Volume 14, Number 15
Monday, April 14, 2014

In this issue: (click heading to view article)
######### Effects of Long-Term Fine Needle Diathermy for Established CNV
######### Inner Retinal Layer of Eyes with Exudative AMD vs. Eyes with AMD
######### Link Between Folate, Vitamins B6 and B12 Intake and Exfoliation Glaucoma or Suspected Exfoliation Glaucoma
######### Color Vision Deficiency in Preschool Children
######### Briefly

Effects of Long-Term Fine Needle Diathermy for Established CNV

Corneal neovascularization (CNV) can lead to significant ocular comorbidity with reduction in vision and cosmesis. A number of techniques have been described to reduce CNV, but these can be expensive. The following five-year retrospective study in the United Kingdom aimed to determine the safety, efficacy and long-term outcomes of fine needle diathermy (FND) for CNV.

Study authors identified all cases of FND and documented Indications, intraoperative complications and postoperative visual acuity following treatment and retreatments, along with the procedure time. They also identified evidence of regression and number of retreatments.

They noted that 56 eyes from 52 patients underwent FND for CNV. The main indications included herpes simplex keratitis (HSK) (53%, n=25) and microbial keratitis/peripheral ulcerative keratitis (13%, n=6). Pretreatment acuity was significantly correlated with extent of CNV (p=0.044), the authors reported. They observed one complication during the procedure: an intrastromal and subconjunctival hemorrhage (rate 2%). They also discovered that 68.1% of patients demonstrated regression at first follow-up (mean 6.9 weeks), and 89.3% (n=42) showed regression with two or fewer treatments. Mean post-FND acuity was 0.72 (range –0.2 to 3.0) vs. 0.82 (–0.2 to 3.0) preprocedure (p=0.08). VA improved in the HSK subgroup (p=0.012). Mean follow-up was 18.9 months (range one to 56 months).

In the largest case series reported, FND appears to be a safe and effective technique in the long-term to induce regression of CNV, with significant improvement in the VA of patients with HSK.

SOURCE: Trikha S, Parikh S, Osmond C, et al. Long-term outcomes of fine needle diathermy for established corneal neovascularization. Br J Ophthalmol. 2014;98(4):454–458.

Inner Retinal Layer of Eyes with Exudative AMD vs. Eyes with AMD + Glaucoma

The incidence of glaucoma increases with age, as does age-related macular degeneration (AMD), with the reported incidence of glaucoma among AMD subjects being 5.4%. Optical coherence tomography (OCT) can detect glaucomatous changes in the inner retina with high sensitivity. The purpose of this study was to compare ganglion cell complex (GCC) parameters and the thickness of the peripapillary retinal nerve fiber layer (RNFL) in normal eyes to that observed in eyes with AMD and eyes with both AMD and glaucoma.

Investigators in Japan measured the GCC components (GCC thickness, focal loss volume [FLV], and global loss volume [GLV]) and peripapillary RNFL thickness using RTVue spectral-domain OCT (SD-OCT). They also evaluated the GCC and RNFL parameters of normal eyes, AMD eyes treated with different types of therapy, and AMD eyes with and without glaucoma using nonparametric tests. Additionally, they used univariate and multivariate analyses to determine whether the GCC and RNFL parameters could be used to differentiate AMD eyes with glaucoma from those without glaucoma.

The study investigators examined 71 normal eyes, 120 eyes with AMD and 23 eyes with AMD + glaucoma. They found that the values of all GCC components were significantly different in the normal eyes from those observed in the eyes with AMD, except for the RNFL thicknesses. They also noted that GCC and RNFL parameters were not significantly different between the eyes receiving different types of therapy among the AMD groups. The RNFL thickness was significantly correlated with glaucoma diagnosis in AMD eyes.

To conclude, these findings indicate that there is damage to the inner retinal layers in eyes with AMD. The RNFL thickness can be a useful parameter for differentiating eyes with AMD from eyes with both AMD and glaucoma.

