Volume 12, Number 27
Monday, July 2, 2012


In this issue: (click heading to view article)
######### Statin Use and OAG
######### Relationship Between OCT-Derived Assessments of Lower Tear Meniscus Parameters and Clinical Features of Dry Eye Disease
######### RRD Following LASIK for Myopia of Up to –10 D
######### Photoreceptor Integrity and Visual Outcome in Neovascular AMD
######### Briefly




Statin Use and OAG

In the following retrospective, longitudinal cohort analysis, researchers sought to determine whether 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) affect the risk of developing open-angle (OAG) in persons with hyperlipidemia.

They included in their study individuals aged ≥60 years with hyperlipidemia enrolled in a national United States managed care network between 2001 and 2009. They performed Multivariable Cox regression analyses to assess the relationship between statin use and the development of OAG (from no prior OAG diagnosis), progression from a prior diagnosis of glaucoma suspect to a diagnosis of OAG, and need for medical or operative interventions for OAG. The researchers also adjusted regression models for sociodemographic factors and medical and ocular comorbidities. Main outcome measures were hazard ratios (HRs) with 95% confidence intervals (CIs).

Of the 524,109 individuals with hyperlipidemia, 316,182 (60%) had ≥1 outpatient prescription for statins, the researchers noted. They found that the hazard of developing OAG decreased 0.3% (adjusted HR, 0.997; 95% CI 0.994–0.999) for every additional month of statin consumption. They also reported that individuals with hyperlipidemia who took statins continuously for 2 years had an 8% (adjusted HR, 0.922; 95% CI, 0.870–0.976) decreased OAG risk relative to those who received no statin therapy. Additionally the study researchers observed that the hazard of progressing from a diagnosis of glaucoma suspect to OAG decreased 0.4% (adjusted HR, 0.996; 95% CI, 0.993–0.999) for every 2 years and had a 9% (adjusted HR, 0.907; 95% CI, 0.846–0.973) decreased risk of progressing from glaucoma suspect to OAG relative to those who received no statin therapy. The hazard of requiring medical treatment for OAG decreased 0.4% (adjusted HR, 0.996; 95% CI, 0.993–0.998) for every additional month of statin exposure. The researchers noted no differences in need for glaucoma surgery among those with OAG who were and were not taking stains (adjusted HR, 1.002; 95% CI, 0.994–1.010).

Statin use was associated with a significant reduction in the risk of OAG among persons with hyperlipidemia. Given the mounting evidence of statin protection against OAG including both basic science and observational clinical studies, an interventional prospective study might provide additional insights into the role of statins in the prevention of early OAG.

SOURCE:Stein JD, Newman-Casey PA, Talwar N, et al. The relationship between statin use and open-angle glaucoma. Ophthalmol. 2012;June 22 [Epub ahead of press].

Relationship Between OCT-Derived Assessments of Lower Tear Meniscus Parameters and Clinical Features of Dry Eye Disease

To measure the correlation between subjective symptom score, conventional clinical tests, and Fourier-domain optical coherence tomography (FD-OCT) of lower tear meniscus parameters in patients with dry eye disease, 18 patients with dry eye disease requiring medical therapy and/or punctal occlusion were recruited for this prospective, nonrandomized, observational case series.

Severity of symptoms of dry eye disease was assessed using the Indiana University Dry Eye Questionnaire 2002. Clinical assessments were completed using slit lamp biomicroscopy, rose Bengal dye staining, fluorescein tear breakup time (TBUT), and a 5-minute Schirmer test with topical anesthesia. The lower tear meniscus was imaged using and FD-OCT system with 5-µm axial resolution and measured manually by a masked grader using computer calipers. Finally, correlation was assessed using Spearman correlation coefficient (ρ).

