Volume 14, Number 34
Monday, August 25, 2014


In this issue: (click heading to view article)
######### Cataract Extraction's Effect on the Visual Field Decay Rate of Glaucoma Patients
######### Treatment of Wet AMD With Intravitreal Bevacizumab and Aflibercept
######### Three-Year Treatment Outcomes in the Ahmed Baerveldt Comparison Study
######### Incidence of Glaucoma in Patients With Obstructive Sleep Apnea


Cataract Extraction's Effect on the Visual Field Decay Rate of Glaucoma Patients

Researchers performed this retrospective, interventional, longitudinal study to evaluate the effect of cataract surgery on the slow and fast components of visual field decay in a group of patients with glaucoma.

Their study included 85 eyes of 68 patients with open-angle glaucoma who had cataract extraction. All patients had five or more reliable visual field measurements before and after surgery. The researchers used a point-wise exponential regression to perform trend analysis on thresholds at visual field test locations before and after cataract surgery. They ranked the test locations according to the decay rate and partitioned them into slow and fast groups. They also measured the slow and fast visual field rate components before and after cataract surgery and compared these. Additionally, they performed linear regressions of the mean deviation and the visual field parameter against time and compared these before and after surgery.

The study researchers reported that the mean (SD) deviation was –5.5 (5.1) dB before cataract surgery and –5.0 (4.9) dB after cataract surgery (p=0.002). They also noted that the mean (SD) Visual Field Index was 86.4% (13.5%) before cataract surgery and 86.6% (13.3%) after cataract surgery (p=0.30). The mean (SD) slow component rate decreased from 0.48% (0.73%) per year before surgery to 0.26% (0.42%) per year after surgery (p=0.04). They identified no statistically significant difference in the fast component mean (SD) rate per year before surgery (3.37% [4.05%]) vs. per year after surgery (3.46% [3.56%]) (p=0.29).

In conclusion, cataract progression seems to be the main determinant for the slow visual field rate component and does not change the fast visual field rate component. The method used can help reduce the confounding effects of cataract progression and cataract extraction on measured perimetric progression in glaucoma.


SOURCE: Lee JW, Morales E, Afifi AA, et al. Effect of cataract extraction on the visual field decay rate in patients with glaucoma. JAMA Ophthalmol. 2014;Jul 31. [Epub ahead of print].

Treatment of Wet AMD With Intravitreal Bevacizumab and Aflibercept

To compare treatment of exudative age-related macular degeneration with bevacizumab versus aflibercept in terms of central retinal thickness and best corrected visual acuity, this retrospective cohort study examined changes in CRT and BCVA over 12 months of follow-up in 111 patients treated with bevacizumab and 91 treated with aflibercept for exudative AMD.

Treatment with bevacizumab and aflibercept reduced CRT from baseline to 12 months. Aflibercept significantly reduced the mean change from baseline CRT at 12 months compared to bevacizumab. However, mean CRT at 12 months was not significantly different after aflibercept versus bevacizumab (271.6 ± 74.0 µm vs. 257.9 ± 48.5 µm). BCVA was significantly better at six months in the aflibercept group. At baseline, 18.5% of bevacizumab and 26.4% of aflibercept patients had BCVA better than 20/40. At 12 months, 34.8% of bevacizumab and 38.9% of aflibercept patients had BCVA better than 20/40.

It was determined that CRT decreased and BCVA improved after treatment with bevacizumab and aflibercept for exudative AMD.

SOURCE: Selid PD, Jundt MC, Fortney AC, Beal JR. Intravitreal bevacizumab and aflibercept for the treatment of exudative age-related macular degeneration. OSLI Retina. 2014;45(4):275–281.

Three-Year Treatment Outcomes in the Ahmed Baerveldt Comparison Study

The authors of the following multicenter, randomized, controlled clinical trial compared three-year outcomes and complications of the Ahmed FP7 Glaucoma Valve (AGV) (New World Medical) and the Baerveldt Glaucoma Implant (BGI) 101-350 (Abbott Medical Optics) for the treatment of refractory glaucoma.

Participants consisted of 276 patients: 143 in the AGV group and 133 in the BGI group. The authors randomized patients aged 18 to 85 years with refractory glaucoma and intraocular pressures ≥18 mmHg in whom an aqueous shunt was planned to an AGV or a BGI. Main outcome measures were IOP, visual acuity, supplemental medical therapy, complications and failure (IOP >21 mmHg or not reduced by 20% from baseline, IOP <5 mmHg, reoperation for glaucoma or removal of implant or loss of light perception vision).

At three years, the authors noted that IOP (mean ± standard deviation) was 14.3 ± 4.7 mmHg in the AGV group and 13.1 ± 4.5 mmHg in the BGI group (p=0.086) on 2.0 ± 1.4 and 1.5 ± 1.4 glaucoma medications, respectively (p=0.020). The also reported that the cumulative probabilities of failure were 31.3% (standard error, 4.0%) in the AGV group and 32.3% (4.2%) in the BGI group (p=0.99). Postoperative complications associated with reoperation or vision loss of more than two Snellen lines occurred in 24 patients (22%) (AGV) and 38 patients (36%) (BGI) (p=0.035). The mean change in the logarithm of the minimum angle of resolution VA at three years was similar (AGV: 0.21 ± 0.88, BGI: 0.26 ± 0.74) in the two treatment groups at three years (p=0.66). Furthermore, the cumulative proportion of patients (SE) undergoing reoperation for glaucoma before the three-year postoperative time point was 14.5% (3.0%) in the AGV group compared with 7.6% (2.4%) in the BGI group (p=0.053, log rank). The relative risk of reoperation for glaucoma in the AGV group was 2.1 times that of the BGI group (95% confidence interval, 1.0–4.8; p=0.045, Cox proportional hazards regression).

