Boston researchers assessing the efficacy of a combination treatment approach consisting of lipid emulsion eye drops, eyelid cleansing wipes and omega-3 vitamin supplements compared to the standard of care (warm compresses) for improving meibomian gland functionality in patients with lipid-deficient/evaporative dry-eye disease concluded that the regimen resulted in a significant improvement in both gland functionality and symptom relief.

The single-center, open-label, investigator-masked, randomized study enrolled patients 18 years of age and older who had been clinically diagnosed with LLDDE, which was defined as having six or fewer functional meibomian glands (as tested by meibomian gland yielding liquid secretion), and positive for dry-eye symptoms at screening. Patients were randomized to receive either the combination treatment of lipid emulsion eye drops, omega-3 supplements and lid hygiene with eyelid wipes, or to apply warm, wet compresses once a day for eight minutes, for three months time. The primary outcome of this study was meibomian gland functionality (MGYLS), with a secondary outcome of patient-reported subjective assessments (SPEED and OSDI questionnaires).

The mean patient age was 41.7 years (n=26; 13 per group.) The mean ± standard deviation number of MGYLS was not statistically significant between groups (combination treatment, 3.5 ±1.5; warm compresses, 4.2 ±1.4) at baseline (p>0.5) and was significantly greater with combination treatment vs. warm compresses after three months of treatment (9.3 ±2.7 vs. 4.7 ±2.3; p=0.006). Dry-eye symptoms were significantly improved in both groups at all follow-up visits. The best-corrected visual acuity was unchanged from baseline in both groups; two adverse events (infectious mononucleosis and sinusitis) for a single patient in the combination group were reported, but were not considered treatment-related.
Three of this article’s authors disclose financial interest in the products and/or companies referenced in this article.
Cornea 2015;34:407-412.
Korb D, Blacie C, Finnemore V, Douglass T.

IOP Trends After IVI of Anti-VEGF Agents for DME
Saudi Arabian doctors studying intraocular pressure trends and risk factors relating to IOP elevation after intravitreal anti-vascular endothelial growth factor injections in patients with diabetic macular edema determined that persistent IOP elevation after IVI anti-VEGF is uncommon but may be associated with a higher number of injections.

A retrospective review of 760 eyes of 486 patients treated with IVI anti-VEGF for DME was performed and the rate and risk factors for IOP elevation were assessed. Intraocular pressure elevation was defined as an increase above baseline IOP by ≥6 mmHg, increase above baseline IOP by >20 percent or IOP elevation to >24 mmHg on two or more consecutive visits after treatment. When more than one pretreatment IOP reading was available, baseline IOP was calculated as the mean of the available pretreatment readings (up to a maximum of three previous readings). Intraocular pressure elevation was considered transient unless it was maintained through the entire follow-up period or required treatment (a persistent elevation).

Over a mean follow-up of 18 months, persistent and transient IOP elevation occurred in 44 (5.8 percent) and 53 (7 percent) eyes, respectively. The majority of eyes with persistent IOP elevation (70.4 percent) showed IOP elevation of >20 percent from baseline. Only 13 eyes (1.71 percent) met the more strict criteria (≥6 mmHg from baseline or an IOP elevation >25 mmHg). Final IOP was higher in the persistent IOP elevation group than the rest of the eyes (p<0.001). Only the number of injections was associated with IOP elevation (p<0.001).
Retina 2015;35:440-448.
Al-Abdullah A, Nowilaty S, Asghar N, Al-Kharashi A, Ghazi N.

Referral-Warranted ROP Predictors in Telemedine
A report from the Telemedine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study cooperative group finds four strong independent predictors for referral-warranted ROP, when controlling for very low birth rate and prematurity: the presence of preplus disease; stage 2 ROP; retinal hemorrhage; and the need for ventilation at the time of the first study-related eye exam.

This multicenter observational cohort study included secondary analysis of data from the e-ROP Study. Infants included in the study had a birth weight of less than 1,251 grams. The main outcome was incidence of RW-ROP, defined as the presence of plus disease, zone 1 ROP or ROP stage 3 or greater in either eye and associations with predictive factors.

