Volume 14, Number 13
Monday, March 31, 2014


In this issue: (click heading to view article)
######### Risk of Cataract Surgery with Use of Selective Serotonin Reuptake Inhibitor

######### Affect of Anti-VEGF Treatment on VA in Neovascular AMD
######### Meta-Analysis of Infectious Endophthalmitis Following Intravitreal Injection of Anti-VEGF Agents
######### Low-Luminance VA and Microperimetry in AMD
######### Briefly

Risk of Cataract Surgery with Use of Selective Serotonin Reuptake Inhibitor

To investigate whether selective serotonin reuptake inhibitor use is associated with an increased risk of cataract surgery, this population-based, case-control study evaluated 6,024 eligible county residents in the Rochester Epidemiology Project aged 50+ years who underwent first-eye cataract surgery between January 1, 2004 and December 31, 2011. Controls included 6,024 residents who never had cataract surgery and were matched to cases by age and sex.

Logistic regression models were used to compute odds ratios for differences in selective serotonin reuptake inhibitor use between cases and controls, and to adjust for confounding variables. Rochester Epidemiology Project databases were used to assess cataract surgery and selective serotonin reuptake inhibitor treatment. Selective serotonin reuptake inhibitor use was the main outcome measure.

In the cataract surgery cohort of 6,024 residents, it was reported that 1,024 (17%) were selective serotonin reuptake inhibitor users compared to 788 (13%) in the matched cohort of 6,024 residents never having cataract surgery (p<0.001). Selective serotonin reuptake inhibitor use of one or more years was associated with an increased risk of cataract surgery (OR=1.36; 95% CI, 1.23 to 1.51; p<0.001). The associations were similar in women (OR=1.37; 95% CI, 1.22 to 1.55; p<0.001) and men (OR=1.34; 95% CI, 1.12 to 1.61; p=0.002). Furthermore, the risk of cataract surgery was highest with citalopram use (OR=1.53, 95% CI, 1.33 to 1.77; p<0.001).

It was determined that selective serotonin reuptake inhibitor use of one or more years in people aged 50+ years is associated with an increased risk of cataract surgery.

SOURCE: Erie JC, Brue SM, Chamberlain AM, Hodge DO. Selective serotonin reuptake inhibitor use and increased risk of cataract surgery: a population-based, case-control study. Am J Ophthalmol. 2014; Mar 13. [Epub ahead of print].

Affect of Anti-VEGF Treatment on VA in Neovascular AMD

In this prospective cohort study, researchers evaluated two-year visual acuity (VA) outcome of a treat-and-extend protocol of anti-vascular endothelial growth factor (anti-VEGF) treatment in age-related macular degeneration (AMD).

A total of 120 AMD patients with choroidal neovascularization (CNV) received three initial monthly ranibizumab or bevacizumab injections; monthly injections were continued until there was no CNV activity (subretinal/intraretinal fluid, loss of more than five letters, or persistent/recurrent retinal hemorrhage). When there was no CNV activity, the interval to the next visit/injection was extended by two weeks to a maximum of 12 weeks. In the presence of CNV activity, this interval was shortened by two weeks. Main outcome measures included the percentage losing less than 15 letters and the mean VA change after 12 months and 24 months.

According to the researchers, mean baseline VA was 51.2 ± 12.1 Early Treatment Diabetic Retinopathy Study scores. They noted that mean visual acuity change from baseline was +9.5 ± 10.9 and +8.0 ± 12.9 letters after 12 months and 24 months, respectively, with, on average, 8.6 ± 1.1 visits/injections in the first year and 5.6 ± 2.0 in the second year. After 12 months and 24 months, 97.5% and 95.0% of patients, respectively, lost less than 15 letters.

The “inject-and-extend” protocol—with fewer injections and visits—delivered outcomes comparable to those of the pivotal clinical trials of monthly ranibizumab, the researchers concluded.

SOURCE: Abedi F, Wickremasinghe S, Islam AF, et al. Anti-VEGF treatment in neovascular age-related macular degeneration: a treat-and-extend protocol over 2 years. Retina. 2014;Mar 14. [Epub ahead of print].

