Volume 13, Number 2
Monday, January 14, 2013


In this issue: (click heading to view article)
######### Retinal Vessel Caliber and Glaucoma Incidence

######### Compliance with Morning vs. Evening Dosing of Once-Daily Glaucoma Medication
######### Use of VEGF Trap-Eye for Macula Edema Secondary to CRVO
######### Foveal Function and Thickness Following Verteporfin PDT in CSC with Hyperautofluroescent Subretinal Deposits
######### Briefly



Retinal Vessel Caliber and Glaucoma Incidence

In this population-based cohort study, researchers examined associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG). The Blue Mountains Eye Study examined 3,654 persons at baseline and 2,461 persons at either five years, 10 years or both times. After excluding 44 subjects with OAG at baseline, 2,417 participants at risk of OAG at the five- or 10-year examinations were included.

The researchers measured retinal vessel calibers of baseline retinal photographs using a computer-based program and summarized them as central retinal artery and vein equivalents (CRAE, CRVE). They defined incident OAG as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the two eyes (≥0.3) at either the five- or 10-year examination. Additionally, they used generalized estimating equation models to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP). The researchers assessed the 10-year incidence of OAG as the main outcome measure.

They reported that 82 persons (104 eyes) developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12–2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14–3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11–2.78), and remained significant when analyses were confined to eyes with IOP <20 mmHg and C:D ratio <0.6 at baseline. Furthermore, there were no independent associations between CRVE and incident OAG.

Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma.

SOURCE: Kawasaki R, Wang JJ, Rochtchina E, et al. Retinal vessel caliber is associated with the 10-year incidence of glaucoma: the Blue Mountains Eye Study. Ophthalmology. 2013;120(1):84–90.


Compliance with Morning vs. Evening Dosing of Once-Daily Glaucoma Medication

To determine whether adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening, the following prospective, randomized crossover treatment trial was conducted.

A total of 30 patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for one month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid. Adherence was compared between morning versus evening dosing and first- versus second-month dosing. Demographic characteristics were obtained, treatment effect was measured and patients completed a post-study questionnaire regarding the convenience of the two dosing regimens.

It was reported that patient adherence overall was good (89.3%). There was no statistically significant difference (p=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%) and adherence in the first month (91.7%) was superior to the second month (86.5%). Moreover, there was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing.

In conclusion, early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration.

SOURCE: Ford BA, Goi M, Carlsson A, Crichton A. Morning dosing of once-daily glaucoma medication is more convenient and may lead to greater adherence than evening dosing. J Glaucoma. 2013;22(1):1–4.


Use of VEGF Trap-Eye for Macula Edema Secondary to CRVO

The authors of this German double-masked study evaluated intravitreal VEGF Trap-Eye (VTE) in patients with macular edema secondary to central retinal vein occlusion (CRVO). They found that VTE 2 mg every four weeks was efficacious in CRVO with an acceptable safety profile.

They randomized 177 patients (3:2 ratio) to intravitreal injections of VTE 2 mg or sham procedure every four weeks for 24 weeks. The authors evaluated best-corrected visual acuity using the Early Treatment Diabetic Retinopathy Study chart and measured central retinal thickness (CRT) with optical coherence tomography.

They noted that from baseline until week 24, more patients receiving VTE (60.2%) gained ≥15 letters compared with those receiving sham injections (22.1%) (p<0.0001). VTE patients gained a mean of 18.0 letters compared with 3.3 letters with sham injections (p<0.0001). Mean CRT decreased by 448.6 and 169.3 µm in the VTE and sham groups (p<0.0001). The most frequent ocular adverse events in the VTE arm were typically associated with the injection procedure or the underlying disease, and included eye pain (11.5%), increased intraocular pressure (9.6%) and conjunctival hemorrhage (8.7%).

The study authors found that vision gains with VTE were significantly higher than with observation/panretinal photocoagulation if needed. Based on these data, VTE may provide a new treatment option for CRVO.

SOURCE: Holz FG, Rolder J, Ogura Y, et al. VEGF Trap-Eye for macular edema secondary to central retinal vein occlusion: 6-month results of the phase III GALILEO study. Br J Ophthalmol. 2013; Jan 7. [Epub ahead of print].


