Opthamologists and opometrists

Ophthalmology Journal News

Welcome to the Ophthalmology Journal News page! This page will showcase the latest news from the world of Ophthalmology, as published by The British Journal of Ophthalmology (BMJ).

For the British Ophthalmology Journal Archives, please visit http://bjo.bmj.com/ .

These news items are mainly specific study results that are relevant to the layman.

We have also added another news page with more ‘general’ Opthalmogy news here: Opthamologist News.

Furthermore, we have added a page with general news articles about Eye Health here:  Eye Problems Articles  , which is a good read for both patients and Ophthalmologists alike.

Enjoy!

Ophthalmology Journal News:

The effect of myopic optic disc tilt on measurement of spectral-domain optical coherence tomography parameters
Background

To compare the spectral-domain optical coherence tomography (SD-OCT) parameters, including ganglion cell-inner plexiform layer (GCIPL) thickness, retinal nerve fibre layer (RNFL) thickness and optic nerve head (ONH) parameters between glaucomatous eyes with myopic tilted optic disc and non-tilted optic disc, and to investigate the effect of optic disc tilt on the diagnostic performance of these parameters.

Methods

The study included 82 patients with glaucoma and 41 refraction-matched normal subjects. The OCT parameters and their diagnostic abilities were compared between the non-tilted disc group (N=41) and tilted disc group (N=41).

Results

The ONH parameters in the tilted disc group, except the rim area, were significantly smaller than in the non-tilted disc group. The temporal RNFL was significantly thicker in the tilted disc group compared with the non-tilted group. In addition, the diagnostic capabilities of the vertical cup-to-disc area (CDR) and temporal RNFL thickness in the tilted disc group were inferior to those in the non-tilted disc group. However, there were no significant differences in GCIPL thickness between the two glaucoma groups. Furthermore, the diagnostic capability of GCIPL thickness in the tilted disc group was comparable to that in the non-tilted disc group. The ovality index was significantly associated with temporal RNFL thickness in both regression analyses.

Conclusions

The diagnostic capacities of temporal RNFL thickness and vertical CDR should be interpreted with caution in glaucomatous eyes with tilted optic discs. Macular GCIPL measurement provides reliable diagnostic parameters, regardless of the degree of optic disc tilt.

Author: Shin, H.-Y., Park, H.-Y. L., Park, C. K.
Posted: December 15, 2014, 12:25 pm
Life expectancy following orbital exenteration

Orbital exenteration is a physically debilitating procedure that may be a necessity in the management of orbital malignancy. It requires a sensitive multidisciplinary approach, both preoperatively and postoperatively. Providing life expectancy information for patients during preoperative counselling is pertinent to informed consent and in addressing patients’ expectations. A retrospective review from one tertiary care centre was undertaken for a cohort of patients who were exenterated for orbital malignancy between 1998 and 2010. The cases were identified using an International Classification of Diseases 10th Revision (ICD-10)-derived database and were analysed using Prism statistical software (V.5.04). Cause of death was ascertained by liaising with the general practitioner and the National Registrar Office for Births, Deaths, and Marriages, Southport, UK. In total, 41 men and 32 women were identified. Mean age was 72 years with 47 cases living and 26 deceased at the time of review. The overall 5-year survival rate in this study was 64%. Kaplan–Meier analysis for basal cell carcinoma (BCC) against non-BCC returned a p value of 0.0199, with an HR of 0.3927 (CI 0.1788 to 0.8626). Kaplan–Meier analysis for cleared against non-cleared margins returned a p value of 0.2890, with an HR of 0.6571(CI 0.3024 to 1.428). Our results represent the highest 5-year survival data to date. However, the overall prognosis for patients who undergo orbital exenteration for malignancy remains poor. We hypothesise that the causes are multi-factorial. We recommend a multidisciplinary approach to the care of these patients, involving head and neck teams, oncology and other appropriate specialties, to optimise outcomes for this vulnerable patient group.

