This Issue at a Glance

Abstract

Malhotra et al (p. 1438) retrospectively analyzed 203 673 patients from the Intelligent Research in Sight Registry® database to understand the risk factors—including race, ethnicity, and insurance status—for poor baseline visual acuity (VA) and diabetic retinopathy (DR) severity upon initiation of anti-VEGF therapy for diabetic macular edema (DME). Ethnicity, race, and insurance status were independently associated with worse VA and DR severity, with patients of Hispanic ethnicity, of Black race, and those insured by Medicaid having worse DR severity and baseline VA upon initiation of anti-VEGF treatment. Hispanic ethnicity and Medicaid insurance had the strongest correlation with poor ophthalmic health. The authors suggest the need for public health initiatives to help improve ethnic and insurance-based disparities in VA and disease severity upon initiation of anti-VEGF therapy for DME treatment. Yu et al (p. 1384) evaluated the associations of 12 systemic conditions previously reported as potential dry eye disease (DED) risk factors with the severity of dry eye signs and symptoms in 535 patients with moderate to severe DED. Patients with Sjögren syndrome (mean composite signs severity score 0.52 with disease vs. 0.43 without disease), facial rosacea (0.47 vs. 0.43), rheumatoid arthritis (0.47 vs. 0.42), peripheral artery disease (0.50 vs. 0.43), and daily smoking history (0.45 vs. 0.43) showed more severe dry eye signs than patients without the conditions of interest. There were no significant associations with severity of DED signs for thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolemia, hypertension, or hypertriglyceridemia, and no conditions were associated significantly with Ocular Surface Disease Index. The authors conclude that patients with certain systemic diseases and smoking history showed more severe DED signs. Soh et al (p. 1393) conducted a systematic review and meta-analysis of 61 articles from 55 population-based studies to evaluate the global extent of undetected glaucoma. The studies included 189 359 participants, of whom 6949 had manifest glaucoma, and 5558 were previously undetected. Globally, at least half of all glaucoma cases were estimated to be undetected in every region, with 43.78 million cases projected to be undetected in 2020 and 76.7% of them being in Africa and Asia. Africa (odds ratio [OR]:12.70) and Asia (OR:3.41) showed higher odds of undetected glaucoma compared with Europe. Countries with low Human Development Index (HDI; < 0.55) showed a higher proportion of undetected manifest glaucoma as compared with countries of medium to very high HDI (≥ 0.55). The researchers conclude that undetected glaucoma is highly prevalent across diverse communities worldwide, most commonly in African and Asian regions and in countries with low HDI. Phu et al (p. 1405) performed a head-to-head comparison of the 24-2C and 10-2 test grids for detecting central visual field defects in 131 glaucoma and 57 glaucoma suspect patients. Global indices of visual field performance, such as mean deviation, pattern standard deviation, and central mean sensitivity, were similar. The 10-2 detected more defects and more central clusters of 2+ contiguous points of deficit compared with the 24-2C. The 10-2 also showed greater concordance of structural and functional deficits when structure-function comparisons were performed at locations where visual field and OCT test locations were colocalized. Test duration was longer for the 10-2 (median 201.0 seconds) compared with the 24-2C (median 154.0 seconds). The authors conclude that the 24-2C and 10-2 test grids showed similar global indices of visual field performance and proportionally similar amounts of central visual field loss, but the 10-2 grid returned more clusters of defects and a greater rate of structure-function concordance. Kamalipour et al (p. 1426) retrospectively characterized the artifacts seen in OCT angiography (OCTA) images of healthy and glaucoma eyes. Analysis of 5263 OCTA images from 63 healthy subjects, 61 glaucoma suspects, and 244 glaucoma patients revealed that 33.9% of the OCTA images were of poor quality. The majority of images (76.6%) with acceptable image quality score (QS) had no artifacts, with 13.6% having one artifact and 9.8% having two or more artifacts. Older age, male gender, worse visual field mean deviation, absence of eye tracking technology, and macular scan area were associated with a higher likelihood of obtaining poor-quality images. The area under the receiver operating characteristic curves of QS and signal strength index for discriminating between good- and poor-quality images were 0.65 and 0.70, respectively. The authors conclude that artifacts associated with poor-quality OCTA images are frequent, and their prevalence is affected by individual patient and ocular conditions.