Review of Ophthalmology Online



Vol. 22, #46  •   Monday, November 8, 2021


In this Issue:




Patient-reported Symptoms Associated with Severity of VF Damage in Glaucoma

Researchers studied which patient-reported symptoms best distinguished patients with and without glaucoma, and explained the most variance in visual field damage. They also compared the amount of variance that can be explained by symptoms vs. retinal nerve fiber layer thickness, as part of a cross-sectional study.

Participants included adults diagnosed with glaucoma or suspicion of glaucoma (controls).

Worse-eye VF damage was defined by perimetric testing and RNFL thickness was defined by OCT imaging. Patients rated their visual symptoms on questions collated from several published questionnaires, rating the frequency and severity of 28 symptoms on a scale of one (never/not at all) to four (very often/severe). Multivariable regression models identified patient reported symptoms that contributed the highest variance in VF damage.

Main outcome measures included patient-reported symptoms that explained the most variance in VF damage and RNFL

A total of 170 patients (mean age=64; 58 percent female; 47 percent employed) completed testing, including 95 glaucoma suspects and 75 glaucoma patients. Here are some of the findings:
• In glaucoma patients, median mean deviation of VF damage in the worse eye was -19.3, and ranged from -5.3 to -34.7 dB.
• Symptoms more common among glaucoma patients compared to glaucoma suspects included:
   o better vision in one eye;
   o blurry vision, glare;
   o sensitivity to light;
   o cloudy vision; and
   o little peripheral vision.
• Worse severity ratings for the symptom “little peripheral vision” explained the most variance in VF damage (43 percent).
• A multivariable model including the frequency of cloudy vision, severity of having little peripheral vision, missing patches, one eye having better vision and vision worsening, plus sociodemographic features explained 62 percent of the variance in VF damage.
• Comparatively, a multivariable model of worse-eye RNFL thickness and sociodemographic features explained 42 percent of the variance in VF damage, while a model including only sociodemographic features explained eight percent of the variance in VF damage.

Researchers found that five patient-reported symptoms explained a significant amount of the variance in VF damage. They suggested that asking patients about their symptoms may optimize patient-physician communication and be a useful adjunct to clinical testing in some patients to estimate disease severity.

SOURCE: Shah YS, Cheng M, Mihailovic A, MS, et al. Patient reported symptoms demonstrating an association with severity of visual field damage in glaucoma. Ophthalmology 2021; Oct 27. [Epub ahead of print].




Hyperreflective Foci in the Choroid of Normal Eyes

Investigators evaluated hyperreflective choroidal foci (HCF) using en face swept-source optical coherence tomography, and determined the factors that contribute to the distribution of HCF in normal eyes.

In this retrospective study, investigators included healthy eyes with a normal fundus. HCF were defined as hyperreflective spots on en face SS-OCT images. The number, mean area, total area and circularity of the HCF were compared with various choroid measurements obtained using SS-OCT, SS-OCT angiography and fundus photography.

Investigators included 51 eyes from 51 patients. The mean patient age was 56 ±14.7 years, and 32 (62.7 percent) were female. Here are some of the findings:
• The number and total area of HCF didn’t differ between female and male patients, and the right and left eyes.
• The number of HCF was correlated with the stromal area of the choroid (r=0.291, p=0.040) and subfoveal choroidal vascularity index (r=- 0.364, p=0.009).
• The total area of HCF was correlated with the stromal area of the choroid (r=0.283, p=0.045).
• However, the number and total area of HCF weren’t correlated with age, degree of macular tessellation, subfoveal choroidal thickness, or choriocapillaris vascular density and flow void area.

Investigators reported that HCF were observed in normal eyes, and their distribution was associated with the underlying stromal component of the choroid. They suggested that the results of this study may be used as a reference for determining abnormal hyperreflective foci in the choroid of the eyes with various diseases.

SOURCE: Kim YH, Oh J. Hyperreflective foci in the choroid of normal eyes. Graefes Arch Clin Exp Ophthalmol 2021; Oct 21. [Epub ahead of print].


Incision-related Descemet’s Membrane Detachment Using Phaco with Trapezoid vs. Conventional 2.2-mm Clear Corneal Incision

Scientists compared the incidence of incision-related Descemet’s membrane detachment among eyes undergoing modified vs. conventional 2.2-mm incision phacoemulsification for hard nuclear age-related cataract.

The double-masked, parallel randomized clinical trial was conducted from July 22, 2019, to January 22, 2020, at Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. The study included patients with age-related cataract and nuclear opalescence grade of 4.0 or greater based on the Lens Opacities Classification System III. Patients were enrolled in this study according to the following inclusion criteria: age between 65 to 90 years; pupil size of 6 mm or greater after dilation; Lens Opacities Classification System III nuclear opalescence grade of 4.0 or more; and corneal endothelial cell density greater than 1,500 cells/mm2.

