Mean logMAR Visual Acuity Research Articles

Appearance of Polypoidal Lesions in Patients With Polypoidal Choroidal Vasculopathy Using Swept-Source Optical Coherence Tomographic Angiography

Polypoidal choroidal vasculopathy (PCV) is a major cause of visual loss worldwide, particularly in Asia, and the appropriate understanding of the structures in PCV previously described as polypoidal lesions is important for understanding their pathogenesis, diagnosis, and prognosis. To report the morphologic characteristics of polypoidal lesions and their association with branching vascular networks (BVNs) in eyes with PCV using swept-source optical coherence tomographic angiography (SS-OCTA). This cross-sectional observational study included 20 participants recruited from Shanghai General Hospital with a diagnosis of PCV based on the presence of focal hyperfluorescent spots on indocyanine green angiography (ICGA). Data were collected from December 1, 2017, to September 1, 2018, and analyzed from June 1 through September 30, 2018. Polypoidal lesions in eyes with PCV were characterized using multimodal imaging that included fundus photography, fluorescein angiography, ICGA, SS-OCT, and SS-OCTA, and the images were anatomically aligned. Subfoveal choroidal thickness was manually measured as the distance between the Bruch membrane and the sclerochoroidal interface on the SS-OCT images. Of the 20 Asian patients, 5 (25%) were women and 15 (75%) were men. The mean (SD) age was 61.1 (7.6) years, and the mean (SD) logMAR visual acuity was 0.358 (0.294) (Snellen equivalent, 20/50 [20/40]). Twenty-three eyes underwent imaging and were diagnosed with PCV. Indocyanine green angiography identified 43 polypoidal lesions, and all corresponded to the structures that appeared as clusters of tangled vessels on SS-OCTA images. In addition, SS-OCTA detected 16 tangled vascular structures not seen on ICGA. Branching vascular networks were detected on SS-OCTA imaging in all eyes, but ICGA identified BVNs in only 17 of 23 eyes (74%). Of the 43 tangled vascular structures, 40 (93%) were located at the edge of a BVN and 3 (7%) were associated with type 2 neovascularization. In eyes with PCV undergoing SS-OCTA imaging, previously described polypoidal lesions may appear as tangled vascular structures associated with BVN or type 2 neovascularization. The identification of polypoidal lesions in patients with PCV as neovascular tangles rather than actual polypoidal lesions or aneurysmal dilatations may help facilitate understanding of their pathogenesis and response to treatment.

Pars Plana Vitrectomy Alone for Primary Rhegmatogenous Retinal Detachments Associated With Inferior Breaks in Phakic Eyes.

This study examines whether pars plana vitrectomy (PPV) can achieve a high rate of reattachment in primary rhegmatogenous retinal detachments (RRDs) caused by inferior breaks in phakic eyes. Patients with primary, phakic RRD with inferior retinal breaks repaired by PPV, endolaser, and gas tamponade between January 2012 and December 2016 were included. Twenty-six eyes from 26 patients were included. Mean patient age was 61.7 years (range: 38 years to 82 years). Thirteen RRDs were macula-involving, with an average of 2.00 ± 0.70 quadrants and 2.50 ± 2.00 breaks. Twenty-three of 26 eyes (88.5%) were attached at postoperative month (POM) 3. Mean logMAR visual acuity was 0.72 ± 0.84 at baseline, 0.65 ± 0.44 at POM 3, 0.44 ± 0.50 at POM 12, and 0.43 ± 0.36 at the final visit. Single-surgery success rate of phakic RRD caused by inferior breaks repaired by PPV is high. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:153-158.].