Author: Wong, J. C. L., Thampy, R., Cook, A.
Posted: December 15, 2014, 12:25 pm
A comparison of methods used to evaluate mobility performance in the visually impaired
Purpose

To compare three different approaches to measuring mobility performance when evaluating the visually impaired.

Methods

488 participants, including 192 glaucoma, 112 age-related macular degeneration, 91 diabetic retinopathy and 93 healthy volunteers, completed the Assessment of Disability Related to Vision (ADREV) mobility course. The performance of participants on the mobility course was evaluated by noting errors made and time required for completion. Errors noted and time taken were compared using multivariate logistic regression to determine which measurement better differentiated patients with visual disease from healthy volunteers. Multivariate logistic regression was also used to evaluate the combined metric of ADREV errors divided by time to determine its ability to discriminate participants with visual disease from healthy volunteers.

Results

Errors noted and time taken while ambulating through the standardised mobility course shared a weak but statistically significant association (Pearson's r=0.36, p<0.05). After controlling for demographic and medical comorbidities, logistic regression analysis revealed that errors noted were better at discriminating individuals with visual disease from healthy volunteers (OR 2.8–4.9, 95% CI 1.5 to 10.3) compared with the time taken for mobility course completion (OR 1.1, 95% CI 1.0 to 1.2). These findings were consistent across all comparisons between healthy volunteers and participants with each type of visual impairment. Finally, the combined metric of ADREV errors divided by time was far more predictive of visual disease compared with either time taken or errors noted during mobility testing (OR 11.0–17.7, 95% CI 3.6 to 77.1).

Conclusions

A validated scoring system based on errors is more effective when assessing visual disability during mobility testing than recording the time taken for course completion. The combined metric of ADREV errors noted divided by time taken was most predictive of all the methods used to evaluate visual disability during mobility testing.

Author: Warrian, K. J., Katz, L. J., Myers, J. S., Moster, M. R., Pro, M. J., Wizov, S. S., Spaeth, G. L.
Posted: December 15, 2014, 12:25 pm
Iris stromal imbrication oversewing for pigment epithelial defects

We present a novel iris repair technique for the management of iris transillumination defects secondary to iris pigment epithelium (IPE) loss, which includes iris oversewing over the defect through partial iris stromal bites with 10-0 polypropylene. This technique provides a healthy layer of iris covering the transillumination defect without the creation of new defects on the contiguous IPE.

Author: Snyder, M. E., Perez, M. A.
Posted: December 15, 2014, 12:25 pm
Efficacy and safety of intravitreal aflibercept injection in wet age-related macular degeneration: outcomes in the Japanese subgroup of the VIEW 2 study
Background/aims

To evaluate efficacy and safety of intravitreal aflibercept (IVT-AFL) in Japanese patients with wet age-related macular degeneration (wAMD) from the VIEW 2 trial.

Methods

In this double-masked study, patients were randomised to: 0.5 mg IVT-AFL every 4 weeks (0.5q4); 2 mg IVT-AFL every 4 weeks (2q4); 2 mg IVT-AFL every 8 weeks (2q8) after 3 monthly injections; or 0.5 mg ranibizumab every 4 weeks (Rq4). Main efficacy outcomes included vision maintenance and best-corrected visual acuity (BCVA) at week 52.

Results

At week 52, all Japanese patients in the IVT-AFL groups (n=70) maintained vision, compared with 96% of Japanese patients (n=23/24) treated with ranibizumab. Japanese patients in all treatment groups showed improvement in BCVA after treatment. The Rq4, 2q4 and 2q8 groups experienced similar gains in BCVA from baseline. The 0.5q4 group had higher gains due to an unexpected drop in BCVA between screening and baseline. Central retinal thickness and mean area of choroidal neovascularisation decreased in all treatment groups with similar magnitude. Ocular treatment-emergent adverse events were balanced across treatment groups.

Conclusions

IVT-AFL was effective and well tolerated in Japanese patients. Outcomes in this population were consistent with those in the overall VIEW 2 population.

Trial registration number

NCT00637377.