Main outcomes and measures included incidence of incision-related DMD at postoperative day 1.
A total of 130 eyes of 130 patients were randomized into the conventional group (n=65) or the modified group (n=65). The mean age of participants was 74.5 ±5.9 years and 74.3 ±6 years in the conventional and modified groups, respectively. A total of 26 participants in the conventional group (40 percent) and 27 in the modified group (42 percent) were men. Here are some of the findings:
• Compared with eyes in the conventional group, the incidence of DMD in eyes in the modified group was significantly lower at postoperative day one (difference, 26.15; CI, 9.60 to 42.71; p=0.003).
• The difference at postoperative day seven was 16.92 (CI, 2.91 to 30.94; p=0.02).
• The length of DMD (postoperative day one: difference, 0.188; CI, 0.075 to 0.301; p=0.002) and maximal corneal thickness at incision site (postoperative day 1: difference, 0.032; CI, 0.006-0.057; p=0.02; postoperative day 7: difference, 0.019; CI, 0.003 to 0.035; p=0.02) were lower in the modified group, while visual quality parameter modulation transfer function (postoperative day one: difference, -0.033; CI, -0.064 to -0.001; p=0.04) was higher.
• No difference was observed between the two groups in best-corrected visual acuity, central corneal endothelium loss or surgically induced astigmatism at any follow-up time.
• No intraoperative complications were reported in the two groups.

Scientists wrote that the findings suggested that modified 2.2-mm trapezoid incision phacoemulsification reduced the incidence of DMD for hard nuclear age-related cataract at postoperative day one and might be considered in patients at high risk of incision-related DMD, although they added the clinical relevance couldn’t be determined with certainty from this trial.

SOURCE: Dai Y, Liu Z, Wang W, et al. Incidence of incision-related descemet membrane detachment using phacoemulsification with trapezoid vs conventional 2.2-mm clear corneal incision: A randomized clinical trial. JAMA Ophthalmol 2021; Oct 14. [Epub ahead of print].


Complimentary CME Education Videos



Collateral Vessel Development in CRVO and BRVO and Visual Outcomes

Researchers looked at the effects of the extension of collateral vessels on the outcomes of eyes affected by central retinal vein occlusion and branch retinal vein occlusion.

The study was designed as a cross-sectional case series. Patients affected by CRVO and BRVO were progressively recruited, along with an age- and sex-matched control group of healthy subjects. Structural optical coherence tomography (OCT) and OCT angiography (OCTA; 4.5 × 4.5 mm and 9 × 9 mm acquisitions) were performed on all participants to assess the relationship between the presence of collateral vessels and final anatomical outcomes (central macular thickness, foveal avascular zone) and functional outcomes (best-corrected visual acuity).

Fifty-six eyes affected by CRVO, and 47 eyes affected by BRVO were included. Here are some of the findings:

• Baseline logMAR BCVA was 0.41 ±0.33 logMAR in CRVO and 0.39 ±0.25 LogMAR in BRVO (p<0.01), improving to 0.20 ±0.26 logMAR in CRVO (p<0.01) and 0.19 ±0.22 logMAR in BRVO (p<0.01).
• Baseline CMT was 511 ±214 µm in CRVO and 482 ±178 µm in BRVO (p>0.05), decreasing to 328 ±105 µm in CRVO (p<0.01) and 321 ±78 µm and BRVO (p<0.01).
• Collateral vessels were detected in 16 of 56 eyes (29 percent) in CRVO and in 47 of 47 eyes (100 percent) in BRVO.

Researchers found the extension of collateral vessels was correlated with worse anatomic and visual outcomes, although no correlation was found with peripheral capillary nonperfusion and vessel density impairment.

SOURCE: Arrigo A, Aragona E, Lattanzio R, et al. Collateral vessel development in central and branch retinal vein occlusions are associated with worse visual and anatomic outcomes. Invest Ophthalmol Vis Sci 2021; Nov 1. [Epub ahead of print].




Industry News

B+L to Present Scientific Data and Analyses on Products and ARMOR

Bausch + Lomb announced that seven scientific posters involving the company's products, as well as data from the company's Antibiotic Resistance Monitoring in Ocular MicRoorganisms (ARMOR) surveillance study, will be presented at the American Academy of Ophthalmology in New Orleans (Nov. 12 to 15). In addition to data from the company's ARMOR study, the presentations will include analyses on Xipere (triamcinolone acetonide injectable suspension) for suprachoroidal use, which received approval by the FDA in October, and Bausch + Lomb Infuse Multifocal contact lenses. Read more.

FDA Approves Vuity (pilocarpine HCI ophthalmic solution) 1.25%, First Drop to Treat Presbyopia

Allergan announced the FDA approved Vuity (pilocarpine HCl ophthalmic solution) 1.25% for the treatment of presbyopia in adults as the first FDA-approved drop to treat this condition. The company says that Vuity is a daily prescription drop that works as quickly as 15 minutes and lasts up to six hours, as measured on day 30, “to improve near and intermediate vision without impacting distance vision.” Vuity is a formulation of pilocarpine delivered with “pHast” technology, enabling the drop to rapidly adjust to the physiologic pH of the tear film, Allergan says. Read more.

Dextenza Approved for Ocular Itching

Ocular Therapeutix announced the FDA approved its Supplemental New Drug Application (sNDA) to broaden the Dextenza label to add an additional indication for the treatment of ocular itching associated with allergic conjunctivitis. The intracanalicular insert lasts for up to 30 days, the company says. Dextenza is already approved ocular pain and inflammation following ophthalmic surgery. Read more.

Prevent Blindness Names Essilor’s Rick Gadd Person of Vision Award Recipient

Prevent Blindness announced that the 2022 Person of Vision Award will be presented to Rick Gadd, president of Essilor North America. The award presentation event will take place March 31, 2022, at 583 Park Avenue, New York, NY, in conjunction with Vision Expo East. All proceeds from the event will go to support the sight-saving programs of Prevent Blindness. The Prevent Blindness Person of Vision Award “recognizes an individual, corporation and/or organization whose inspired outlook champions healthy vision and its importance for a healthy life.” Read more.


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