Review of Ophthalmology Online



Vol. 23, #22  •   Monday, June 6, 2022


In this Issue:





Structure-function Relationship Between Advanced POAG and NTG

Researchers looked at characteristics of visual field defects in primary open-angle glaucoma and normal tension glaucoma with advanced glaucomatous damage, and determined whether structure-function relationships found in advanced glaucoma differed based on glaucoma classification.

Ninety-seven eyes of 97 patients (59 with POAG, 38 with NTG) with advanced glaucoma were included in this cross-sectional study. Scores at each test point of the 30-2 VF total deviation map were recorded, and average values at each test point were pointwise compared between the groups. Peripapillary retinal nerve fiber layer and macular thickness (i.e., total, RNFL, ganglion cell layer [GCL] and inner plexiform layer [IPL] thickness) were measured. The structure-function relationship, based on the Garway-Heath map, was determined and compared between the two groups.

Here are some of the findings:
• At advanced stages of glaucoma, POAG eyes demonstrated more diffusely distributed VF defects, while NTG eyes had more severe VF defects at the superior nasal quadrant with increased asymmetry.
• Overall, peripapillary RNFL, macular GCL and macular IPL thickness showed strong relationships with 30-2 VF parameters in both groups.
• In total macular and RNFL thickness, structure-function relationships tended to show different characteristics depending on the glaucoma classification; NTG eyes showed overall better relationships.

Researchers wrote that, in advanced glaucoma, different patterns of VF damage were found between POAG and NTG eyes. They added that conventional peripapillary RNFL and macular measurements showed generally good performance for estimating functional status, particularly in NTG eyes.

SOURCE: Sung MS, Ji YS, Heo H, et al. Comparison of the structure-function relationship between advanced primary open-angle glaucoma and normal-tension glaucoma. J Glaucoma 2022; May 16. [Epub ahead of print].





Flow and Geometrical Alterations in Retinal Microvasculature & DR Occurrence

Investigators assessed the relationship between flow and geometric parameters in optical coherence tomography angiography images and the risk of incident diabetic retinopathy.

This prospective, observational cohort study recruited patients with type 2 diabetes without DR in Guangzhou, China, followed up annually.

An OCTA device (DRI-OCT Triton, Topcon) was used to obtain a variety of flow parameters in superficial capillary plexus (SCP) and deep capillary plexus (DCP):
• foveal avascular zone [FAZ] area;
• vessel density [VD];
• vessel length density [VLD]; and
• geometric (fractal dimension [FD] and blood vessel tortuosity [BVT]). The odds ratio and its 95 percent confidential interval were calculated per 1-SD increase in each OCTA parameter.

Here are some of the findings:
• Over one-year follow-up, 182 of 1,698 participants (10.7 percent) developed incident DR.
• After adjusting for conventional risk factors and image quality score, the higher risk of DR onset was significantly associated with the:
   o reduced parafoveal VD of SCP (OR=0.81; CI, 0.69 to 0.96; p=0.016);
   o reduced parafoveal VLD of SCP (OR=0.73; CI: 0.59 to 0.90; p=0.003);
   o reduced FD of SCP (OR=0.73; CI, 0.61 to 0.87; p<0.001);    
   o increased BVT of SCP (OR=1.39; CI, 1.18 to 1.64; p<0.001); and
   o increased BVT of DCP (OR=1.19; CI, 1.01, 1.40; p=0.033).

Investigators wrote that reduced vessel density and impaired vessel geometry posed higher susceptibility for DR onset in patients with type 2 diabetes, supporting the adoption of OCTA parameters as early monitoring indicators of newly incident DR.

SOURCE: Wang W, Chen Y, Kun X, et al. Flow and geometrical alterations in retinal microvasculature correlated with the occurrence of diabetic retinopathy: Evidence from a longitudinal study. Retina 2022; May 2. [Epub ahead of print].


Complimentary CME Education Videos



Femtosecond Laser-Assisted Cataract Surgery: A Report by the AAO

Scientists evaluated refractive outcomes, safety and cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) compared with phacoemulsification cataract surgery (PCS).

A PubMed search of FLACS was conducted in August 2020. A total of 727 abstracts were reviewed and 33 were selected for full-text review. Twelve articles met inclusion criteria and were included in this assessment. The panel methodologist assigned a level of evidence rating of I to all 12 studies.

Here are some of the findings:
• No significant differences were found in mean uncorrected distance visual acuity, best-corrected distance visual acuity, or the percentage of eyes within ±0.5 and ±1 diopter of intended refractive target between FLACS and PCS.
• Intraoperative and postoperative complication rates were similar between the two groups, and most studies showed no difference in endothelial cell loss between FLACS and PCS at various time points between one and six months.
• In large randomized controlled studies in the United Kingdom and France, FLACS was less cost-effective than PCS.

SOURCE: Lin CC, Rose-Nussbaumer JR, Al-Mohtaseb ZN, et al. Femtosecond laser-assisted cataract surgery: A report by the American Academy of Ophthalmology. Ophthalmology 2022; May 12. [Epub ahead of print].


Vascular Anterior Surface of Type 1 MNV After Anti-VEGF Therapy

Researchers evaluated whether the status of vasculature at the top of type 1 macular neovascularization could function as mediator of the observed protective effect against the development of complete retinal pigment epithelial and outer retinal atrophy (cRORA).

