Individualized treat and extend TREX-DME trial for DME resulted in significantly fewer injections and yielded visual and anatomic gains comparable to monthly dosing at 2 years.
Decreasing the treatment burden while providing clinically significant visual and anatomic improvements is of paramount importance.
“Randomized Trial of Treat and Extend Ranibizumab With and Without Navigated Laser Versus Monthly Dosing for Diabetic Macular Edema: TREX-DME 2-Year Outcomes”
Am. J. Ophthalmol 202:91-99, June 2019
John F. Payne, Charles C. Wykoff, W. Lloyd Clark, Beau B. Bruce, David S. Boyer, and David M. Brown, For the TREX-DME Study Group
Full Paper: Randomized Trial of Treat and Extend Ranibizumab With and Without Navigated Laser Versus Monthly Dosing for Diabetic Macular Edema: TREX-DME 2-Year Outcomes
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If you suspect or have patients with Choroideremia, X linked Retinitis Pigmentosa, RP6R or Achromotopsia, we can screen these patients to determine if they are candidates for gene therapy protocols.
If you would like more information please call our office at 800-643-8197 and speak with Norman Radtke, MD or Kevin.
Full Paper: Gene Therapy Protocols
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The findings of this five-year study by the Diabetic Retinopathy Clinical Research Network support either anti-VEGF therapy or panretinal photocoagulation as viable treatment for patients with proliferative diabetic retinopathy.
“Five-Year Outcomes of Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy”
A Randomized Clinical Trial
JAMA Ophthalmol 136, Vol 10:1138-1148, Oct 2018
Jeffrey G. Gross, MD et al
Full Paper: Five-Year Outcomes of Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy
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Most patients of VMT gained significant functional and anatomical improvements after vitrectomy. Group 1 optical coherence tomography pattern, shorter symptom duration, and younger age are significant predictive factors of better visual outcome.
“Predictive Factors of Visual Outcome for Vitreomacular Traction Syndrome After Vitrectomy”
Retina 38:1533-1540, 2018
Chang-Sue Yang, MD, MHA; Ming-Hung Hsieh, MD; Yu-Fan Chang, MD; Chiao-Yu Wang, MD; Shih-Jen Chen, MD, PhD
Full Paper: Predictive Factors of Visual Outcome for Vitreomacular Traction Syndrome After Vitrectomy
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In a real-world setting, patients with cataracts and wet age-related macular degeneration underwent treatment for age-related macular degeneration fluid and surgery for cataracts. These patients did well postoperatively with no worsening of their neovascular process.
“Outcomes of Cataract Surgery in Patients With Exudative Age-related Macular Degeneration and Macular Fluid”
Am. J. Ophthalmol 192:91-97, August 2018
Matthew R. Starr; Michael A. Mahr; Andrew J. Barkmeier; Raymond Iezzi; Wendy M. Smith; Sophie J. Bakri
Full Paper: Outcomes of Cataract Surgery in Patients With Exudative Age-related Macular Degeneration and Macular Fluid
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There are no approved drug treatments for autosomal-dominant retinitis pigmentosa.
A study of oral Valproic acid (VPA) does not support the use of VPA in the treatment of autosomal-dominant retinitis pigmentosa.
The lessons learned from a trial of Valproic acid are:
- Rigorous evaluation of drug treatment for retinitis pigmentosa is necessary.
- FDA-approved drugs for other uses can have major adverse effects.
- Patients vary greatly in their rates of progression of retinitis pigmentosa with identical gene mutations.
“Methodological Insights for Randomized Clinical Trials of Retinitis Pigmentosa”
Lessons Learned from a Trial of Valproic Acid
JAMA Ophthalmol 136:857-858, August 2018
Brian P. Brooks, MD, PhD; Brett Jeffrey, PhD
Full Paper: Methodological Insights for Randomized Clinical Trials of Retinitis Pigmentosa_08-13-18
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Considerable controversy has erupted in recent years regarding whether genotyping should be part of standard care for patients with age-related macular degeneration (AMD) who are being considered for treatment with antioxidants and zinc. We aimed to determine whether genotype predicts response to supplements in AMD.
Three separate statistical teams reanalyzed data derived from the Age-Related Eye Disease Study (AREDS), receiving data prepared by the AREDS investigators and, separately, data from investigators reporting findings that support the use of genotyping.
The population of interest was AREDS participants with AMD worse than category 1 and genotyping data available. Data from the 2 groups overlap imperfectly with respect to measurements made: the largest common set involved 879 participants for whom the same CFH and ARMS2 single nucleotide polymorphisms were measured by both groups.
Each team took a separate but complementary approach. One team focused on data concordance between conflicting studies. A second team focused on replicating the key claim of an interaction between genotype and treatment. The third team took a blank slate approach in attempting to find baseline predictors of treatment response.
Main Outcome Measures
Progression to advanced AMD.
We found errors in the data used to support the initial claim of genotypeetreatment interaction. Although we found evidence that high-risk patients had more to gain from treatment, we were unable to replicate any genotypeetreatment interactions after adjusting for multiple testing. We tested 1 genotype claim on an independent set of data, with negative results. Even if we assumed that interactions in fact did exist, we did not find evidence to support the claim that supplementation leads to a large increase in the risk of advanced AMD in some genotype subgroups.
