July 20, 2022

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

In this week's issue

  • Deep parapapillary choroidal microvasculature metrics emerge as a potential new OCT angiography biomarker of glaucomatous microvascular injury.
  • Retrospective study reveals intermittent fasting is associated with lower rates of age related macular degeneration.
  • Netarsudil, a rho kinase inhibitor topical glaucoma medication, can cause a reversible punctal stenosis.
  • A trained artificial intelligence model can detect retinopathy of prematurity efficiently.
  • TikTok emerges as a new method of provider-patient education and sharing of the patient experience. 

Assessing choroidal microvascular density in POAG and APAC

British Journal of Ophthalmology

It’s parapapillary choroidal microvasculature, not peripapillary microvasculature. Choroidal microvasculature drop-out at the superficial radial peripapillary area differs between primary-open angle glaucoma (POAG) and acute primary angle closure (APAC), suggesting ischemia may be involved in pathogenesis to different extents. However, few studies have explored whether changes exist at the level of deep parapapillary choroidal microvasculature (PPCMv). In this prospective, observational study, 149 eyes with POAG (n=65), APAC (n=40), or healthy controls (n=44) were examined with OCTA to determine PPCMv density. Whereas global peripapillary perfused capillary density (PCD) in APAC and POAG groups differed compared to healthy controls (-4.66% and -3.46%, respectively), it did not differ between study groups. However, when examined by sector, PPCMv was significantly lower in POAG than APAC in the outer annulus (by 3.6%), inner hemi-superior (5.9%), and outer hemi-superior (4.4%). This study demonstrates that the degree of choroidal microvasculature drop-out at the level of the PPCMv is lower in POAG than APAC, and both groups are lower than healthy controls. This study provides strong support for considering PPCMv as a reliable clinical biomarker of disease reflecting the severity of ischemic capillary dropout in POAG and APAC.

Intermittent fasting may reduce risk of AMD in certain populations

American Journal of Ophthalmology

Intermittent fasting can be demanding, but is it worth it if it can help reduce risk of eye disease? Age-related macular degeneration (AMD) is the leading cause of vision loss in the elderly in developed countries, and with an aging population the number of cases is expected to grow exponentially. While age is the most important risk factor for development of AMD, hypertension, hyperlipidemia, obesity, diet, alcohol consumption, smoking, and sun-exposure are all associated risk factors for AMD. Intermittent fasting has shown potential for numerous cardiovascular and other health benefits, but the effects of intermittent fasting on AMD have not been extensively studied. This retrospective, cross-sectional study analyzed 4,504 subjects aged ≥ 55 years using a Korean population-based, government led survey from 2015–2018. Groups were made based on breakfast frequency per week: intermittent fasting (0 times/week) and non-fasting (5–7 times/week). AMD was identified in 25.1% of total subjects, with intermittent fasters having a significantly reduced risk of AMD (aOR 0.413) compared to the non-fasting group (25.6% in non-fasters vs. 14.2% in intermittent fasters). This effect was particularly pronounced in individuals with age less than 70 years, obesity, and urban residence. It must be noted that the study did not differentiate between wet and dry AMD. Other potential confounders include the IF group having an average younger age, more physical activity, less dyslipidemia, and less smokers. While there are several limitations to interpreting retrospective self-reported survey studies, these results offer numerous avenues for future interventional prospective studies that can further elucidate risk factors of AMD.

What are the side effects associated with topical netarsudil use?


New medications, new side effects. Topical intraocular pressure (IOP) lowering agents frequently are associated with adverse side effects. Use of netarsudil, a rho-kinase inhibitor (which lowers eye pressure by increasing outflow through the trabecular meshwork), can cause conjunctival hyperemia, corneal verticillata, conjunctival hemorrhage, and irritation in the eye receiving medication. This retrospective case series identified 16 patients who developed reversible punctal stenosis in the eye(s) being treated with netarsudil 0.02% that resolved with cessation of treatment. Fifty percent of patients terminated netarsudil due to the punctal stenosis, with symptoms resolving after cessation. One patient had a biopsy of the lacrimal punctae, which demonstrated lymphocytic infiltrate. Netarsudil may induce an inflammatory mediated punctal stenosis. Providers and patients should be aware of and monitor for this reversible side effect.

