Review of Ophthalmology Online

FROM THE EDITORS OF REVIEW OF OPHTHALMOLOGY:







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Volume 18, Number 35
Monday, August 27, 2018
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AUGUST IS CHILDREN’S EYE HEALTH/SAFETY MONTH



In this issue: (click heading to view article)
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######### Comparing Disposable GAT, ICare ic100 & Tono-pen XL With a Goldmann Nondisposable Applanation Tonometer
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######### Anterior & Posterior Corneal Irregularity After DMEK
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######### Natural History of DPED Associated With AMD
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######### Choroidal Structures & Visual Functions in Eyes With Retinitis Pigmentosa
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  Briefly

 

Comparing Disposable GAT, ICare ic100 & Tono-pen XL With a Goldmann Nondisposable Applanation Tonometer

Researchers assessed intraocular pressure measurements using Goldmann applanation tonometry and three other tonometers. They examined 74 individuals with varying glaucoma status in outpatient clinics, and compared the GAT with the disposable Tonojet prism, Tonopen XL and ICare ic100.

Researchers reported good intraclass correlation coefficients between IOP measurements by GAT and disposable Tonojet prisms (0.95), Tonopen (0.83) and ICare (0.77), all p<0.001. IOP mean differences were:
• between disposable Tonojet prisms and GAT: mean 0.80 mmHg; CI: -3.35 to 4.96 mmHg;
• between Tonopen and GAT: mean -1.67 mmHg; limits of agreement: -8.55 to 5.21 mmHg; and
• between ICare and GAT: mean 0.44 mmHg; limits of agreement: -8.18 to 9.06 mmHg.

Researchers concluded that the most reliable modality, with good correlation with the Goldmann tonometer values, was the GAT with disposable Tonojet prisms, followed in descending order by the Tonopen-XL and ICare. They observed good interdevice agreement and consistency. On subgroup analysis, researchers found all three modalities to be less reliable at extreme IOP values (<10 mmHg and >24 mmHg). As a result, researchers suggested that disposable modalities should be avoided in extreme IOP ranges outside the normal range.

SOURCE: Wong B, Parikh D, Rosen L, et al. Comparison of disposable Goldmann applanation tonometer, ICare ic100 and Tono-pen XL to standards of care Goldmann nondisposable applanation tonometer for measuring intraocular pressure. J Glaucoma 2018; Aug. 21. [Epub ahead of print].





Anterior & Posterior Corneal Irregularity After DMEK

Investigators analyzed changes in anterior and posterior corneal irregularity after Descemet’s membrane endothelial keratoplasty, as part of a retrospective study including 27 eyes of 23 individuals who underwent DMEK and 27 eyes of age-matched healthy controls.

They preoperatively and postoperatively evaluated corneal irregularity indexes— surface regularity of height (SR_H) and higher-order aberrations in 4-mm and 6-mm diameters of the cornea—using anterior segment optical coherence tomography, and summarized the following findings:

• Best spectacle-corrected visual acuity (logMAR) improved from 1.01 ±0.54 preoperatively to 0.08 ±0.11 at six months postoperatively.
• Anterior SR_H was significantly lower at six months postoperatively, from 1.86 ±0.73 to 1.20 ±0.34 (p<0.01)(4 mm), and from 2.29 ±0.62 to 1.64 ±0.42 (p<0.01)(6 mm).
• Posterior SR_H showed a significant decrease from 6.87 ±4.19 to 2.18 ±0.51 (4 mm), and from 5.21 ±2.60 to 2.44 ±0.38 (6 mm) at six months postoperatively (p<0.001).
• SR_H was positively correlated with BSCVA (anterior 4 mm: R=0.524; anterior 6 mm: R=0.477; posterior 4 mm: R=0.655; posterior 6 mm: R=0.655, p<0.001), with higher order aberrations for 4-mm diameters (R=0.511) and 6-mm diameters (R=0.325)(p<0.001).

Investigators wrote that SR_H was useful for indicating corneal irregularity and was correlated with visual outcomes after DMEK. They suggested that the measurement might help corneal surgeons determine the severity of corneal irregularity before DMEK and the quality of visual function after DMEK.

SOURCE: Oyakawa I, Hayashi T, Kobashigawa Y, et al. Evaluation of anterior and posterior corneal irregularity after Descemet membrane endothelial keratoplasty. Cornea 2018; Aug 14. [Epub ahead of print].



Natural History of DPED Associated With AMD

Scientists reviewed the natural history and genetic associations of drusenoid pigment epithelial detachments associated with age-related macular degeneration as part of a retrospective analysis of a prospective cohort study.

Of 4,203 Age-Related Eye Disease Study 2 participants, 391 eyes (325 participants) were identified as having DPED without late AMD at the time of DPED detection. Genetic analyses included 120 white AREDS2 participants and 145 AREDS participants with DPED.

Scientists graded baseline and annual stereoscopic fundus photographs according to a standardized protocol to detect DPED, a well-defined yellow elevated mound of confluent drusen, measuring ≥ 433 μm in diameter, to evaluate progression rates to late AMD (geographic atrophy and neovascular). They investigated five single-nucleotide polymorphisms (CFH [rs10611670], C3 [rs2230199], CFI [rs10033900], C2/CFB [rs114254831] and ARMS2 [rs10490924]) and a genetic risk score group for association with DPED development. They also performed Kaplan-Meier analyses and multivariable proportional hazard regressions.

