Citing strides made by women in ophthalmology in the traditional metrics of professional advancement, researchers from a half-dozen U.S. and one Australian medical center  sought to test one more: professional ties to industry as another potential means of career advancement, recognition and income.

They found that women make up a minority of ophthalmologists with professional industry relationships, and the average woman partnering with industry earns less than her male colleagues.

The observational, retrospective study used data from the Centers for Medicare & Medicaid Services to track payments to ophthalmologists by biomedical companies. Primary outcome measures were percentage of representation of women vs. men overall and in industry research, consulting, speaking roles, royalties and licenses, grants, services other than consulting and honoraria.

As of 2013, 4,164 (19.5 percent) ophthalmologists were women, and of 1,204 ophthalmologists analyzed for industry payments, 176 (4.2 percent) women had industry ties compared with 1,028 (6 percent) men (p<0.001). Mean payments to women were $11,419 compared with $20,957 for men (p=0.001), and median payments to women were $3,000 compared with $4,787 for men (p=0.007). While women represented 19.5 percent of the profession, they were underrepresented among ophthalmologists receiving industry payments for research at 10.6 percent; consulting 15.7 percent; honoraria 6.4 percent; industry grants 14.3 percent; royalties and licenses 7.7 percent; and faculty/speaker roles 4.2 percent.

In 2014, 20.2 percent of ophthalmologists were women. Of 1,518 ophthalmologists analyzed for industry payments, 255 (6 percent) women had industry ties compared with 1,263 (7.4 percent) men (p<0.001). Mean payments to women were $14,848 compared with $30,513 for men (p=0.004), and median payments to women were $3,750 compared with $5,000 for men (p=0.005). Women remained underrepresented among ophthalmologists receiving industry payments for research 10.4 percent; consulting 15.7 percent; honoraria 12.6 percent; industry grants 12 percent; royalties and licenses 4.6 percent; and faculty/speaker roles 11.1 percent.

The group reported that the reasons are multifactorial and could not be determined by their study.

JAMA Ophthalmol 2016;134:636-643.
Reddy AK, Bounds GW, Bakri SJ, Gordon LK.

NFL Thinning May Predict Functional Decline
Progressive retinal nerve fiber layer thinning is predictive of detectable functional decline in glaucoma and underscores the significance of detecting progressive RNFL thinning to initiate or augment treatment for glaucoma patients, based on a long-term prospective study by researchers from China and San Diego. They recommend that progressive RNFL thinning may be an outcome measure for clinical trials.

For five years they followed 139 primary open-angle glaucoma patients (240 eyes), with RNFL imaging and visual field testing at about four-month intervals. Progressive RNFL thinning was determined by event analysis (GPA) and trend analysis (TPA) of serial registered RNFL thickness maps. VF progression was detected according to the Early Manifest Glaucoma Trial and pointwise linear regression criteria. Hazard ratios for predicting VF progression were calculated by Cox proportional hazard modeling, with progressive RNFL thinning as a time-dependent covariate. Main outcome measures were the hazard ratios of the VF progression. The specificity of GPA/TPA for detection of RNFL changes was determined by the proportion of eyes with significant RNFL thinning/thickening in 25 normal subjects followed weekly for eight consecutive weeks and the proportion with significant RNFL thickening in the glaucoma group.

A total of 65 (27.1 percent) and 117 eyes (48.8 percent) had progressive RNFL thinning based on GPA and TPA, respectively, and 30 (12.5 percent) and 39 eyes (16.3 percent) had VF progression per the EMGT and PLR criteria, respectively, during follow-up. Eyes with progressive RNFL thinning had lower VF survival estimates and a faster decline of visual field index than eyes without. Progressive RNFL thinning predicted the development of VF progression with HRs of 8.44 (95 percent confidence interval) (EMGT criteria) and 5.11 (PLR criteria) for TPA and 3.95 (EMGT criteria) and 3.81 (PLR criteria) for GPA after controlling for baseline covariates. The specificities of GPA and TPA were 100 percent (83.4 to 100 percent) in the normal group and 81.7 percent and 84.2 percent, respectively, in the glaucoma group.

