From the editors of Review of Ophthalmology:
NOVEMBER IS DIABETIC EYE DISEASE AWARENESS MONTH
In this issue: (click heading to view article)
Role of Diagnostic PPV in Determining Etiology of Uveitis
Researchers estimated the success and safety of diagnostic pars plana vitrectomy in determining the etiology of uveitis. They searched PubMed, Embase and Ovid up to October 2017 to identify relevant studies, and performed various statistical analyses.
Researchers also assessed the statistical heterogeneity by the chi-square test and I2 statistics, and performed sensitivity analysis and subgroup analyses to identify the source of heterogeneity. They also evaluated publication bias by the Egger test. Sixteen studies involving 1,195 individuals were included. The pooling result showed the successful rate of diagnostic PPV was 44 percent (CI [39 percent ∼50 percent).
• Among individuals whose diagnostic PPV yielded a definitive diagnosis, 69 percent were infectious uveitis (CI [61 to ∼77 percent]), 23 percent were lymphoma (CI [17 to ∼30 percent]) and 4 percent were metastatic carcinoma (CI [2 to ∼10 percent]).
• Among those diagnosed with infectious uveitis, the most frequent pathogens identified were viruses, followed by bacteria, Toxocara canis, Toxoplasma gondii, tuberculosis and fungus.
• The incidence of postoperative cataract and postoperative retinal detachment was 19 percent (CI, 8 to ∼29 percent) and 5 percent (CI, 1 to ∼10 percent), respectively, and the rate of secondary vitrectomy surgery was 10 percent (CI, 2 to ∼22 percent).
• Postoperative visual improvement rate was 46 percent (CI, 39 to ∼52 percent), and the postoperative treatment strategy was changed in light of the results of diagnostic PPV in 20 percent of cases (CI, 10 to ∼29 percent).
Researchers concluded that, for uveitis of unknown cause, diagnostic PPV appeared to be an effective, reliable, and relatively safe procedure for establishing the definite diagnosis and guiding further treatment. They added that positive therapeutic effect could also be achieved.
SOURCE: Zhao XY, Xia S, Chen YX. Role of diagnostic pars plana vitrectomy in determining the etiology of uveitis initially unknown. Retina 2018; Oct 23. [Epub ahead of print].
Visualization of LC Microvasculature in Normal & Glaucomatous Eyes Using SS-OCTA
The purpose of this study was to investigate lamina cribrosa microvasculature using swept-source optical coherence tomography angiography images processed using multiple image averaging and a projection-resolved algorithm. Investigators wrote that OCTA has recently gained popularity for assessing retinal and choroidal microvasculature, but that it wasn’t known if the LC microvasculature, which likely holds important information for further understanding of glaucoma, could be visualized with OCTA.
Investigators enrolled one normal subject and one glaucomatous subject, and obtained optic disc 3×3 mm SS-OCTA cubic images. They developed anterior LC slab frames, and created averaged images using three frames. And they examined images with and without removal of projection artifacts.
• The OCTA images of anterior LC slabs before projection artifact removal contained information on superficial and deep layer vessel blood flow;
however, after projection artifact removal, fewer blood flow signals remained.
• En face OCTA images showed flow signals on, or immediately adjacent, to lamina beams but not inside lamina pores.
• Glaucomatous eyes had sectoral reductions in LC microvasculature blood flow that wasn’t detected in normal eyes.
Investigators wrote that this first demonstration of inner LC microvasculature imaging was arranged in a polygonal pattern, which was consistent with prior histological reports. They noted that glaucomatous eyes had decreased flow signals in comparison with normal eyes, and suggested that future imaging studies with OCTA might be helpful for identifying and better understanding LC pathological changes associated with glaucoma.
Source: Numa S, Akagi T, Uji A, et al. Visualization of the lamina cribrosa microvasculature in normal and glaucomatous eyes: a swept-source optical coherence tomography angiography study. J Glaucoma 2018; Aug 29. [Epub ahead of print].
ETDRS 7-field Imaging With Ultrawide-field Imaging to Determine DR Severity
Scientists indicated that moderate to substantial agreement between Early Treatment Diabetic Retinopathy Study 7-field imaging and ultrawide-field imaging has been suggested in single-center studies. Comparing images obtained by multiple centers could increase confidence that UWF images can be used reliably in place of ETDRS imaging in future clinical trials, they added.
