This Issue at a Glance

Abstract

Which factors predict visual loss and complications in patients with intermediate uveitis? Niederer et al (p. 393) investigated this question in a cross-sectional study of 305 uveitis patients (550 eyes) who were treated by a single clinician between 2011 and 2013. They found that 39.7% of the patients were diagnosed with a systemic disease, with sarcoidosis (22.6%) and multiple sclerosis (4.6%) emerging as the most frequent systemic associations. Cystoid macular edema (CME) was observed in 224 eyes (40.7%) and frequently responded well to treatment with local and systemic therapy. With regard to visual acuity (VA), mean best-corrected VA was 20/30 at presentation, as well as at the 5- and 10-year marks. Even so, permanent vision loss occurred in 12.6% of eyes in the study. The researchers note that eyes with a more prolonged inflammation had a poorer prognosis; in addition, macular atrophy and scarring linked to CME was also associated with vision loss. Parikh et al (p. 352) reviewed the first 10 years of intravitreal injections of aflibercept, bevacizumab, and ranibizumab in the OptumLabs Data Warehouse. While they found an overall yearly increase in the number of injections given for all 3 drugs, they also found that the overall use of ranibizumab declined after 2014. For this retrospective cohort study, the researchers searched administrative claims data from 2006 to 2015. During this period, 959 945 intravitreal injections were given to 124 835 patients. Among all injections, 64.6% were of bevacizumab, 22% of ranibizumab, and 13.4% of aflibercept, and the leading conditions treated were age-related macular degeneration (AMD; 62.7%), diabetic retinal diseases (16.1%), and retinal vein occlusions (8.3%). Nuances emerged regarding the treatment of these diseases—for instance, the use of bevacizumab and ranibizumab for AMD began to plateau in 2011 and declined thereafter—and some of these shifts occurred following publication of phase 3 study results. Souzeau et al (p. 303) investigated whether cascade genetic testing for the familial Myocilin (MYOC) variant in patients with primary open-angle glaucoma (POAG) has clinical utility. They found that it does, as it allows clinicians to identity patients at risk of developing the disease, as well as those in the very early stages of glaucoma, before significant damage has occurred. For this retrospective clinical and molecular study, the researchers evaluated 73 patients who carry the MYOC mutation and classified them by (1) how they initially presented to an ophthalmologist (either referred by another clinician or identified via genetic testing) and (2) the extent of their disease at the time of their first ophthalmic evaluation (unaffected, glaucoma suspect, glaucoma, or advanced glaucoma). At their initial examination, 83% of the “genetic cases” were unaffected and 17% were glaucoma suspects. In contrast, 44% of the “clinical cases” were glaucoma suspects, while 28% had glaucoma and 28% had advanced glaucoma. This is the first study to demonstrate the clinical utility of predictive genetic testing for MYOC glaucoma, the researchers said. Haripriya et al (p. 295) assessed the long-term posterior capsule opacification (PCO) and Nd:YAG capsulotomy rates associated with 3 different intraocular lenses (IOLs): (1) a modified square-edge PMMA lens, (2) a round-edge PMMA lens, and (3) a square-edge hydrophobic acrylic lens. They found that the mean PCO score was significantly lower in patients who received the modified square-edge PMMA IOL, while the incidence of PCO in those who received the round-edge PMMA IOL continued to escalate throughout the study. This prospective fellow eye study involved 94 patients. All patients had the modified IOL implanted in 1 eye and then were randomized to receive either the round-edge PMMA IOL or the square-edge hydrophobic acrylic IOL in the other eye. PCO density and capsulotomy rates were tracked annually for the first 5 years and measured again at year 9. The results are of particular importance for surgeons and patients in developing countries, the researchers said, as cost constraints often mandate the use of round-edge PMMA lenses—and lack of access to follow-up care places patients at greater risk of developing visual problems related to PCO. In the first clinical study to do so, Vehof et al (p. 280) investigated predictors of discordance between the symptoms and signs of dry eye disease (DED). They found that the presence of a painful chronic disease—notably irritable bowel syndrome, fibromyalgia, and chronic pelvic pain—is the strongest predictor of a discordance, indicating that part of the DED population may show signs of dysfunctional somatosensory pathways. Other conditions associated with greater symptoms than signs included allergy and atopic disorders, depression, diabetes, and osteoarthritis. In contrast, Sjögren syndrome and graft-vs.-host disease were associated with fewer symptoms than signs, as was increasing age. Awareness of these predictors should provide additional guidance to clinicians as they assess patients with DED, the researchers said.