Patients who meet criteria for supplements to prevent AMD progression should be offered zinc and antioxidants without consideration of genotype. Ophthalmology 2018;125:391-397 ª 2017 by the American Academy of Ophthalmology
Full Paper: Genetic Polymorphisms of CFH and ARMS2 Do Not Predict Response to Antioxidants and Zinc in Patients with Age-Related Macular Degeneration
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Results of the OASIS Trial ERG Substudy
To explore a possible association between full-field electroretinograms with vitreomacular adhesion resolution and best-corrected visual acuity as part of the prospective, randomized, double-masked, sham-controlled Ocriplasmin for Treatment for Symptomatic Vitreomacular Adhesion Including Macular Hole (OASIS) trial studying ocriplasmin.
The ERG substudy enrolled 62 of 220 OASIS subjects (randomized 2:1) and analyzed full-field electroretinograms and their association with both vitreomacular adhesion resolution and best-corrected visual acuity from baseline through Month 24. Electroretinogram reductions were defined as acute full-field electroretinogram reductions in amplitude of $40% from baseline occurring at postinjection Day 7 or Day 28.
In the ocriplasmin group, 16/40 (40%) subjects developed ERG reductions, compared to 1/21 (4.8%) in the sham group; 13/16 (81.3%) and 1/1 (100%) resolved by study end, respectively. A total of 11/16 (68.8%) ocriplasmin-treated subjects with ERG reductions achieved vitreomacular adhesion resolution, compared to those without (9/24, 37.5%). The ocriplasmin-treated subjects with ERG reductions also gained more letters on average (11.3 vs. 9.3 letters) from baseline and had a difference of 6.7 letters in mean bestcorrected visual acuity by study end compared to those without ERG reductions.
Ocriplasmin-treated subjects with ERG reductions had a higher rate of vitreomacular adhesion resolution and showed better visual improvement than their counterparts without ERG reductions or sham subjects by study end.
RETINA 38:364–378, 2018
Full Paper: Evaluation of Full-Field Electroretinogram Reductions After Ocriplasmin Treatment
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To identify the most accurate diagnostic imaging modality for classifying pediatric eyes as papilledema (PE) or pseudopapilledema (PPE).
Prospective observational study.
Nineteen children between the ages of 5 and 18 years were recruited. Five children (10 eyes) with PE, 11 children (19 eyes) with PPE owing to suspected buried optic disc drusen (ODD), and 3 children (6 eyes) with PPE owing to superficial ODD were included.
All subjects underwent imaging with B-scan ultrasonography, fundus photography, autofluorescence, fluorescein angiography (FA), optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL), and volumetric OCT scans through the optic nerve head with standard spectral-domain (SD OCT) and enhanced depth imaging (EDI OCT) settings. Images were read by 3 masked neuro-ophthalmologists, and the final image interpretation was based on 2 of 3 reads. Image interpretations were compared with clinical diagnosis to calculate accuracy and misinterpretation rates of each imaging modality.
Main Outcome Measures
Accuracy of each imaging technique for classifying eyes as PE or PPE, and misinterpretation rates of each imaging modality for PE and PPE.
Fluorescein angiography had the highest accuracy (97%, 34 of 35 eyes, 95% confidence interval 92%e100%) for classifying an eye as PE or PPE. FA of eyes with PE showed leakage of the optic nerve, whereas eyes with suspected buried ODD demonstrated no hyperfluorescence, and eyes with superficial ODD showed nodular staining. Other modalities had substantial likelihood (30%e70%) of misinterpretation of PE as PPE.
The best imaging technique for correctly classifying pediatric eyes as PPE or PE is FA. Other imaging modalities, if used in isolation, are more likely to lead to misinterpretation of PE as PPE, which could potentially result in failure to identify a life-threatening disorder causing elevated intracranial pressure and papilledema.
Full Paper: Accuracy of Diagnostic Imaging Modalities for Classifying Pediatric Eyes as Papilledema Versus Pseudopapilledema
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To evaluate the 24-month natural course of visual changes in patients discontinuing treatment despite persistent or recurrent fluid and factors predictive of visual prognosis.
This retrospective, observational study included 35 patients (35 eyes) who initially received anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD), but discontinued treatment despite persistent or recurrent fluid. The best-corrected visual acuity (BCVA) at treatment discontinuation was determined and compared with the 24-month BCVA, which was then compared between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes. Baseline characteristics predictive of visual outcome and the degree of visual change were also analyzed.
The mean number of anti-vascular endothelial growth factor injections before treatment discontinuation was 4.0 ± 1.6. The mean logarithm of minimal angle of resolution of BCVA at treatment discontinuation and that at 24 months were 1.02 ± 0.20 (Snellen equivalents = 20/209) and 1.60 ± 0.56 (20/796), respectively (P , 0.001). The 24-month BCVA was not different between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes (P = 0.803). The type of fluid (intraretinal fluid vs. no intraretinal fluid) was predictive of 24-month BCVA (P = 0.004) and the degree of changes in BCVA (P = 0.043).
Marked deterioration in visual acuity was noted in patients discontinuing treatment, regardless of neovascular age-related macular degeneration subtypes. The presence of intraretinal fluid was associated with worse visual prognosis, suggesting that patients with intraretinal fluid should be strongly warned about their poor prognosis before they decide to discontinue treatment.
Full Paper: Natural Course of Patients Discontinuing Treatment for Age-Related Macular Degeneration and Factors Associated with Visual Prognosis
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