October 27, 2021

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

In this week's issue

  • Corneal cross-linking was effective at slowing keratoconus progression
  • In optic disk melanocytoma, blood vessel network absence corresponded with visual field deficits
  • Removing applicant identifiers (sex/gender/race/ethnicity) did not change how reviewers graded medical students applying for ophthalmology at Standford

Keratoconus: When Treatment and Prevention Cross Paths


Keratoconus, you’re under arrest. An observer-masked, randomized, controlled trial investigated the efficacy of corneal cross-linking (CXL) in arresting keratoconus progression (a 1.5 diopter increase in steep keratometry (K2)) among 60 participants between the ages of 10 and 16 years old. Currently, standard care for those with keratoconus includes treatment of refractive errors due to the condition or replacement of diseased cornea via transplant. In this study, 30 patients received treatment with CXL and standard care for 18 months, while the other 30 received standard care alone. Patients in the CXL group had lower mean K2 measurements (p=0.002), superior visual acuity (p=0.002), and lower odds of disease progression (p=0.004) when compared with those in the standard care group. These results highlight noteworthy advancements in keratoconus treatment, as implementing CXL therapy before patients experience refractive consequences may significantly prevent disease progression and the need for subsequent invasive treatment.

Implicit biases in ophthalmology residency selection

JAMA Ophthalmology

‘Tis the (application) season. Diversity in the ophthalmology workforce needs improvement, with little change in the past decade. In the US, only 44.3% of ophthalmologists are women (50.8% of the general population), and only 6% of ophthalmologists are URIM (30.7% of the general population). It is therefore of utmost importance to recruit and train diverse classes of residents. In this study of Stanford Ophthalmology Program’s recruitment process, Pershing et al. evaluate the utility of redacting applicant identifiers of sex/gender, race/ethnicity, and related terms, as well as evaluate the factors most associated with application review scores. Each application was read by one reviewer with all information and a second reviewer with identification information redacted. Reviewers received a mix of redacted and non-redacted applications. The authors then compared the scores between the redacted and non-redacted applicants. The distribution of scores was similar between the open and redacted reviewers, both in aggregate, and when stratified by sex, URIM, and IMG status. Additionally, none of these variables were associated with application review scores. Factors most associated with scores were attending a top-ranked medical school, having a second degree, and Step 1 Score. In the literature, there is robust evidence for implicit bias, and the authors note that one possible reason for a lack of association between redaction and scores observed in this study could be a change in policy and culture that preceded the study. One weakness of this work is that it only assessed implicit bias at a single training program, so conclusions cannot be drawn about the application process as a whole. Therefore, an important application of this study is the potential to use this method in other residency programs, so that they may evaluate whether implicit bias is plaguing their application process as well.

Optic Disc Melanocytoma: Visual Field Defects and Blood Vessel Formation

British Journal of Ophthalmology

Optic disc melanocytoma (ODM) is a rare benign tumor of the optic disc that can lead to significant visual field (VF) defects. Prior literature has used flourescein angiography to evaluate the effect of ODM retinal blood vessels. The authors sought to use Optical Coherence Tomography Angiography (OCTA) to better study how blood vessel network (BVN) formation correlated with visual field defects to further understand the pathogenesis of ODM. This retrospective study of 32 eyes (32 patients) with ODM found that VF indices were significantly worse in the incomplete BVN group than in the complete BVN group. Linear regression of mean deviation and visual field index illustrated a statistically significant association with area of BVN absence, but not with tumor area. This study found that the location of BVN absence corresponded with the location of VF defect, rather than the tumor area itself in patients with ODM.


How Does Diabetes Affect Vision in Patients with Thyroid Eye Disease?

Ophthalmic Plastic and Reconstructive Surgery

Diabetes and thyroid dysfunction are the two most common disorders in endocrinology, but how does one impact the other?  This study sought to evaluate if diabetes mellitus (DM) was an independent risk factor for sight-threatening thyroid eye disease (TED) and if DM was predictive of worsening vision in patients with TED. This was a retrospective cohort study of 202 TED patients who presented to a tertiary eye care center in India between 2013 and 2019. Patients with TED and DM had a 3-times higher risk for developing active TED and a 4-times higher risk for developing bilateral sight-threatening disease. DM was also an independent risk factor for developing dysthyroid optic neuropathy (HR 2.22, P = 0.02). TED patients with DM had worse best-corrected visual acuity at follow-up, especially if these patients also had a smoking history. These results suggest that patients with DM and TED are at higher risk for adverse outcomes due to TED; these patients may necessitate closer follow-up in order to prevent vision loss.


Long-term outcomes in patients presenting with optic neuropathy

Journal of the Neurological Sciences

Timing of treatment is a debated issue among neurologists treating clinically isolated syndrome. There are limited data on the long-term visual outcomes of patients with multiple sclerosis and optic neuritis. This study utilized the MSBase registry to compare outcomes between patients treated for optic neuritis and those who were not treated. Analyses of data from 60,933 patients enrolled in the database revealed that patients who received treatment for optic neuritis had a reduced risk and delayed progression to clinically definitive multiple sclerosis after a 5 year follow-up period. Treatment was also associated with improved visual and neurological function. Overall, this study supports early treatment of optic neuritis in patients with multiple sclerosis. 

End of Month Quiz

1. True or False: Results from a double-masked randomized controlled trial published in AJO found that blue-blocking lenses reduce eye strain from extended screen type.
A. True
B. False

2. A retrospective analysis of 203,707 patients in the IRIS Registry found that upon initiation of anti-VEGF therapy for diabetic macular edema:
A. Hispanic patients were more likely to have more severe DR when compared with non-Hispanic patients
B. Black patients were more likely to have more severe DR when compared with White patients
C. Medicaid patients were more likely to have more severe DR when compared with Private insurance patients
D. All of the above

3. A multivariate logistic regression of patient encounters from the year 2020 at Mass Eye and Ear found that which factors were associated with patients being less likely to engage in tele-ophthalmology encounters?
A. Male sex
B. English primary language
C. Education attainment college or more

4. A retrospective analysis extended release/long-acting (ER/LA) opioid prescription patterns by 142 oculoplastic surgeons from 2013 to 2017 found that:
A. Over the study period, the number of ER/LA prescriptions increased
B. Over the study period, the number of prescribers increased
C. Over the study period, the mean number of ER/LA opioids per prescriber increased

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