Detection of retinopathy of prematurity using artificial intelligence

JAMA Ophthalmology

Artificial Intelligence eyes new detection methods for retinopathy of prematurity. Retinopathy of prematurity (ROP) occurs when blood vessels in the retina grow in an abnormal manner. As these vessels are reabsorbed by the body, membranous bands develop which can lead to retinal detachment and blindness. ROP disproportionately affects infants born in low and middle-income countries, highlighting the need for early detection and management. In this study 3,760 infants at 30 weeks postmenstrual age (gestational age plus chronological age) across India, Nepal, and Mongolia had retinal fundus images collected as part of ROP screening. A trained AI model was used to determine a Vascular Severity Score (VSS), and a logistic regression model analyzed VSS and gestational age as parameters in the development of ROP (a gestational age below 37 weeks is considered premature). The AI model had a sensitivity and specificity of detection, respectively, as: India 100.0% and 63.3%; Nepal 100.0% and 77.8%; and Mongolia 100.0% and 45.8%. When compared to diagnosis by a physician, the AI model detected treatment-required ROP on average 2 weeks earlier in India, 0.5 weeks earlier in Nepal, and 0 weeks earlier in Mongolia. These results showcase the efficacy of a trained AI model in detecting a treatable cause of blindness before a physician’s diagnosis can be made, decreasing the number of examinations required and increasing the identification of high-risk infants before the development of treatment-required ROP.


#Oculoplastics: An analysis of TikTok’s top oculoplastics content

Ophthalmic Plastic and Reconstructive Surgery

Could oculoplastics be the secret to going viral? TikTok, the viral video-sharing app, is famously popular with young teenagers and is successful in promoting various plastic surgery procedures. In this retrospective review, 25 oculoplastics-related hashtags such as blepharoplasty, eyelid surgery, and brow lift were queried, and 20 most highly suggested videos were included (n=386 videos). The videos were categorized by views, likes, comments, and other characteristics such as the purpose of the video content. The videos in total had over 218 million views, with the leading content (38.1%) being patient-delivered descriptions of their experience. About a quarter of the videos were posted by non-ophthalmology physicians, and 16.3% were posted by ophthalmologists. Using a patient education materials assessment tool, physician-created content scored higher in understandability and actionability compared to the patient-created content. Although this study suggests that physician-created oculoplastics content can be of value in health literacy and empowering patients, it is largely limited by the transient nature of what is trending on TikTok.

Lens Landmarks

Can corticosteroids get you aHEaD of the curve for HSV stromal keratitis? In the HEDS trial, patients with active herpes simplex stromal keratitis were randomly assigned to either a placebo group (n = 49) or topical prednisolone phosphate group (n = 57). Both groups received topical trifluridine and a 10-week tapered regimen of the treatment drug/placebo.

Key Points:
  • Compared to placebo, the steroid group had a reduced risk of persistent stromal keratouveitis by 68%.
  • The time to resolution was significantly shorter in the steroid group.
  • At 6 months, there were no clinically or statistically significant differences in visual outcome or recurrent herpetic eye disease between both groups.
Overall, this subset of the HEDS is a landmark study because it demonstrated how administering topical corticosteroids were efficacious in treating herpes simplex stromal keratitis. Before this trial, it was unclear whether topical corticosteroids were safe and effective for these patients. In the HEDS, researchers found steroids were specifically advantageous in hindering the progression of stromal inflammation and shortening the duration of stromal keratitis.

Question of the Week

A 4-year-old male presents with an unprovoked convulsive episode. The patient was born with a unilateral pink-red color on the right side of his face, affecting all three distributions of the trigeminal nerve. He also developed elevated intraocular pressure in the right eye.
Which of the following is most likely to be found on funduscopic examination?

A. Choroidal hemangioma with tomato catsup appearance
B. Disk with sharp margins and is normal in color, with small central cup
C. Multifocal, sectoral heavily pigmented lesions clustered in groups
D. Chalk white retinal lesions associated with surrounding vitreous haze

Keep scrolling for answer or click here

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