Foveal Function and Thickness Following Verteporfin PDT in CSC with Hyperautofluroescent Subretinal Deposits

Investigators sought to assess the prognostic effect of subretinal deposits in eyes with central serous chorioretinopathy (CSC).

They included 21 eyes with foveal detachment and subretinal deposits at presentation that underwent photodynamic therapy (PDT). The investigators found no symptoms or signs of CSC in the fellow eyes. They performed microperimetry, autofluorescence imaging and optical coherence tomography (OCT) in both eyes before and after PDT. Subgroup analyses included comparison of eyes with an initial episode versus a recurrent episode of CSC.

According to the investigators, four months following PDT, foveal sensitivity had improved significantly in both initial episode eyes and recurrent episode eyes, but sensitivity remained at 3.1 dB (SD=3.06, p=0.008) and 2.7 dB (SD=3.55, p=0.028), respectively, lower than in the fellow eyes. Four months after PDT, foveal thickness was 245 µm (SD=24.2) in the initial episode eyes versus 285 µm (SD=22.6) in the fellow eyes (p<0.001) and 246 µm (SD=33.7) in the recurrent episode eyes versus 291 µm (SD=24.8) in the fellow eyes (p=0.001).

To conclude, eyes with foveal detachment and subretinal deposits that underwent PDT for CSC did not recover to the functional and structural level of the asymptomatic fellow eyes, irrespective of the number of episodes of CSC. The study indicates that subretinal deposits are associated with irreversible foveal damage in CSC.

SOURCE: Pryds A, Larsen M. Foveal function and thickness after verteporfin photodynamic therapy in central serous chorioretionpathy with hyperautofluorescent subretinal deposits. Retina. 2013;33(1):128–135.

  • STERNBERG BEGINS TERM AS ACADEMY PRESIDENT. In a recent news release, the American Academy of Ophthalmology announced that Paul Sternberg Jr, MD, has begun his term as the Academy’s 116th president. He is a nationally recognized leader in ophthalmic education and research as well as a highly respected retina specialist. Dr. Sternberg currently serves as the G.W. Hale professor of ophthalmology and chairman of the Vanderbilt Eye Institute of the Vanderbilt School of Medicine in Nashville.
  • SARCODE ENROLLS FIRST SUBJECT IN OPUS-2. The initial subject has been enrolled in SARcode Bioscience Inc.’s second pivotal Phase III clinical efficacy study (OPUS-2) of lifitegrast ophthalmic solution 5.0%. According to the company, the study will assess the efficacy and safety of lifitegrast in the treatment of dry eye disease. Roughly 700 subjects will be randomized to receive lifitegrast or placebo twice daily over 12 weeks. The co-primary endpoints of the study are inferior corneal fluorescein staining score and eye dryness. The results from OPUS-1 and OPUS-2, along with results from ongoing year-long safety study called SONATA, will support a planned New Drug Application. Read more here.
  • BAUSCH + LOMB LICENSES NEW TECHNOLOGY FOR TREATMENT OF OCULAR REDNESS. Bausch + Lomb has acquired an exclusive global license to a new platform technology that may lead to a faster, more effective and longer-lasting treatment for ocular redness. The company says the technology, licensed from Eye Therapies LLC, employs a different mechanism of action to relieve ocular redness than currently available redness relief products, using a uniquely formulated low dose of brimonidine. In a Phase II study, it appeared effective in reducing ocular redness based on both clinician assessment and patient reporting. Onset of action was shown to be rapid (within five minutes), with a duration of effect lasting at least two hours. Furthermore, the formulation was found to be safe and well-tolerated as dosed in the study, with no serious adverse events reported. Bausch + Lomb says that, if approved, the new technology would dramatically expand Bausch + Lomb’s potential to compete in the $350 million global ocular redness relief market, and also create opportunity to explore expanded ophthalmic applications. Visit the company's website for more information.
  • BREVIUM AND FIRST INSIGHT UNVEIL A CERTIFIED INTEGRATION FOR MAXIMEYES USERS. Brevium Inc. and First Insight Corporation have announced a certified integration that allows users of First Insight’s MaximEyes 11.0 practice management software to integrate with Brevium software. Learn more here.
  • MAZZO JOINS ACUFOCUS BOARD OF DIRECTORS. AcuFocus Inc. recently announced that James Mazzo, former senior vice president of Abbott and president of Abbott Medical Optics Inc, has joined its board of directors as chairman.

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