible presence of subretinal deposits on SD OCT. It was noted that geographic atrophy (GA) was present in 43/110 eyes (39.0%) and showed increased NIR and fluorescence (FA), absent FAF and NIA, and loss of RPE on SD OCT. The hyperautofluorescence of the GA margin was never larger in FAF than that in NIA, while in 16.2% of cases, it was larger in NIA than that in FAF and corresponded to mild choroidal hyperreflectivity on SD OCT.

In conclusion, simultaneous recording of SD OCT scans provided ultrastructural data for the evaluation of NIR, FAF, NIA and FA in dry AMD. Near-infrared autofluorescence might detect earlier than FAF areas of RPE cell loss at the GA margin.

SOURCE: Forte R, Querques G, Querques L, et al. Multimodal imaging of dry age-related macular degeneration. Acta Ophthalmol. 2012;90(4):e281–e287.

Detection of Early Exudative AMD with OCT

Researchers conducted the following prospective, observational, nonrandomized study to investigate the ability of optical coherence tomography (OCT) to detect early choroidal neovascularization (CNV) in age-related macular degeneration (AMD).

They enrolled 79 patients, diagnosed with nonexudative macular degeneration in one eye and exudative macular degeneration in the other. Participants underwent examination (visual acuity, intraocular pressure, biomicroscopy and ophthalmoscopy) followed by OCT in the study eye (nonexudative macular degeneration eye) every 3 months for 2 years. If examination did not show CNV, but OCT images raised suspicion, then researchers reexamined patients in 4 weeks to 6 weeks and/or performed fluorescein angiography. They also examined visual acuity, OCT anomaly detected and time between OCT and fluorescein angiography detection.

According to the researchers, 15 (19%) patients developed exudative macular degeneration, as confirmed by fluorescein angiography, in the study eye. Four additional patients showed potential exudative macular degeneration on OCT only. Of the 15 patients who developed exudative macular degeneration, 13 had disease progression identified on OCT before examination and/or fluorescein angiography showed changes. Moreover, subretinal pigment epithelium fluid was the most common OCT anomaly, with development of sub-/intraretinal fluid also visible.

OCT could be a powerful screening tool for patients with AMD at high risk for developing CNV.

SOURCE: Padnick-Silver L, Weinberg AB, Lafranco FP, Macsai MS. Pilot study for the detection of early exudative age-related macular degeneration with optical coherence tomography. Retina. 2012;32(6):1045–1056.


Longitudinal Changes in Anterior Chamber Configuration in Eyes with OAG and Associated Factors

To investigate longitudinal changes in anterior chamber depth (ACD) and anterior chamber angle (ACA) and the associated factors in patients with primary open-angle glaucoma (POAG) using the scanning peripheral ACD analyzer, the scanning peripheral ACD analyzer evaluated ACD by numeric grade (ACDG 1 to 12) and ACA twice in 2003 and 2008.

The study authors reported that exclusion criteria were as follows: history of laser or incisional surgery, other ocular diseases that may affect visual field, visual acuity less than 20/30, and treatment with pilocarpine ophthalmic solution. Patients with pseudophakic eye were used as control.

The authors noted that 157 patients with glaucoma and 26 patients with pseudophakic eye were subjected to the analysis. They also reported that ACDG and ACA of patients with glaucoma were significantly decreased from 7.2 ± 2.3 to 6.5 ± 2.1 (p < 0.001) and from 34.2 ± 12.6 to 28.1 ± 10.3 degrees (p < 0.0001), respectively, whereas patients with cataract surgery showed no significant changes in ACDG and ACA. They observed that the change in ACD was greater at the peripheral region than at the central region and the decrease in ACDG was significantly associated with deep initial ACDG and wide ACA. Moreover, patients having shallow ACDG and narrow ACA showed more rapid deterioration of visual field than those having deep ACDG and wide ACA.

To conclude, ACDG and ACA decreased with age, and initial ACDG and ACA were related to the progression of open-angle glaucoma.

SOURCE: Pan Z, Furuya T, Kashiwagi K. Longitudinal changes in anterior chamber configuration in eyes with open-angle glaucoma and associated factors. J Glaucoma. 2012;21(5):296–301.



A Closer Look at Management and Outcomes of Cataract in Children

Investigators used an observational series of consecutive cases identified from the hospital's outpatient billing records and surgical data program to review the management and outcomes of pediatric patients with cataract who were managed by one of two surgeons at a single institution.

