By Brooke Strickland

The purpose of this study was to look at the link between dietary patterns and the links they had with age-related macular degeneration (AMD). For the study, researchers collected food frequency data from the Melbourne Collaborative Cohort Study (MCCS) in which patients were studied from 1990 to 1994. These same patients were followed up again in 2003-2007, and retinal photos were taken to assess AMD and principal component analysis was used to label dietary patterns. The study included 41,514 participants between age 40 and 70. Of these, 69% were born in Australia or New Zealand and 31% had migrated there from the United Kingdom, Italy, Greece, or Malta. Out of these people, 21,132 were evaluated for AMD prevalence at follow up.

Results showed that 12.8% of patients had early stages of AMD and 0.6% had advanced AMD. There were six factors that were labeled as factors characterized by predominant intakes of fruits:

-Fruits (F1)
-Vegetables (F2)
-Grains, fish, steamed or boiled chicken, vegetables, and nuts (F3)
-Red meat (F4)
-Processed foods (cakes, sweet biscuits, and desserts) (F5)
-Salad (F6)

Higher F3 scores were associated with a lower prevalence of advanced AMD (fourth vs. first quartile) (OR, 0.49; 95% confidence interval [CI], 0.28–0.87), whereas F4 scores greater than the median were associated with a higher prevalence of advanced AMD (OR, 1.46; 95% CI, 1.0–2.17). (1)

What to take away from the study: A diet that is low in red meat consumption and high in fruits, vegetables, chicken, and nuts shows less incidence of advanced AMD. However, there weren’t clear food patterns linked with early stages of AMD.

1. Islam Amirul, Fakir, M., PhD, Chong, Elaine, W., MBBS, PhD, Hodge, Allison, M., PhD, Guymer, Robyn, H., MBBS, PhD, Aung Zaw, Khin, MBBS, Makeyeva, Galina, A., MBBS, PhD, Baird, Paul, N., PhD, Hopper, John, L., PhD, English, Dallas, PhD, Giles, Graham, G., PhD, Robman, Liubov, D., MBBS, PhD. “Dietary Patterns and Their Associations with Age-Related Macular Degeneration.” Ophthalmology. Volume 121, Issue 7, Pages 1428-1434 e.2, July 2014. Accessed online August 16, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900009-8/abstract

 

 

By Brooke Strickland

The purpose of this study was to analyze the 5-year experience outcomes of intra-arterial chemotherapy (IAC) for retinoblastoma as primary or secondary therapy. The case series included a total of 70 eyes in 67 patients. Researchers used ophthalmic artery chemotherapy infusion under fluoroscopic guidance using melphalan in every case, in addition to 1 mg topotecan and/or carboplatin (30 to 50mg) as needed. The main outcome measures were tumor control and treatment complications. The average patient age at IAC was 30 months.

Results showed that treatment was primary in 36 eyes and secondary in 34 eyes. Those primary therapy eyes were classified according to the International Classification of Retinoblastoma (ICRB) as group A (n = 0), B (n = 1), C (n = 4), D (n = 17), or E (n = 14). The secondary therapy eyes had failed previous intravenous chemotherapy (n = 34) in every case. Each eye received a mean of 3 IAC sessions per eye (3 average sessions). After IAC with an average follow-up of 19 months, globe salvage was achieved in 72% of primary-treated cases and in 62% of secondary-treated cases. Primary therapy achieved globe salvage for group B (100%), group C (100%), group D (94%), and group E (36%). For all of the eyes, complete regression was reached for solid tumor in 94% of eyes, subretinal seeds in 95% of eyes, and vitreous seeds in 87% of eyes.
After each catheterization (n = 198), the main complications included transient eyelid edema (5%), blepharoptosis (5%), and forehead hyperemia (2%). More lasting complications included vitreous hemorrhage (2%), branch retinal artery obstruction (1%), ophthalmic artery spasm with reperfusion (2%), ophthalmic artery obstruction (2%), partial choroidal ischemia (2%), and optic neuropathy (<1%).The past 3 years showed that the combined incidence of ophthalmic, retinal, and choroidal vascular ischemia was brought down to just 1%. None of the patients experienced major complications like stroke, seizure, neurological impairment, etc. (1)

What to take away from the study: Whether it’s primary or secondary treatment, after five year experience with IAC, results show that this technique is very beneficial in managing retinoblastoma.

