Current Issue

---

In this week’s issue

• A trial demonstrates utility of low-level red-light therapy with orthokeratology in treating myopia
• Female speakers are less likely to be introduced by their formal titles at ophthalmology grand rounds 
• A study analyzes the vitreous metabolome of endophthalmitis patients

Too busy to read the lens? Listen to our weekly summary on your daily commute:

https://podcasters.spotify.com/pod/show/lens-pod/episodes/The-Lens-Newsletter-November-13th--2024-e2qtdt3

Ophthalmology

Low-Level Red-Light Therapy with Orthokeratology Affects Myopia

Shining a light on myopia control. Myopia is a major public health concern impacting quality of life. The focus of myopia management has begun to shift toward emphasizing control of myopia progression rather than simply correcting refractive error. Orthokeratology is currently a first-line intervention for myopia control, which works by inducing corneal surface reshaping through the use of fitted contact lenses. Repeated low-level red light (RLRL) therapy is emerging as another intervention for myopia control that may slow axial elongation, thereby reducing myopia progression. This study aimed to analyze the unique concept of combining these two therapies to maximize benefit. This study is a multicenter randomized parallel-group trial in which children 8-13 years of age received RLRL therapy with orthokeratology in the RCO group or orthokeratology alone group. Axial length (AL) change was measured at 12 months. Adjusted mean AL lengths at 12 months were -0.02 mm (95% CI, -0.08 to +0.03) in the RCO group and 0.27 mm (95% CI, 0.19 to 0.34) in the orthokeratology group. The adjusted mean difference in AL change between the groups was -0.29 mm (95% CI, -0.44 to -0.14). While long-term studies are necessary to fully understand this treatment's efficacy, the combination of RLRL therapy with orthokeratology may present an option for myopia control by slowing axial elongation. 

American Journal of Ophthalmology 

Doctor Who? Female Speakers Less Likely to Get Formal Introductions at Grand Rounds

Is gender bias influencing how speakers are introduced in academic medicine? A new study explored this question by analyzing speaker introductions at ophthalmology grand rounds in the U.S. and Canada. The study reviewed 399 introductions from 298 teaching sessions and found that after adjusting for variables such as degree type and academic appointment, female speakers were significantly less likely to be introduced by their formal title (OR = 0.55), academic degrees (OR = 0.61), and awards (OR = 0.62) than male speakers when introduced by male hosts. These gender disparities were not present when a female host introduced the speaker. Additionally, female speakers were 2.39 times more likely to present on non-clinical topics, such as ethics and wellness, than male speakers. The findings highlight subtle biases in professional introductions that potentially undermine female professionals’ recognition in academic settings. Implementing standardized, equitable introduction practices could help address these disparities and create a more inclusive environment.

IOVS 

Vitreous Metabolome of Endophthalmitis Patients

Omics: The final frontier. Bacterial endophthalmitis, a sight-threatening intraocular infection, occurs primarily after ocular surgery or trauma. With an increasing number of elderly people undergoing procedures such as cataract surgery, the authors aimed to explore metabolic alterations in the vitreous of these patients. This study included 29 eyes of 29 subjects who underwent vitrectomy, for either bacterial endophthalmitis (n=15) or non-infectious retinal conditions (n=14). Subjects were classified by age as young, middle, or elderly. Untargeted metabolomic analysis was performed by high-resolution mass spectrometry (HRMS). Of the 109 endogenous metabolites measured, many were differentially abundant in endophthalmitis compared to the control group. For example, in young patients with endophthalmitis there were 52 significantly altered metabolites (P <0.05) and in elderly patients, 27 metabolites (P < 0.05). Pathway analysis also revealed differences between groups: young endophthalmitis patients had altered amino acid, purine, and steroid metabolism while elderly patients had uniquely altered biotin, nucleic acid, amino acid, and cysteine sulfinic acid metabolism processes. In older individuals, differential metabolites found in oxidative stress and inflammatory pathways, among others, may give clues as to why the elderly are often more susceptible to severe and persistent infections that those who are younger. This work could further aid in the rational design of therapeutic targets for these patients.

JAMA Ophthalmology

Can genetic scores help detect risk of glaucoma onset?

The answer might be written in our genes. Primary open-angle glaucoma (POAG) is a highly heritable condition where genetics play a significant role in disease onset and progression. Polygenic risk scores (PRSs), which aggregate genetic risk from numerous POAG-associated variants, have shown promise in predicting disease prevalence and severity. This study explored the utility of PRS to identify patients with ocular hypertension at low risk for developing POAG, aiming to optimize patient care by reducing unnecessary surveillance and treatment. In a post hoc analysis of the Ocular Hypertension Treatment Study (OHTS), involving 1010 participants with genetic data, a PRS below the 48th percentile was associated with a 1.49 times higher likelihood of remaining disease-free after 20 years compared to those with high PRS (95% CI, 1.04-2.15; P = .03; unadjusted hazard ratio [HR], 1.64; 95% CI, 1.13-2.38; P = .009). These findings suggest that integrating PRS with clinical factors could improve patient stratification, enabling tailored interventions for those in the greatest need while minimizing unnecessary treatment for low-risk individuals.

Frontiers in Cell and Developmental Biology

Generative Diffusion Model for Predicting Post-operative Outcomes for Ptosis Surgery

Eye see the future! Blepharoptosis (Ptosis) is a condition of abnormally low upper eyelid margin in primary gaze, which partially covers the eye in many cases leading to negative visual or psychological effects on patients. Current management includes surgical correction for cosmetic or functional improvement, however there is much variability in outcomes due to the precise adjustments required. Attempts at postoperative prediction of outcomes have been explored to aid in the effectiveness of surgery and patient satisfaction. This study used PtsosisDiffusion, a generative diffusion model trained on 39 preoperative photos to predict the outcome of surgery, with 2 ophthalmologists as raters of the prediction quality. Ptosis diffusion was compared to three other diffusion models (Conditional, Repaint, and Dragon Diffusion), outperforming them in terms of overlap ratio (0.87 ± 0.07) and mean mid-pupil lid distance (1.01 ± 0.10). This study demonstrates the ability of diffusion models to predict post-operative symmetry in patients with bilateral and unilateral ptosis with high accuracy. Notable these models do not require paired post-operative data for training due to the generative properties. 

Tolerating Subretinal Fluid (FLUID)

Might perfect be the enemy of good…when it comes to subretinal fluid retention. In the 2019 FLUID Study, visual acuity was assessed in patients with neovascular age-related macular degeneration (nAMD) previously randomized to treatment with monthly ranibizumab 0.5mg until resolution of intraretinal fluid (IRF) only (tolerating 200 microns of SRF) (n=175) versus complete resolution of both IRF and subretinal fluid (SRF) (n=174) before extending treatment intervals.

Key Points:

• Of the 279 (79.9%) patients completing 24-month follow-up, there was no statistical difference in visual acuity outcomes between the two groups (P=0.99)
• Participants in group that allowed residual SRF received fewer ranibizumab injections over 24 months (P = 0.001) and significantly more participants with residual SRF extended to and maintained 12-week treatment intervals (P = 0.005)

Overall, the FLUID study is a landmark study because it showed that incomplete subretinal fluid resolution did not create significant differences in long-term visual acuity in patients with nAMD and demonstrated the need for fewer injections with longer maintenance intervals in its treatment.