To conclude, implantation of the AGV was associated with the need for significantly greater adjunctive medication to achieve equal success relative to implantation of the BGI and resulted in a greater relative risk of reoperation for glaucoma. More subjects experienced serious postoperative complications in the BGI group than in the AGV group.

SOURCE: Barton K, Feuer WJ, Budenz DL, et al; and the Ahmed Baerveldt Comparison Study Group. Three-year treatment outcomes in the Ahmed Baerveldt Comparison Study. Ophthalmology. 2014;121(8):1547–1557.


Incidence of Glaucoma in Patients With Obstructive Sleep Apnea

This study was conducted to examine the prevalence and progression of glaucoma in patients receiving treatment for obstructive sleep apnea. The investigators also looked into whether there is an association between severity of obstructive sleep apnea and the incidence of glaucoma.

They assessed 39 patients aged >30 years who had been diagnosed with moderate and severe obstructive sleep apnea in the sleep clinic at Hamad General Hospital for the presence of glaucoma. They then graded severity of obstructive sleep apnea as mild, moderate or severe based on American Association of Sleep Medicine criteria using the apnea hypopnea index. Before enrollment, all patients underwent a complete ophthalmic examination including serial visual field tests, optical coherence tomography with fundus photographs and pachymetry. Enrolled patients were followed up in the ophthalmology outpatient clinic and sleep clinic for three years.

According to the investigators, examinations found that eight (20.5%; 95% confidence interval 9.9 to 37%) of the 39 patients with obstructive sleep apnea had glaucoma. Six (75%; 95% CI 36 to 96%) of these patients had normal-tension glaucoma and two (25%; 95% CI 4.5 to 64.4%) patients had high-tension glaucoma. Among the 27 patients with severe obstructive sleep apnea, seven (25.9%; 95% CI 8 to 34%) had glaucoma, and among 12 patients with moderate obstructive sleep apnea, one (8.3%; 95% CI 0.1 to 15%) had glaucoma. During the course of follow-up, two patients who previously did not have glaucoma were reclassified as NTG and two patients with glaucoma deteriorated. A higher prevalence of glaucoma in the severe obstructive sleep apnea group compared with the moderate obstructive sleep apnea group was found, albeit a statistically significant difference could not be attained (p=0.4).

This study showed that severe obstructive sleep apnea is an important risk factor for developing glaucoma. Adequate treatment of the condition, along with optimal ophthalmic care, resulted in better control of glaucoma.

SOURCE: Hashim SP, Mansouri FA, Farouk M, et al. Prevalence of glaucoma in patients with moderate to severe obstructive sleep apnea: ocular morbidity and outcomes in a 3 year follow-up study. Eye. Aug 15. [Epub ahead of print].


  • AMARANTUS TO LICENSE INTELLECTUAL PROPERTY FROM BASCOM PALMER EYE INSTITUTE FOR USE OF MANF IN RETINAL DISORDERS. Amarantus Bioscience Holdings Inc. announced that it exercised its exclusive option to license intellectual property related to the utility of mesencephalic-astrocyte-derived neurotrophic factor (MANF) in treating retinal disorders from the University of Miami's Bascom Palmer Eye Institute and has entered into an exclusive license for said intellectual property. According to the agreement, Amarantus has been granted a perpetual, exclusive worldwide license to intellectual property, covering the use of MANF for the treatment of retinal disorders including retinitis pigmentosa. The license agreement covers the use of the MANF family of proteins for retinal diseases including age-related macular degeneration, glaucoma, inherited retinal disorders, sporadic retinal disorders, other degenerative retinal disorders and retinal injuries.

  • TEL AVIV UNIVERSITY RESEARCHERS DEVELOP ADHD DIAGNOSTIC TOOL. A new study from researchers at Tel Aviv University may provide the objective tool medical professionals need to accurately diagnose Attention Deficit Hyperactivity Disorder. The researchers used an eye-tracking system to monitor the involuntary eye movements of two groups of adults (those with ADHD and a control group of individuals not diagnosed with ADHD) taking an ADHD diagnostic computer test. The exercise was repeated twice by each participant. The ADHD group initially took the test unmedicated, then took it while on methylphenidate. The researchers found a direct correlation between ADHD and the inability to suppress eye movement in the anticipation of visual stimuli. Additionally, the study revealed improved performance by participants taking the drug, which normalized the suppression of involuntary eye movements to the average level of the control group. Read more here.

  • VOLK OPTICAL TO HIGHLIGHT NEW PRODUCTS AT AAO. Volk Optical plans to feature new products at its booth during the American Academy of Ophthalmology Annual Meeting in Chicago October 18–21. In addition to showing its entire line of diagnostic, therapeutic and surgical ophthalmic lenses, equipment and accessories, Volk will also be introducing its Pictor Plus handheld imager, which allows high-resolution images of the retinal and anterior segment to be captured during non-office exams on non-ambulatory patient visits, at off-site clinics and during field work. Volk says that the Retinal module provides a 45° field of view of the fundus and that nine fixation points target different regions of the retina. Moreover, using a nonmydriatic imaging method, the device can image pupils as small as 3 mm. Also featured will be the Volk Eye Check electronic handheld ocular measurement device capable of a number of key measurements, including pupil diameter, horizontal visible iris diameter, interpupillary distance, pupil eccentricity and strabismus angle. Special show pricing will be available, along with a free multi-lens case with purchase.

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