An innovative visual acuity chart for urgent and primary care settings: validation of the Runge near vision card

ObjectiveWe evaluated the Runge card, a near-vision eye chart designed for ease of use, by testing agreement in visual acuity results between it and the Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity chart. As a clinical reference point, we compared the Runge card and an electronic Snellen chart with respect to agreement with ETDRS results.MethodsParticipants consisted of adult eye clinic patient volunteers who underwent a protocol refraction, followed by testing with a Runge card, ETDRS chart, and Snellen chart. Mean logMAR visual acuities were calculated for each method. Agreement levels among the tests were assessed for the group overall and for subjects with good (ETDRS logMAR < 0.6; better than 20/80 Snellen equivalent) and poor (logMAR ≥ 0.6) acuity.ResultsOne hundred and thirty-eight participants completed testing. The mean ( ± standard deviation) logMAR visual acuities (Snellen equivalent) with Runge, ETDRS, and Snellen, respectively, were 0.66 ± 0.50 (20/91, n = 138), 0.59 ± 0.51 (20/78, n = 138), and 0.67 ± 0.62 (20/94, n = 137). Runge testing agreed similarly with ETDRS and Snellen testing, with CCC 0.92 between Runge and ETDRS, and 0.87 between Runge and Snellen (p = 0.14). Runge agreed better with ETDRS than Snellen agreed with ETDRS in participants with poor acuity (CCC = 0.79 vs. 0.63, respectively, p = 0.001) but not in those with good acuity (CCC = 0.70 vs. 0.87, respectively, p = 0.005).ConclusionVisual acuity measurements with the Runge near card agreed with measurements from the ETDRS to approximately the same degree as did the Snellen chart, suggesting potential utility of the Runge near card, particularly given its user-friendly characteristics and ease of use.

Effect of glaucoma on identification of bottle cap color in ophthalmic medications.

A prospective, nonrandomized, observational trial of 60 glaucoma patients to correlate visual acuity and visual field with ability to distinguish bottle cap color of commonly used ophthalmic medications was conducted. A total of 103 eyes from 60 patients (30 women) were evaluated. The mean logMAR acuity was 0.34±0.54 (approximately 20/45 Snellen acuity), average Humphrey Visual Field (HVF) mean deviation was -8.58±8.69 dB, mean Ishihara plates (out of 14) were 11.78±4.15, and bottle cap color score (out of 10) was 8.56±2.51. Multiple linear regression analysis revealed an independent correlation of visual acuity (P=0.0137) and Ishihara score (P<0.001) with cap color score, but no significant effect with visual field mean deviation (P>0.05). Glaucoma patients with poor visual acuity, but not necessarily advanced visual field loss, are likely to have difficultly identifying the color of their bottle caps. Physicians should be cognizant of this potential issue when reviewing medications with patients.

Focal laser application versus bevacizumab for treatment of central serous chorioretinopathy

Aim To report and compare the efficacy of macular grid laser versus intravitreal bevacizumab injection (IVBI) in patients with central serous chorioretinopathy (CSCR). Patients and methods A prospective study on 36 eyes of 35 patients with CSCR was conducted. The diagnosis of CSCR was established by fluorescein angiography and optical coherence tomography (OCT). All patients underwent measurement of best-corrected visual acuity, intraocular pressure, dilated fundus examination, and (OCT) imaging at baseline and follow-up visits. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Patients were classified into group A, comprising 19 patients who were treated with macular grid laser and group B, comprising 17 patients who were treated with IVBI. The outcome measures were the resolution of neurosensory detachment, improvement in visual acuity, and resolution of leakage. All cases were evaluated after 3, 6, 12, and 24 weeks. Data were classified into two groups and statistically analyzed. Results In group A, the mean age of patients was 43.6 years (range, 23–52 years), there were 11 (57.89%) males and eight (42.10%) females, and the mean of follow-up period was 9.2 months (range, 7–18 months). The mean log MAR visual acuity score improved from 0.8 to 0.40 after 3 months of follow-up. The mean baseline central macular thickness (CMT) was 466 µm (range, 358–576 µm), which decreased to 309 µm (range, 268–356 µm) after 6 weeks, with statistically significance difference change from the baseline, and to 247 µm (range, 225–319 µm) after 3 months, with statistically significance difference change from the baseline (P Conclusion Both macular grid laser and IVBI for CSCR can lead to improvements of visual acuity and hasten recovery period. Macular grid laser may be considered as effective as anti-vascular endothelial growth factor for treatment of CSCR. More studies using larger scales may be needed to clarify the uncertain relationship between pathogenesis and results of treatment.

