We read with great interest the recent article by Tham et al. In their prospective study, the authors compared the results of clear lens phacoemulsification (CLP) versus trabeculectomy with mitomycin C in eyes with medically uncontrolled chronic angle…
Author: Ophthalmology
Author reply
Dear Editor: We thank Drs Bateman and Silva for their comments. We share their belief in the importance of genetic counseling and written documentation when caring for families affected with genetic diseases, which is why we included genetic counseli…
This Issue At A Glance
Tozer et al (p. 2029) evaluated the effectiveness of rescue therapy in eyes with neovascular age-related macular degeneration (AMD) that failed monotherapy with intravitreal injections of bevacizumab or ranibizumab. They found that the combination of …
Author reply
We thank Dr Fraunfelder for his comments and discussion of cryotherapy as an adjunctive treatment for pterygia. Based on the established requirements of an Ophthalmic Technology Assessment Committee (OTAC) publication, we were unable to include the top…
AAO Task Force on Genetic Testing
In this era of rapidly expanding genetic medicine, the American Academy of Ophthalmology (AAO)’s recently published document of recommendations for genetic testing of inherited eye diseases comes none too soon. Guidelines for genetic testing are import…
Author reply
We are grateful to Spratt et al for their interest in our article, and for allowing us the opportunity to further elaborate on our study. We did observe an apparent decrease in the perceived extent of peripheral anterior synechiae (PAS) after lens e…
Liquid Nitrogen Cryotherapy of Pterygia
The January 2013 issue of Ophthalmology includes an article by Kaufman et al that provides an excellent review of the surgical options and adjuvants used in surgery for pterygia. Labeled as a “Report by the American Academy of Ophthalmology,” the …
Editorial Board
Erratum
With apologies from the editorial office, the Correspondence entitled, “Gene Expression Profiling vs. TNM Classification,” which printed in the May 2013 issue (Ophthalmology 2013;120:1109) erroneously included a statement that the authors of the or…
期刊一览
Tozer (p. 2029) 等人评估了新生血管性年龄相关性黄斑变性 (AMD) 患眼行补救治疗的有效性，这些患眼行单药治疗（玻璃体腔注射贝伐单抗或雷珠单抗）失败。他们发现，联合光动力治疗(PDT)及抗
Contents
Consolidated Financial Statements
Anterior Capsulotomy Integrity after Femtosecond Laser-Assisted Cataract Surgery – Corrected Proof
Objective: To compare the incidence of anterior capsular tears after femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification cataract surgery (PCS) and to assess the ultrastructural features of anterior capsulotomy specimens (FLA…
Mutations in the Mevalonate Kinase (MVK) Gene Cause Nonsyndromic Retinitis Pigmentosa – Corrected Proof
Objective: Retinitis pigmentosa (RP) is a clinically and genetically heterogeneous disorder characterized by night blindness and peripheral vision loss, and in many cases leads to blindness. Despite extensive knowledge about genes involved in the patho…
Intravitreal Aflibercept Injection for Macular Edema Resulting from Central Retinal Vein Occlusion: One-Year Results of the Phase 3 GALILEO Study – Corrected Proof
Purpose: To evaluate the efficacy and safety of intravitreal aflibercept injections for treatment of macular edema secondary to central retinal vein occlusion (CRVO).Design: A randomized, multicenter, double-masked phase 3 study.Participants: A total of 177 treatment-naive patients with macular edema secondary to CRVO were randomized in a 3:2 ratio.Methods: Patients received either 2-mg intravitreal aflibercept or sham injections every 4 weeks for 20 weeks. From week 24 to 48, the aflibercept group received aflibercept as needed (pro re nata [PRN]), and the sham group continued receiving sham injections.Main Outcome Measures: The primary efficacy end point was the proportion of patients who gained 15 letters or more in best-corrected visual acuity (BCVA) at week 24. This study reports week 52 results including the proportion of patients who gained 15 letters or more in BCVA and the mean change from baseline BCVA and central retinal thickness. Efficacy end points at week 52 were all exploratory.Results: At week 52, the mean percentage of patients gaining 15 letters or more was 60.2% in the aflibercept group and 32.4% in the sham group (P = 0.0004). Aflibercept patients, compared with sham patients, had a significantly higher mean improvement in BCVA (+16.9 letters vs. +3.8 letters, respectively) and reduction in central retinal thickness (−423.5 μm vs. −219.3 μm, respectively) at week 52 (P < 0.0001 for both). Aflibercept patients received a mean of 2.5 injections (standard deviation, 1.7 injections) during PRN dosing. The most common ocular adverse events in the aflibercept group were related to the injection procedure or the underlying disease, and included macular edema (33.7%), increased intraocular pressure (17.3%), and eye pain (14.4%).Conclusions: Treatment with intravitreal aflibercept provided significant functional and anatomic benefits after 52 weeks as compared with sham. The improvements achieved after 6 monthly doses at week 24 largely were maintained until week 52 with as-needed dosing. Intravitreal aflibercept generally was well tolerated.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
