The most important ophthalmology research updates, delivered directly to you.
The most important ophthalmology research updates, delivered directly to you.
New “Eye Chart” app, free for The Lens readers!
Dr. Michael Ullman has developed the "Eye Chart" app, a tool for eyecare professionals. This app utilizes the True Depth camera to gauge viewing distance. This functionality allows for calibration of the eye chart, ensuring reliable vision checks directly from the phone. It has a large variety of helpful optotypes like LEA figures and Allen figures. The app also includes features like an OKN drum and color plates. While it bears similarities to other apps, Dr. Ullman's integration of the True Depth feature significantly enhances the app's functionality. Also the app contains NO ads and NO required registration. Normally priced at $10 in the App Store, readers of 'The Lens' can contact Dr. Ullman at mullman@gmail.com, for a promo code to download the "Eye Chart" app free of charge.
In this week’s issue
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Ophthalmology
The effects of omega-3 fatty acids on diabetic retinopathy
FISHING for answers about omega-3 fatty acids? LOOK no further. Experimental evidence supports the role of omega-3 fatty acids in visual pathways and protection against oxidative stress and has been suggested to benefit diabetic retinopathy due to their anti-inflammatory properties. The ASCEND-Eye study is a substudy of ASCEND, a double-blind, randomized control trial that investigated the effects of 1g omega-3 fatty acids daily for preventing serious cardiovascular events in 15,480 UK adults aged 40 or older with diabetes. The study used electronic records and medical reviews to assess the time to the first recording of referable eye disease, including retinopathy and maculopathy, as the primary outcome, along with other secondary and tertiary outcomes related to diabetic eye disease. This study found no significant difference in the occurrence of referable eye disease, progression in retinopathy grade, incident diabetic maculopathy, or worsening visual acuity between participants taking omega-3 fatty acid supplementation for 6.5 years and those taking a placebo (p=0.29). Adherence to omega-3 fatty acids declined over time, and overall, there were no substantial effects on diabetic eye disease outcomes. The findings underscore the importance of robust, large-scale, randomized trials in evaluating potential treatments for diabetic eye disease and guiding patient care.
JAMA Ophthalmology
A meta analysis examining patient sex with ABCA4-associated retinopathy
Women may be a minority in many cases, but not when it comes to a type of retinopathy! Stargardt disease is an ABCA4-associated retinopathy with previous literature pointing to female sex being a potential modifier of disease. In order to determine whether women are overrepresented in various groups of this retinopathy, a meta-analysis was conducted with 6 cohorts at 3154 individuals. Females were significantly overrepresented in the mild ABCA4 variant group (proportion, 0.59; 95% CL, 0.56-0.62; P < 0.001) but not in the non-mild variant group (proportion, 0.50; 95% CL, 0.46-0.54; P < 0.89). Based on these results, sex is likely a modifying factor in patients carrying a mild ABCA4 variant for Stargardt disease. Future investigations are required to capture why women appear to be overrepresented and whether it is due to the inherent disease or different patterns of health-seeking behaviors.
American Journal of Ophthalmology
Comparing epithelium thickness in keratoconus using AS-OCT and AS-OCT/Placido Topography
When it comes to sizing up corneas, not all tools measure up! Keratoconus (KC) is a corneal condition that progressively distorts its normally round dome shape into a cone-like bulge, leading to blurred vision and sensitivity to light. Accurately gauging the corneal epithelial thickness is critical for diagnosing the severity of KC and determining the appropriate intervention. Clinicians often rely on optical coherence tomography (OCT) to capture these measurements, but the question remains: Are all OCT devices created equal? To enhance the precision of diagnosing KC, this study compares two OCT devices: the RTVue and the MS-39. This prospective reliability analysis involved 119 eyes diagnosed with varying stages of KC. Researchers assessed the agreement between the two devices using Bland-Altman plots and investigated the repeatability of measurements with RTVue. The 95% limits of agreement for center epithelium thickness measurements ranged from -5.9 to 4.8 μm, and from -5.7 to 8.2 μm for the thinnest epithelium thickness. The repeatability of measurements using the RTVue was acceptable across all KC severity levels, although it decreased with increasing distance from the center. The study underscores that while the RTVue shows acceptable repeatability, both devices differ significantly in measurements, especially in more severe KC cases, stressing the need for careful instrument choice in clinical settings to avoid diagnostic errors.