Author: Ogura, Y., Terasaki, H., Gomi, F., Yuzawa, M., Iida, T., Honda, M., Nishijo, K., Sowade, O., Komori, T., Schmidt-Erfurth, U., Simader, C., Chong, V., for the VIEW 2 Investigators
Posted: December 15, 2014, 12:25 pm
Using continuous intraoperative optical coherence tomography measurements of the aphakic eye for intraocular lens power calculation
Background/aims

To include intraoperative measurements of the anterior lens capsule of the aphakic eye into the intraocular lens power calculation (IPC) process and to compare the refractive outcome with conventional IPC formulae.

Methods

In this prospective study, a prototype operating microscope with an integrated continuous optical coherence tomography (OCT) device (Visante attached to OPMI VISU 200, Carl Zeiss Meditec AG, Germany) was used to measure the anterior lens capsule position after implanting a capsular tension ring (CTR). Optical biometry (intraocular lens (IOL) Master 500) and ACMaster measurements (Carl Zeiss Meditec AG, Germany) were performed before surgery. Autorefraction and subjective refraction were performed 3 months after surgery. Conventional IPC formulae were compared with a new intraoperatively measured anterior chamber depth (ACD) (ACDIntraOP) partial least squares regression (PLSR) model for prediction of the postoperative refractive outcome.

Results

In total, 70 eyes of 70 patients were included. Mean axial eye length (AL) was 23.3 mm (range: 20.6–29.5 mm). Predictive power of the intraoperative measurements was found to be slightly better compared to conventional IOL power calculations. Refractive error dependency on AL for Holladay I, HofferQ, SRK/T, Haigis and ACDintraOP PLSR was r2=–0.42 (p<0.0001), r2=–0.5 (p<0.0001), r2=–0.34 (p=0.010), r2=–0.28 (p=0.049) and r2<0.001 (p=0.866), respectively,

Conclusions

ACDIntraOP measurements help to better predict the refractive outcome and could be useful, if implemented in fourth-generation IPC formulae.

Author: Hirnschall, N., Norrby, S., Weber, M., Maedel, S., Amir-Asgari, S., Findl, O.
Posted: December 15, 2014, 12:25 pm
Comparative histology of orbital, hepatic and subcutaneous cavernous venous malformations

Although cavernous malformations tend to be isolated, they are not exclusively localised to the orbit. Similar lesions have been described in a variety of sites including the liver and the skin.12 Recently, we have described the clincopathophysiological nature of orbital cavernous malformations.3 The purpose of this follow-up investigation is to extend these findings to lesions of the liver and skin.

We examined four representative, consecutive cases with a pathological diagnosis of cavernous malformation found in the liver, skin and orbit, respectively. A total of 12 cases were reviewed. All slides were stained as previously described.3

Morphological analysis revealed flat, mature vascular endothelium staining uniformly for CD31 without elastic lamina in all specimens. Vascular spaces were arranged in a back-to-back fashion, giving all cases a classic cavernous malformation appearance (figure 1A–C).

Hepatic lesions tended to have minimal stroma, with...

Author: Rootman, D. B., Rootman, J., White, V. A.
Posted: December 15, 2014, 12:25 pm
Validation of a new static perimetric thresholding strategy (GATE)
Aims

To validate the EyeSuite version of German Adaptive Threshold Estimation (GATE), a new thresholding algorithm for automated static perimetry.

Methods

Specification of agreement and its clinical evaluation as validation criteria. Comparison of local differential luminance sensitivity (DLS) and test time values between the prototype version of GATE (GATEp) and a clinical trial version, implemented in EyeSuite (GATEe), by means of modified Bland–Altman plots. All examinations were performed on the Octopus 900 perimeter (Haag-Streit Inc., Köniz, Switzerland). Visually impaired patients (anterior ischaemic optic neuropathy [n=3], glaucomatous optic neuropathy [n=15], (post-)chiasmal visual pathway lesion [n=6], retinitis pigmentosa [n=6]) were either tested with grid 30A (30° excentricity, 83 test locations) or grid 84NO (90° excentricity, 109 test locations, patients with RP only).

