By Brooke Strickland

 

In this study, researchers wanted to measure aniseikonia in patients going through vitrectomy for epiretinal membrane (ERM) and to research what the relationship was between aniseikonia and the foveal microstructure by spectral-domain (SD) optical coherence tomography (OCT). The study looked at 44 patients (44 eyes) that underwent vitrectomy for idiopathic ERM.

Researchers gathered information on visual acuity and aniseikonia using the New Aniseikonia Test and SD-OCT prior to surgery, then at 3 and 6 month intervals after surgery. They also used the status of the photoreceptor inner segment/outer segment junction, external limiting membrane, and cone outer segment tips. On the basis of the OCT image that they got, researchers divided the 1.0×1.0-mm area centered on the fovea into 9 sections at 0.25-mm intervals and quantified the following parameters using an image-processing program: central foveal thickness and mean thickness of the ganglion cell layer, inner nuclear layer (INL), and outer retinal layer (outer nuclear layer + outer plexiform layer). The goal was to find the amount of aniseikonia at 6 months post-surgery.

 

Results showed that 89% of the patients examined had macropsia, 2% had micropsia, and 9% had no aniseikonia pre-operatively. The average preoperative aniseikonia was 6.2%±4.5%. For patients with ERM, vitrectomy helped improve visual accuracy, but it didn’t change the aniseikonia numbers. Multiple regression analysis showed that preoperative aniseikonia at 6 months was related to preoperative INL thickness, whereas postoperative aniseikonia at 6 months was linked with postoperative INL thickness at 6 months. Preoperative INL thickness was found to be of significant prognostic value for postoperative aniseikonia at 6 months. (1)

 

What to take away from the study: A high percentage of patients with ERM also had macropsia, but aniseikonia did not lessen after surgery. In addition, aniseikonia numbers were also linked to inner nuclear layer thickness.

 

1. Okamoto, Fumiki, MD, Sugiura, Yoshimi, MD, Okamoto, Yoshifumi, MD, Hiraoka, Takahiro, MD, Oshika, Tetsuro, MD. “Time Course of Changes in Aniseikonia and Foveal Microstructure after Vitrectomy for Epiretinal Membrane.” Ophthalmology: Journal of the AAO. Manuscript no. 2014-409. Published online July 7, 2014. Accessed July 16, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900452-7/abstract

 

 

 

 

 

By Brooke Strickland

In this observational study, researchers looked at 1,257 premature infants that weighed less than 1251 grams (average age was 27 weeks) and were in neonatal intensive care units in 13 different places in North America from May 2011 to October 2013. The goal was to evaluate the effectiveness of a telemedicine system that had severe retinopathy of prematurity to see if continual exam of at-risk infants was necessary.

For the study, ophthalmologists regularly scheduled diagnostic exams and digital imaging using a wild-field digital camera. They documented the information they gathered with referral-warranted (RW) ROP. A standard 6-imag set per eye was sent to a central server and graded by two trained, masked non-physician readers and if disagreements occurred, a reading supervisor stepped in to settle. The validity of grading retinal image sets was based on the sensitivity and specificity for detecting RW-ROP when compared with the criterion standard diagnostic exam.

The infants that were involved in the study completed an average of 3 exams and imaging sessions. Diagnostic exams showed RW-ROP in 18.2% of eyes (19.4% of infants). Remote grading of images of an eye at a single session had 81.9% sensitivity and specificity of 90.1%. When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0%, with specificity of 87.0%, negative predictive value of 97.3%, and positive predictive value of 62.5% at the observed RW-ROP rate of 19.4%. (1)

What to take away from the study: There is strong support for the validity of remote evaluation by trained non-physician readers of digital retinal images taken by trained non-physician imagers from infants at risk for RW-ROP.

1. Quinn, Graham, E., MD, MSCE, Ying, Gui-shuang, PhD, Daniel, Ebenezer, MBBS, MS, PhD, Hildebrand, P. Lloyd, MD, Ells, Anna, MD, FRCS, Baumritter, Agnieshka, MS, Kemper, Alex, R., MD, MPH, MS, Schron, Eleanor, B., PhD, RN, Wade, Kelly, MD, PhD, MSCE, for the e-ROP Cooperative Group. “Validity of a Telemedicine System for the Evaluation of Acute-Phase Retinopathy of Prematurity.” JAMA Opthalmology. Published online June 26, 2014. Accessed online July 21, 2014. http://archopht.jamanetwork.com/article.aspx?articleid=1883696

 

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By Brooke Strickland

In this retrospective study, researchers wanted to look at the benefits and complications for patients with ocular inflammatory disorders that had received periocular depot corticosteroid injections. Researchers looked at the medical records of 914 patients (1192 eyes) that had received ≥1 periocular corticosteroid injection at five tertiary uveitis clinics across the United States. They looked at the control of inflammation, improvement of visual acuity (VA) to ≥20/40, improvement of VA loss credited to macular edema (ME), incident cataract affecting VA, cataract surgery, ocular hypertension, and glaucoma surgery.

The results showed that out of the 914 patients (1192 eyes), 286 (31.3%) were classified as having anterior uveitis, 303 (33.3%) as intermediate uveitis, and 324 (35.4%) as posterior or panuveitis. Cumulatively by ≤6 months, 72.7% of the eyes achieved complete control of inflammation and 49.7% showed an improvement in VA from <20/40 to ≥20/40. Among the subset with VA <20/40 attributed to ME, 33.1% improved to ≥20/40. By 12 months, the collective incidence of ≥1 visits with an intraocular pressure of ≥24 mmHg and ≥30 mmHg was 34.0% respectively; glaucoma surgery was performed in 2.4% of eyes. Within 12 months, among phakic eyes initially ≥20/40, the incidence of a reduction in VA to <20/40 attributed to cataract was 20.2%; cataract surgery was performed within 12 months in 13.8% of the initially phakic eyes. (1)

What to take away from the study: Periocular injections were beneficial in treating people that had active intraocular inflammation. They also helped improve reduced visual acuity attributed to macular edema in a large portion of the patients. There was a similar pattern shown across anatomic locations of uveitis and over half of the patients reported improved visual acuity results within 6 months. However, cataract and ocular hypertension occurred in a substantial minority.

1. Sen, H., Nida, MD, MHS, Vitale, Susan, PhD, MHS, Gangaputra, Sapna, S., MD, MPH, Nussenblatt, Robert, B., MD, MPH, Liesegang, Teresa, L., COT, CRC, Levy-Clarke, Grace, A., MD, Rosenbaum, James, T., MD, Suhler, Eric, B., MD, MPH, Thorne, Jennifer, E., MD, PhD, Foster, C. Stephen, MD, Jabs, Douglas, A., MD, MBA, Kempen, John, H., MD, PhD. “Periocular Corticosteroid Injections in Uveitis.” Published online July 11, 2014. Accessed July 14, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900485-0/abstract

 

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