April 19, 2023

The most important ophthalmology research updates, delivered directly to you.
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In this week's issue

  • A majority of ophthalmology researchers have incomplete financial disclosures with underreported physician-industry relationships. 
  • Risk of retinal vascular occlusion after mRNA COVID-19 vaccination is extremely low and commensurate with historically used vaccines for influenza and Tdap.
  • Ranibizumab and bevacizumab showed different risks for intraocular pressure increase compared to aflibercept in a nondiabetic cohort in Tuscany, Italy. 

Incomplete financial disclosures among ophthalmology researchers


Are ophthalmologists turning a blind eye on their financial disclosures? Physician-industry relationships are important for advancing the field from a research and technological perspective, but failure to report a conflict of interest can bias research and ultimately impact patient care. A recent study analyzed self-reported relationships with industry among US physician authors of articles published in four major ophthalmology journals. The authors compared self-reported relationships in the articles with relationships reported in the Open Payments Database (OPD), a publicly available database. Out of 660 authors (486 unique authors), the majority (63%) did not report any of their relationships that were reported to the OPD. On the other hand, 112 (17%) reported some of their relationships, while 9 (1%) reported all of them. No difference was found in self-reporting rates by journal policy or author position, but higher rates were observed among those who received more funding. This study highlights the high rate of incomplete self-reporting by ophthalmology researchers, even when journals require disclosure of all financial relationships. To improve transparency and minimize conflicts of interest, journals need to establish clear and consistent financial disclosure policies, while authors must be diligent in disclosing all relevant financial relationships.

No association between mRNA COVID-19 vaccine and RVO

JAMA Ophthalmology

Looks like vaccines truly are an eye opener! The COVID-19 pandemic has led to an unprecedented global vaccination effort to protect people against the virus. However, there have been concerns about potential side effects associated with the vaccines. This study investigated the incidence of retinal vascular occlusion (RVO), a condition that can cause vision loss or blindness, after the mRNA COVID-19 vaccine compared to historically used vaccines. Of the 3,108,829 patients who received the mRNA COVID-19 vaccine in the study, 104 (0.003%) were diagnosed with retinal vascular occlusion (RVO) within 21 days of vaccination. After propensity score matching, the relative risk (RR) for new RVO diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.74; 95% CI, 0.54-1.01) or Tdap (RR, 0.78; 95% CI, 0.44-1.38) vaccinations. However, the RR was greater when compared with the second dose of the COVID-19 vaccination (RR, 2.25; 95% CI, 1.33-3.81). The findings of this study may provide reassurance to individuals considering the mRNA COVID-19 vaccine.

Relationship between different intravitreal VEGF inhibitors and IOP

American Journal of Ophthalmology

With so many VEGF inhibitors to choose from, there can be a lot of pressure picking between them. Intravitreal injections of vascular endothelial growth factor inhibitors (VEGFis) are commonly used to treat various eye conditions, including age-related macular degeneration and diabetic retinopathy. However, prior literature has suggested these medications may impact intraocular pressure increase (IOPi), which can lead to glaucoma or other vision problems. This study aimed to evaluate the risk of IOPi among new users of bevacizumab, ranibizumab, and aflibercept in nondiabetic patients. In this retrospective cohort study, researchers utilized a Tuscany database to identify 6,585 nondiabetic, first-time users of intravitreal VEGFi as well as their first incidence of IOPi. After analysis of adjusted hazard ratios, the incidence of IOPi was higher among bevacizumab (HR = 2.20, 95% CI = 1.64-2.95) and ranibizumab (HR = 1.88, 95% CI = 1.46-2.42) users compared with aflibercept users. The large sample size and comprehensive analysis of this study provide valuable insights into the risk of IOPi associated with different VEGFis, although the lack of data on glaucoma location and indications for VEGFi use limits its generalizability to other populations.


Safety and efficacy of combined PPV and phacoemulsification for epiretinal membrane and macular hole

Ophthalmology Retina

Two surgeries in one day may be convenient and cost-saving for patients, but are outcomes truly better? Macular holes and epiretinal membranes occur when traction at the vitreous/retina interface leads to disruption of normal retina morphology. Standard of care for visually significant cases is to perform a pars plana vitrectomy (PPV) to relieve the tension, however most phakic patients will also develop cataracts and require subsequent phacoemulsification within a few years. In this meta-analysis of 10 studies, 435 combined eyes (same day PPV + phacoemulsification) and 420 sequential eyes were identified and analyzed for visual and refractive outcomes as well as incidence of complications. In terms of efficacy, there was no significant difference in 12-month best corrected visual acuity (GRADE evaluation, moderate certainty of evidence) or absolute refractive error (GRADE evaluation, low certainty of evidence). The safety profiles of combined versus sequential surgeries were also similar (p>0.05) – however due to low event rates, these conclusions may be underpowered. Although limited by small sample size and retrospective analysis, this study suggests that there is no difference in outcomes when performing combined and sequential phacovitrectomy for macular hole and epiretinal membrane. 

Lens Landmarks

Usually a quick patch doesn’t solve the real problem, but could it be enough in amblyopia?  Evidence shows that patching improves amblyopia, however many have questioned this due to the lack of inclusion of an untreated control group. In this Amblyopia Treatment Study (ATS), 180 children ages 3-7 with moderate-severe amblyopia were randomized to be treated with either 2 hours of patching or spectacles alone (if required), after a 16-week period of refractive correction.

Key Points:
  • Patching led to a statistically significant increase in VA (0.6 lines) and BCVA (0.9 lines) compared to control group
  • In a secondary cohort, children with mild amblyopia following spectacle correction experienced further improvement in BCVA and VA in the patching group
The ATS – patching versus correction study provided concrete evidence that patching the sound eye provides modest improvement in amblyopia in children ages 3-7.

Question of the Week

A 32-year-old African-American woman presents with floaters and blurred vision in her right eye. Slit lamp examination shows nodules on the iris (image below). A recent chest radiograph revealed hilar adenopathy.
Biopsy of her lacrimal gland would most likely reveal?

A. Epithelioid cells within necrotic tissue
B. Multinucleated giant cells of the Touton type
C. Multinucleated giant cells of the Langhans type
D. Diffuse lymphocytic infiltration

Keep scrolling for answer or click here

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Quiz Answer: C
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