Review of Ophthalmology Online



Vol. 22, #17  •   Monday, April 26, 2021


In this Issue:


A Message from Review's Chief Medical Editor:

I don’t know about you, but I’m really ‘Zoomed’ out. I think perhaps I could do a few more Zoom cocktail hours with family and friends, but much scientific information is pretty dry, and passively absorbing it via laptop isn’t terrible easy or fun. At this point, I’m toast when it comes to trying to keep up with our profession this way. Don’t get me wrong, I think virtual education has become a necessary and useful adjunct, but personally I cant wait to get back to an honest-to-goodness, in-person, real meeting.

As we look forward to the benefits of vaccination, one of the ones I look forward to most will be the ability to travel and interact with others. Entire industries are counting on that, and are planning on a late spring start date. In that regard, you’ve probably already received emails about a number of our professional meetings returning to an in-person format. While ARVO will remain virtual this year, most other meetings will have both in-person and virtual options. I’ll vote with my feet for the in-person format. While I value the didactic portion of a meeting, I often find I learn the most by simply talking to my colleagues—face to face. After the past year, even the most misanthropic of us can now better appreciate human contact.

It’s finally time to start planning a return to the world at large. I encourage all of you to pick a favorite meeting this year, near or far, and make a statement of optimism and support by showing up in-person. I’ll see you at ASCRS—I might even shake your hand.

Mark H. Blecher, MD
Chief Medical Editor
Review of Ophthalmology


Rapid OCT RNFL Thinning & VF Loss

Researchers evaluated the relationship between the rate of retinal nerve fiber layer loss during initial follow-up and the magnitude of associated visual field loss during an extended follow-up period, as part of a retrospective cohort study.

A total of 1,150 eyes of 839 glaucoma patients were extracted from the Duke Glaucoma Registry. Rates of RNFL loss were obtained from global RNFL thickness values of the first five optical coherence tomography scans. Rates of visual field loss were assessed using standard automated perimetry mean deviation (SAP MD) during the entire follow-up period. Joint longitudinal mixed effects models were used to estimate rates of change. Eyes were categorized as fast, moderate or slow progressors based on rates of RNFL loss, with cutoffs of ≤-2 µm/year, -2 to -1 µm/year and ≥-1 µm/year, respectively. Univariable and multivariable regressions were completed to identify significant predictors of SAP MD loss.

Here were some of the findings:
• The rate of RNFL change was -0.76 ±0.85 µm/y during initial follow-up, which occurred over 3.7 ±1.5 years.
• 765 (66 percent) eyes were slow progressors with RNFL thinning rates of -0.36 ±0.54 µm/year; 328 (29 percent) eyes were moderate progressors with RNFL thinning rates of -1.34 ±0.25 µm/year; and 57 (5 percent) were fast progressors with RNFL thinning rates of -2.87 ±1.39 µm/year.
• The rate of SAP MD loss was: among slow OCT progressors, -0.16 ±0.35 dB/y; among moderate OCT progressors, -0.32 ±0.43 dB/y; and among fast OCT progressors, -0.71 ±0.65 dB/y, over the follow-up period of 6.1 ±1.9 years (p<0.001).
• Age, OCT progressor group and concurrent SAP rate were all significantly associated with the overall rate of SAP MD loss in a multivariable model (all p<0.001).

Researchers concluded that rapid RNFL thinning during an initial follow-up period was predictive of concurrent and subsequent rates of visual field decline over an extended period of time.

SOURCE: Swaminathan SS, Jammal AA, Berchuck SI, et al. Rapid initial OCT RNFL thinning is predictive of faster visual field loss during extended follow-up in glaucoma. Am J Ophthalmol 2021; Mar 25. [Epub ahead of print].




Real-world Outcomes Following Intravitreal Brolucizumab for nAMD: SHIFT Study

Brolucizumab recently was approved in Europe as a novel treatment for patients with neovascular age-related macular degeneration. Investigators reported on early experiences with real-world outcomes of switching to brolucizumab therapy in previously anti-vascular endothelial growth factor-treated patients. Two of the authors received grants from Novartis.

Patients with recalcitrant nAMD were switched to brolucizumab therapy. Functional and structural parameters four weeks after the first brolucizumab injection were evaluated, including best-corrected visual acuity (logMAR), foveal center point (FCP [µm]), central subfield retinal thickness (CSRT [µm]) and macular volume (mm³).

Sixty-three eyes of 57 patients with nAMD (52.6 percent females) with a mean age of 79.5 ±6.7 years were included. Here were some of the findings:
• Mean change of BCVA was -0.02 ±0.13 logMAR (p=0.322).
• Significant reductions were recorded for FCP with a mean change of -66.79 ±72.64 µm, -66.76 ±60.71 µm for CSRT and -0.27 ±0.24 mm³ for macular volume (all p<0.001).
• Intraocular inflammation was observed in seven eyes of seven patients (11 percent), including one case of retinal vasculitis without occlusion.

Investigators wrote that the SHIFT study findings indicated that the switch to brolucizumab may represent a treatment option in patients with nAMD poorly responsive to other anti-VEGF agents. They suggested that further long-term analyses would be helpful to assess the efficacy and safety of brolucizumab in a routine clinical setting.

SOURCE: Bulirsch LM, Saßmannshausen M, Nadal J, et al. Short-term real-world outcomes following intravitreal brolucizumab for neovascular AMD: SHIFT study. Br J Ophthalmol 2021; Apr 12. [Epub ahead of print].