Rigid gas permeable contact lenses for visual rehabilitation of unilateral aphakic children in China

PurposeTo investigate the effectiveness, safety and tolerance of rigid gas-permeable contact lenses (RGP CLs) in the visual rehabilitation of unilateral aphakic children in China. MethodsRecords of 36 children (36 eyes) with RGP CLs to unilateral aphakia between 2014 and 2018 were evaluated. Each enrolled child underwent vision assessment (visual acuity, fixation, and deviation) at each follow-up visit and their caregivers completed a questionnaire designed to find out the reasons for RGP CLs dropout. The fit characteristics and adverse events were also evaluated. ResultsThe mean age was 7.0 months (interquartile range, 5.0–12.8 months). The final mean logMAR visual acuity (VA) of the treated eyes was 1.2 ± 0.7 for 12 patients who cooperated in visual assessments and 6 out of these subjects had a VA of better than 1.0 logMAR. The proportion of treated eyes which could be recorded the visual results increased significantly after RGP CLs intervention (5.6% vs. 33.3%, P < 0.001). The final VA assessed for the fellow eyes and both eyes were 0.7 ± 0.4 and 0.6 ± 0.3, respectively. Of the 36 patients, 24 had strabismus. There was no severe lens-related adverse event except only one patient had mild conjunctivitis. At the end of the follow-up it was found that 25 eyes are still using RGP CLs (69%). Indications to discontinue contact lens wear included difficult manipulation of RGP CL, loss of motivation, unstable lens, and eye irritation. ConclusionsRGP contact lenses provide an effective and safe alternative method for visual rehabilitation and can be well tolerated in pediatric aphakia.

Optical coherence tomography in central nervous system demyelinating diseases related optic neuritis.

To compare the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) among patients with various forms of optic neuritis (ON) and to identify whether any particular parameters or their thinning pattern can be used to distinguish the type of ON. This prospective study was conducted at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Thailand, between January, 2015 and December, 2016. We enlisted patients over 18 years of age with history of ON and categorized patients into 4 groups: 1) aquaporin 4 antibodies (AQP4-IgG) positive; 2) multiple sclerosis (MS); 3) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) positive; 4) idiopathic-ON patients. Healthy controls were also included during the same study period. All patients underwent complete ophthalmological examination and spectral domain optical coherence tomography (OCT) imaging to analyze RNFL and GCIPL thickness after at least 3mo since the last episode of acute ON. The generalized estimating equation (GEE) models were used to compare the data amongst ON groups. Among 87 previous ON eyes from 57 patients (43 AQP4-IgG+ON, 17 MS-ON, 8 MOG-IgG+ON, and 19 idiopathic-ON), mean logMAR visual acuity of AQP4-IgG+ON, MS-ON, MOG-IgG+ON, and idiopathic-ON groups was 0.76±0.88, 0.12±0.25, 0.39±0.31, and 0.75±1.08, respectively. Average, superior, and inferior RNFL were significantly reduced in AQP4-IgG+ON, MOG-IgG+ON and idiopathic-ON eyes, relative to those of MS-ON. Differences were not statistically significant for RNFL or GCIPL between the AQP4-IgG+ON and MOG-IgG+ON groups, whereas visual acuity in MOG-IgG+ON was slightly, but not significantly, better (0.39 vs 0.76). Although RNFL thickness in MOG-IgG+ON was significantly reduced as compared to MS-ON, mean visual acuity and GCIPL were not different. Thinning of superior and inferior quadrants of RNFL are more commonly seen in MOG-IgG+ON and AQP4-IgG+ON. Long term visual acuity in MOG-IgG+ON is often better than AQP4-IgG+ON, whereas the structural change from OCT is comparable.

Treatment of Punctate Inner Choroidopathy with Choroidal Neovascularization Using Corticosteroid and Intravitreal Ranibizumab.

