Category: Peer-reviewed

Parallelism as a Novel Marker for Structural Integrity of Retinal Layers in Optical Coherence Tomographic Images in Eyes With Epiretinal Membrane – Corrected Proof

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Purpose: To propose a new parameter, “Parallelism,” to evaluate retinal layer integrity on spectral-domain optical coherence tomography (SDOCT), and to investigate the association between parallelism and visual function in eyes with idiopathic epiretinal membrane (ERM).Design: Retrospective, observational evaluation of a diagnostic test.Methods: We evaluated a consecutive series of 57 eyes of 57 patients with ERM and 30 healthy eyes of 30 volunteers for whom M-CHARTS testing and SDOCT were performed on the same day. OCT images were skeletonized, and the orientation of segmented lines in the image was termed “Parallelism” and was expressed as a value ranging from 0-1 and increasing as the retinal layers ran more parallel with each other. The relationships between parallelism and visual acuity and between parallelism and metamorphopsia score were evaluated.Results: In normal eyes, parallelism was nearly homogeneous and varied slightly with the location. Parallelism in eyes with ERM was significantly lower than that in normal eyes. In the horizontal and vertical scans, parallelism was significantly correlated with visual acuity, horizontal metamorphopsia score, and vertical metamorphopsia score. Parallelism of the center (1 mm) in the horizontal scan was strongly correlated with horizontal metamorphopsia score (R = −0.632; P < .0001). Significant negative correlation was found between parallelism and retinal thickness both in horizontal and vertical scans.Conclusions: Parallelism was significantly lower in eyes with ERM than in normal eyes, and correlated strongly with metamorphopsia and visual acuity in eyes with ERM.

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Intravitreal Bevacizumab at 4-Month Intervals for Prevention of Macular Edema after Plaque Radiotherapy of Uveal Melanoma – Corrected Proof

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Purpose: To evaluate the efficacy of intravitreal bevacizumab for prevention of macular edema after plaque radiotherapy of uveal melanoma.Design: Retrospective, single-center, nonrandomized, interventional comparative study.Participants: Patients with uveal melanoma treated with plaque radiotherapy were divided into 2 groups: a bevacizumab group and a control group.Intervention: The bevacizumab group received intravitreal bevacizumab injection at the time of plaque removal and every 4 months thereafter for 2 years (total, 7 injections). The control group had no intravitreal bevacizumab injection. Both groups had periodic follow-up with ophthalmoscopy and optical coherence tomography (OCT).Main Outcome Measures: Development of OCT-evident macular edema.Results: There were 292 patients in the bevacizumab group and 126 in the control group. The median foveolar radiation dose was 4292 cGy (bevacizumab) and 4038 cGy (control; P = 0.327). The cumulative incidence of OCT-evident macular edema over 2 years (bevacizumab group vs. control group) was 26% versus 40% (P = 0.004), respectively; that for clinically evident radiation maculopathy was 16% versus 31% (P = 0.001), respectively; that for moderate vision loss was 33% versus 57% (P < 0.001), respectively; and that for poor visual acuity was 15% versus 28% (P = 0.004), respectively. There was no statistically significant difference in clinically evident radiation papillopathy (P = 0.422). Kaplan-Meier estimates at 2 years showed statistically significantly reduced rates of OCT-evident macular edema (P = 0.045) and clinically evident radiation maculopathy (P = 0.040) in the bevacizumab group compared with controls.Conclusions: Patients receiving intravitreal bevacizumab injection every 4 months after plaque radiotherapy for uveal melanoma demonstrated OCT-evident macular edema, clinically evident radiation maculopathy, moderate vision loss, and poor visual acuity less frequently over a period of 2 years than patients not receiving the injections.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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The United Kingdom Glaucoma Treatment Study: A Multicenter, Randomized, Double-masked, Placebo-controlled Trial: Baseline Characteristics – Corrected Proof

