Volume 20, Number 33Monday, August 3, 2020AUGUST IS CHILDREN’S EYE HEALTH AND SAFETY MONTH
In this issue: (click heading to view article)
Sight Outcomes Data on Triaging Glaucoma Patients During PandemicsDuring the novel-coronavirus pandemic, eye-care professionals caring for patients with sight-threatening diseases, such as glaucoma, have had to determine whether some patient appointments could safely get postponed, while weighing the risk that the patient’s glaucoma could worsen during the interim vs. the morbidity risk of acquiring COVID-19 while seeking ophthalmic care. Practices also have needed to prioritize appointment rescheduling during the ramp-up phase (when pandemic-associated service reductions are eased). Researchers described a flexible and scalable scoring algorithm for patients with glaucoma that considers glaucoma severity and progression risk vs. the presence of high-risk features for morbidity from COVID-19, using information from a large data repository. In this cross-sectional study, researchers identified patients with upcoming clinic appointments for glaucoma from March 16, 2020, to April 16, 2020, at an academic institution enrolled in the Sight Outcomes Research Collaborative (SOURCE) Ophthalmology Electronic Health Record Data Repository. The study authors developed a risk stratification tool that calculated a glaucoma severity and progression risk score, and a COVID-19 morbidity risk score. These scores were summed to determine a total score for each patient. Main outcomes and measures included total scores and percentages of clinic appointments recommended for rescheduling. Among 1,034 individuals with upcoming clinic appointments for glaucoma, the mean age was 66.7 ±14.6 years, with 575 women (55.6 percent), 733 white individuals (71 percent) and 160 black individuals (15.5 percent). Here were some of the findings:
Researchers wrote that they developed and implemented a tool that considers the risk of underlying ophthalmic disease progression from delayed care receipt and the morbidity risk from COVID-19 exposure, facilitating the triage of upcoming ophthalmic appointments. They added that comparable approaches for other ophthalmic and nonophthalmic care during the COVID-19 pandemic and similar crises may be created using this methodology. SOURCE: Bommakanti NK, Zhou Y, Ehrlich JR, et al. Application of the sight outcomes research collaborative ophthalmology data repository for triaging patients with glaucoma and clinic appointments during pandemics such as COVID-19. JAMA Ophthalmol 2020; July 17. [Epub ahead of print]. F-DALK for Keratoconus: Multi-surgeon ResultsInvestigators compared the clinical outcomes in femtosecond laser-assisted deep anterior lamellar keratoplasty (F-DALK) to manual non-laser deep anterior lamellar keratoplasty (M-DALK) for keratoconus in a multi-surgeon public health care setting. The single-center, comparative, retrospective interventional case series included consecutive cases of keratoconus treated with big-bubble F-DALK from August 1, 2015 to September 1, 2018, and big-bubble M-DALK from September 1, 2012, to September 31, 2016, at Moorfields Eye Hospital, London. Data on preoperative status, operative details, intraoperative and postoperative complications, secondary interventions and visual outcomes were archived on a customized spreadsheet for analysis. Investigators analyzed 58 eyes of 55 individuals who underwent F-DALK, and 326 eyes of 309 individuals who underwent M-DALK. Here were some of the findings:
Investigators wrote that laser automation of some steps in DALK for keratoconus may reduce the rate of intraoperative Descemet’s perforation and the conversion to PK, in a multi-surgeon setting. SOURCE: Gadhvi KA, Romano V, Fernández-Vega Cueto L, et al. Femtosecond laser assisted deep anterior lamellar keratoplasty for keratoconus: Multi-surgeon results. Am J Ophthalmol 2020; July 21. [Epub ahead of print]. Prognostic Value of Peripheral Retinal Nonperfusion in DR Using Ultra-widefield Fluorescein AngiographyScientists assessed the prognostic value of peripheral retinal nonperfusion in individuals with diabetic retinopathy, using ultra-widefield fluorescein angiography (UWFA). The cross-sectional study included 78 treatment-naïve eyes with nonproliferative and proliferative diabetic retinopathy (NPDR and PDR). Eyes were divided into three groups: mild/moderate NPDR (n=31); severe NPDR (n=31); and PDR (n=16). Three nonperfusion variables were calculated, reflecting the proportion of nonperfused to visible retina based on initial UWFA: central nonperfusion (CNP) index; peripheral nonperfusion (PNP) index; and PNP ratio. Scientists evaluated the relationships between these indices, central subfield thickness (CST) and spectacle-corrected visual acuity (SCVA). Here were some of the findings:
Scientists determined that higher amounts of retinal nonperfusion were seen in patients with more severe retinopathy. Further, increased CNP was associated with macular thickening and subsequent vision loss; and having predominantly PNP was independently associated with worse VA, regardless of macular thickness. Scientists suggested that further studies would be needed to investigate the role of PNP in vision loss in diabetic retinopathy. SOURCE: Antaki F, Coussa RG, Mikhail M, Archambault C, Lederer DE. The prognostic value of peripheral retinal nonperfusion in diabetic retinopathy using ultra-widefield fluorescein angiography. Graefes Arch Clin Exp Ophthalmol 2020; Jul 16. [Epub ahead of print]. Early Changes on SD-OCT After Treatment with Intravitreal Aflibercept for nAMDResearchers evaluated early changes on spectral-domain optical coherence tomography during the loading phase with intravitreal aflibercept therapy in individuals with neovascular age-related macular degeneration. In the prospective, open-label, single-arm, multicenter study, nAMD patients who were anti-vascular endothelial growth factor treatment-naïve received three monthly initial doses of intravitreal aflibercept 2 mg. The primary outcome was the proportion of patients with dry SD-OCT at 12 weeks, defined as an absence of intraretinal edema, intraretinal cysts, subretinal fluid and subretinal pigment epithelium fluid. Fifty eyes of 50 individuals were investigated. Here were some of the findings:
Researchers found that the anatomic and functional outcomes improved over the 12-week study period. All outcome variables peaked after the third aflibercept injection, confirming the benefit of three initial doses. Source: Korobelnik J-F, Souied EH, Oubraham H, et al. Assessment of early changes in spectral domain-optical coherence tomography (SD-OCT) after initiation of treatment with intravitreal aflibercept (Eylea) over a 12-week period for patients with neovascular age-related macular degeneration. Retina 2020; July 13. [Epub ahead of print]. BRIEFLY jCyte Announces Phase IIb Results of jCell Therapy Aerie Reports Topline Results for AR-1105 Phase II Trial 4D Molecular Therapeutics Doses First Patient in Phase I Clinical Trial of 4D-110 4D Molecular Therapeutics announced the first patient was dosed in its Phase I clinical trial of 4D-110, a Roche-licensed product candidate delivered by a single intravitreal injection for choroideremia. The open-label, dose-exploration and
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