Author: Ophthalmology

This Issue At A Glance

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Young et al (p. 2390) compared the long-term outcome of limbal conjunctival autograft (LCAU) with that of intraoperative applications of mitomycin C (MMC) in minimizing pterygium recurrence. They also evaluated the effects of MMC on corneal endothelia…

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A Simple Vista en Este Número

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Young y otros (p. 2390), compararon el resultado a largo plazo del autoinjerto limbal conjuntival (LCAU) con el de la aplicación de mitomicina C (MMC) para minimizar la recurrencia del pterigio. Evaluaron también los efectos de la MMC en la densidad …

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Evidence-Based Ophthalmology

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It is easy to assume that colleagues are familiar with the structure and function of the international Cochrane Collaboration (List of contributors to CEVG available at http://aaojournal.org), but often this is off the mark or their understanding is misinformed. The Collaboration consists of >30 000 persons around the world who are committed to responding to Archie Cochrane’s challenge to the medical world in 1979:It is surely a great criticism of our profession that we have not organized a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials.

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Author reply

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We appreciate the opportunity to discuss the recent report on innovative draping methods to minimize elevated oxygen concentrations in ophthalmic surgical fields. We agree that using a standard nasal cannula does not absolutely eliminate the risk of …

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Author reply

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We appreciate Suelves, Gregori, and Diaz-Llopis’ interest in our recent article “A National Survey of Practice Patterns: Temporal Artery Biopsy.” In this study, we surveyed neuro-ophthalmologists, oculoplastic surgeons, and rheumatologists regarding temporal artery biopsy practices in the assessment of patients suspected to have giant cell arteritis (GCA). Specifically, we questioned practitioners as to whether they favored unilateral or bilateral temporal artery biopsy and their thoughts regarding the effect of prior corticosteroid therapy on biopsy findings. In short, responses varied greatly within and between specialists. Of slightly >1000 respondents, 37% recommended unilateral biopsy alone, 29% recommended initial unilateral biopsy with biopsy of the contralateral side if the first side is negative, 18% recommended bilateral biopsy in all cases, and 16% stated that their preference depended on the degree of suspicion. Most respondents believed that biopsies remained accurate for >14 days after initiating steroid therapy.

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期刊一览

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Young (p. 2390) 等人对角结膜缘自体结膜移植术(LCAU)及术中使用丝裂霉素C对减少翼状胬肉复发的长期疗效进行了比较。他们也评估了丝裂霉素C对角膜内皮细胞密度(ECD)的影响。在随机、对照试验

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Predicting Progression of Glaucoma from Rates of Frequency Doubling Technology Perimetry Change – Corrected Proof

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Purpose: To evaluate the ability of longitudinal frequency doubling technology (FDT) to predict the development of glaucomatous visual field loss on standard automated perimetry (SAP) in glaucoma suspects.Design: Prospective, observational cohort study.Participants: The study included 587 eyes of 367 patients with suspected glaucoma at baseline selected from the Diagnostic Innovations in Glaucoma Study (DIGS) and the African Descent and Glaucoma Evaluation Study (ADAGES). These eyes had an average of 6.7±1.9 FDT tests during a mean follow-up time of 73.1±28.0 months.Methods: Glaucoma suspects had intraocular pressure (IOP) >21 mmHg or an optic disc appearance suspicious of glaucoma. All patients had normal or nonrepeatable abnormal SAP at baseline. Humphrey Matrix FDT (Carl Zeiss Meditec, Inc, Dublin, CA) testing was performed within 6 months of SAP testing. The study end point was the development of 3 consecutive abnormal SAP test results. Joint longitudinal survival models were used to evaluate the ability of rates of FDT pattern standard deviation (PSD) change to predict the development of visual field loss on SAP, adjusting for confounding variables (baseline age, mean IOP, corneal thickness, and follow-up measurements of SAP PSD).Main Outcome Measures: The R2 index was used to evaluate and compare the predictive abilities of the model containing longitudinal FDT PSD data with the model containing only baseline data.Results: Sixty-three of 587 eyes (11%) developed SAP visual field loss during follow-up. The mean rate of FDT PSD change in eyes that developed SAP visual field loss was 0.07 dB/year versus 0.02 dB/year in those that did not (P < 0.001). Baseline FDT PSD and slopes of FDT PSD change were significantly predictive of progression, with hazard ratios of 1.11 per 0.1 dB higher (95% confidence interval [CI], 1.04–1.18; P = 0.002) and 4.40 per 0.1 dB/year faster (95% CI, 1.08–17.96; P = 0.04), respectively. The longitudinal model performed significantly better than the baseline model with an R2 of 82% (95% CI, 74–89) versus 11% (95% CI, 2–24), respectively.Conclusions: Rates of FDT PSD change were highly predictive of the development of SAP visual field loss in glaucoma suspects. This finding suggests that longitudinal FDT evaluation may be useful for risk stratification of patients with suspected glaucoma.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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Lifitegrast Ophthalmic Solution 5.0% for Treatment of Dry Eye Disease: Results of the OPUS-1 Phase 3 Study – Corrected Proof