Investigative Ophthalmology and Visual Science (IOVS)
Genetics underlying uveal melanomas in european pediatric and young adult population
Are young patients more likely to have germline mutations causing uveal melanoma than adults? Uveal melanoma (UM) is the most common primary intraocular cancer in adults. It is less common in children and young adults (< 25 years old) and tends to cause smaller tumors that occur more frequently in females. This multicenter, retrospective study sought to characterize genes and chromosome 3 aberrations commonly implicated in UM pathogenesis in patients younger than 25 with confirmed choroidal or ciliary body melanoma. Tumor tissue was analyzed from 50 enucleated eyes, 6 resections, and 2 biopsy samples. The mean metastasis-free survival time was 9.0 years and males survived longer than females. A germline BAP1 pathogenic variant was found in one female patient. All other patients lacked germline mutations in genes associated with UM. Four tumors had GNAQ/GNA11 pathogenic mutations, three tumors had pathogenic BAP1 mutations, and one tumor had a pathogenic variant in SF3B1. No mutations were detected in EIF1AX. Out of 18 pediatric UM patients evaluated for chromosome 3 copy number variants in tumor tissue, half had disomy 3, three had monosomy 3, and six had loss of heterozygosity. The authors conclude that their data does not support a higher rate of germline BAP1 mutations in pediatric and young adults affected with UM compared to adults.
Journal of Cataract and Refractive Surgery
Can playing music during cataract surgery help reduce patient anxiety?
Is it time to pass the aux cord? Cataracts are increasingly prevalent and affect millions of people globally. However, patients often experience anxiety during the surgery as a result of exposure to lights, sounds, and movement during phacoemulsification while under local anesthesia. Prior studies have shown that listening to music prior to cataract surgery can reduce anxiety and risk of hypertensive episodes while improving patient satisfaction. This was a prospective, randomized control trial to determine the effect of playing patient-selected music intraoperatively upon self-reported anxiety and subsequent sedative doses needed during cataract surgery. A total of 107 patients were randomized into either music group or control group (without music) and on post-op day 1 completed a Likert-style survey to assess anxiety levels. Patients in the music group had significantly lower average anxiety scores compared to the control group (5.98 vs 7.13, p=0.006), as well as feeling significantly less frightened, nervous, and confused during surgery (p=0.002, p=0.007, p=0.017). However, there was no significant difference in number and dosage of sedatives given between groups. For surgeries done without general anesthesia, patients often experience high levels of anxiety intraoperatively. This study paves the way for future studies to continue analyzing the benefit of music and the impact it can have upon perioperative anxiety and other physiological parameters.
Ranibizumab for macular edema following CRVO/BRVO - 2010
Keep your friends close, but your anti-VEGF injections closer… The BRAVO and CRUISE trials looked to find the best course of treatment for macular edema in the setting of branch and central retinal vein occlusions. Prior to this, laser therapy had proven to be ineffective and patients were simply observed with little hope in visual improvement. In the BRAVO and CRUISE trials, patients with macular edema following BRVO (n=397) and CRVO (n=392) were randomized to receive monthly intravitreal injections of 0.3 or 0.5 mg of ranibizumab or sham injections.
Key Points:
The importance of this study was showing that anti-VEGF injections were effective in treating macular edema following retinal vein occlusions leading to marked improvement in visual acuity while still maintaining a very low risk of complications.
A 55-year-old male patient presents with decreased vision bilaterally. He also complains of itchy eyes and mucoid discharge. Past relevant medical history include a history of waxing and waning eczema over the past ten years. He denies any ocular pain, photophobia, or fever/chills. Surgical history was unremarkable. Visual acuity was 20/70 OD and 20/60 OS. His right and left eyes are shown below (A and B, respectively).
Which of the following is the most likely diagnosis?
A. Atopic Keratoconjunctivitis
B. Vernal keratoconjunctivitis
C. Seasonal allergic conjunctivitis
D. Giant papillary conjunctivitis
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