High Prevalence of Peripheral Retinal Vascular Anomalies in Family Members of Patients with Familial Exudative Vitreoretinopathy – Corrected Proof
Objective: To describe the prevalence and severity of familial exudative vitreoretinopathy (FEVR) in asymptomatic relatives of known symptomatic FEVR patients.Design: Uncontrolled and retrospective case series at a single tertiary referral vitreoretina…
Evaluation of Telemedicine for Screening of Diabetic Retinopathy in the Veterans Health Administration – Corrected Proof
Objective: To explore the cost-effectiveness of telemedicine for the screening of diabetic retinopathy (DR) and identify changes within the demographics of a patient population after telemedicine implementation.Design: A retrospective medical chart review (cohort study) was conducted.Participants: A total of 900 type 1 and type 2 diabetic patients enrolled in a medical system with a telemedicine screening program for DR.Methods: The cost-effectiveness of the DR telemedicine program was determined by using a finite-horizon, discrete time, discounted Markov decision process model populated by parameters and testing frequency obtained from patient records. The model estimated the progression of DR and determined average quality-adjusted life years (QALYs) saved and average additional cost incurred by the telemedicine screening program.Main Outcome Measures: Diabetic retinopathy, macular edema, blindness, and associated QALYs.Results: The results indicate that telemedicine screening is cost-effective for DR under most conditions. On average, it is cost-effective for patient populations of >3500, patients aged <80 years, and all racial groups. Observable trends were identified in the screening population since the implementation of telemedicine screening: the number of known DR cases has increased, the overall age of patients receiving screenings has decreased, the percentage of nonwhites receiving screenings has increased, the average number of miles traveled by a patient to receive a screening has decreased, and the teleretinal screening participation is increasing.Conclusions: The current teleretinal screening program is effective in terms of being cost-effective and increasing population reach. Future screening policies should give consideration to the age of patients receiving screenings and the system’s patient pool size because our results indicate it is not cost-effective to screen patients aged older than 80 years or in populations with <3500 patients.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Risk of Geographic Atrophy in the Comparison of Age-related Macular Degeneration Treatments Trials – Corrected Proof
Purpose: To describe risk factors for geographic atrophy (GA) in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT).Design: Cohort within a randomized clinical trial.Participants: We analyzed 1024 CATT patients with no GA visible on color fundus photographs (CFPs) and/or fluorescein angiograms (FAs) at enrollment.Methods: Eyes were assigned to ranibizumab (0.5 mg) or bevacizumab (1.25 mg) treatment and to a 2-year monthly or pro re nata (PRN) injection regimen, or monthly injections for 1 year and PRN for 1 year. Demographic, genetic, and baseline ocular characteristics and lesion features of CFP/FA and optical coherence tomography (OCT) were evaluated as risk factors for GA through 2 years of follow-up. Time-dependent Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs).Main Outcome Measures: Development of GA.Results: By 2 years, GA developed in 187 of 1024 patients (18.3%). Baseline risk factors for GA development included baseline visual acuity (VA) ≤20/200 (aHR, 2.65; 95% confidence interval [CI], 1.43–4.93), retinal angiomatous proliferation (RAP; aHR, 1.69; 95% CI, 1.16–2.47), GA in the fellow eye (aHR, 2.07; 95% CI, 1.40–3.08), and intraretinal fluid at the foveal center (aHR, 2.10; 95% CI, 1.34–3.31). Baseline factors associated with lower risk for GA development included blocked fluorescence (aHR, 0.49; 95% CI, 0.29–0.82), OCT measurements of subretinal fluid thickness of >25 μ (aHR, 0.52; 95% CI, 0.35–0.78), subretinal tissue complex thickness of >275 compared with ≤75 μ (aHR, 0.31; 95% CI, 0.19–0.50), and vitreomacular attachment (aHR, 0.55; 95% CI, 0.31–0.97). Ranibizumab compared with bevacizumab had a higher risk (aHR, 1.43; 95% CI, 1.06–1.93), and monthly dosing had a higher risk (aHR, 1.59; 95% CI, 1.17–2.16) than PRN dosing. There were no strong associations between development of GA and the presence of risk alleles for CFH, ARMS 2, HTRA1, C3, or TLR3.Conclusions: Approximately one fifth of CATT patients developed GA within 2 years of treatment. Independent baseline risk factors included poor VA, RAP, foveal intraretinal fluid, monthly dosing, and treatment with ranibizumab. Anti-vascular endothelial growth factor therapy may have a role in the development of GA.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Intravitreal Aflibercept Injection for Neovascular Age-Related Macular Degeneration: Ninety-Six–Week Results of the VIEW Studies – Corrected Proof