They measured visual acuity with the Snellen or Allen charts and defined glaucoma as IOP >20 mm Hg with clinical signs of glaucoma or visual field loss. They excluded procedures for aphakic/pseudophakic glaucoma from analysis of additional surgeries performed subsequent to cataract extraction.

The search identified 778 patients (1,122 eyes) diagnosed with cataract over 10 years. Of these, 74% of eyes were treated surgically. The investigators noted that those patients with total, nuclear and lamellar cataracts were significantly more likely than the overall population to undergo surgery. Additional surgeries were required in 12% of surgically treated eyes, with pseudophakic eyes representing more than one-half. Aphakic and pseudophakic glaucoma prevalence were 12% and 1%, respectively. The study investigators did not find cataract morphology to be a predisposing factor in the development of glaucoma. They did note that visual outcomes were significantly better for posterior subcapsular (p = 0.0001), nuclear p = 0.025), lamellar (p = 0.03) and traumatic cataracts (p = 0.005) than for other morphological types at all ages. They also reported that visual acuity was 20/30 or better in 63% of children with unilateral pseudophakia, 45% of children with unilateral aphakia and approximately 75% of children with bilateral aphakia and pseudophakia.

The investigators in this study determined that patients with total, nuclear and lamellar cataracts were more likely to undergo surgery. Approximately 10% of patients required additional surgeries and no cataract morphology predisposed patients to developing glaucoma. Good visual outcomes were attained in bilaterally pseudophakic/aphakic and unilaterally pseudophakic children.

SOURCE: Lim Z, Rubab S, Chan YH, Levin AV. Management and outcomes of cataract in children: the Toronto experience. J AAPOS. 2012;16(3):249–254.


  • OPHTHOTECH'S FOVISTA SHOWS SUPERIOR EFFICACY IN CLINICAL TRIAL. Ophthotech Corporation recently announced results from the first clinical trial to show statistically significant superior efficacy over Lucentis (ranibizumab) monotherapy for the treatment of neovascular age-related macular degeneration (wet AMD). The company reported that in the prospective, randomized, controlled Phase 2b clinical trial of 449 patients with wet AMD, its Fovista anti-PDGF therapy (1.5 mg), administered in combination with Lucentis anti-VEGF therapy, met the pre-specified primary efficacy endpoint of mean vision gain. Patients receiving the combination of Fovista and Lucentis gained a mean of 10.6 letters of vision on the ETDRS standardized chart at 24 weeks, compared to 6.5 letters for patients receiving Lucentis monotherapy (p=0.019), representing a 62% additional benefit. No significant safety issues were observed for either treatment group in the trial. Enhanced visual outcomes of Fovista anti-PDGF combination therapy as compared to Lucentis monotherapy were demonstrated at every monthly timepoint. The increasing divergence of the efficacy curves suggests the benefit of chronic anti-PDGF combination therapy. Further results will be presented at future medical congresses.
  • STUDY RESULTS INDICATE OPTOMAP EQUAL TO ETDRS IN ASSESSING DIABETIC RETINOPATHY. Optos plc has announced the results of a clinical validation study comparing Optos ultra-widefield imaging to Early Treatment Diabetic Retinopathy Study (ETDRS) protocol fundus photography, the gold standard for assessing severity of diabetic retinopathy. In the study, which was conducted by researchers at Joslin's Beetham Eye Institute, Optos's ultra-widefield non-dilated optomap images compared favorably with dilated ETDRS photos and dilated retinal examination in determining clinical severity of diabetic retinopathy and diabetic macular edema. The study compared non-dilated ultra-widefield images and ETDRS photos in 103 patients with various levels of diabetic retinopathy and the two imaging modalities exactly matched for clinical level of diabetic retinopathy in 84% of patients and were within 1 level of agreement in 91%. The study also measured the length of time to capture images using both the Optos device and a traditional digital fundus camera and found that the optomap imaging took less than half the time of dilated ETDRS photos, not including the time needed to dilate the eyes. The results of the study appear in the American Journal of Ophthalmology.
  • OZURDEX ACCEPTED FOR USE IN THE NATIONAL HEALTH SERVICE IN SCOTLAND. Allergan has announced that the Scottish Medicines Consortium (SMC) has accepted Ozurdex (dexamethasone 700 microgram intravitreal implant) for use in the National Health Service in Scotland. This is good news for Scottish patients with BRVO, who will now have access to a reimbursed pharmacological treatment option. Click here to read more.


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