From the editors of Review of Ophthalmology:
MARCH IS WORKPLACE EYE WELLNESS MONTH
In this issue: (click heading to view article)
Non-exudative Macular Neovascularization – Systematic Review and OCTA Insights
Researchers 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 Trial
Investigators 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.
Fifty-four pseudophakic eyes of 54 individuals with corneal endothelial dysfunction due to Fuchs’ endothelial corneal dystrophy were enrolled in six corneal centers in the Netherlands.
Participants were allocated to either DMEK (n=29) or UT-DSAEK (n=25) using minimization randomization based on preoperative BSCVA, recipient central corneal thickness, sex, age and institution. Donor corneas were pre-stripped for DMEK and pre-cut for UT-DSAEK. Six corneal surgeons participated in this study.
The primary outcome measure was BSCVA at 12 months postoperatively. Secondary outcome measures were BSCVA at three and six months postoperatively, ECD and refractive astigmatism. Here were some of the findings:
• Central graft thickness of UT-DSAEK lamellae measured 101 μm (90 to 112).
• BSCVA didn’t differ significantly between DMEK and UT-DSAEK, respectively:
o at three months (0.15 logMAR [0.08 to 0.22] vs. 0.22 logMAR [0.16 to 0.27]; p=0.15);
o six months (0.11 logMAR [0.05 to 0.17] vs. 0.16 logMAR [0.12 to 0.21]; p=0.20); and
o 12 months (0.08 logMAR [0.03 to 0.14] vs. 0.15 logMAR [0.10 to 0.19]; p=0.06).
• Twelve months after surgery, the percentage of eyes reaching ≥20/25 Snellen BSCVA was higher in DMEK compared with UT-DSAEK (66 vs. 33 percent, p=0.02).
• ECD didn’t differ significantly 12 months after DMEK and UT-DSAEK (1,870 cells/mm2 [1,670 to 2,069] vs. 1,612 cells/mm2 [1,326 to 1,898]; p=0.12).
• Both techniques induced a mild hyperopic shift (12 months: +0.22 D [-0.23 to 0.68], DMEK, vs. +0.58 D [0.13 to 1.03], UT-DSAEK; p=0.34).
Investigators found that DMEK and UT-DSAEK didn’t differ significantly in mean BSCVA, but the percentage of eyes reaching 20/25 Snellen vision or better was significantly higher with DMEK. Endothelial cell loss didn’t differ significantly between both treatment groups, and both techniques induced a minimal hyperopic shift.
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 OAG
Scientists 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 nAMD
Researchers 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
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
• However, no statistically significant differences were found in membrane morphology (p
=0.86), lesion size (p
=0.80) or flow area (p
• 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].
Ophthalmic Companies Make Coronavirus Testing Available
Quidel received Emergency Use Authorization from the FDA to market its Lyra SARS-CoV-2 Assay, a real-time RT-PCR test intended for the qualitative detection of nucleic acid from SARS-CoV-2 in nasopharyngeal or oropharyngeal swab specimens from patients suspected of having COVID-19. Testing is limited to laboratories certified under the Clinical Laboratory Improvement Amendments of 1988 to perform high-complexity tests. EUAs allow for the early availability of important diagnostic tools “when there are no adequate, approved and available alternatives.” Read more.
In addition, Avellino is adding additional production shifts for its newly developed coronavirus diagnostic, the Avellino SARS-CoV-2/COVID-19 Test. The ultra-rapid genetic test is in increasing demand so the company is temporarily suspending sequencing operations of its AvaGen genetic test that identifies the risk of developing keratoconus and the presence of corneal dystrophies, in order to meet demand. On March 5, Avellino completed the validation process for AvellinoCoV2 according to FDA issued guidance. The test must be ordered by a physician and cannot be made available directly to the public. Read more.
ImprimisRx Announces Supply Agreement with EyeCare Services Partners
ImprimisRx agreed to a product supply agreement with EyeCare Services Partners. ImprimisRx currently provides a limited number of ophthalmic formulations to practices within the ESP group, but the agreement will expand the number of formulations available to new and existing ESP facilities. Read more.
Clearside Appoints Dr. Lasezkay as President and CEO
Clearside Biomedical announced George Lasezkay, PharmD, JD, has been appointed president and chief executive officer. Dr. Lasezkay will continue to serve on the board of directors. For the past 15 years, he served as an independent director on the boards of a number of domestic and foreign emerging biopharmaceutical companies. Read more.
To Slow Viral Spread, AAO Calls for Halt of Non-urgent/Non-emergency Care
Due to the COVID-19 pandemic, the American Academy of Ophthalmology now finds it essential that all ophthalmologists cease providing any treatment other than urgent or emergent care immediately.
“It is essential that we as physicians and as responsible human beings do what we can and must to reduce virus transmission and enhance our nation’s ability to care for those desperately ill from the disease,” the AAO announcement states. “Public health experts unanimously agree that our window to modify the spread of disease is a narrow and closing one.
“Accordingly, the American Academy of Ophthalmology strongly recommends that all ophthalmologists provide only urgent or emergent care. This includes both office-based care and surgical care. The Academy recognizes that “urgency” is determined by physician judgment and must always take into account individual patient medical and social circumstances. Each of us has a societal responsibility to not function as a vector of a potentially fatal disease—and one for which a widely available treatment or vaccine does not currently exist.” Read more.
Major Ophthalmology Meeting Canceled
In a move that appeared inevitable in the face of widespread cancellations of almost all large-scale group activities and meetings in the United States due to the potential for spreading the coronavirus, the American Society of Cataract and Refractive Surgery has canceled its annual meeting, originally scheduled for May 15 to 20. ASCRS says it came to this decision in the interest of public safety, after monitoring daily recommendations from the Centers for Disease Control and Prevention, the World Health Organization, the Massachusetts Department of Public Health and the city of Boston. Read more.
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