Review of Ophthalmology Online



Vol. 23, #19  •   Monday, May 16, 2022


In this Issue:





Diagnostic Performance of OCT for Pseudoexfoliation Glaucoma

Researchers compared the diagnostic performance of different geometric parameters derived from optical coherence tomography scans (retinal nerve fiber layer thickness, lamina cribrosa [LC] thickness, LC curvature index [LCCI] and Bruch's membrane opening-minimum rim width [BMO-MRW]) to distinguish eyes with pseudoexfoliation glaucoma (PXG) from pseudoexfoliation syndrome (PXS) and healthy eyes.

Fifty-five eyes of 55 patients with PXG, 55 eyes of 55 patients with PXS and 50 healthy subjects were enrolled in this cross-sectional study. The areas under the receiver operating characteristic curves of RNFL thickness, LC thickness, LCCI and BMO-MRW were calculated and compared.

Here are some of the findings:
• With regard to discriminating PXG from PXS eyes, LC thickness (0.930 [CI, 0.883 to 0.978]) and global RNFL thickness (0.974 [CI, 0.947 to 0.992]) presented comparable AUCs (p=0.244).
• With regard to distinguishing PXG subjects from healthy controls, LC thickness (0.972 [CI, 0.948 to 0.997]) and LCCI (0.983 [CI, 0.968 to 0.998]) had comparable AUCs with global RNFL thickness (0.988 [CI, 0.974 to 1.000])(p=0.094 and p=0.239, respectively).
• Global BMO-MRW had lower AUCs than RNFL thickness (0.839 [CI, 0.759 to 0.920] and 0.897 [CI, 0.836 to 0.958], respectively) in distinguishing PXG from PXS and healthy controls (p=0.001 and p=0.002, respectively).
• BMO-MRW also had significantly lower AUCs than LC thickness and LCCI in distinguishing PXG from healthy controls (p=0.034 and p=0.001, respectively).

Researchers wrote that LC thickness and LCCI had better diagnostic performance than BMO-MRW in distinguishing PXG from PXS and healthy controls, which were comparable to RNFL thickness.

SOURCE: Ozcelik-Kose A, Yıldız MB, Imamoglu S. Diagnostic performance of optical coherence tomography for pseudoexfoliation glaucoma. J Glaucoma 2022; Apr 27. [Epub ahead of print].





Progression of Atrophy Between Neovascular & Non-neovascular AMD

Investigators compared enlargement rates over five years of follow-up in geographic atrophy vs. macular atrophy associated with macular neovascularization, as part of a retrospective, longitudinal comparative case series.

Atrophic regions on serial registered fundus autofluorescence (FAF) images were semiautomatically delineated, and area measurements were recorded every 6 ±3 months for the first two years of follow-up and at yearly intervals up to five years. Main outcome measures included annual raw and square root transformed atrophy growth rates.

A total of 117 eyes of 95 patients were included (61 in the GA and 56 in the MA cohort); 100 percent and 38.5 percent of eyes completed two and five years of follow-up, respectively. Here are some of the findings:
• Mean baseline lesion size was similar between the two groups (raw: 1.74 vs. 1.53 mm2, p=0.56; square root transformed: 1.17 vs. 1.02 mm, p=0.26).
• Overall enlargement rates were greater for the GA cohort (raw: 1.72 vs. 1.32 mm2/year, p=0.002; square root transformed: 0.41 vs. 0.33 mm/year; p=0.03), as well as the area of atrophy growth at 5 years (raw: +8.06 vs. +4.55 mm2, p=0.001; square root transformed: +1.93 vs. +1.38 mm, p=0.02).
• Estimated square root transformed area was also significantly greater for the GA cohort at two years (1.84 vs. 1.67 mm, p=0.01).

Investigators reported that presence of MNV was associated with a slower rate of expansion resulting in overall smaller areas of atrophy over time. They added that the findings support the hypothesis that MNV may protect against the progression of atrophy.

SOURCE: Airaldi M, Corvi F, Cozzi M, et al. Differences in long-term progression of atrophy between neovascular and non-neovascular age-related macular degeneration. Ophthalmol Retina 2022; Apr 20. [Epub ahead of print].




Microthin DSAEK vs. DMEK

Scientists reported two-year outcomes of a double-blinded randomized controlled trial comparing Descemet’s membrane endothelial keratoplasty and microthin Descemet’s stripping automated endothelial keratoplasty.

Fifty-six eyes of 56 patients were randomized to DMEK or MT-DSAEK. The main outcome measure was best spectacle-corrected visual acuity at 24 months. Other secondary outcomes included complications, endothelial cell density, and vision-related quality-of-life scores.