Results

The comparison of local DLS values showed good-to-acceptable agreement between GATEp and GATEe (bias <2 dB, limits of agreement [LOA] <5 dB) and very good repeatability for GATEp (bias <0.5 dB, LOA<3 dB). Median test times for GATEp and GATEe were 7.8  and 8.8 min for the 30° grid and 6.7  and 7.8 min for the 90° grid.

Conclusions

GATEp and GATE, implemented in the commercially available EyeSuite software package (GATEe), show good agreement regarding local differential luminance sensitivity. GATEe can thus be also recommended for clinical practice.

Clinical trial number

NCT01265628.

Author: Luithardt, A. F., Meisner, C., Monhart, M., Krapp, E., Mast, A., Schiefer, U.
Posted: December 15, 2014, 12:25 pm
Evaluation of iris and iridociliary body lesions with anterior segment optical coherence tomography versus ultrasound B-scan
Aims

To compare anterior segment optical coherence tomography (AS-OCT) with ultrasound B-scan (USB) in evaluating iris and iridociliary body lesions.

Methods

Image features and resolution comparison between AS-OCT and USB in 126 patients (126 eyes) presenting with iris or iridociliary body lesion. Bland–Altman plots were generated to assess the level of agreement between the two techniques.

Results

The three most common diagnoses were iris naevi (62 (49.2%)), iris pigment epithelial cysts (23 (18.3%)) and iris melanoma (11 (8.7%)). Image feature comparison for USB was better than AS-OCT in visualising all tumour margins (81 (64.3%) vs 59 (46.8%)), posterior tumour margin (54 (42.9%) vs 16 (12.7%)) and producing less posterior shadowing (121 (96%) vs 43 (34.1%)). Image resolution comparison revealed USB to be slightly better for resolving the overall tumour (45 (35.7%) vs 43 (34.1%)) and posterior tumour surface (70 (55.6%) vs 32 (25.4%)) but AS-OCT was better for resolving the anterior (62 (49.2%) vs 4 (3.2%)) and lateral tumour surface (62 (49.2%) vs 31 (24.6%)). Comparing the three most common diagnoses, USB was better for visualising iris pigment epithelial cysts (12 (52.2%) vs 2 (8.7%)) and iris melanoma (7 (63.6%) vs 1 (9.1%)) but AS-OCT was better (28 (45.2%) vs 15 (24.2%)) for visualising iris naevi. Bland–Altman plots showed good agreement between the two techniques for lesions smaller than 3 mm in base and 2 mm in elevation.

Conclusions

AS-OCT is superior to USB for imaging small lesions pertaining to the anterior iris but USB is better for imaging larger iris lesions with posterior or ciliary body extension.

Author: Hau, S. C., Papastefanou, V., Shah, S., Sagoo, M. S., Restori, M., Cohen, V.
Posted: December 15, 2014, 12:25 pm
The Spaeth/Richman contrast sensitivity test (SPARCS): design, reproducibility and ability to identify patients with glaucoma
Aims

(1) To determine the ability of a novel, internet-based contrast sensitivity test titled the Spaeth/Richman Contrast Sensitivity Test (SPARCS) to identify patients with glaucoma. (2) To determine the test-retest reliability of SPARCS.

Methods

A prospective, cross-sectional study of patients with glaucoma and controls was performed. Subjects were assessed by SPARCS and the Pelli-Robson chart. Reliability of each test was assessed by the intraclass correlation coefficient and the coefficient of repeatability. Sensitivity and specificity for identifying glaucoma was also evaluated.

Results

The intraclass correlation coefficient for SPARCS was 0.97 and 0.98 for Pelli-Robson. The coefficient of repeatability for SPARCS was ±6.7% and ±6.4% for Pelli-Robson. SPARCS identified patients with glaucoma with 79% sensitivity and 93% specificity.

Conclusions

SPARCS has high test-retest reliability. It is easily accessible via the internet and identifies patients with glaucoma well.

Trial Registration:

NCT01300949.

Author: Richman, J., Zangalli, C., Lu, L., Wizov, S. S., Spaeth, E., Spaeth, G. L.
Posted: December 15, 2014, 12:25 pm

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