This Issue at a Glance

Abstract

Ajana et al (p. 587) used a machine learning algorithm to develop a prediction model for advanced age-related macular degeneration (AMD) based on phenotypic, genotypic, and lifestyle factors. The training dataset included 3838 participants enrolled in the Rotterdam Study I (RS-I) and the validation dataset included 362 participants enrolled in the Antioxydants, Lipids Essentiels, Nutrition et Maladies Oculaires (ALIENOR) study. Of 33 variables analyzed, 9 were selected as being the most predictive of incident advanced AMD. The cross-validated area under the receiver operating characteristic curve (AUC) estimation in RS-I was 0.92 at 5 years, 0.92 at 10 years, and 0.91 at 15 years, whereas the AUC in ALIENOR reached 0.92 at 5 years. The researchers conclude that their model reached high discrimination performances and showed a good stratification of participants into low-risk and high-risk groups of incident advanced AMD. Jaffe et al (p. 576) conducted a prospective, randomized, pivotal phase 2/3 clinical trial to assess the safety and efficacy of avacincaptad pegol, a complement C5 inhibitor, in 286 participants with geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Mean GA growth rate was significantly reduced over 12 months by 27.4% for the avacincaptad pegol 2 mg cohort and by 27.8% for the avacincaptad pegol 4 mg cohort compared with their corresponding sham-control cohorts. In addition, avacincaptad pegol was generally well tolerated after 12 months with no ocular or serious adverse events. The authors conclude that complement C5 inhibition through intravitreal administration of avacincaptad pegol 2 mg and 4 mg significantly reduced GA progression over 12 months in eyes with AMD. West et al (p. 545) conducted a prospective observational study to determine whether the 10-2 test of the Humphrey Field Analyzer detected a higher proportion of abnormal visual fields compared with the 24-2 test in the central 10° of patients with early glaucomatous visual field damage. The study included one eye each of 97 glaucoma patients and 65 control participants. The area under the receiver operating characteristic curve, values for a range of criteria—total deviation (TD) and pattern deviation (PD) analyses at 5% and 2% probability levels—were not significantly different. In patients with an abnormal field with either test, the overlap varied from 60% to 86% depending on the criterion, whereas by quadrant, concordance ranged from 70% to 87%. Repeatability of test results varied from a high of 70% of patients with TD analysis at the 5% level to a low of 55% of patients for PD analysis at the 5% level. The authors conclude that the 10-2 test did not offer a higher diagnostic performance compared with the 24-2 test. In a cross-sectional study, Arora et al (p. 494) investigated the presence of SARS-CoV-2 RNA in tears of patients with moderate to severe COVID-19. Of 75 patients analyzed, 36 (48%) had moderate disease and 39 (52%) had severe disease. Reverse-transcriptase polymerase chain reaction (RT-PCR) showed positive results in the tears of 18 patients (24%) by at least one of the following methods: conjunctival swab (group 2), Schirmer paper strips (group 3) or conjunctival swab with Schirmer test strips (group 1). Positive results were found in 11 (14.7%), 11 (14.7%), and 7 (9.3%) patients in groups 1, 2, and 3, respectively. The study suggests that considerable viral shedding can occur in the precorneal tear film in patients with moderate to severe COVID-19, and SARS-CoV-2 presence can be satisfactorily assessed by conjunctival swab tear collection for RT-PCR. Numa et al (p. 504) present the 5-year follow-up results of a prospective observational study of 11 eyes of 11 patients with pseudophakic endothelial failure conditions who underwent a novel cell injection therapy using cultured human corneal endothelial cells (hCECs). At 5 years after surgery, normal corneal endothelial function was restored in 10 of the 11 eyes and the central corneal endothelial cell density was 1257 ± 467 cells/mm2. Additionally, mean best corrected visual acuity improved significantly in 10 treated eyes from 0.876 to 0.046 logarithm of the minimum angle of resolution. No major adverse reactions directly related to the hCEC injection therapy were observed. The authors conclude that the results offer a potential paradigm shift in using cultured hCEC injection therapy for complete corneal restoration in patients afflicted with severe corneal endothelial failure conditions.