December 8, 2021

The most important ophthalmology research updates, delivered directly to you.

In this week's issue

  • The recombinant zoster vaccine is effective in preventing herpes zoster ophthalmicus
  • Children with T2DM are at higher risk of developing serious ocular complications than those with T1DM, including diabetic retinopathy and visually significant cataract
  • A newly developed implantable IOP sensor is safe and accurate in continuously measuring IOP in open angle glaucoma

Ophthalmologists' Role in Promoting Herpes Zoster Vaccination


Could a vaccine  prevent blindness? Herpes zoster ophthalmicus can cause conjunctivitis, keratitis, or uveitis, and in serious cases can lead to blindness. In this retrospective cohort study of almost 5 million individuals, investigators assessed the effectiveness of the recombinant zoster vaccine (RZV, brand name Shingrix) in preventing herpes zoster ophthalmicus (HZO) by measuring the incidence of HZO in vaccinated and unvaccinated cohorts. 3.7% of subjects successfully received two valid doses of the HZO vaccine. The incidence rate of HZO was 25.5 cases per 100000 person-years in the vaccinated group versus 76.7 cases in the unvaccinated group. The overall adjusted effectiveness of RZV against HZO was 89.1%. Given the alarmingly low vaccination rate in this study, the authors highlight the important role of ophthalmologists in strongly recommending RZV to patients, especially in regards to the immense disease burden of HZO. 

Ocular Complications of Childhood Onset Diabetes

JAMA Ophthalmology

Diabetes is a common diagnosis and longer duration of disease is associated with increased ocular complications. In this retrospective, population-based study, the authors sought to assess the risk of developing diabetes-associated ocular complaints in children diagnosed with type 1 or type 2 diabetes. Ocular complications occurred in 31% (147/461) of children with type 1 diabetes and 26.6% (17/64) of children with type 2 diabetes. Type 2 diabetics were at higher risk than type 1 diabetics in developing any diabetic retinopathy (HR 1.88), proliferative diabetic retinopathy (HR 2.33), diabetic macular edema (HR 1.49), visually significant cataract (HR 2.43), and requiring a pars plana vitrectomy (HR 4.06). Overall, ocular complications were more likely in children with type 2 compared with type 1 diabetes. Because there was historically a low prevalence in type 2 diabetes in children, this important study adds to a previously small body of literature detailing the natural course of this disease. 

Surgically Implanted Suprachoroidal Intraocular Pressure Sensor

British Journal of Ophthalmology

Sometimes, you just need a mate to check in on you – EYEMATE-SC might be the one for you. Continuous monitoring of IOP has been of great interest for glaucoma. The authors developed a telemetric IOP sensor (EYEMATE-SC) that can be surgically implanted into the suprachoroidal space. In this prospective, single-arm study, no serious or sight-threatening complications nor any device malfunctions occurred at the 6 month follow-up (n=24). The most common complication was a hyphema (9/24), but all spontaneously resolved after surgery. Although Goldmann Applanation and the EYEMATE initially differed in measurements, by the 6 month follow-up, no statistically significant difference between the two methods was found. Overall, this study is the first to show that a suprachoroidal sensor is safe and effective at continuous IOP measurements at a 6 month follow-up, but larger, more heterogeneous studies need to be done to fully validate the EYEMATE-SC.


Combined versus Sequential Phacoemulsification and Pars Plana Vitrectomy


In grade school class, PEMDAS taught us the order of mathematical operations. Does order of ocular operations matter too? Specially, does performing a phacoemulsification (phaco) at the same time as a pars plana vitrectomy (PPV) impact outcomes when compared to performing them sequentially at different time points. This question is important as an estimated 80% of patients develop cataract after PPV, ultimately requiring removal within 2 years of surgery. In a meta-analysis of 1407 combined phaco and PPV eyes and 951 sequentially treated eyes with phaco and PPV separately, the efficacy and incidence of complications was compared between these two surgical approaches. No significant differences were found in visual acuity (p = 0.76) and refractive outcomes (p = 0.46) between combined and sequential phaco-PPV. Safety outcomes such as risks of synechiae formation (p < 0.001), fibrin formation (p < 0.001), and retinal detachment (p = 0.03) were significantly higher after combined surgery. However, the risks of posterior capsular tear (p = .002) and macular hole non closure or reopening (p = 0.04) were significantly lower in the combined group. Since much of this meta-analysis included data from retrospective studies, more randomized control trials would help assess the validity of these results.

Question of the Week

A 32-year-old man presents to the cornea clinic complaining of poor vision in both eyes. IOP is 12mmHg OD and 15mmHg OS. Best corrected visual acuity with glasses is 20/100 OD and 20/50 OS. Anterior exam of the right eye is shown below. Pachymetry during the visit revealed a central corneal thickness of 425 microns (thinnest area 358) in the right eye and a central corneal thickness of 458 micron (thinnest area 386) in the left eye. Posterior segment examination is normal OU.
Which of the following is the best next step?
A.   New prescription for glasses
B.   Penetrating Keratoplasty
C.   Observation
D.   Hard contact lenses

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Quiz Answer: D
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