It was reported that the mean (±SD) scaled symptom score was 58 ± 21, with a range of 0 to 100. Vital staining test averaged 1.7 ± 3.4, TBUT averaged 4.4 ± 1.8 seconds, and Schirmer tests averaged 10.2 ± 8.1 mm. As determined by OCT, the meniscus height was 228 ± 153 µm, depth was 127 ± 79 µm, and cross-sectional area was 0.018 ± 0.021 mm². It was also noted that OCT meniscus area was negatively correlated with the symptom questionnaire score (p<0.01) and positively correlated with Schirmer test results (p<0.01). Moreover, there was no significant correlation between symptom score and rose bengal staining, TBUT, or Schirmer test results (p>0.01).

To conclude, lower tear meniscus measurement with FD-OCT is an objective noninvasive test that correlates well with symptoms of dry eye disease and the Schirmer test.

SOURCE: Nguyen P, Huang D, Li Y, et al. Correlation between optical coherence tomography-derived assessments of lower tear meniscus parameters and clinical features of dry eye disease. Cornea. 2012;31(6):680–685.


RRD Following LASIK for Myopia of Up to –10 D

The authors of the following retrospective, single-center, interventional, non-comparative case series aimed to characterize rhegmatogenous retinal detachment (RRD) in more than 22,000 eyes following laser-assisted in situ keratomileusis (LASIK) for the correction of myopia ≤ –10.00 D, its characteristics, and its frequency at 10 years of follow-up.

They included 22,296 myopic eyes that underwent surgical correction of myopia ≤ –10.00 D. LASIK for the correction of myopia was performed in all eyes and patients were followed for 10 years after LASIK. The study authors reviewed the clinical charts of patients that developed RRD after LASIK.

They reported that 11,594 (52%) eyes returned for follow-up after LASIK at 10 years and that 22 eyes (19 patients) developed a RRD after LASIK at 10 years. The study authors noted that RRDs occurred between 1 month and 10 years (mean: 31.6 ± 39.3 months) after LASIK. They also found that eyes that developed an RRD had from –1.50 to –9.75 D of myopia (mean: –4.81 ± 2.2 D) before LASIK. Furthermore, the frequency of RRD after LASIK determined in this study was 0.05% (11/22,296) at 1 year, 0.15% (18/11,371) at 5 years, and 0.19% (22/11,594) at 10 years.

In conclusion, RRD after LASIK for the correction of myopia ≤ –10.00 D is infrequent and the risk of RRD after LASIK is very low if you screen patients, and do prophylactic treatment as performed in this study. RRD, if managed promptly, will result in good vision. The study authors recommend that patients scheduled for refractive surgery undergo a very thorough dilated indirect funduscopy with scleral depression and treatment of any retinal lesion predisposing to the development of an RRD before LASIK surgery should be performed.

SOURCE: Arevalo JF, Lasave AF, Torres F, Suarez E. Rhegmatogenous retinal detachment after LASIK for myopia of up to –10 diopters: 10 years of follow-up. Graefes Arch Clin Exp Ophthalmol. 2012;250(7):963–970.



Photoreceptor Integrity and Visual Outcome in Neovascular AMD

Korean investigators evaluated the association between improvement of photoreceptor integrity and visual acuity (VA) after anti-vascular endothelial growth factor (anti-VEGF) injections in neovascular age-related macular degeneration (AMD) in this retrospective, cross-sectional study.

They retrospectively reviewed 87 eyes of 84 patients who were newly diagnosed with neovascular AMD and treated with anti-VEGF injections. Using spectral-domain optical coherence tomography (OCT), they graded the status of the inner segment/outer segment photoreceptor junction (IS/OS) and classified it into 3 groups at baseline and 1 and 2 months after 3 monthly injections. They also analyzed the proportion of the improved IS/OS line after treatment and correlated this with VA. The investigators noted that the number of eyes in the IS/OS+ group, representing disrupted IS/OS line less than 200 µm, was increased from 9 (10%) at baseline to 33 (38%) at 1 month. They observed a significant difference in the ratio of IS/OS+ group between IS/OS line between baseline and 1 month (p<.001). According to the investigators, those in the IS/OS± group, showing focal disrupted IS/OS line between 200 and 800 µm, decreased from 29 (33%) to 22 eyes (25%). They also reported improvement of the IS/OS line at 1 month compared to baseline in 43 eyes (49%), which correlated with better VA (p<.016). They saw no increase of VA in 44 eyes without definite improvement. There was no significant correlation between improvement of the IS/OS line and VA from 1 to 2 months.