They aimed to compare diabetic retinopathy severity from modified ETDRS 7-field imaging and UWF imaging. This preplanned, cross-sectional analysis included modified ETDRS 7-field images, obtained using the Diabetic Retinopathy Clinical Research Network acquisition protocol, and UWF images, captured with the Optos 200Tx system, from adult participants (≥18 years old) with type 1 or 2 diabetes. Both image types were evaluated by trained graders masked to clinical data.
Main outcomes and measures included agreement between UWF images, UWF images masked to include only the ETDRS 7-field area and ETDRS 7-field images calculated using κ statistics. A total of 764 eyes from 385 participants were included, with a median (IQR) age of 62.2 (53.6 to 69.2) years; 194 (50.4 percent) were women, and 256 (66.5 percent) were white.
• Of 742 eyes, 359 (48.4 percent [CI, 44.4 to 52.4 percent]) eyes had exact agreement, and 653 eyes (88 percent [CI, 85.2 to 90.3 percent]) agreed within one step (weighted κ, 0.51 [CI, 0.44 to 0.58]).
• After open adjudication by an independent senior grader of images with more than a two-step discrepancy, perfect agreement was found in 435 eyes (59 percent [CI, 55.1 to 62.8 percent]); and agreement within one step was found in in 714 eyes (96.9 percent [CI, 95.1 to 98 percent]; κ, 0.77 [CI, 0.73 to 0.82]).
• Ability of the imaging modalities to detect retinopathy severity in an eye was considered similar in 59 eyes (50.9 percent [CI, 41.3 to 60.4 percent]), better for ETDRS 7-field imaging in 22 eyes (19 percent [CI, 12.5 to 27.7 percent]) and better for UWF-masked images in 31 eyes (26.7 percent [CI 18.8 to 36.5 percent]).
• Comparing UWF masked and unmasked images, 94 of 751 eyes (12.5 percent) had DR graded as at least one step more severe on UWF unmasked images vs. UWF masked images.
• Predominantly peripheral DR lesions were present in 308 of 751 eyes (41 percent); this suggested increased DR severity by two or more steps in 34 eyes (11 percent).
Scientists determined that imaging by ETDRS 7-field and UWF imaging systems had moderate to substantial agreement when evaluating the severity of DR within the seven standard fields. Disparities within an individual eye were equivalently distributed between imaging modalities, and could be better or worse on one or the other. Researchers wrote that longitudinal follow-up could help determine if peripheral retinal findings were associated with future retinopathy outcomes.
Aiello LP, Odia I, Glassman AR, et al. Comparison of early treatment diabetic retinopathy study standard 7-field imaging with ultrawide-field imaging for determining severity of diabetic retinopathy. JAMA Ophthalmol 2018; Oct 18. [Epub ahead of print].
Preoperative Vision & Surgeon Volume as Predictors of Visual Outcomes Following Cataract Surgery
Researchers assessed the relationship between preoperative vision and surgeon volume with visual outcomes following cataract surgery, as part of a retrospective, cohort study. Subjects included individuals >18 years old enrolled in the Kaiser Permanente Southern California health plan who underwent cataract surgery performed by non-trainee surgeons, between Dec. 31, 2013, and Jan. 1, 2015.
A total of 103,920 cataract surgeries, performed by 136 surgeons, were included. Researchers used a multivariate analysis including Generalized Additive Mixed Models to determine the relationship between surgeon volume and postoperative visual acuity after controlling for patient age, preoperative VA, history of diabetes and history of diabetic retinopathy. Modeling was also done to assess the relationship between preoperative vision and visual outcomes. The main outcome measures were absolute letter change and percentage of patients achieving >5 Early Treatment Diabetic letters postoperatively.
• Patients whose surgeons performed <91 surgeries/year (CI, 61.1 to 139, p<0.05) gained fewer letters postoperatively, while those whose surgeons performed >91 but <227 surgeries/year (CI, 169 - ∞, p<0.05) gained more letters than average.
• Although statistically significant, the difference between the lowest and highest performing groups was approximately 1.25 letters. Surgeons who performed <110 surgeries/year (CI, 81.7-149, p<0.05) had less patients who gained >5 letters.
• Surgeons who performed >110 but <293 surgeries/year (CI, 232-∞, p<0.05) were 15 to 20 percent more likely to have patients who gained >5 letters.