SOURCE: Rimayanti U, Kiuchi Y, Yamane K, et al. Inner retinal layer comparisons of eyes with exudative age-related macular degeneration and eyes with age-related macular degeneration and glaucoma. Graefes Arch Clin Exp Ophthalmol. 2014;252(4):563–570.

Link Between Folate, Vitamins B6 and B12 Intake and Exfoliation Glaucoma or Suspected Exfoliation Glaucoma

Effective strategies for primary prevention are lacking for exfoliation glaucoma (EG), which is the most common type of secondary glaucoma. Massachusetts researchers examined the association between B vitamin intake and EG or suspected EG (EG/SEG) risk in this national prospective cohort study using more than 20 years of follow-up data from the Nurses' Health Study (all female registered nurses) and the Health Professionals Follow-up Study (all male health professionals) from June 1, 1980, to May 31, 2010 (Nurses' Health Study) and January 1, 1986, to December 31, 2010 (Health Professionals Follow-up Study).

They included a subset of 78,980 Nurses' Health Study women and 41,221 Health Professionals Follow-up Study men who were 40 years or older, free of glaucoma, had completed diet questionnaires, and reported eye examinations (follow-up rate, >85%). Exposures included cumulatively updated intake of B vitamins (folate, vitamin B6 and vitamin B12) as ascertained by repeated administration of validated questionnaires. As for main outcome measures, the researchers first identified incident cases of EG/SEG, totaling 399 (329 women and 70 men), with the questionnaires and subsequently confirmed them with medical records. They also calculated multivariable relative risks for EG/SEG in each cohort and then pooled them with meta-analysis.

According to the researchers, vitamins B6 and B12 intake was not associated with EG/SEG risk in pooled analyses (p=0.52 and p=0.99 for linear trend, respectively). However, they observed a suggestive trend of a reduced risk with higher intake of folate: compared with the lowest quintile of cumulatively averaged updated total folate intake, the multivariable relative risk for EG/SEG for the highest quintile (≥654 µg/d) was 0.75 (95% CI, 0.54 to 1.04; p=0.02 for linear trend). These results were not materially altered after adjustment for vitamins B6 and B12 intake. The study researchers observed an association for supplemental folate intake, but not for dietary folate only (p=0.03 and p=0.64 for linear trend, respectively). Greater frequency of multivitamin use showed a modest suggestive inverse association (current multivitamin use of ≥6 times per week vs. nonuse multivariable relative risk, 0.84; 95% CI, 0.64 to 1.11; p=0.06 for linear trend).

Conclusions and Relevance  Higher total folate intake was associated with a suggestive lower risk for EG/SEG, supporting a possible causal role of homocysteine in EG/SEG.

SOURCE: Kang JH, Loomis SJ, Wiggs JL, et al. A prospective study of folate, vitamin B6, and vitamin B12 intake in relation to exfoliation glaucoma or suspected exfoliation glaucoma. JAMA Ophthalmol. 2014; Apr 3. [Epub ahead of print].

Color Vision Deficiency in Preschool Children

The Multi-Ethnic Pediatric Eye Disease Study is a population-based evaluation of the prevalence of vision disorders in children in Southern California. To determine the sex- and ethnicity-specific prevalence of color vision deficiency (CVD) in black, Asian, Hispanic and non-Hispanic white preschool children, this population-based, cross-sectional study recruited 5,960 subjects 30 to 72 months of age, of whom 4,177 were able to complete color vision testing (1,265 black; 812 Asian; 1,280 Hispanic; and 820 non-Hispanic white).

Color vision testing was performed using Color Vision Testing Made Easy color plates (Home Vision Care). Diagnostic confirmatory testing was performed using the Waggoner HRR Diagnostic Test color plates (Home Vision Care). Testability of color vision in preschool children between 30 and 72 months of age and prevalence of CVD stratified by age, sex and ethnicity was the main outcome measure.

