This Issue at a Glance

Abstract

Pasquale et al (p. 2318) investigated the link between oral health and primary open-angle glaucoma (POAG). They found that the recent loss of at least 1 tooth was associated with a modest increase in the risk of POAG. For this prospective study, the researchers evaluated data on 40 536 male health professionals, who had been followed biennially from 1986 to 2012. During follow-up, 485 cases of POAG were confirmed. Although some markers of dental disease (notably, having periodontal disease or having undergone a root canal) were not associated with POAG, the experience of having lost teeth within the previous 2 years was associated with a 1.45-fold increased risk of developing POAG. Because this is the first study to link recent tooth loss with POAG, the researchers noted that some of the results may be due to chance and should be interpreted with caution and confirmed with other studies. In the first study to do so, Ha et al (p. 2435) measured pterygium severity using Pentacam Schempflug imaging. They report that this automated method is highly associated with visual acuity and corneal tomography, is more precise than previously reported severity measures, and is unaffected by obscured limbi and iris pigments. The researchers term the method DPC, for “distance from the pterygium head's leading edge to the corneal apex.” For this study, the researchers evaluated 50 consecutive patients with primary unilateral pterygium. Data were collected on DPC, as well as on the standard measurements of relative encroachment length (RL) area and corneal coverage percent (CC). The researchers reported that automated DPC was 3 times faster than standard strategies for measuring RL and CC—and it required only 1 click. However, they also noted that DPC does not incorporate vertical length measurements of pterygium. Future modifications of Schempflug imaging software could help create a consensus on grading pterygium severity for standard comparisons of surgical outcomes, they suggested. Suh et al (p. 2309) set out to investigate whether glaucomatous eyes with focal lamina cribrosa (LC) defects have reduced vessel density, as measured by optical coherence tomography angiography (OCT-A). They found that vessel density was significantly lower in primary open-angle glaucoma (POAG) eyes with focal LC defects, especially in the superotemporal and inferotemporal sectors. In addition, they found that reduction of vessel density was spatially correlated with the location of the LC defect. For this cross-sectional case-control study, the researchers evaluated 82 patients with POAG, half of whom had LC defects. Overall, the mean circumpapillary vessel density (cpVD) in eyes with LC defects was lower than in those without LC defects. The findings are consistent with those from previous studies suggesting that a relationship exists between focal LC defects and impaired ocular hemodynamics, the researchers noted. Moreover, the results add to the evidence that mechanical and vascular mechanisms of glaucomatous optic nerve injury are “inseparably intertwined.” Dickman et al (p. 2276) compared visual acuity, refraction, endothelial cell density (ECD), and complication rates after Descemet stripping automated endothelial keratoplasty (DSAEK) and ultrathin DSAEK (UT-DSAEK). They found that the ultrathin method resulted in faster and better recovery of best spectacle-corrected visual acuity (BSCVA). Other outcomes were similar between the 2 procedures. For this prospective, double-masked trial, the researchers evaluated 66 patients (66 eyes) with irreversible corneal endothelial dysfunction due to Fuchs' corneal dystrophy. The patients were randomly assigned to undergo DSAEK or UT-DSAEK. While preoperative BSCVA did not differ between the 2 groups of patients, postoperative BSCVA was better in UT-DSAEK patients at all follow-up points (3, 6, and 12 months). Refraction, ECD loss, donor loss, and graft dislocation did not differ between the DSAEK and UT-DSAEK patients at all follow-up evaluations. Essex et al (p. 2393) prepared a detailed analysis of the behavior of eyes in the maintenance phase of a treat-and-extend regimen for neovascular age-related macular degeneration (AMD). They found that mean visual acuity (VA) was well maintained, while median injection interval progressively increased from 35 days at study entry to 63 days at 12 months and levelled off at 60 days at 36 months. With regard to disease reactivation, they found that the most common treatment interval at first recurrence was 8 weeks and that treatment intervals >12 weeks appeared to be associated with an increased risk of disease reactivation. Longer duration of induction phase was associated with worse VA outcomes and earlier disease reactivation, perhaps due to undertreatment, they said. For this observational study of 2096 eyes, the researchers analyzed clinical information obtained from a large prospective international voluntary registry of neovascular AMD.