Main outcome measures included progression rates to late AMD and decrease of ≥ three lines in visual acuity from time of DPED detection. Mean (SD) follow-up time from DPED detection was 4.7 (0.9) years. Scientists reported the following findings:

• Presence of DPED was associated with increased risk of progression to late AMD (hazard ratio=2.36, CI, 1.98 to 2.82, p<0.001); 67 percent of eyes progressed to late AMD five years after DPED detection.
• DPED was associated with an increased risk of ≥ three lines of VA loss (HR=3.08, CI, 2.41 to 3.93, p<0.001), with 46 percent of eyes experiencing vision loss at five years (with or without progression to late AMD).
• ARMS2 risk alleles (1 vs. 0: HR=2.72, CI, 1.58 to 4.70, p<0.001; 2 vs. 0: HR=3.16, CI, 1.60 to 6.21, p<0.001) and increasing GRS group (4 vs. 1) (HR=12.17, CI, 3.66 to 40.45, p<0.001) were significantly associated with DPED development in AREDS.
• Scientists found no significant genetic results in the AREDS2 analyses.

Scientists wrote that their findings replicated the results of previous natural history studies of eyes with DPED, including the high rates of progression to late AMD and vision loss (regardless of progression to late AMD). They added that the genetic associations were consistent with genes associated with AMD progression.

SOURCE: Yu JJ, BA, Agrόn E, Clemons TE, et al. Natural history of drusenoid pigment epithelial detachment associated with age-related macular degeneration: Age-Related Eye Disease Study 2 Report No. 17. Ophthalmology 2018; Aug. 22. [Epub ahead of print].




Choroidal Structures & Visual Functions in Eyes With Retinitis Pigmentosa

Researchers assessed the choroidal structures in the enhanced depth imaging optical coherence tomographic images in eyes with retinitis pigmentosa, and determined correlations between the choroidal structures and visual functions.

They binarized EDI-OCT images of 100 eyes with typical RP, and 60 age-, sex- and axial length-matched normal eyes using the image-processing program ImageJ, and measured cross-sectional luminal and stromal areas of the inner and outer subfoveal choroid of 1,500-µm width. The inner choroid included the choriocapillaris and medium vessel layer, and the outer choroid included the larger vessel layer.

In the inner choroid, the luminal area and ratio of luminal/total choroidal area (L/C ratio) were significantly smaller in RP (p=0.010) than in controls (p<0.001), whereas the stromal area wasn’t significantly different (p=0.114). The inner choroidal L/C ratio was significantly correlated with best-corrected visual acuity, mean deviation, foveal sensitivity, and width of the ellipsoid zone and central foveal thickness in RP after adjusting for axial length, age and sex (all p<0.005).

Researchers determined that the significant correlations between the inner choroidal structures, and visual functions and retinal structures indicated that the choroidal structures were altered in association with the progression of RP.

SOURCE: Egawa M, Mitamura Y, Niki M, et al. Correlations between choroidal structures and visual functions in eyes with retinitis pigmentosa. Retina 2018; Aug 10. [Epub ahead of print].





  • New Postop Corticosteroid Approved
    Kala Pharmaceuticals’ Inveltys (loteprednol etabonate ophthalmic suspension) 1% was recently approved for the treatment of postoperative inflammation and pain following ocular surgery. Kala says Inveltys is the first twice-daily ocular corticosteroid approved for this indication. Read more.



  • B+L Names Gordon U.S. President; Vyzulta Available in 2.5-mL Bottles
    Bausch + Lomb named Joseph Gordon as U.S. president. In this role, Gordon will oversee the U.S. eye-care business, including four business units—Vision Care, Consumer Health, Surgical and Pharmaceuticals—and report directly to chairman and CEO of Bausch Health, Joseph C. Papa. Gordon was most recently president of Bausch + Lomb’s Consumer Health and Vision Care businesses. Read more.

    In addition, the company shared news that Vyzulta (latanoprostene bunod ophthalmic solution), 0.024%, an FDA-approved nitric oxide releasing prostaglandin analog, is now available in 2.5-mL bottle sizes in addition to 5-mL sizes. The company says that this will enable eye-care professionals to provide a one-month supply option to help patients reduce intraocular pressures. Read more.



  • Dompé Gets FDA Nod for Oxervate Drops to Heal Neurotrophic Keratitis
    Dompé announced that the U.S. FDA approved Oxervate (cenegermin-bkbj ophthalmic solution), a new therapy for neurotrophic keratitis. The novel recombinant human nerve growth factor is structurally identical to the nerve growth factor protein made in the ocular tissues, the company says. Dompé says the drug supports corneal integrity though several mechanisms—by acting directly on corneal epithelial cells to stimulate their growth and survival, by binding receptors on lacrimal glands to promote tear production, and also through supporting corneal innervation (shown experimentally), which is lost in neurotrophic keratitis. Read more.



  • Allegro Appoints New CEO, Takes Risuteganib to Phase III
    Allegro Ophthalmics’ board of directors named Vicken Karageozian, MD, as president and chief executive officer. Dr. Karageozian will prepare the company to enter Phase III clinical trials with lead compound risuteganib (Luminate) in diabetic macular edema and continue developing the drug for other retinal disease indications. Dr. Karageozian has more than 25 years’ experience in building, leading and raising capital for companies in the ophthalmic pharmaceutical space, Allegro says. An ophthalmic surgeon by training and prior managing partner of Clarity Eye Group, Dr. Karageozian is the co-founder of three ophthalmic biotech companies and inventor/co-inventor of numerous ophthalmic products, with 82 patents issued or pending. Read more.



  • Topcon Announces Date for Annual ISSOCT Conference
    Topcon Medical Systems’ third annual ISSOCT Conference will be held Feb. 10 and 11, 2019, at the Sanibel Harbour Marriott Resort in Fort Myers, Fla. World-leading ophthalmologists will present new clinical findings made possible with swept-source imaging and OCT angiography. The conference, headed by Chairman Richard F. Spaide, MD, will include discussions on SS-OCT, AMD, uveitis, OCTA, and ocular tumors and glaucoma. Read more.



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