Office-based therapy with home reinforcement produced the most significant results of four methods testing for treating young patients with symptomatic convergence insufficiency, according to a first-of-its-kind clinical trial.
The Convergence Insufficiency Treatment Trial randomly assigned 221 children aged 9 to 17 years with symptomatic convergence insufficiency to one of four treatments. The four: home-based pencil push-ups (HBPP); home-based computer vergence/accommodative therapy and pencil push-ups (HBCVAT+); office-based vergence/accommodative therapy with home reinforcement (OBVAT); and office-based placebo therapy with home reinforcement (OBPT) as treatments for symptomatic convergence insufficiency.
The main outcome measure was the Convergence Insufficiency Symptom Survey score after 12 weeks of treatment. Secondary outcomes were near point of convergence and positive fusional vergence at near.
After 12 weeks of treatment, the OBVAT group's mean Convergence Insufficiency Symptom Survey score (15.1) was statistically significantly lower than those of the HBCVAT+ group (21.3), the HBPP group (24.7), and the OBPT group (21.9) (p<.001). The OBVAT group also demonstrated a significantly improved near point of convergence and positive fusional vergence at near compared with the other groups (p=.005 for all comparisons). A successful or improved outcome was found in 73 percent of the OBVAT group, 43 percent of the HBPP group, 33 percent of the HBCVAT+, and 35 percent of the OBPT groups.
(Arch Ophthalmol 2008;126:1336-1349)
Convergence Insufficiency Treatment Trial Study Group
Cigarette Smoking Not Tied to Primary Open-Angle Glaucoma
A systematic literature Search at the
There was no evidence of a dose-response relationship with smoking or of reversibility of effect in the studies where this was assessed. Given the limited evidence from high-quality studies, and the possibility that flaws in many of the studies reviewed biased the results toward the null, further high-quality research to confirm their conclusions, the researchers say.
(J Glaucoma 2008;17:558-66)
Edwards R,
Long-term Data on Telescope Implant for End-stage AMD
Two-year results of a multicenter U.S. trial of a telescope prosthesis in patients with end-stage age-related macular degeneration show that the safety and substantial visual acuity improvement found at one year is maintained.
In the prospective, open-label clinical trial, patients with end-stage AMD (bilateral geographic atrophy or disciform scars; BCVA, 20/80 to 20/800) received the telescope prosthesis at 28 centers. Fellow-eyes served as controls. Main outcome measures included BCVA change from baseline, endothelial cell density and morphometry and incidence of complications.
At two years, data from 174 (92.6 percent) of 188 available patients revealed that 103 (59.5 percent) of 173 telescope-implanted eyes gained three lines or more (doubling of visual angle) of BCVA compared with 18 (10.3 percent) of 174 fellow control eyes (p<.0001). Mean BCVA improved 3.6 lines (standard deviation, 1.9 lines) and 2.8 lines (SD, 2.3 lines) from baseline in eyes with the 3X and 2.2X device models, respectively. Mean ECD stabilized through two years, with 2.4 percent mean cell loss occurring from one to two years.
There was no significant change in coefficient of variation or percentage of hexagonal endothelial cells from within six months to two years after surgery. The most common complication was inflammatory deposits. Key indicators of corneal health demonstrate ECD change that reflects remodeling of the endothelium associated with the implantation procedure. ECD stabilizes over time, and there is no evidence of any ongoing endothelial trauma.
(Am J Ophthalmol 2008;146:664-673. Epub 2008 Aug 30)
Poor Night Vision a Risk for AMD Progression
Night vision problems in AMD patients may be an independent risk factor for vision loss, choroidal neovascularization and geographic atrophy, according to a
The cohort study within a multicenter randomized clinical trial included 1,052 participants with ≥10 large (>125 µm) drusen and VA ≥20/40 in each eye. At baseline, participants self-administered a 10-item Night Vision Questionnaire (NVQ-10). VA testing was performed at baseline, six months and annually. One eye of each participant was randomly assigned to laser treatment, and the contralateral eye was assigned to observation. Main outcome measures were a ≥three-line loss in VA, development of CNV and end-point GA.
Compared with participants with the best night vision, participants with the worst night vision (first quartile of scores) were at increased risk of ≥three-line loss in VA in both observed and treated eyes; odds ratios (95 percent confidence interval) were 2.85 (1.85 to 4.39) and 2.00 (1.27 to 3.14), respectively. The relative risk for the first quartile versus the fourth quartile for development of GA was 4.18 (1.80 to 9.68) in observed eyes and 2.59 (1.13 to 5.95) in treated eyes. The relative risk for CNV incidence was 1.99 (1.12 to 3.54) in observed eyes and 1.33 (0.81 to 2.19) in treated eyes. These relationships were maintained after adjustment for baseline participant and ocular characteristics.
(Ophthalmology 2008 Jul 30. [Epub ahead of print])
Ying GS, Maguire MG, Liu C, Antoszyk AN; Complications of Age-related Macular Degeneration Prevention Trial Research Group.
Cataract Surgery Cuts IOP in PFX Patients
Cataract surgery produces a reduction in intraocular pressure in patients with pseudoexfoliation regardless of their glaucoma status, according to a large, single-surgeon retrospective analysis in
The analysis comprised 1,122 eyes with PFX having uneventful phacoemulsification with IOL implantation. Of the eyes, 882 did not have glaucoma (PFX group) and 240 had glaucoma (PXG group). The mean IOP was statistically significantly reduced through seven years postoperatively compared with preoperatively in the PFX group.
The PXG group had reduced mean IOP for one year and reduced glaucoma medication requirements at almost all postoperative time intervals. Higher mean preoperative IOP was associated with a greater reduction in mean IOP postoperatively in both groups. Intraocular pressure spikes (>30 mmHg) one day postoperatively occurred in 4 percent in the PFX group and 17 percent in the PXG group. Postoperatively, 2.7 percent of PFX eyes progressed to a need for glaucoma medication and 3.7 percent of PXG eyes progressed to a need for laser and/or glaucoma surgery.
The IOP reduction was proportional to the preoperative IOP; higher preoperative IOP was associated with a greater reduction in IOP. The low glaucoma progression in both groups suggests a protective effect of phacoemulsification on IOP in these eyes, the authors say.
(J Cataract Refract Surg 2008;34: 1834-41)
Shingleton BJ, Laul A, Nagao K, Wolff B, O'Donoghue M, Eagan E, Flattem N, Desai-Bartoli S.