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Purpose: To assess the efficacy and safety of lifitegrast ophthalmic solution 5.0% compared with placebo in subjects with dry eye disease.Design: Prospective, randomized, double-masked, placebo-controlled, parallel arm, multicenter clinical trial.Participants: A total of 588 adult subjects with dry eye disease.Methods: Eligible subjects were randomized 1:1 to receive topically administered lifitegrast (5.0%) or placebo (vehicle) twice daily for 84 days after a 14-day open-label placebo run-in period. After enrollment (day 0), subjects were evaluated at days 14, 42, and 84. Key objective (fluorescein and lissamine staining scores [Ora scales]) and subjective (Ocular Surface Disease Index [OSDI], 7-item visual analog scale, and ocular discomfort score [Ora scale]) measures were assessed at all visits.Main Outcome Measures: The primary objective efficacy measure (sign) was mean change from baseline inferior corneal staining score (ICSS) at day 84. The co-primary subjective efficacy measure (symptom) was the mean change from baseline in the visual-related function subscale score of the Ocular Surface Disease Index (VR-OSDI). Supportive measures included corneal fluorescein scores (superior, central, total region) and conjunctival lissamine scores (nasal, temporal, total region) and symptom scores at day 84.Results: The study met the primary objective efficacy ICSS end point in demonstrating superiority of lifitegrast compared with placebo (P = 0.0007). Lifitegrast significantly reduced corneal fluorescein staining (superior, P = 0.0392; total cornea, P = 0.0148) and conjunctival lissamine staining (nasal, P = 0.0039; total conjunctiva, P = 0.0086) at day 84 versus placebo. Significant (P < 0.05) improvements in nasal and total lissamine scores were observed at day 14 and maintained through day 84. The study did not meet the co-primary subjective VR-OSDI measure (P = 0.7894). However, significant improvements were observed at day 84 in ocular discomfort (P = 0.0273) and eye dryness (P = 0.0291), the most common and severe symptoms reported at baseline in both groups. There were no unanticipated or serious ocular adverse events (AEs). The most frequent reported ocular AEs were transient intermittent instillation site symptoms (irritation, discomfort) primarily on the initial lifitegrast dose at day 0.Conclusions: Lifitegrast ophthalmic solution 5.0% significantly reduced corneal fluorescein and conjunctival lissamine staining and improved symptoms of ocular discomfort and eye dryness compared with placebo when administered twice daily over 84 days.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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Discriminant Value of Custom Ocular Response Analyzer Waveform Derivatives in Keratoconus – Corrected Proof

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Purpose: To evaluate the performance of corneal hysteresis (CH), corneal resistance factor, and 16 investigator-derived Ocular Response Analyzer (ORA) variables in distinguishing keratoconus (KC) from the nondiseased state.Design: Retrospective case series.Participants: Fifty-four eyes of 27 unaffected patients and 49 eyes of 25 KC patients from the Instituto de Olhos, Rio de Janeiro, Brazil.Methods: Sixteen candidate variables were derived from exported ORA signals to characterize putative indicators of biomechanical behavior. Area under the receiver operating characteristic curve (AUC) and the Z statistic were used to compare diagnostic performance.Main Outcome Measures: Discriminant value of standard and derived ORA variables as measured by AUC.Results: Fifteen of 16 candidate variables performed significantly better than chance (AUC, >0.5) at discriminating KC. Diagnostic performance was greatest for a custom variable related to the depth of deformation as defined by the minimum applanation signal intensity during corneal deformation (concavitymin; mean AUC ± standard error, 0.985±0.002) and a new measure incorporating the pressure-deformation relationship of the entire response cycle (hysteresis loop area, 0.967±0.002). Z statistics assessing the discriminative value of each of the top 5 variables demonstrated superiority to CH (AUC, 0.862±0.002). Concavitymin had the best overall predictive accuracy (cutoff value, 50.37; 94.9% sensitivity, 91.7% specificity, and 93.2% test accuracy), and the top 4 variables demonstrated the most consistent relationships to KC severity.Conclusions: Investigator-derived ORA variables related to the depth of deformation and the pressure-deformation relationship demonstrated very high test accuracy for detecting the presence of KC. Beyond their diagnostic value, the candidate variables described in this report provide mechanistic insight into the nature of the ORA signal and the characteristic changes in corneal dynamics associated with KC.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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