The most important ophthalmology research updates, delivered directly to you.
The most important ophthalmology research updates, delivered directly to you.
In this week’s issue
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Ophthalmology
Outcomes after secondary intraocular lens implantation for pediatric aphakia
What kind of cataract catastrophes could happen in children? Infants 7 months or younger with unilateral congenital cataracts are typically treated with lensectomy without lens implantation, followed by subsequent aphakic spectacle correction, with implantation of a secondary intraocular lens (IOL) implantation later in life to accommodate normal eye growth (The Infant Aphakia Treatment Study or IATS). This study builds on the IATS, aiming to describe glaucoma-related adverse events (GRAE), refractive error, and visual acuity in 80 children aged 13 years or younger approximately 5 years after undergoing secondary IOL implantation for nontraumatic cataracts, with data collected from the Pediatric Eye Disease Investigator Group (PEDIG) cataract registry. The cumulative incidence for GRAEs was 17% (95% CI, 3-29%) in bilateral cases and 12% (95% CI, 0-23%) in unilateral cases. The median spherical equivalent refractive error at 5 years was +0.50 D (IQR, -2.38 to +2.94 D) for bilateral cases and +0.06 D (IQR, -2.25 to +0.75 D) for unilateral cases. Median monocular VA at 5 years was 20/63 (IQR, 20/50-20/100) for bilateral cases and 20/400 (IQR, 20/160/20/800) for unilateral cases. Secondary IOL implantation carries an ongoing risk of GRAEs as well as a concern for the development of myopia as the eyes were less hyperopic on average than intended. This marks the importance of further studies to identify a target hyperopic refractive error following secondary IOL implantation.
JAMA Ophthalmology
Can addressing vision impairment help prevent dementia?
What if improving your vision could help save your memory too? This study explored the link between vision impairment and dementia, aiming to quantify the impact of vision health on dementia risk among older adults. Utilizing data from the National Health and Aging Trends Study, researchers assessed 2,767 participants aged 71 and older for various visual impairments, including near and distance visual acuity and contrast sensitivity. Results indicated that up to 19% of dementia cases could potentially be avoided if vision impairments were eliminated, with contrast sensitivity impairment contributing the highest risk (15%). The study employed a cross-sectional design and used statistical models to calculate the population attributable fractions (PAFs) of dementia due to vision impairment, stratified by age, sex, race, and education. Findings revealed that PAFs were higher among individuals aged 71 to 79, women, and non-Hispanic White participants. The researchers suggest that addressing vision issues such as cataracts or refractive errors could significantly reduce dementia risk.
American Journal of Ophthalmology
Psoriasis linked to increased risk of nAMD in diabetic patients
Could a common skin condition be silently impacting your eyesight? New research suggests that psoriasis may elevate the risk of neovascular age-related macular degeneration (nAMD) in individuals with type 2 diabetes mellitus (T2DM). This population-based study in Korea analyzed data from over 2.2 million patients with T2DM, 20,853 of whom also carried a diagnosis of psoriasis. Researchers observed that patients with both T2DM and psoriasis had a significantly higher incidence of nAMD compared to those without psoriasis. After adjusting for covariates including age, sex, body mass index, income level, smoking status, drinking status, regular exercise habits, hypertension, dyslipidemia, and other health conditions, the study found that psoriasis increased the risk of developing nAMD by approximately 32% (hazard ratio = 1.329). The study's findings highlight a potential link between the systemic inflammation associated with psoriasis and the development of nAMD. Both conditions involve elevated levels of vascular endothelial growth factor and inflammatory cytokines, which play crucial roles in angiogenesis and inflammation. These results highlight the importance of regular eye examinations for diabetic patients, especially those diagnosed with psoriasis.
IOVS
Retinal organoid sheet transplants form functional synapses with host tissue
When restoring vision, connection is key. Retinitis pigmentosa (RP) is characterized by retinal degeneration due to photoreceptor death. Stem cell-derived retinal organoid sheet transplant is being explored as a therapeutic option for RP patients, and promising data are coming from animal model studies. This report takes a closer look at the synapses formed post-transplant. The rd1 mouse model of retinal degeneration, whose photoreceptors are lost within weeks of birth, was engineered to express GFP in rod bipolar cells. Mouse embryonic stem cell-derived retinal organoids, engineered to express tdTomato at photoreceptor ribbon synapses, were transplanted to the rd1 mice. Correlative array tomography, a sequential imaging technique where confocal fluorescence microscopy is followed by electron microscopy, was used to examine the microstructure of the junction between host and graft tissue. Host-graft synapses mimicked endogenous microstructure, with horizontal cell followed by bipolar cell processes communicating with the transplanted photoreceptors. Furthermore, multielectrode arrays were used to demonstrate that light responsiveness of host retinal ganglion cells was correlated with the number and density of these host-graft synapses formed. This report provides support for the capacity of stem cell-derived retinal organoid transplants to restore functional connections and potentially restore vision in degenerative conditions like retinitis pigmentosa.
Ophthalmology
Do socioeconomic disparities influence amblyopia treatment outcomes?
When it comes to amblyopia, sooner is always better. In children with amblyopia, early diagnosis and access to treatment are critical, but disparities in socioeconomic status can delay intervention and affect post-treatment visual outcomes. This retrospective study analyzed clinical and sociodemographic factors affecting amblyopia treatment outcomes in children ≤8 years old treated for unilateral refractive or strabismic amblyopia. A total of 168 patients treated at Children’s Hospital Los Angeles from 2012 to 2022 were categorized as having resolved amblyopia (<0.2 logMAR interocular difference or no fixation preference) or persistent amblyopia. Among each group, factors assessed included Childhood Opportunity Index (COI) scores based on zip code, estimated annual household income, and distance to the hospital. Amblyopia resolution (131 patients, 78%) was associated with younger age at diagnosis (3.3 vs. 4.5 years), English as the primary language (79.4% vs. 62.2%), higher annual income ($83,315.93 vs. $71,623), higher COI scores (50.9 vs. 40.0), and living farther from the institution (28.6 vs. 14.9 miles). Resolved cases also showed better treatment compliance (83.2% vs. 75.6%) and shorter delays in follow-up (40.1 vs. 61.1 days). Overall, this study highlights the importance of early vision screening and expanding access to pediatric eye care in underserved communities to improve amblyopia treatment outcomes.
Prevalence of Age-Related Maculopathy (Beaver Dam) - 1992
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:
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.
A 9 year old boy presents to clinic with vision loss in his right eye last week. Physical examination is significant for visual acuity of 20/200 and absent red reflex in the right eye. Fundoscopy reveals retinal hemorrhages and extrafoveal exudation in his right eye. IOP is within normal range. Retina is attached. A fluorescein angiogram was ordered and is shown below.
What is the most appropriate next step in management
A. Laser photoablation
B. Cryotherapy
C. Enucleation
D. Anti-VEGF therapy
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