Testability was 17% in children younger than 37 months of age, increasing to 57% in children 37 to 48 months of age; 89% in children 49 to 60 months of age; and 98% in children 61 to 72 months of age. The prevalence of CVD among boys was 1.4% for black, 3.1% for Asian, 2.6% for Hispanic and 5.6% for non-Hispanic white children; the prevalence in girls was 0.0% to 0.5% for all ethnicities. The ethnic difference in CVD was statistically significant between black and non-Hispanic white children (p=0.0003) and between Hispanic and non-Hispanic white children (p=0.02). In boys, most CVD cases were either deutan (51%) or protan (34%); 32% were classified as mild, 15% as moderate and 41% as severe.

Testability for CVD in preschool children is high by four years of age. The prevalence of CVD in preschool boys varies by ethnicity, with the highest prevalence in non-Hispanic white and lowest in black children.

SOURCE: Xie JZ, Tarczy0Hornoch K, Lin J; Multi-Ethnic Pediatric Eye Disease Study Group. Color vision deficiency in preschool children: The Multi-Ethnic Pediatric Eye Disease Study. Ophthalmology. 2014;Apr 3. [Epub ahead of print].

  • UNOPROSTONE NOW BEING STUDIED FOR AMD. R-Tech Ueno has announced that it is now working toward the development of unoprostone 0.15% (development code UF-021) for the treatment of age-related macular degeneration (AMD). The company is currently developing UF-021 for the treatment of retinitis pigmentosa. The investigators who initiated the clinical research presented their findings at the 118th Annual Meeting of the Japanese Ophthalmological Society in Tokyo. They reported that unoprostone had a suppressive effect on geographic atrophy occurring after anti-vascular endothelial growth factor treatment.

  • EYEGATE'S EGP-437 MATCHES STANDARD OF CARE'S RESPONSE RATE IN PHASE III STUDY FOR ANTERIOR UVEITIS. EyeGate Pharma says the topline results from its Phase III study of the corticosteroid formulation EGP-437 in anterior uveitis patients demonstrates that two iontophoretic treatments of EGP-437 achieved the same response rate as the positive control, prednisolone acetate 1% ophthalmic suspension administered as multiple daily eye drops, the current standard of care. In the randomized, double-masked, placebo-controlled study, 193 patients were randomly assigned into one of two treatment arms (iontophoretic treatment on days zero and seven or 14 days daily treatment of prednisolone acetate 1% ophthalmic solution, which was followed by two weeks of standard tapering). The primary efficacy endpoint was the proportion of patients with anterior chamber cell count of zero on day 14, which is defined as a complete response. In all randomized subjects, only two iontophoretic treatments with EGP-437 (days zero and seven) resulted in 32 complete responses out of 96 patients on day 14. The standard of care uveitis treatment (daily treatment) prednisolone acetate 1% ophthalmic suspension also yielded 32 complete responses out of 97 patients who received multiple daily self-administered eye drops over the first 14 days (days one to seven: eight drops per day and days eight through 14: six drops per day). The incidence and severity of treatment-emergent adverse events in both groups were comparable and there were fewer incidences of elevated intraocular pressure in the EGP-437 group.

  • FDA APPROVE’S PARAGON BIOTECK’S PHENYLEPHRINE HYDROCHLORIDE OPHTHALMIC SOLUTION, USP 2.5% AND 10%. In a recent statement to the press, Paragon BioTeck Inc. reported that the FDA approved its phenylephrine hydrochloride ophthalmic solution, USP 2.5% and 10', to dilate the pupil. The drug is readily available through Bausch + Lomb.
  • NOVARTIS ANNOUNCES STAFFING CHANGES. Novartis has appointed Jeff George as division head of Alcon, effective May 1, 2014. He succeeds Kevin Buehler, who is retiring after a 30-year career with Alcon. Filling Mr. George's previous role as division head of Sandoz is Richard Francis, who joins Novartis from Biogen Idec. For additional details, click here.

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