• Patients with preoperative vision <74.7 letters (CI, 74.7 to 74.8, p<0.05) gained more letters, and with preoperative vision <75.8 letters (CI 75.8 to 75.9, p<0.05) were more likely to gain >5 letters postoperatively.
Researchers found that patients whose vision was approximately 20/32 or worse were more likely to have significant visual gains after cataract surgery. They added that statistically significant differences existed in postoperative vision based on surgeon volume, but they didn’t appear to be clinically meaningful. Furthermore, they wrote, overall, visual outcomes were clinically and functionally comparable across a wide range of surgeon volumes.
SOURCE: Modjtahedi BS, Hull MM, Adams A, et al. Pre-operative vision and surgeon volume as predictors of visual outcomes following cataract surgery. Ophthalmology 2018; Oct. 25. [Epub ahead of print].
STAIRWAY Study Shows Potential for Extended Durability With Faricimab in Wet AMD
Genentech announced positive results from the Phase II STAIRWAY study, which explored the extended durability of faricimab (RG7716) in the treatment of wet age-related macular degeneration. At 52 weeks, faricimab subjects dosed either every 16 weeks or every 12 weeks demonstrated sustained vision outcomes comparable with ranibizumab dosed every four weeks. Results of the study were presented as an oral presentation during the American Academy of Ophthalmology’s annual meeting in Chicago. Read more.
GenSight Enrolls First Subject in PIONEER Phase I/II Trial of GS030 for RP
GenSight Biologics announced that the first subject was treated in the PIONEER Phase I/II clinical trial of GS030 at the Moorfields Eye Hospital in London. PIONEER is a multicenter, open-label, dose-escalation study of the safety and tolerability of GS030 in 18 subjects with retinitis pigmentosa. GS030 combines a gene therapy administered via a single intravitreal injection with a wearable optronic visual stimulation device. GS030 is based on the Optogenetics technology platform developed by GenSight, which uses gene therapy to introduce gene encoding for a light-sensitive protein into retinal ganglion cells by a single intravitreal injection, making them responsive to light and bypassing destroyed photoreceptors. Read more.
Ophthotech Expands Retinal Disease Pipeline with Inception 4 Acquisition, Enters Into Agreement With Penn & UFRF
Ophthotech acquired Inception 4, expanding the company’s therapeutic pipeline in age-related retinal indications, and giving the company worldwide development and commercialization rights to Inception 4’s small molecule inhibitors of HtrA1 (high temperature requirement A serine peptidase 1 protein). HtrA1 is potentially implicated in a range of retinal diseases, including geographic atrophy, the company says. Read more.
In addition, Ophthotech entered into an exclusive option agreement with the University of Pennsylvania and University of Florida Research Foundation for rights to negotiate to acquire an exclusive global license to develop and commercialize novel adeno-associated virus gene therapy product candidates for the treatment of Best vitelliform macular dystrophy, i.e., Best disease. Preclinical anatomical proof-of-concept studies conducted by Penn and the University of Florida demonstrated promising results in a canine Best disease model. Read more.
Noninvasive Laser Vision Correction Procedure in Clinical Trials
Clerio Vision is commercializing LIRIC—a novel, noninvasive method to correct human vision; the core technology, in development for more than 15 years, has entered clinical trials. The procedure is based on ultrafast laser technology developed by Gerard Mourou, PhD, and Donna Strickland, PhD, at the University of Rochester, who received the 2018 Nobel Prize in Physics. Wayne Knox, PhD, an early colleague of Dr. Mourou, previously refined the novel femtosecond techniques for noninvasive ophthalmic applications. In preclinical studies, the femtosecond lasers were optimized to change the refractive index of corneal tissue as a method to correct nearsightedness, farsightedness, astigmatism and presbyopia. Read more.
Review of Ophthalmology® Online is published by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073.
To subscribe to other JMI newsletters or to manage your subscription, click here.
To change your email address, reply to this email. Write "change of address" in the subject line. Make sure to provide us with your old and new address.
To ensure delivery, please be sure to add email@example.com to your address book or safe senders list.
Click here if you do not want to receive future emails from Review of Ophthalmology Online.
Advertising: For information on advertising in this e-mail newsletter or other creative advertising opportunities with Review of Ophthalmology, please contact sales managers James Henne or Michele Barrett.
News: To submit news or contact the editor, send an e-mail, or FAX your news to 610.492.1049