Background To evaluate the treatment outcomes of patients with punctate inner choroidopathy (PIC) and secondary choroidal neovascularization (CNV). Methods This is a retrospective study of 24 eyes in 22 patients suffering from PIC with CNV. Patients were treated with intravitreal ranibizumab monotherapy (14 eyes) or combined oral corticosteroid and intravitreal ranibizumab therapy (corticosteroid-ranibizumab group, 10 eyes). Mean follow-up duration was 24.0 months. We evaluated best-corrected visual acuity (BCVA), fundus autofluorescence, fluorescein angiography, indocyanine green angiography, and optical coherence tomography, before and after treatment. The following variables were compared between groups: number of intravitreal ranibizumab injections, BCVA, recurrence of CNV, and change in PIC lesions. Results The ranibizumab monotherapy group received an average of 3 intravitreal ranibizumab injections; mean logMAR visual acuity improvement was 0.34, and 8 eyes developed recurrent CNV during follow-up. The corticosteroid-ranibizumab group received an average of 1.9 intravitreal ranibizumab injections; mean logMAR visual acuity improvement was 0.61, and there was no recurrence of CNV. Combined corticosteroid-ranibizumab therapy also resulted in better resolution of PIC lesions and fewer new PIC lesions. Conclusion Both corticosteroid-ranibizumab treatment and ranibizumab monotherapy could significantly improve the vision of PIC patients with CNV. Combined corticosteroid and intravitreal ranibizumab treatment appeared to reduce CNV recurrence and development of new PIC lesions compared with ranibizumab monotherapy.

Simultaneous penetrating keratoplasty and amniotic membrane transplantation in eyes with a history of limbal stem cell deficiency

To describe the outcomes of simultaneous penetrating keratoplasty (PK) and amniotic membrane transplantation (AMT) performed both as a ring-shaped graft and as a temporary patch in eyes with a history of limbal stem cell deficiency (LSCD). Prospective observational case series including 48 simultaneous PK/AMT procedures (48 patients) in eyes with a history of partial or total LSCD. Patients with total LSCD were first treated with limbal stem cell transplantation. The preoperative indication was graft failure in 58.3% of cases. Most recipients (89.6%) were at high-risk for rejection. The mean graft reepithelialization time was 29.2±30.8 days. Graft reepithelialization was achieved in 30 days in 70.8% of cases. No AMT-related adverse events were observed. The mean time from keratoplasty-to-last visit was 84.5±54.5 months. The 3-year graft survival rate was 62.5%. Recurrence of corneal epithelial defects after graft reepithelialization (47.9%) was associated with lower graft survival (P=0.004). In eyes with successful grafts at the last visit, the mean LogMAR visual acuity was 1.90 (20/1575)±5 lines before keratoplasty and 0.89 (20/155)±10 lines at 5 years. A ring of amniotic membrane was visible between the graft stroma and the corneal epithelium on slit-lamp examination and optical coherence tomography in all successful cases. In this series of eyes with a history of LSCD and at high-risk of rejection, simultaneous PK and AMT were associated with satisfactory graft survival and no additional adverse events.

Combined Intravitreal Triamcenolone Acetonide and Bevacizumab for Refractory Diabetic Macular Edema.

To evaluate the effectiveness of combined Intravitreal triamcinolone acetonide (IVTA) and Intravitreal Bevacizumab (IVB) for treatment of refractory diabetic macular edema. Quasi-experimental study. Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, from January to December 2017. Pseudophakic diabetic patients with macular edema refractory to prior treatment were included. Patients having best corrected visual acuity (BCVA) better than 20/40 (6/12) or worse than 20/200(6/60) or the central subfield thickness (CSFT) less than 300 um on spectral domain optical coherence tomography (OCT) were excluded. Effectiveness of treatment was compared in terms of change in BCVA and CSFT on OCT. Intravitreal injection of 2 mg IVTA and 1.25 mg of IVB was given. IVB was repeated on monthly basis in next two months. Follow-up was done after one week of first injection and then monthly for next three months. Fifty eyes of 42 patients were studied. Mean age of the patients was 62.4 years +7.13. Male to female ratio was 2:1. Mean pre op LogMAR visual acuity was 0.708 +0.12 and CSFT was 439.10 +54.64 um. Mean postoperative LogMAR visual acuity was 0.586 +0.13 um and mean post op CSFT was 382.80 +56.12. There is statistically significant difference in improvement of LogMAR BCVA and decrease in CSFT after treatment. (p<0.001, paired t-test). Eyes with refractory macular edema showed improvement of visual acuity and reduction of CSFT at three months when treated with combined IVTA and IVB.