Ophthalmology 2016;123:1201-10.
Yu M, Lin C, Weinreb RN, Lai G, Chiu V.

Shift Workers, Sleep-Deprived May be at Risk for CSCR
Shift work or sleep disturbances may be risk factors for central serous chorioretinopathy, according to researchers in France and Switzerland.

Their prospective case-control series recruited 45 patients with active CSCR and 40 age- and sex-matched controls. All patients completed a questionnaire on previously described risk factors and working hours, as well as an Insomnia Severity Index. Mean age in study subjects was 44 ±9 years, and 43 ±10 years in controls.

By use of multivariate analysis, shift work (odds ratio [95 percent confidence interval]: 5 [1.2 to 20.4], p=0.02); steroid use (OR: 5.5 [1.1 to 26.2], p=0.03); and recent psychological stress (OR: 15.3 [4.1 to 54.5]; p<0.001) were found to be independently associated with CSCR.

Am J Ophthalmol 2016;165:23-8.
Bousquet E, Dhundass M, Lehmann M, Rothschild PR.

Study Reports Daily Vesneo Results vs. B.I.D. Timolol
APOLLO, a Phase III study by Bausch + Lomb, has demonstrated significantly greater intraocular pressure-lowering effect by latanoprostene bunod (LBN) ophthalmic solution 0.024% (Vesneo, B+L) administered every evening compared with timolol maleate 0.5% twice daily in subjects with open-angle glaucoma or ocular hypertension.

The Phase III, randomized, controlled, multicenter, double-masked, parallel-group clinical study included 420 subjects with OAG or OHT; they were randomized (2:1) to a three-month regimen of LBN 0.024% q.p.m. or timolol 0.5% one drop b.i.d. IOP was measured at 8 a.m., 12 p.m. and 4 p.m. of each postrandomization visit (week two, week six and month three).

The primary efficacy endpoint was IOP in the study eye measured at each of the nine assessment time points. Secondary efficacy endpoints included the proportion of subjects with IOP ≤18 mmHg consistently at all nine time points and the proportion of subjects with IOP reduction ≤25 percent consistently at all nine time points.

At all nine time points, the mean IOP in the study eye was significantly lower in the LBN 0.024% group than in the timolol 0.5% group (p≤0.002). At all nine time points, the percentage of subjects with mean IOP ≤18 mmHg and the percentage with IOP reduction ≥25 percent were significantly higher in the LBN 0.024% group versus the timolol 0.5% group (mean IOP ≤18 mmHg: 22.9 percent vs. 11.3 percent, p=0.005; IOP reduction ≥25 percent: 34.9 percent vs. 19.5 percent, p=0.001). Adverse events were similar in both treatment groups.

Ophthalmology 2016;123:965-973.
Weinreb R, Sforzolini B, Vittitow J, Liebmann, J.

Transplant Techniques Have Their Own Advantages
Researchers in Brazil compared two surgical procedures for the treatment of corneal thinning: lamellar corneal transplantation—reported to be efficient, but whose results can be jeopardized by allograft rejection, opacification or high astigmatism—and amniotic membrane transplantation—considered a good alternative, but not as resistant as LCT and subject to tissue being reabsorbed after surgery.

The prospective, randomized, interventional and comparative study included 19 consecutive patients with corneal thinning over six months. All were examined before transplant surgery and then repeated days one, seven, 15, 30, 90 and 180; ultrasound biomicroscopy was performed before and then 30, 90 and 180 days after surgery to assess corneal thinning.

Herpes simplex infection was the main cause of corneal thinning (nine eyes), followed by surgery (cataract, glaucoma, five cases), and one each for rheumatoid arthritis, chemical burn, perforating trauma, previous band keratopathy treatment and Stevens-Johnson syndrome. Although all patients showed significant increase in final thickness in the area of thinning, it was higher in those submitted to LCT at 180 days postoperatively. Regardless of the surgical technique, all patients showed epithelialization. Patients undergoing AMT showed an 89-percent decrease in neovascularization. Final corrected distance visual acuity was better in patients submitted to AMT.

Cornea 2016;35:438-44.
de Farias CC, Allemann N, Gomes JÁ.