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

 

 

By Brooke Strickland

For this study, researchers looked to describe what pathological changes preceded the onset of drusen-associated atrophy for patients living with age-related macular degeneration (AMD). A cross-section of 181 patients with intermediate AMD in at least 1 eye (141 unilateral, 40 bilateral) were assessed longitudinally. A total of 230 patients with bilateral intermediate AMD (40 longitudinal participants with an additional 90 patients) were included. Researchers examined participants every 3 months for up to 30 months using the following methods: spectral domain OCT, color fundus photography (CFP), near-infrared reflectance, and fundus autofluorescence imaging. Spectral-domain OCT volume scans were studied for features that foreshadow the development of drusen-associated atrophy, and the topography, prevalence, and risk factors of these features were determined through cross-sectional analysis.

Results showed that 20 areas from 16 eyes (16 patients) had drusen-associated atrophy after an average of 20 months (range, 8 to 30 months). Spectral-domain OCT features distinctive in these areas were: subsidence of the outer plexiform layer (OPL) and inner nuclear layer (INL), and development of a hyporeflective wedge-shaped band within the limits of the OPL. These characteristics were named “nascent geographic atrophy” (nGA) and were used to name features that indicate the development of drusen-associated atrophy. After patients with bilateral intermediate AMD underwent cross-section exams, results showed independent risk factors for the presence of nGA included the presence of pigmentary changes and nGA in the fellow eye. In addition, nGA was present in 21.9% of participants with drusen >125 μm and pigmentary changes in both eyes. (1)

What to take away from the study: Pathological changes in eyes occur before drusen-associated atrophy using SD-OCT (defined as nGA). Even though nGA is not seen on CFP, it is helpful in defining risks of future vision loss in AMD. It can also be used as an earlier substitute end point in interventional trials that look at early stages of AMD.

1. Wu, Zhichao, BAppSc(Optom), Luu, Chi, D., PhD, Goh, Jonathan, K., MBBS, BMedSci, Lucci, Lucia, M., MD, Hubbard, William, C., BS, Hageman, Jill, L., RN, Hageman, Gregory, S., PhD, Guymer, Robyn, MBBS, PhD. “Optical Coherence Tomography—Defined Changes Preceding the Development of Drusen-Associated Atrophy in Age-Related Macular Degeneration.” Ophthalmology. Manuscript no. 2014-395. Published online August 8, 2014. Accessed online August 10, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900568-5/abstract

 

 

 

By Brooke Strickland

In this study, researchers looked at patients with AIDS in order to evaluate the risk of cataract development. The patients had AIDS and did not have ocular opportunistic infections throughout catamnesis. There were 1,606 patients (3,212 eyes) included in the study and they were documented at enrollment and semiannually from 1998 to 2008. Researchers defined cataract as high-grade lens opacity seen by biomicroscopy judged to be the cause of a best-corrected visual acuity worse than 20/40. Patients that had cataract surgery during follow-up were considered to have developed cataract before the first visit when pseudophakia or aphakia was seen.

Results showed that of the eyes enrolled in the study, at initial enrollment, there were 1.9% of eyes that had cataracts or prior cataract surgery. There were a remaining 2,812 eyes that did not have cataracts, so they were followed longitudinally at an average follow up of 4.6 years. For these eyes, there was an incidence of cataract that showed 0.37%/eye-year. Age was named as one of the risks of developing cataracts, but in addition to this, there were other significant factors, which included: prior cataract in the contralateral eye, anterior segment inflammation, prior retinal detachment, and vitreous inflammation. These were studied as time-updated characteristics.
Detectable human immunodeficiency virus RNA in peripheral blood was linked with lower risk of cataract at enrollment but not of incident cataract. After adjustment for other factors, neither the then-current absolute CD4+ T-cell count nor antiretroviral therapy status showed consistent association with cataract risk, nor did an additive diagnosis of other comorbidities. Compared with the available population-based studies that used similar definitions of cataract, the age-specific prevalence of cataract in this group was higher than in 1 of 2 such studies, and the age-specific incidence of cataract surgery was higher. (1)

What to take away from the study: People living with AIDS may develop cataracts earlier than the general population of non-AIDS patients. Age was the main risk for cataract development, but with improvements in AIDS treatment, people with HIV or AIDS will likely be able to deal better with cataracts as time goes on.

1. Kempen, John, H., MD, PhD, Sugar, Elizabeth, A., PhD, Varma, Rohit, MD, MPH, Dunn, James, P., MD, Heinemann, Murk-Hein, MD, Jabs, Douglas, A., MD, MBA, Lyon, Alice, T., MD, Lewis, Richard, A., MD, MS for the Studies of Ocular Complications of AIDS Research Group. “Risk of Cataract among Subjects with Acquired Immune Deficiency Syndrome Free of Ocular Opportunistic Infections.” Ophthalmology. Manuscript no. 2013-2093. Published online August 8, 2014. Accessed online August 11, 2014. http://www.aaojournal.org/article/S0161-6420%2814%2900527-2/abstract

 

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