Behavior of hyperreflective foci in non-infectious uveitic macular edema, a 12-month follow-up prospective study

BackgroundHyperreflective foci have been described in OCT imaging of patients with retinal vascular diseases. It has been suggested that they may play a role as a prognostic factor of visual outcomes in these diseases. The purpose of this study is to describe the presence of hyperreflective foci in patients with non-infectious uveitic macular edema and evaluate their behavior after treatment.MethodsWe conducted a multicenter, prospective, observational, 12-month follow-up study. Inclusion criteria were age > 18 years and a diagnosis of non-infectious uveitic macular edema, defined as central macular thickness of > 300 μm as measured by OCT and fluid in the macula. Collected data included best corrected visual acuity, central macular thickness and the presence, number and distribution (inner or outer retinal layers) of hyperreflective foci. Evaluations were performed at baseline, and at 1, 3, 6, and 12 months after starting treatment.ResultsWe included 24 eyes of 24 patients. The frequency of patients with ≥11 hyperreflective foci was 58.4% at baseline, falling to 20.8% at 12 months. Further, hyperreflective foci were observed in the outer retinal layers in 50% of patients at baseline and just 28.6% at 12 months. Mean LogMAR visual acuity improved from 0.55 (95% CI 0.4–0.71) at baseline to 0.22 (95% CI 0.08–0.35) at 12 months (p < 0.001). Mean central macular thickness decreased from 453.83 μm (95% CI 396.6–511) at baseline to 269.32 μm (95% CI 227.7–310.9) at 12 months (P < 0.001). Central macular thickness was associated with number (p = 0.017) and distribution (p = 0.004) of hyperreflective foci.ConclusionsWe have observed hyperreflective foci in most of our patients with non-infectious uveitic macular edema. During follow-up and after treatment, the number of foci diminished and they tended to be located in the inner layers of the retina.

Comparison of the effects of photodynamic therapy, intravitreal ranibizumab and combination for polypoidal choroidal vasculopathy under 1\u2009+\u2009PRN regimen

BackgroundThe optimal treatment for polypoidal choroidal vasculopathy (PCV) is still under debate. Little knowledge is known about the treatment effect of “1+pro re nata(PRN)” treatment regimen for PCV. The aim of this study was to compare the outcomes of photodynamic therapy (PDT), intravitreal ranibizumab injection (IVR) and combination therapy under the “1 + PRN” treatment regimen for PCV.MethodsFifty-seven eyes of 57 patients completed the 12 months’ follow-up in this prospective study. The patients in the PDT arm(n = 23), ranibizumab arm(n = 18), or combination arm(n = 16) underwent a session of PDT, IVR or combination of both at baseline followed by additional IVR as needed. Mean change of logarithm of the minimal angle of resolution (logMAR) visual acuity (VA), central foveal thickness (CFT) and the regression rate of polyps were evaluated. Cost-benefit analysis was also performed.ResultsAt Month 12, the mean logMAR VA improved from 0.90 ± 0.52 to 0.75 ± 0.57 in the PDT group (P < 0.05), from 0.96 ± 0.58 to 0.77 ± 0.41 in the IVR group (P < 0.05), and from 0.94 ± 0.55 to 0.72 ± 0.44 in the combination group (P < 0.05), respectively. The CFT decreased from 478.04 ± 156.70 μm, 527.5 ± 195.90 μm, and 522.63 ± 288.40 μm at the baseline to 366.43 ± 148.28 μm, 373.17 ± 134.88 μm and 328.44 ± 103.25 in the PDT group (P < 0.05), IVR group (P < 0.01), and the combination group (P < 0.05), respectively. However, no statistical difference was found between groups (P > 0.05). PDT treatment (60.87%) was superior to the IVR therapy (22.22%) in achieving complete regression of polyps (P < 0.05). Cost-benefit analysis showed that IVR treatment cost the least money for improving per 0.1logMAR units and the combination therapy demanded the least money for reducing per 100 μm of CFT.ConclusionsPDT, IVR and the combination therapy have similar efficacy in the VA improvement as well as the reduction of CFT under the “1 + PRN” treatment regimen.Trial registrationCurrent Controlled Trials NCT03459144. Registered retrospectively on March 2, 2018.

