Volume 20, Number 12Monday, March 23, 2020MARCH IS WORKPLACE EYE WELLNESS MONTH In this issue: (click heading to view article)
Non-exudative Macular Neovascularization – Systematic Review and OCTA InsightsResearchers wrote that non-exudative macular neovascularization (MNV) is known to be more prevalent in individuals with AMD than initially thought and is bringing new insights into both the natural history and management of the disease.Researchers conducted a literature search on PubMed, Scopus and Web of Science, along with a manual search, from January 2014 to June 2019. They included studies that used optical coherence tomography angiography as a primary diagnostic tool to evaluate subclinical (treatment-naïve), non-exudative, neovascular AMD. Of the 258 screened articles, 12 were included. Here were some of the findings: • The prevalence of subclinical non-exudative neovascular AMD in the fellow eyes of individuals with unilateral exudative AMD ranged from 6.25 to 27 percent. Although the lesions weren’t associated with a significant decrease in visual acuity, researchers wrote that the presence of non-exudative MNV seemed to be an important predictor of exudative disease. • Incidence of exudation in the reviewed studies ranged from 20 to 80 percent (follow-up: six months to two years). • There was some evidence that non-exudative MNV might have slowed down the growth of adjacent geographic atrophy. • As long as exudation didn’t occur, it appeared that subclinical non-exudative MNV wasn’t responsible for the deterioration of visual function. Researchers wrote that non-exudative MNV is an asymptomatic condition. While it appeared to be a precursor for the formation of exudative neovascular AMD, some evidence suggested a protective effect in slowing the progression of GA. Researchers added that early detection of non-exudative MNV before exudation develops should result in better monitoring of individuals at high risk of conversion to exudative AMD. While no controlled clinical trial has been performed to provide definitive recommendations, the authors of the studies agreed that non-exudative lesions shouldn’t be treated until symptomatic exudation develops. Moreover, the researchers wrote, the existence of a non-exudative form of neovascular AMD suggested that the term “neovascular AMD” should be preceded by “exudative” or “non-exudative” when describing the neovascular stage of AMD. SOURCE: Laiginhas R, Yang J, Rosenfeld PJ, et al. Non-exudative macular neovascularization – a systematic review of prevalence, natural history, and recent insights from OCT angiography. Ophthalmology 2020; March 13. [Epub ahead of print]. DMEK vs. Ultrathin DSAEK: Multicenter Randomized Controlled Clinical TrialInvestigators compared best spectacle-corrected visual acuity, endothelial cell density (ECD), refractive astigmatism and complications after Descemet’s membrane endothelial keratoplasty and ultrathin Descemet’s stripping automated endothelial keratoplasty (UT-DSAEK), as part of a prospective, multicenter, randomized controlled trial. Source: Dunker SL, Dickman MM, Wisse RPL, et al. DMEK versus ultrathin DSAEK: A multicenter randomized controlled clinical trial. Ophthalmology 2020; March 2. [Epub ahead of print.] VF Cluster Map & Bruch’s Membrane Opening-minimum Rim Area Sectors in OAGScientists generated a new visual field cluster map corresponding with Bruch’s membrane opening-minimum rim area sectors, describing in detail the structure-function relationships between the optic nerve head and visual field in individuals with open-angle glaucoma. They assessed the structure-function relationship between Bruch’s membrane opening-minimum rim area (BMO-MRA) and VF in individuals with open-angle glaucoma.Scientists retrospectively reviewed 67 eyes of 50 individuals with open-angle glaucoma who underwent spectral-domain optical coherence tomography for BMO-MRA and Humphrey VF test. BMO-MRA of the glaucomatous optic nerve head was divided into 12 sectors. The correlation between BMO-MRA sectors and the VF points was analyzed to generate a new VF cluster map. Here were some of the findings: • Forty-three of 52 VF points showed significant correlation with at least one BMO-MRA sector. • The VF cluster map was generated using the BMO-MRA sectors, and each VF point that showed the most correlation. • The superior hemifield correlated with 5, 6, 7 and 8 o’clock positions (p=0.312 to 0.710), while the inferior hemifield correlated with 10, 11, 12, and 2 o’clock positions (p=0.241 to 0.483). • The VF cluster maps of superior and inferior hemifields showed a different configuration of VF clusters and topographical relationship with the glaucomatous optic nerve head. Scientists wrote that the newly generated VF cluster map corresponding with BMO-MRA sectors showed a significant structure-function relationship and could be useful in the diagnosis and evaluation of glaucoma. SOURCE: Choi HS, Park SP, Na KI, et al. Visual field cluster map corresponding to Bruch’s membrane opening-minimum rim area sectors in open-angle glaucoma. J Glaucoma 2020; March 6. [Epub ahead of print]. Using OCTA to Compare Neovascularization Features in PNV with Type 1 nAMDResearchers compared neovascular membrane features of pachychoroid neovasculopathy (PNV) and type 1 neovascular age-related macular degeneration using optical coherence tomography angiography, as part of a retrospective study.They assessed 34 treatment-naïve eyes with a diagnosis of PNV and 36 treatment-naïve eyes with a diagnosis of type 1 nAMD. Morphological patterns of neovascular membranes were categorized, and lesion sizes and flow areas were calculated by using en face images on the AngioVue (Optovue) OCTA system. Here were some of the findings: • Statistically significant differences were found between groups in age (p=0.001), baseline best corrected visual acuity (p=0.005) and baseline subfoveal choroidal thickness (p<0.001). • However, no statistically significant differences were found in membrane morphology (p=0.86), lesion size (p=0.80) or flow area (p=0.96). • All membranes that could be detected by OCTA could also be detected by indocyanine green angiography (ICGA). • OCTA couldn’t identify the neovascularization in 11.8 percent of eyes with PNV and 16.7 percent of eyes with nAMD, which could be identified on ICGA images. Researchers determined that PNV was seen in younger individuals and those with thicker choroids, but in terms of morphological characteristics and vessel density, membranes detected by OCTA weren’t different from those of nAMD. Researchers added that dye angiography remained the gold standard for identifying neovascularization, especially in treatment-naïve patients, owing to blockage of fluid and hemorrhage and scattering of OCTA signals. SOURCE: Arf S, Sayman Muslubas I, Hocaoglu M, et al. Features of neovascularization in pachychoroid neovasculopathy compared with type 1 neovascular age-related macular degeneration on optical coherence tomography angiography. Jpn J Ophthalmol 2020; March 10. [Epub ahead of print]. BRIEFLY Ophthalmic Companies Make Coronavirus Testing Available ImprimisRx Announces Supply Agreement with EyeCare Services Partners Clearside Appoints Dr. Lasezkay as President and CEO To Slow Viral Spread, AAO Calls for Halt of Non-urgent/Non-emergency Care Major Ophthalmology Meeting Canceled Review of Ophthalmology® Online is published by the Review Group, a Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073. |