Among 979 infants without RW-ROP at the first study-related eye examination (median postmenstrual age, 33 weeks; range: 29 to 40 weeks) who underwent at least two eye examinations, 149 (15.2 percent) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio, 1.8); nonblack race (OR, 2.76); low birth weight (OR, 5.16); younger gestational age (OR, 9.79); number of quadrants with preplus disease (OR, 7.12); stage 2 ROP (OR, 4.13); the presence of retinal hemorrhage (OR, 4.36); the need for respiratory support via controlled mechanical ventilator (OR, 4.99) or high frequency oscillatory ventilation (OR, 11) vs. no respiratory support; and slow weight gain (OR, 2.44). These characteristics predicted the development of RW-ROP significantly better than birth weight and gestational age alone.
JAMA Ophthalmol 2015; 133:3:304-311.
Ying G, Quinn G, Wade K, Repka M, Baumriter A, et al.

Possible Protective Effects of Statins on Preventing Uveitis
A retrospective, population-based case control study to assess whether there is a protective association between statin use and uveitis diagnosis concluded that statin use may be protective against uveitis.

Medical records of all patients in the Kaiser Permanente Hawaii health plan between Janury 1, 2006 and December 31, 2007 (n=217,061) were searched electronically for ICD-9 diagnosis codes related to uveitis. Chart review was done to confirm incident uveitis diagnosis during the study period. Two control groups were each randomly selected at a 5:1 ratio to cases, and controls were assigned an index date to match their respective case diagnosis date. One control group was selected from the general Kaiser Permanente Hawaii population that had at least one health-care visit during the study period. Another control group was selected from the population of Kaiser Permanente Hawaii members who had at least one visit to the ophthalmology clinic during the study period. Statin use was defined as filling a prescription for a statin medication in the year prior to the diagnosis or index date based on an electronic search of the Kaiser Permanente Hawaii pharmacy database for Generic Product Identification codes. A conditional logistic regression model with clinical diagnosis of uveitis was used to assess the relationship between statin use and uveitis.

Within the patient population, 108 incident cases of uveitis were identified. Of these patients, 19 percent had filled a prescription for statin medication in the year prior to diagnosis, compared to 30 percent of the patients in the general Kaiser population control (p=0.03) and 38 percent of the patients in the ophthalmology clinic control (p<0.001). Using the general Kaiser population control and adjusting for age, sex, race and autoimmunue diseases, the odds of a statin user developing uveitis were 48 percent less than the odds of a non-statin user developing uveitis (OR, 0.52; 95 percent CI: 0.29 to 0.94; p=0.03). Similarly, the odds of developing uveitis were 33 percent less for statin users compared to non-statin users (OR, 0.67; 95 percent CI: 0.38 to 1.19; p=0.17) when adjusting for these factors and using the ophthalmology clinic control group.
Am J Ophthalmol 2015;159:707-713.
Borkar D, Tham V, Shen E, Parker J, et al.

Associations Among Dry Eye, Depression and Anxiety
Researchers from the University of North Carolina, utilizing a study population of more than 7,000 patients with dry-eye disease across all age groups, identified a statistically significant association between dry eye and anxiety, as well as dry eye and depression.

All patients over the age of 18 who were seen at the University of North Carolina outpatient clinics between July 2008 and June 2013 were included in this analysis, giving researchers a total pool of 460,611 patients to screen: 7,207 patients with dry eye; 20,004 patients with anxiety; and 30,100 patients with depression. Cases were defined according to ICD-9 diagnosis codes for dry-eye disease, anxiety and depression.

Separate odds ratios were calculated for dry-eye disease and anxiety and dry eye and depression. Similar odds ratios were also calculated between dry eye and rheumatoid arthritis, a systemic disease with a known association with dry-eye disease, as a way of validating the study approach. The adjusted odds ratio for dry-eye disease and anxiety was 2.8 percent (95 percent CI, 2.6 to 3). For dry-eye disease and depression, the odds ratio was 2.9 (95 percent CI, 2.7 to 3.1).
Am J Ophthalmol 2015;159:420-474.
Van der Vaart R, Weaver M, Lefebvre C, Davis R.