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Objective: The United Kingdom Glaucoma Treatment Study (UKGTS) tests the hypothesis that treatment with a topical prostaglandin analog, compared with placebo, reduces the frequency of visual field (VF) deterioration events in patients with open-angle glaucoma (OAG) by 50% over a 2-year period. Additional goals are to evaluate study power with novel clinical trial outcomes: (1) VF deterioration velocity and (2) VF and quantitative imaging measurements modeled as joint outcomes.Design: The UKGTS is a randomized, double-masked, placebo-controlled, multicenter treatment trial for OAG.Participants: A total of 516 patients with newly diagnosed (previously untreated) OAG were prospectively recruited at 10 UK centers between 2007 and 2010.Methods: Eligible patients were randomly assigned to treatment with latanoprost 0.005% or placebo. The observation period was 2 years, with subjects monitored by VF testing, quantitative imaging, optic disc photography, and tonometry at 11 visits.Main Outcome Measures: The primary outcome measure is time to VF deterioration within 24 months. Secondary outcomes include the deterioration velocity of VF and quantitative imaging measures.Results: The main source of referrals was optometrists (88%). A total of 777 subjects were assessed for eligibility, and 261 were excluded because they did not meet the inclusion criteria or declined to participate. The mean age of the 516 participants was 66 years, and 52.9% were male; 90.1% of the participants were white, and approximately one third (32.2%) reported a family history of glaucoma. A total of 777 eyes were eligible at initial assessment. Both eyes were eligible for 265 participants. Mean (standard deviation) intraocular pressure (IOP) at baseline for the eyes with better versus worse mean deviation (MD) was 18.9 (4.1) and 19.9 (4.7) mmHg, respectively (P = 0.0053). Some 56.1% of all eligible eyes had IOP <20 mmHg at baseline. The median (interquartile range) VF MD for all eligible eyes was −2.9 dB (−1.6 to −4.8 dB).Conclusions: This is the first randomized, placebo-controlled trial to evaluate the efficacy of medical treatment in reducing VF deterioration in OAG. The baseline characteristics for eligible patients and eyes from this cohort are presented and compared with those of previous trials. The baseline characteristics are similar to those of the largely population-based Early Manifest Glaucoma Trial. The early stage of the glaucoma and relatively low IOP at diagnosis suggest remarkably sensitive case findings by community optometrists in the United Kingdom.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

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Extended Depth of Focus With Induced Spherical Aberration in Light-Adjustable Intraocular Lenses – Corrected Proof

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Purpose: To evaluate the quality of vision and depth of focus induced by controlled amounts of negative spherical aberration in patients implanted bilaterally with light-adjustable intraocular lenses.Design: Prospective, nonrandomized clinical trial.Methods: Seventeen patients were implanted and treated with appropriate spatial irradiance light profiles. One eye was set for emmetropia, and the fellow eye received an additional aspheric light treatment to induce controlled amounts of negative spherical aberration. We used a Hartmann-Shack sensor to measure the eye’s refraction and aberrations for a 4-mm pupil diameter. Decimal visual acuity (VA) was measured using a micro-display placed at 10 m, 60 cm, 40 cm, and 30 cm.Results: Eyes treated with aspheric profiles were divided into 2 groups depending on the final amount of induced negative spherical aberration: low [−0.05, −0.10 μm] and high [−0.13, −0.23 μm]. In both groups, the mean uncorrected decimal VA at 60 cm was over 0.90. In the first group, distance VA was 0.97 ± 0.16, but in the second group it was lower (0.76 ± 0.16). As expected, the VA for nearer distances is higher in the eyes with a larger magnitude of spherical aberration (P value < .01): 0.94 ± 0.10 and 0.73 ± 0.16 at 40 and 30 cm, respectively, in comparison with 0.71 ± 0.15 and 0.50 ± 0.14. Binocular summation with the fellow eye, adjusted for emmetropia, produces an excellent binocular distance VA (>1.10) in both groups.Conclusions: Controlled amounts of negative spherical aberration and defocus can be induced in eyes implanted with adjustable intraocular lenses to enhance near vision.