In consecutive treatment-naïve patients, the vasculature at the anterior surface of the MNV was isolated using a slab designed to extract the most superficial vascular portion of the MNV lesion showing a choriocapillaris (CC)-like structure which researchers termed the “neo-CC.” The ratio between the neo-CC area (isolated using this custom slab) and the MNV area (isolated using the standard outer retina-CC slab) at baseline and at last follow-up was evaluated.

Forty-four eyes from 44 patients were included. Here are some of the findings:
• 20 eyes showed cRORA by the final follow-up (median 23 months);
• 24 eyes didn’t progress to atrophy (median 23.5 months);
• the proportion of MNV with neo-CC at the anterior surface was significantly lower in eyes that progressed to cRORA compared with those that didn’t; and
• multivariate regression showed that a lower proportion of neo-CC coverage over the MNV increased the risk of cRORA development.

Researchers reported that more extensive coverage of neo-CC was associated with a lower likelihood of development of macular atrophy in eyes receiving anti-vascular endothelial growth factor therapy. They wrote the findings suggested the protective effect of type 1 MNV may be mediated by the development of a neo-CC and may provide insights into the biological significance of MNV as a response mechanism in eyes with age-related macular degeneration.

SOURCE: Corvi F, Bacci T, Corradetti G, et al. Characterisation of the vascular anterior surface of type 1 macular neovascularisation after anti-VEGF therapy. Br J Ophthalmol 2022; May 10. [Epub ahead of print].




Industry News

Byooviz Biosimilar Now Available in the United States

Biogen and Samsung Bioepis launched Byooviz (ranibizumab-nuna), a biosimilar referencing Lucentis (ranibizumab), in the United States. Byooviz will be commercially available starting July 1 through major U.S. distributors. The list price will be $1,130 per single use vial to administer 0.5 mg via intravitreal injection, which is 40 percent lower than the current list price of Lucentis, according to the companies. The FDA approved Byooviz in September 2021 to treat neovascular age-related macular degeneration, macular edema following retinal vein occlusion, and myopic choroidal neovascularization. Read more.

Novartis Gets FDA Nod of Beovu Treatment for DME

The FDA approved Beovu (brolucizumab-dbll) 6 mg for the treatment of diabetic macular edema, based on year one data from the Phase III, randomized, double-masked KESTREL and KITE studies. The companies say the studies met their primary endpoint of non-inferiority in change in best-corrected visual acuity from baseline vs. aflibercept at year one. Learn more.


CorneaGen Grafts Recalled

The FDA and CorneaGen have announced that the company is recalling the entire lot of Scleral Patch Grafts obtained from lot number W419221008338 because the grafts were obtained from a donor who tested reactive for HIV-1/HIV-2 Plus O antibody and HIV NAT, and were shipped prior to being medically cleared. Read more.

Apellis Submits NDA to the FDA for Pegcetacoplan

Apellis Pharmaceuticals announced the company submitted a New Drug Application to the FDA for intravitreal pegcetacoplan, an investigational, targeted C3 therapy for the treatment of geographic atrophy secondary to age-related macular degeneration. The NDA submission is based on results from the Phase III DERBY and OAKS studies at 12 and 18 months, and the Phase II FILLY study at 12 months. The FDA decision on NDA filing acceptance is expected in August 2022. Read more.

Luxa Bio Announces First Participant Dosed in Phase I/IIa Trial of RPESC-RPE-4W

Luxa Biotechnology announced transplantation of cell product RPESC-RPE-4W into the first participant with dry age-related macular degeneration in its Phase I/IIa clinical trial. Read more.

B+L Launches Biotrue Hydration Plus Multi-Purpose Solution in United States

Bausch + Lomb announced the U.S. launch of Biotrue Hydration Plus Multi-Purpose Solution. The new contact lens solution, which is formulated with bio-inspired ingredients, is designed to provide more moisture on lenses, excellent cleaning and a triple disinfectant system that helps deliver effective disinfection, the company says. Learn more.

Alcon to Acquire Eysuvis & Inveltys

Alcon signed an agreement to acquire Eysuvis (loteprednol etabonate suspension) 0.25% pharmaceutical eye drops from Kala Pharmaceuticals. As part of the agreement, Alcon will also acquire Inveltys (loteprednol etabonate suspension) 1%, a corticosteroid for twice-a-day treatment of postoperative inflammation and pain following ocular surgery. Read more.

Aerie Announces First Participant Dosed in Phase III AR-15512 Trial

Aerie Pharmaceuticals announced the first participant was dosed in the Phase III COMET-2 study to evaluate AR-15512 ophthalmic solution as a treatment for the signs and symptoms of dry eye. COMET-2 is the first of three trials in the program for AR-15512. Read more.

New Appointments

• Neurophth Therapeutics appointed Xiaoning Guo, PhD, as chief medical officer. Read more.
• Applied Genetic Technologies formed a scientific advisory board of experts in age-related macular degeneration. View the inaugural members.

New Data from GEMINI Glaucoma Study

Sight Sciences recently announced publication of data from its GEMINI study of the Omni Surgical system used in conjunction with cataract surgery. In 159 patients, the company says the procedure significantly reduced unmedicated mean diurnal intraocular pressure, medication use and daily fluctuations in IOP in patients with open-angle glaucoma. Read more.

Prevent Blindness Announces Call for Nominations, Will Host Annual Focus on Eye Health National Summit

The National Center for Children’s Vision and Eye Health at Prevent Blindness issued a call for nominations for the eighth annual Bonnie Strickland Champion for Children’s Vision Award. Learn more.
In addition, Prevent Blindness will host the 11th annual Prevent Blindness Focus on Eye Health National Summit July 13 to 14, as a virtual event. Learn more.









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