Assessing the change of the photoreceptor integrity before and after treatment would be a useful indicator to predict initial response to treatment and visual prognosis in patients with neovascular AMD.

SOURCE: Kim YM, Kim JH, Koh HJ. Improvement of photoreceptor integrity and associated visual outcome in neovascular age-related macular degeneration. Am J Ophthalmol. 2012;154(1):164–173.e1.


  • pSIVIDA CORP. ENROLLS FIRST PATIENT IN UVEITIS TRIAL. pSivida Corp. has enrolled the first patient in an investigator-sponsored clinical trial of its injectable sustained release device in posterior uveitis. According to the company, the insert is a tiny tube about the size of an eyelash containing the steroid fluocinolone acetonide that is released at a consistent rate over a period of approximately 36 months. The micro-insert is placed in the back of the eye during an office visit through a fine-gauge needle. Read more here.
  • FDA CLEARS SYNERGETICS' VERSAVIT VITRECTOMY SYSTEM. Synergetics USA, Inc. has received 510(k) clearance from the FDA for VersaVIT, a novel vitrectomy system for the retinal surgery market. Click here to read more.
  • FDA APPROVES GLAUKOS CORPORATION'S iSTENT TRABECULAR MICRO-BYPASS. According to a recent press release Glaukos Corporation has received FDA approval for the iStent Trabecular Micro-Bypass, which is indicated for use in conjunction with cataract surgery for the reduction of IOP in adult patients with mild to moderate open-angle glaucoma (OAG) currently treated with ocular hypotensive medication. Because the 1-mm iStent device is implanted ab-interno, the procedure is conjunctival-sparing and blebless and preserves future therapeutic and surgical options for glaucoma patients. Glaukos has enrolled more than 4,000 patients worldwide in clinical studies evaluating iStent devices in open-angle glaucoma.
  • HRX VITRECTOMY LENSES WITH NEW STERILIZATION OPTIONS OFFERED BY VOLK. Volk Optical is offering its HRX (High Resolution eXtreme field) Vit Lens with expanded lens choices, including two sterilization and two contact options. The HRX Vit is available in either steam or gas (ETO) sterilizable options and are available with a choice of either a standard contact option or Volk’s patented SSV (Self Stabilizing Vitrectomy) design. SSV lenses eliminate the need for suture or stabilizing rings, reducing associated patient discomfort and surgical prep time. These new options offer retinal surgeons unmatched imaging in a package tailored to fit individual working procedures. Click here for further information.
  • STAAR SURGICAL REVEALS ENHANCED CONSUMER AWARENESS INITIATIVES FOR ICL. STAAR Surgical Company has launched enhanced global consumer awareness initiatives for the Visian ICL product line. STAAR Surgical says the initiatives include a redesigned consumer-friendly website, increased support for practices and distributors for their own Visian ICL awareness campaigns and added consumer marketing in Asia. Additional information about the initiatives can be found at www.staar.com.
  • FDA CLEARS BIOTRUE ONEDAY CONTACT LENSES. The FDA has issued clearance of Bausch + Lomb's Biotrue ONEday premium daily disposable contact lens. Made from HyperGel, the bio-inspired lens contains 78 percent water and the outer surface is designed to mimic the lipid layer of tear film to prevent dehydration. Visit the company's website for additional information.
  • OMEROS PRICES PUBLIC OFFERING OF COMMON STOCK. Omeros Corporation has priced an underwritten public offering of 2,926,830 shares of its common stock at a price to the public of $10.25 per share for gross proceeds of $30 million. The net proceeds from the sale of the shares, after deducting the underwriter's discounts and other estimated offering expenses, will be approximately $28.1 million and will be used by Omeros for general corporate purposes, including expenses related to the clinical development of its two ongoing Phase 3 clinical development programs. The offering is expected to close on or about July 2, 2012, subject to the satisfaction of customary closing conditions. Find out more here.


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