Meta-Analysis of Infectious Endophthalmitis Following Intravitreal Injection of Anti-VEGF Agents

To examine the rate of endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents, the spectrum of causative organisms, and associated visual acuity outcomes, investigators identified and reviewed PubMed articles containing the keywords “endophthalmitis” and “intravitreal” between January 2005 and May 2012. Inclusion criteria included article in English, more than 100 intravitreal anti-VEGF injections, and report of adverse events including endophthalmitis after intravitreal injection.

The study investigators analyzed 43 articles were analyzed and found that endophthalmitis occurred after 197 of 350,535 intravitreal anti-VEGF injections (0.056%). The most common organisms isolated were coagulase-negative Staphylococcus (38.24%) and Streptococcus species (29.41%).

The reported rate of endophthalmitis following intravitreal anti-VEGF injection is low. Coagulase-negative Staphylococcus and Streptococcus species were the most frequent causative organisms. Streptococcus species represent the causative organism of endophthalmitis after intravitreal VEGF injections at a higher rate than rates reported in the literature for endophthalmitis following most incisional intraocular surgeries. Among patients with endophthalmitis after intravitreal anti-VEGF injection, the investigators determined that endophthalmitis caused by Streptococcus species is associated with poorer visual acuity outcomes than endophthalmitis caused by coagulase-negative Staphylococcus and culture-negative cases.

SOURCE: Fileta JB, Scott IU, Flynn HW. Meta-analysis of infectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmic Surg Lasers Imaging Retina. 2014;45(2):143–149.

Low-Luminance VA and Microperimetry in AMD

The authors of the following prospective cross-sectional study sought to compare the effectiveness of low-luminance visual acuity (LLVA) and microperimetry as functional measures in early stages of age-related macular degeneration (AMD).

Included in the study were 179 participants with a clinical spectrum of non-neovascular AMD and 26 control participants. The authors measured best-corrected visual acuity (BCVA), LLVA and microperimetric retinal sensitivity on one eye of all participants. They calculated low-luminance deficit (LLD) as the difference between LLVA and BCVA. Additionally, they compared functional parameters between six clinical severity groups (from controls to non-foveal geographic atrophy [GA]), and they determined and compared the relationships and magnitude of these parameters. Visual acuity parameters (BCVA, LLVA and LLD) and central retinal sensitivity were the main outcome measures.

The authors found that BCVA, LLVA and central retinal sensitivity were reduced significantly for all AMD clinical severity groups when compared with control participants (p≤0.002), except for those with drusen between 63 µm and 125 µm (p≥0.107). However, they noted that LLD was not significantly different from control participants in all groups (p≥0.073), except in the non-foveal GA group (p=0.008). A significant positive relationship between central retinal sensitivity and LLD (r=0.613; p<0.001), but not BCVA, suggests that there is a trend for LLVA to detect a greater extent of functional deficit than BCVA in eyes with increasingly poorer retinal sensitivity. However, the results of the linear regression models estimated central retinal sensitivity to be 6.1, 3.7, and 5.1 standard deviations (SDs) less than normal by the time BCVA, LLVA and LLD, respectively, were two SDs less than normal.

To conclude, in early stages of AMD, LLVA did not detect a greater extent of functional deficit than BCVA when compared with control participants. Although there was a trend for LLVA to be more effective at detecting foveal deficits than BCVA in eyes with increasingly poorer retinal sensitivity, both VA measures were much less sensitive compared with microperimetry.

SOURCE: Wu Z, Ayton LN, Guymer RH, Luu CD. Low-luminance visual acuity and microperimetry in age-related macular degeneration. Ophthalmology. 2014;Mar 24. [Epub ahead of print].