Here are some of the findings:
• No statistically significant difference was found in BSCVA between DMEK and MT-DSAEK groups at the two-year time point (mean ±SD; 0.04 ±0.14 vs. 0.12 ±0.19, p=0.061) in contrast to the one-year results (mean ±SD; 0.04 ±0.13 vs. 0.11 ±0.09; p=0.002) previously reported.
• Endothelial cell density didn’t show a statistically significant difference at 24 months between the DMEK and MT-DSAEK groups (1,522 ±293 cell/mm2 vs. 1,432 ± 327 cells/mm2, p=0.27).
• Two additional graft rejection episodes were reported in the MT-DSAEK group between the one- and two-year follow-up periods, but this didn’t result in graft failure.
• The mean vQoL scores between DMEK and MT-DSAEK indicated similar patient satisfaction between the groups (97.1 ±4 vs. 92.6 ±10.2; p=0.13).

Scientists found no significant difference in BSCVA at 24 months between DMEK and MT-DSAEK groups. Both techniques continued to demonstrate comparable outcomes for complication rates, endothelial cell loss and patient-reported vQoL scores.

SOURCE: Pujari R, Matsou A, Kean J, et al. A randomized controlled trial comparing microthin Descemet stripping automated endothelial keratoplasty with Descemet membrane endothelial keratoplasty: Two-year report. Cornea 2022; Apr 9. [Epub ahead of print].


Complimentary CME Education Videos



Changes in Lens Clarity After Repeated Injections of Ranibizumab in Patients with nAMD

Researchers objectively evaluated changes in lens densitometry in eyes with neovascular age-related macular degeneration treated with repeated intravitreal ranibizumab injections during a 12-month period, and compared the results with those in untreated healthy fellow eyes and healthy control eyes.

In this prospective study, the 36 treated eyes and the 37 untreated fellow eyes of 38 patients with nAMD, and the 32 control eyes of 32 healthy individuals were analyzed. Lens densitometry was evaluated using the Scheimpflug imaging. All data in both groups regarding lens densitometry were recorded at baseline and 12 months.

Here are some of the findings:
• The mean densitometry of zone 1 in the treated eyes of patients increased significantly at 12 months compared with the baseline (baseline: 9.3 ±1.5; 12 months: 11.9 ±1.7; p=0.004) and was significantly greater than those measurements in fellow eyes (9.8 ±1.6; p=0.02) and control eyes (9.6 ± 1.9; p=0.01) at 12 months as well.
• No significant differences were found in terms of densitometry values between the fellow and control eyes at baseline and 12 months (for all, p>.05).

Researchers wrote that the results objectively demonstrated early nuclear lens density changes using Scheimpflug images in nAMD eyes treated with repeated ranibizumab injections for 12 months.

SOURCE: Altunel O, Irgat SG, Özcura F. Objective evaluation of changes in lens clarity after repeated injections of ranibizumab in patients with neovascular age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol 2022; Apr 21. [Epub ahead of print].




Industry News


The following companies presented these findings at the Association for Research in Vision and Ophthalmology annual meeting, May 1-4, in Denver and virtually.
• Apellis Pharmaceuticals announced detailed, longer-term data from the Phase 3 DERBY and OAKS studies of intravitreal pegcetacoplan—an investigational, targeted C3 therapy—for the treatment of geographic atrophy (GA) secondary to AMD. Read more.
• Clearside Biomedical announced several poster presentations were delivered on Clearside’s proprietary suprachoroidal delivery platform, Xipere, and gene therapy delivery utilizing Clearside’s SCS Microinjector. Read more.
• C. Light Technologies shared engineering and software development updates on the Retitrack, a medical instrument for the collection and analysis of retinal images. Read more.

Ophthalmologists Awarded for Using Big Data

The American Academy of Ophthalmology announced recipients of the Knights Templar Eye Foundation, Pediatric Ophthalmology Fund and the H. Dunbar Hoskins Jr., MD, Center for Quality Eye Care IRIS Registry Research Fund—supporting vision research using big data. The awards honor Academy members in private practice utilizing the Academy’s IRIS Registry to advance patient care. View the winners.



If you have a patient with X-linked RP, there's a clinical trial recruiting that your patient might be interested in. The VISTA clinical trial is studying the AGTC-501 investigational gene therapy for patients with X-linked retinitis pigmentosa. The VISTA Phase II/III clinical trial is to evaluate the safety and effectiveness of AGTC-501. Refer a patient here.

Retinal Cell Map Could Advance More Precise Therapies

NEI researchers have identified five subpopulations of retinal pigment epithelium. Using artificial intelligence, the researchers analyzed images of RPE at single-cell resolution to create a reference map that locates each subpopulation within the eye. They found that different RPE subpopulations are vulnerable to different types of retinal degenerative diseases and that age-related morphometric changes also may appear in some RPE subpopulations before they’re detectable in others. Read more.

RetinAI Discovery Gets FDA Nod

RetinAI Medical announced FDA 510(k) clearance of RetinAI Discovery, the company’s image and data management platform. Learn more.



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