1. Shields, Carol, L., MD, Manjandavida, Fairooz, P., MD, Lally, Sara, E., Pieretti, Giulia, MD, Arepalli, Sruithi, A., BA, Caywood, Emi, H., MD, Jabbour, Pascal, MD, Shields, Jerry, A., MD. “Intra-arterial chemotherapy for retinoblastoma in 70 eyes.” Opthalmology. Volume 121, Issue 7, Pages 1453-1460, July 2014. Accessed online August 16, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900070-0/abstract

 

 

By Brooke Strickland

In this study, researchers wanted to develop new parameters to monitor glaucoma progression. The visual field index (VFI) summarizes global visual field (VF) data and was used to monitor glaucoma progression using 24-2 and 30-2 methods. The same types of principles were used in this study in order to develop new parameters in the central field index (CFI) and monitor 10-2 VF progression. There were 142 patients included in the study (176 eyes).

For the study, researchers looked at glaucoma patients with paracentral defects seen on 24-2 perimetry and followed up with at least 5 10-2 VF tests. The CFI was created by calculating age-corrected defect depth at test points gathered during 10-2 exams. The sensitivities at these points were scored as percentages similar to the method described for the VFI. A weighting procedure was used based on published estimates of the occipital cortical spatial magnification. For validation, reserachers completed mixed linear model testing for the link between CFI rates of change (%/year) and identified risk factors for glaucoma progression in a population with established glaucoma and at least 5 10-2 VF tests. To determine whether the CFI was affected by cataract, as is known to occur with mean deviation (MD), they conducted a pilot evaluation comparing rates of CFI change in 3 groups. The first group had eyes with cataract, the second group had pseudophakic eyes, and the last group had eyes in which cataract surgery was performed in the middle of the series.

Results showed that the average rate of CFI change of the entire sample was −1.10%/year. Elevated intraocular pressure was linked significantly with faster CFI change, whereas lens status did not influence CFI rates of change. (1)

What to take away from the study: The new index system that researchers created to monitor glaucoma progression showed that central field progression that is slightly affected by the presence or removal of cataract and that relates significantly with an important risk factor for glaucoma progression. This new index may prove helpful for glaucoma management.

1.Gustavo de Moraes, Carlos, MD, Furlanetto, Rafael, L., MD, Ritch, Robert, MD, Liebmann, Jeffrey, M., MD. “A New Index to Monitor Central Visual Field Progression in Glaucoma.” Ophthalmology. Volume 121, Issue 8, Pages 1531-1538. Manuscript no. 2013-1407. Published online August 9, 2014. Accessed online August 13, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900135-3/abstract

 

 

By Brooke Strickland

The purpose of this study was to look at the progression of retinal pigment epithelium (RPE) and choroidal atrophy in patients living with neovascular age-related macular degeneration (AMD) and to see if there were links in the number and type of anti-vascular endothelial growth factor treatments. Fellow eyes with non-neovascular AMD were used as the control group of eyes. Researchers measured retinal pigment epithelial atrophy area and choroidal thickness by using spectral-domain optical coherence tomography. To gather statistic data, they used multivariable regression models. A total of 415 eyes were included in the study and the average follow up time was 2.2 years.

Results showed that patients that had neovascular AMD had greater progression of RPE atrophy and choroidal atrophy when compared to people that had non-neovascular AMD. Progression of RPE atrophy and choroidal atrophy was independently related with the total number of injections of bevacizumab and ranibizumab. In the subgroup of 84 eyes with neovascular AMD and without RPE atrophy at baseline, only bevacizumab was associated with the progression of RPE atrophy. This study likely lacked statistical power to sense an association with ranibizumab in this subgroup. (1)

What to take away from the study: Retinal pigment epithelial atrophy and choroidal atrophy in neovascular AMD seem to be aggravated by anti–vascular endothelial growth factor treatment. Further study is needed to note potential differences between bevacizumab and ranibizumab.

1. Young, Mei, MASc, Chui, Lica, MD, Fallah, Nader, PhD, Or, Chris, BSc, Merkur, Andrew, B., MD, Kirker, Andrew, W., MD, Albiani, David, A., MD, Forooghian, Farzin, MD, FRCSC. “Epithelial atrophy after anti-vascular endothelial growth factor treatment in neovascular age-related macular degeneration.” The Journal of Retinal and Vitreous Diseases. July 2014, Volume 34, Issue 7, p. 1308-1315. Accessed August 13, 2014. http://journals.lww.com/retinajournal/Abstract/2014/07000/EXACERBATION_OF_CHOROIDAL_AND_RETINAL_PIGMENT.5.aspx

 

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