Rebubbling with Post-DMEK for FED

Scientists assessed the potential impact of rebubbling on the anterior segment parameters and refractive outcomes in patients with graft detachment following uneventful DMEK for Fuchs’ endothelial dystrophy.

The retrospective institutional cohort study compared 34 eyes of 31 patients with rebubbling for graft detachment following Descemet’s membrane endothelial keratoplasty to 33 eyes of 28 patients with uneventful DMEK. Main outcome parameters were various corneal parameters obtained by Scheimpflug imaging, refractive outcomes, corrected distance visual acuity and endothelial cell density.

Here were some of the findings:
• Anterior and posterior corneal astigmatism, corneal densitometry, central corneal thickness, and anterior chamber depth and volume showed no significant differences.
• Preoperative distribution of astigmatism axis orientations showed a high proportion of anterior corneal with-the-rule astigmatism (71 percent) in eyes requiring rebubbling.
• Mean postoperative cylinder in the rebubbling group (1.21 ±0.85 D) was significantly higher compared to the controls (p=0.04), while differences in spherical equivalent (SE) were insignificant (p=0.24).
• Postoperative corrected distance visual acuity was 0.11 ±0.11 in the control group compared with 0.21 ±0.17 in the rebubbling group (p=0.03).
• Eyes with subsequent rebubbling demonstrated a significantly higher endothelial cell loss (56 percent vs. 37 percent)(p<0.001).

Scientists found that, apart from higher cylinder values, refractive outcome and corneal parameters assessed by Scheimpflug imaging were comparable in eyes with rebubbling and controls. However, they noted that the potential for reduced visual acuity and increased endothelial cell loss should be taken into consideration prior to rebubbling, especially in eyes with circumscribed graft detachment.

SOURCE: Agha B, Forster R, Kohnen T, et al. Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy. Graefes Arch Clin Exp Ophthalmol 2021; Apr 6. [Epub ahead of print].


Impact of Residual Subretinal Fluid Volumes on Outcomes in a SRF-tolerant T&E Regimen

Researchers looked at associations between residual subretinal fluid (rSRF) volumes and treatment outcomes in an SRF-tolerant treat-and-extend regimen in neovascular age-related macular degeneration.

Patients enrolled in the prospective, multicenter FLUID study randomized in an SRF-tolerant T&E regimen were examined by SD-OCT and tested for best-corrected visual acuity. SRF and intraretinal fluid volumes were quantified using artificial intelligence tools. A total of 375 visits of 98 patients were divided into subgroups: extended intervals despite rSRF and extended intervals without fluid. Associations between BCVA change, SRF volume, subgroups and treatment intervals were estimated using linear mixed models.

Here were some of the findings:
• In extended intervals despite rSRF, increased SRF was associated with reduced BCVA at the next visit in the central 1 mm (-0.138 letters/nl; p=0.014) and 6 mm (-0.024 letters/nl; p=0.049).
• A negative association between increased interval and BCVA change was found for rSRF in 1 and 6 mm (-0.250 and -0.233 letter/week interval, respectively, both p<0.001).
• Extended intervals despite rSRF had significantly higher SRF-volumes in the central 6 mm at the following visit (p=0.002).

Researchers reported that AI-based analysis of extended visits despite rSRF demonstrated increasing SRF-volumes associated with BCVA loss at the consecutive visit. They wrote that this negative association increases understanding about the role of rSRF volumes on treatment outcomes in nAMD.

SOURCE: Grechenig C, Reiter GS, Riedl S, et al. Impact of residual subretinal fluid volumes on treatment outcomes in a SRF-tolerant treat & extend regimen. Retina 2021; Apr 1. [Epub ahead of print.]




Industry News

J&J Vision Receives FDA Clearance & CE Mark for Veritas Phacoemulsification Device

Johnson & Johnson Vision announced FDA 510 clearance and the CE mark for its next-generation phacoemulsification device, the Veritas Vision System. The company says the system “features technologies that enable surgeons to guide through any lens density with less surge and more stability.” It also provides advancements in ergonomics to enhance usability during cataract surgery. The machine will be available for purchase later this year. Read more.


Adverum to Present New Data from OPTIC Trial at ARVO 2021

Adverum Biotechnologies is planning to present additional clinical data for cohorts one to four in the OPTIC clinical trial of ADVM-022 intravitreal injection gene therapy in wet age-related macular degeneration during the Association for Research in Vision and Ophthalmology 2021 Virtual Meeting. Read more.



Qlaris Enrolls First Patient in Phase I/II Studies of QLS-101

Qlaris Bio enrolled the first patient in the Phase I/II clinical program for QLS-101, an investigational therapy designed to lower intraocular pressure by reducing episcleral venous pressure in individuals with glaucoma. Read more.



First 2021 Video Journal Entry Available

The Video Journal of Cataract, Refractive, and Glaucoma Surgery’s first video entry for 2021, titled “History and Evolution of Contemporary Refractive Surgery,” with Guest Host George Waring IV, MD, is available for viewing. Watch the video.

Ora Appoints Dr. Bingaman as Chief Development Officer

Ora, an ophthalmic pharmaceutical and device development firm, announced that David P. Bingaman, DVM, PhD, D. ACVO, joined in the newly created role of chief development officer. Prior to that, Dr. Bingaman served in positions at Alcon Laboratories, Alcon/Novartis, PanOptica and, most recently, Oculis, where he was vice president and head of global clinical development. Read more.




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