April 26, 2023

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

  • 1 in 8 eyes undergoing routine glaucoma care were found to have fast progression of their visual field loss
  • Epidemiological data showed that ROP increased from 4.4% to 8.1% between 2003 and 2019, especially in low-income, black, and Hispanic populations
  • 10-year data for tube shunt placement showed good IOP data, but a high rate of worsening visual acuity and tube failure

Fast progressors in glaucoma


Slow and steady wins the race. Glaucoma is a major cause of blindness associated with functional disability and poorer vision-related quality of life. Fast rates of global visual field loss and central visual field loss are proxies for glaucoma progression; thus, the purpose of this study was to identify the prevalence of individuals at high-risk for functional impairment. Visual field tests for 693 eyes of 461 patients with glaucoma (1 clinic in Australia, 3 sites in the United States) were reviewed. Patients were undergoing routine care, and they had a median follow-up period of 4.5 years.  “Fast” progression was defined as a > -1 dB/year decline, in accordance with established guidelines. 1 in 8 eyes (12.5%) under routine glaucoma care were found to exhibit fast progression of global visual field loss. Similar proportions exhibited fast progression in the central 10°region, with nearly 1 in 3 eyes (33.3%) demonstrating at least -0.5 dB/year decline. Results from this study highlight the importance of routine monitoring in glaucoma patients to minimize risk of functional disability.

Retinopathy of prematurity: Trends in the US from 2003 to 2019

JAMA Ophthalmology

What is the landscape of retinopathy of prematurity in the US? Retinopathy of prematurity (ROP) can lead to poor visual outcomes and blindness in premature babies. Identifying infants and populations at greater risk for ROP can improve delivery of care and prevention strategies. However, epidemiological data is limited. A retrospective cohort study was performed looking at ROP discharges through an inpatient database from 2003 to 2019 within the United States. All populations saw an increase in ROP during this time frame. Premature infants from the lowest median household income quartile had the highest proportional increase of ROP diagnosis (from 4.9% to 9.0%), premature black infants experienced the largest increase (from 5.8% to 11.6%), while Hispanic infants experienced the second largest increase (from 4.6% to 8.2%). This study highlights populations that may require increased attention and care to reduce the incidence and burden of ROP. 

What do we know from a decade of tube shunts?

American Journal of Ophthalmology

Digest these details from a decade of drainage. Filtration surgeries such as trabeculectomy and tube shunt have become the mainstay of treatment for advanced glaucoma. However, there are relatively few studies that report treatment outcomes beyond 5 years. This retrospective study reported the 10-year clinical outcomes of tube shunt surgery with both Baerveldt glaucoma implant (BGI) and Ahmed glaucoma valve (AGV) at a tertiary care center. Seventy-eight patients were included in the study and had a mean follow-up time of 11.9 years. Of the 85 eyes included, there was a mean preoperative IOP of 29.2 ± 10.4 mmHg followed by a mean 10-years IOP of 12.6 ± 5.8 mmHg. Visual acuity worsened by 5 lines or more in 33 eyes (39%). At 10-years, 48 eyes (56%) met failure criteria for the tubes not working, 29 eyes (34%) underwent additional glaucoma surgery, and 34 eyes (40%) underwent tube shunt revisions. All in all, IOP control was a successful outcome for this cohort of patients at 10-year follow-up. However, additional glaucoma surgery and decreasing visual acuity were troublesome sequelae experienced by many. Thus, physicians and patients must engage in cost-benefit analysis when deciding how to treat advanced glaucoma.

Mouse model of dry eye activates corneal inflammatory pathways


While dry eye might seem like a benign nuisance, it quickly brews more insidious trouble below the surface. The cornea is constantly exposed to environmental stresses like microbes, osmotic agents, and dryness. In response to prolonged insult, the corneal epithelium activates inflammatory pathways such as NF-kB and NLRP3 inflammasome. It is unknown how quickly this activation occurs. This study aimed to determine if 24 hours was sufficient time to upregulate these two inflammatory pathways and their downstream products. They compared mice who were housed in a drafty, low-humidity environment and treated with scopolamine to normally housed, untreated mice. Experimental assays revealed that the RNA and protein levels of molecules involved in these inflammatory pathways were significantly increased within 24 hours of the dry eye model. Furthermore, time-dependent activation of the inflammatory cytokine, IL1b, was evidenced by a decreasing ratio of the pro-form to the mature-form of the cytokine measured over five days. This result indicates sustained activation of the associated NLRP3 pathway. The authors conclude that their findings support the use of drugs such as corticosteroids which suppress NF-kB gene expression and can prevent inflammatory damage to the cornea catalyzed by dry eye. Limitations of this study include the use of only female mice and not injecting control mice with a vehicle only control.


The proof is in the ibuprofen

Journal of Glaucoma

Don’t burst my bleb! Controlling excessive inflammation post-trabeculectomy has been shown to further reduce the risk of bleb failure as part of an overall goal to reduce intraocular pressure (IOP) in the surgical treatment of glaucoma. To date there has been limited and conflicting literature describing the use of nonsteroidal anti-inflammatory drugs (NSAIDS) as an alternative and possible adjunctive treatment alongside intraoperative antimetabolites (e.g. mitomycin C) and postoperative topical corticosteroids. This retrospective cohort analysis aimed to address this gap by evaluating 288 eyes of 273 patients with primary glaucoma who underwent trabeculectomy, analyzing the association with oral ibuprofen and bleb failure over 1 year. Those who received ibuprofen experienced significantly greater postoperative IOP reductions at week 1 (p = 0.015) and month 1 (p = 0.045), with substantially lower odds of bleb failure at >18mmHg and >15mmHg compared to the non-ibuprofen group (p = 0.032). While there were not statistically significant differences of IOP reduction at time markers past month 1, these results suggest that oral nonsteroidal anti-inflammatory drugs may be a safe way to improve bleb longevity in higher-risk eyes.

Lens Landmarks

Does age affect retinal drusen, pigmentary abnormalities, and overall macular degeneration? In the Beaver Dam Eye study, 4926 patients from age 43 to 68 were studied using stereoscopic color fundus photography to answer this question.

Key Points:
  • Data indicated that individuals 75 years of age or older commonly had signs of AMD
  • Identified features included large drusen, soft indistinct drusen, abnormal retinal pigmentation, exudative macular degeneration, and geographic atrophy
  • 95.5% of the population studied had at least one drusen in the macula of one of their eyes.
Overall, the Beaver Dam Eye study is a landmark trial because it demonstrated the association between AMD and age, and was one of the first large scale prevalence studies for the disease. This association was deemed a “substantial public health problem” that previously had not been realized.

Question of the Week

A 68 year old man presents to the clinic with progressive vision loss in both eyes. He is denies any other ophthalmic or systemic symptoms. VA OD 20/100 IOP 21 C/D 0.4. Results of OD slit lamp examination are shown below:
Upon further questioning, he states he worked as a glass blower. What is the characteristic finding of this patient’s most likely condition? 

A. Sampaolesi Line
B. Phacodonesis
C. Double-Ring Sign (DRS)
D. Amyloid

Keep scrolling for answer or click here

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