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Imaging of the Macula Indicates Early Completion of Structural Deficit in Autosomal-Dominant Optic Atrophy – Corrected Proof

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Purpose: Optical coherence tomography (OCT) enables 3-dimensional imaging of the retina, including the layer of ganglion cells that supplies the optic nerve with its axons. We tested OCT as means of diagnosing and phenotyping autosomal-dominant optic atrophy (ADOA).Design: Cross-sectional study.Participants: The study included 49 patients with OPA1 exon 28 (2826delT) ADOA (age, 8.6–71.5 years; best-corrected visual acuity [BCVA], 20/700–20/20) and 51 mutation-free first-degree relatives as healthy controls (BCVA 20/25–20/10).Methods: Participants underwent routine examination, including automated perimetry, and OCT with segmentation of the perifoveal retinal ganglion cell–inner plexiform layer (GC-IPL) and the peripapillary retinal nerve fiber layer (RNFL).Main Outcome Measures: Perifoveal GC-IPL thickness.Results: All subjects with ADOA had a thinner GC-IPL in the inferonasal macula than the thinnest healthy control. The GC-IPL thickness was also subnormal in the superotemporal macula (P < 0.0001), where it varied with visual acuity (P ≤ 0.03). Attenuation of the peripapillary nerve fiber layer was prominent on the temporal side of the optic disc in ADOA (P < 0.0001), but there was considerable overlap with healthy controls. In ADOA, there was no detectable variation with age in BCVA, autoperimetry mean deviation, GC-IPL thickness, or RNFL thickness, except that the thickness of the superior RNFL quadrant decreased with age.Conclusions: Optical coherence tomography enabled a highly sensitive diagnosis of ADOA and identification of a structural correlate with the variation in visual acuity. The defect associated with the OPA1 exon 28 (2826delT) seems to be fully developed from early childhood or the perinatal period.Financial Disclosure(s): The authors have no proprietary or commercial interest in any of the materials discussed in this article.

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Assessing the Effectiveness of Surface Cleaning Methods in Intravitreal Injection Procedure Rooms – Corrected Proof

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Purpose: To assess cleaning effectiveness of room surfaces in an office-based intravitreal injection practice by using adenosine triphosphate (ATP) luminometry.Design: Prospective, comparative case series.Participants: A total of 792 intravitreal injection room surfaces were sampled (396 before cleaning, 396 after cleaning) using 3 cleaning methods.Methods: Three cleaning methods were evaluated: baseline terminal cleaning, directed terminal cleaning, and enhanced terminal cleaning. For each method, residual ATP bioburden (relative light units [RLUs]/sample) was sampled from 9 high-touch injection room surfaces before and after terminal cleaning using the 3M Clean-Trace ATP System (3M Inc, St. Paul, MN). Surface ATP RLUs were used to compare cleaning methods and against an ATP benchmark of fewer than 250 RLU. Differences between cleaning methods were compared by using paired t tests with Bonferroni correction for 3 comparisons.Main Outcome Measures: Surface ATP RLU levels.Results: In baseline terminal cleaning and directed terminal cleaning, the median ATP level of all surfaces exceeded threshold when sampled after terminal cleaning (391 RLU and 264 RLU, respectively), and levels were increased significantly at the completion of the injection clinic and before terminal cleaning (780 RLU and 626 RLU, respectively; P < 0.003). In enhanced terminal cleaning, the median ATP level was below threshold after terminal cleaning (71 RLU), was unchanged at the completion of injection clinic and before terminal cleaning (63 RLU; P = 0.27), and was significantly lower than after the baseline terminal and directed terminal cleaning methods (P < 0.003).Conclusions: An easily adopted enhanced terminal cleaning program reduced surface ATP bioburden in intravitreal injection rooms to less than clean benchmarks used in nonophthalmologic healthcare settings.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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