  • STELLARIS PC VISION ENHANCEMENT SYSTEM RECEIVES 510(K) CLEARANCE FOR INTEGRATED 532-nm LASER. In a recent press release, Bausch + Lomb announced that its Stellaris PC Vision Enhancement System has received 510(k) clearance from the FDA for the integrated 532-nm laser and software. With this advance, the company says the Stellaris PC now offers additional advantages to surgeons' facilities including: a first-of-its-kind wireless, dual-linear foot pedal that features integrated laser control and improved design; a redesigned interface and laser control software that offers improved clarity, enhanced contrast, and ease of use for surgeons and staff; and a fully integrated 532-nm green laser, which is upgradable for existing Stellaris PC Vision Enhancement Systems and connects within the sterile field.
  • AAO LAUNCHES IRIS REGISTRY. The American Academy of Ophthalmology recently announced the official launch of the IRIS Registry, or Intelligent Research in Sight, the nation's first comprehensive eye disease and condition registry. According to the organization, the centralized data repository and reporting tool aggregates patient data from electronic health records (EHRs) and performs statistical analysis that enables ophthalmologists to improve patient care, reduce the cost and enhance the speed of some large clinical trials, assist in monitoring resource utilization, comply with federal payment programs and enhance quality and practice efficiency. The IRIS Registry was designed to be interoperable with any EHR, from which it automatically syncs data rather than requiring manual entry, and is now available for open enrollment to all U.S.-based Academy members and their practices. The Academy is initially offering multi-year, fee-free access to member physicians who sign an agreement and integrate their EHR with the IRIS Registry in 2014. Get more details at www.aao.org.
  • FINALISTS ANNOUNCED FOR OWL AWARDS. Ophthalmic Women Leaders (OWL) previously reported that it will honor three award winners during its signature “OWL Monday” reception and program held in conjunction with the American Society of Cataract & Refractive Surgeons meeting in Boston on Monday, April 28th. Finalists for the Visionary Woman Award are: Jane Rady, divisional vice president, Business Development, Abbott Medical Optics Inc.; Candace S. Simerson, COE, CMPE, CAHCM, president and COO at Minnesota Eye Consultants; and Ellen Troyer, MT MA, CEO/chief research officer at Biosyntrx Inc. Finalists for the Catalyst Award are: Laurie Brown, COMT, COE, OSA, CPSS, practice administrator for Drs. Fine, Hoffman & Sims LLC; Georgette Pascale, president and CEO, Pascale Communications LLC; and Melissa Toyos, MD, ophthalmic partner at Discover Vision Centers. And finalists for the Rising Star Award are: Tamara Bogetti, MBA, publisher, Bryn Mawr Communications LLC; Michael Elofer, account executive, Pascale Communications LLC; and Megan Sweeney, associate director of New Product Planning & Market Development, Nicox Inc. To learn more about the reception and the finalists—or to vote—visit www.owlsite.org. You must be a member of the organization to vote for the winners of each award category. Voting will conclude on April 9.
  • PSIVIDA RESUBMITS NDA FOR ILUVIEN. pSivida Corp. has resubmitted its New Drug Application (NDA) for Iluvien for the treatment of chronic diabetic macular edema to the FDA. According to a statement to the press, in the resubmission, pSivida's licensee, Alimera Sciences, responded to questions raised in the FDA's October 2013 complete response letter and provided a safety update, which included commercial experience with Iluvien in Europe. Alimera is now awaiting the FDA's acceptance of the resubmission, as well as a Prescription Drug User Fee Act date.
  • RETAINE HPMC LUBRICANT EYE DROPS NOW AVAILABLE IN MULTI-DOSE, PRESERVATIVE-FREE BOTTLE. OCuSOFT Inc.'s Retaine HPMC Lubricant Eye Drops are now available in a patented Multi-Dose, Preservative-Free delivery system. The drops are a preservative-free hypromellose ophthalmic solution (0.3%) that provides relief to soothe dry, irritated eyes and has a three-month stability after opening with guaranteed sterility. Utilizing a patented proprietary airless pump system that prevents harmful bacteria from entering the bottle and contaminating the solution, Retaine HPMC enables delivery of multiple sterile doses to the eye without preservatives. Click here for additional information.

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