Purpose: To determine efficacy and safety of intravitreal aflibercept in patients with neovascular age-related macular degeneration (AMD) during a second year of variable dosing after a first-year fixed-dosing period.Design: Two randomized, double-masked, active-controlled, phase 3 trials.Participants: Two thousand four hundred fifty-seven patients with neovascular AMD.Methods: From baseline to week 52, patients received 0.5 mg intravitreal ranibizumab every 4 weeks (Rq4), 2 mg aflibercept every 4 weeks (2q4), 0.5 mg aflibercept every 4 weeks (0.5q4), or 2 mg aflibercept every 8 weeks (2q8) after 3 monthly injections. During weeks 52 through 96, patients received their original dosing assignment using an as-needed regimen with defined retreatment criteria and mandatory dosing at least every 12 weeks.Main Outcome Measures: Proportion of eyes at week 96 that maintained best-corrected visual acuity (BCVA; lost <15 letters from baseline); change from baseline in BCVA.Results: Proportions of eyes maintaining BCVA across treatments were 94.4% to 96.1% at week 52 and 91.5% to 92.4% at week 96. Mean BCVA gains were 8.3 to 9.3 letters at week 52 and 6.6 to 7.9 letters at week 96. Proportions of eyes without retinal fluid decreased from week 52 (60.3% to 72.4%) to week 96 (44.6% to 54.4%), and more 2q4 eyes were without fluid at weeks 52 and 96 than Rq4 eyes (difference of 10.4% [95% confidence interval {CI}, 4.9–15.9] and 9.0% [95% CI, 3.0–15.1]). Patients received on average 16.5, 16.0, 16.2, and 11.2 injections over 96 weeks and 4.7, 4.1, 4.6, and 4.2 injections during weeks 52 through 96 in the Rq4, 2q4, 0.5q4, and 2q8 groups, respectively. The number of injections during weeks 52 through 96 was lower in the 2q4 and 2q8 groups versus the Rq4 group (differences of −0.64 [95% CI, −0.89 to −0.40] and −0.55 [95% CI, −0.79 to −0.30]; P < 0.0001, post hoc analysis). Incidences of Antiplatelet Trialists’ Collaboration–defined arterial thromboembolic events were similar across group (2.4% to 3.8%) from baseline to week 96.Conclusions: All aflibercept and ranibizumab group were equally effective in improving BCVA and preventing BCVA loss at 96 weeks. The 2q8 aflibercept group was similar to ranibizumab in visual acuity outcomes during 96 weeks, but with an average of 5 fewer injections. Small losses at 96 weeks in the visual and anatomic gains seen at 52 weeks in all arms were in the range of losses commonly observed with variable dosing.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
The Association between Scholarly Impact and National Institutes of Health Funding in Ophthalmology – Corrected Proof
Objective: To examine whether there is an association between scholarly impact, as measured by the h-index, academic rank, and National Institutes of Health (NIH) awards in academic ophthalmology.Design: Retrospective analysis of NIH RePORTER and Scopus databases.Participants: Not applicable.Methods: Five hundred seventy-three NIH awards to 391 primary investigators (PIs) in ophthalmology departments were examined. Grant recipients were organized by academic rank, obtained from online listings, and h-index, calculated using the Scopus database. Non–NIH-funded faculty from 20 randomly chosen academic ophthalmology departments also were organized by rank and h-index for comparison with their NIH-funded colleagues.Main Outcome Measures: Scholarly impact, as measured by the h-index, and NIH funding.Results: The h-index increased with successive academic rank among non–NIH-funded and NIH-funded faculty, as did NIH funding among the latter group. The NIH-funded faculty had higher scholarly impact, as measured by the h-index, than their non–NIH-funded PIs (h = 18.3 vs. 7.8; P < 0.0001), even when considering publications only in the prior 5 years; h-index increased with increasing NIH funding ranges. The h-indices of those holding an MD degree (21.4±1.6 standard error of mean) were not statistically higher than those of PhD holders (17.9±0.6) and those with both an MD and PhD degree (18.1±1.7; P = 0.14).Conclusions: The h-index increases with increasing academic rank among NIH-funded and non–NIH-funded faculty in ophthalmology departments. This bibliometric is associated strongly with NIH funding because NIH-funded PIs had higher scholarly impact than their non–NIH-funded colleagues, and increasing impact was noted with higher funding. The h-index is an objective and easily calculable measure that may be valuable as an adjunct in assessing research productivity, a significant factor for academic promotion in academic ophthalmology.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.