Researchers assessed the characteristics and rate of central visual field loss after optic disc hemorrhages, as part of a prospective cohort study.

A total of 343 eyes of 220 subjects who had at least three years of follow-up with a minimum of five visits with 10-2 and 24-2 visual fields were recruited. Rates of 10-2 mean deviation (MD) loss in each hemifield and pre-defined zones were compared using a linear mixed-effects model in DH and non-DH eyes. Clustered pointwise regression analysis defined central VF progressors, and researchers compared findings to 24-2 VF loss using Guided Progression Analysis.

A total of 39 eyes with DHs and 304 eyes without DHs had a mean follow-up of 5.2 years. Here are some of the findings: 

  • Eyes with DHs had rates of 10-2 mean deviation (MD) loss that were three times faster than non-DH eyes (mean difference [CI] -0.36 dB/year [0.54, 0.18; p<0.001) and were 3.7 times more likely to progress (p=0.002).
  • A larger proportion of glaucomatous eyes showed central VF progression rather than peripheral VF progression (30.8 percent vs. 20.5 percent) in the DH group, compared with the non-DH group (10.9 percent vs. 9.2 percent).
  • In early glaucoma, the rate of 10-2 MD loss was 5.5 times faster in DH eyes than in non-DH eyes (p<0.001). 
  • Superonasal and superotemporal central VF regions progressed more rapidly than other regions, especially in DH eyes.

Researchers found that central visual field loss was accelerated in glaucoma eyes with optic disc hemorrhages and corresponded topographically to the DH location. They suggest that for glaucoma patients with DHs, clinicians should consider supplementing 10-2 VFs with 24-2 VFS to monitor disease.


Am J Ophthalmol 2021; June 6 [Epub ahead of print].

David RCC, Moghimi S, Do JL, et al. 


Dry-eye Subtypes Explored 

Scientists evaluated subtypes and characteristics of dry eye using conventional tests and dynamic tear interferometry, and reported determinants of disease severity in each DE subtype.

A total of 309 patients were diagnosed with DE, and 69 healthy controls were prospectively enrolled. All eyes were evaluated using the Ocular Surface Disease Index (OSDI), Schirmer’s test I (ST1) and meibomian gland dysfunction (MGD) grade. The tear interferometric pattern and lipid layer thickness were determined using DR-1α and LipiView II, respectively.

Here are some of the findings:

  • Dynamic interferometric analysis revealed 56.6 percent of patients with DE exhibited Jupiter patterns, indicative of aqueous-deficiency, while 43.4 percent exhibited crystal patterns, indicative of lipid deficiency. These findings were in accordance with classification based on ST1 scores and MGD grade. 
  • Conventional assessment indicated 286 patients exhibited evidence of evaporative DE (EDE) due to MGD, while 11 exhibited signs of pure aqueous-deficient DE (pure ADDE, only ST1 ≤5 mm). 
  • Of 286 patients with EDE, 144 were categorized into the mixed-ADDE/EDE group, in which ST1 was identified as a strong negative determinant of OSDI. 
  • In contrast, 72.2 percent of patients with mixed-ADDE/EDE exhibited Jupiter patterns (Jupiter mixed), while 27.8 percent exhibited crystal patterns (crystal mixed). 
  • OSDI values were significantly higher in the crystal-mixed group than in the Jupiter-mixed, where OSDI scores were independently associated with ST1 values only.

Scientists reported that the majority of EDE patients also exhibited aqueous deficiency, which can aggravate symptoms in patients with lipid-deficient mixed-ADDE/EDE. They recommended that conventional assessments be combined with interferometric tear analysis to determine the most appropriate treatment for each DE patient.


Br J Ophthalmol 2021; June 9 [Epub ahead of print].

Ji YW, Seong H, Seo JG, et al.


PDR Progression in the Real World vs. Trials

While clinical trials have demonstrated that treatment of diabetic macular edema with anti-VEGF drugs can ameliorate disease severity and progression, little evidence has shown if these outcomes translate to real-word settings. 

To get answers, researchers in the United Kingdom analyzed what they said is the largest cohort of DME patients who received anti-VEGF treatments and were evaluated for development of proliferative diabetic retinopathy in a real-world setting. They recently presented their results at the Association for Research in Vision and Ophthalmology.

Baseline DR grade is an important influential factor for PDR development during DME treatment, the researchers noted. They add that DR improvement in clinical trials may not be reproduced in routine-care settings where patients receive fewer treatments and could have less rigorous diabetes mellitus control.

The study analyzed data on 4,922 patients from 27 centers in the United Kingdom. The patients received anti-VEGF injections for DME between February 2013 and December 2018, and the centers used the same electronic medical record system. The median patient age (standard deviation) was 66.4 years (11.9 years) and median follow-up was 13 months (15.29 months). Fifty-eight percent of the patients were men.

The primary outcome was the time from the first DME treatment to progression to PDR. The study used time-to-event analysis to demonstrate the rate of PDR progression stratified by baseline DR grade.

On average, the patients received 6.3 (SD 6.3) treatments during the study period. Patients with more severe DR grades required more injections: 5.81 injections for mild nonproliferative DR, 6.56 for moderate NPDR and 6.84 for severe NPDR. 

Progression to PDR was strongly influenced by baseline DR grade. But when the researchers controlled for baseline DR grade, a higher number of injections, using six as a threshold between lower and higher number, didn’t reduce the risk of PDR development.

“This will help inform clinicians about the importance of carefully following these patients and adjusting their follow-up intervals accordingly as these injections may not change the disease course in the long term,” Dr. Alsaedi said.

Dr. Alsaedi and co-authors have no disclosures.


Paper presented at Association for Research in Vision and Ophthalmology. Diabetic Retinopathy – Diagnosis and Therapies session; May 6, 2021.

Alsaedi AH, Herren T, Thomas D, et al.


Silver Nanoparticles Reduce Acanthamoeba Risk

Acanthamoeba keratitis is particularly common among contact lens wearers, occurring most often due to improper storage or failure to remove the lenses prior to showering or swimming. Recently, a study evaluated silver nanoparticles as possible agents against Acanthamoeba and found that low concentrations in contact lens solution might help to decrease infection risk.

The researchers examined properties of silver nanoparticles (AgNPs) when conjugated with five multipurpose contact lens solutions against the NEFF strain of Acanthamoeba in five in vitro assays. Here are some of their findings:

  • Opti-Free (Alcon) reduced Acanthamoeba activity by up to 27.8 percent after three hours and 23.8 percent after four hours of incubation, compared to a pure contact lens solution. The researchers noted that they observed increased activity after up to six hours of incubation, which is the minimum time of disinfection for Opti-Free.

  •  SoloCare Aqua (Menicon) demonstrated reduced activity up to 17.2 percent after three hours and 20.3 percent after four hours of incubation compared to a pure contact lens solution.

  •   B-Lens, Best View and ReNu MultiPlus (Bausch + Lomb) demonstrated no statistically significant increase in anti-amoebic activity after up to six hours of incubation when conjugated with the silver nanoparticles.

When conjugated with silver nanoparticles, The Opti-Free and SoloCare Aqua contact lens solutions demonstrated a significant increase in anti-amoebic activity without increasing overall cytotoxicity, researchers said. 


Pathogens 2021;10:5:583.

Hendiger EG, Padzik M, Sifaoui I, et al.


Ocular Allergy’s Impact Surprisingly Severe in Kids

The severity of allergic conjunctivitis may cause children with the condition—and their parents—to have a lower quality of life, a recent study published in JAMA Ophthalmology suggests.

The condition is especially problematic in children and adolescents, the study notes. 

The case-control study enrolled 188 children and their parents. Participants included 92 children between the ages of 5 and 18 and their parents in the study group, and 96 healthy, age-matched youths and their caretakers in the control group.

The members of the study group were subdivided into cohorts of vernal keratoconjunctivitis, atopic keratoconjunctivitis, seasonal allergic conjunctivitis and perennial allergic conjunctivitis. 

Participants responded to the Pediatric Quality of Life Inventory Questionnaire (PedsQL), with scores ranging from zero to 100. Higher scores on the questionnaire indicated better health-related quality of life and fewer negative findings.

Key findings from the study include:

  • PedsQL scores were 27 points lower in children with allergic conjunctivitis and their parents compared with their counterparts in the control group.

  • Having vernal keratoconjunctivitis or atopic keratoconjunctivitis reduced QOL by about another four points than the mean for all allergy subjects.

  •  In the allergic conjunctivitis group, a higher corneal fluorescein staining score was linked with a lower quality of life in children.

  •  Parents whose children had higher corneal fluorescein staining scores and multiple clinical consultations reported a lower quality of life. Considering sub-scores, parents were most worried about whether their child’s treatment would be effective.

  •  Parents’ scores correlated with their children’s.

The decreased quality of life in children with allergic conjunctivitis was actually worse than in previous studies of youth diagnosed with blinding diseases such as glaucoma and congenital cataract.

The study’s results suggest a detailed assessment of quality of life may be useful to inform chronic condition care for children with allergic conjunctivitis, the investigators concluded. 


JAMA Ophthalmology 2021; June 10 [Epub ahead of print].

Zhang SY, Li J, Liu R, et al.