Five-Year Postoperative Outcomes of Bilateral Aphakia and Pseudophakia in Children up to 2 Years of Age: A Randomized Clinical Trial

Comparative evaluation of complications and visual outcomes following bilateral congenital cataract surgery in children up to 2 years of age with and without primary intraocular lens (IOL) implantation at 5 years follow-up. Randomized controlled clinical trial. Sixty children (120 eyes) up to 2 years of age undergoing bilateral congenital cataract surgery were randomized to Group 1, primary aphakia (n=30), or Group 2, primary IOL implantation (pseudophakia) (n= 30). A single surgeon performed surgeries with identical surgical technique. All patients were followed up regularly until 5 years postoperatively. At each follow-up, glaucoma, visual axis obscuration (VAO) requiring surgery, and inflammation (cell deposits, posterior synechiae) were assessed. Visual acuity was assessed until 5 years follow-up. The first operated eye was selected for statistical analysis. Median age of the patients at time of surgery was 5.11months (aphakia group) and 6.01months (pseudophakia group) (P= .56). Five years postoperatively, incidence of glaucoma was 16% and 13.8% in Groups 1 and 2 (P= .82). Incidence of posterior synechiae was significantly higher in the pseudophakia group (27.6%) compared to the aphakia group (8%) (P= .004). VAO requiring surgery was seen in 8% and 10.3% of eyes in Groups 1 and 2 (P= .76). Mean logMAR visual acuity at 5 years follow-up was 0.59 ± 0.33 and 0.5 ± 0.23 in Groups 1 and 2, respectively (P= .79). However, more eyes in the pseudophakic group started giving documentable vision earlier in their postoperative follow-ups. Incidence of postoperative complications was comparable between the groups, except for a higher incidence of posterior synechiae in pseudophakic eyes. Visual rehabilitation was faster in the pseudophakic group.

High-Definition Optical Coherence Tomography of the Macula in Deprivational Amblyopia

This study evaluated macular thickness in deprivational amblyopia and compared it to matched controls. The authors present a cross-sectional study of patients with amblyopia from pediatric cataract and matched controls. Macular high-definition optical coherence tomography scans of each eye were acquired. Central macular thickness (CMT) and parafoveal thicknesses at 500 μm, 1,000 μm, and 1,500 μm in the nasal, temporal, inferior, and superior locations were measured. Thirty-four eyes were included: 14 eyes with deprivational amblyopia and 20 controls. In amblyopes, the mean age was 10.06 years ± 3.89 years and logMAR visual acuity (VA) was 0.41 ± 0.53, whereas in the control group, mean age was 8.96 years ± 1.89 years and mean logMAR VA was 0.03 ± 0.05. The macula in deprivational amblyopia was significantly thicker centrally compared to controls (P = .0013), but only tended to be thicker at 500 μm and thinner at 1,000 μm and 1,500 μm. Male gender, poorer VA, and hyperopic refraction positively correlated with CMT (P = .011, P = .018, and P = .038, respectively). Eyes with deprivational amblyopia had increased CMT compared to controls, and this correlated with the severity of amblyopia. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:198-204.].

Vision screening for correctable visual acuity deficits in school-age children and adolescents.

Vision screening for correctable visual acuity deficits in school-age children and adolescents.

Low frequency ranibizumab versus dexamethasone implant for macular oedema secondary to branch retinal vein occlusion

BackgroundThe aim was to make a real‐world comparison of the efficacy of ranibizumab, dexamethasone and grid laser treatments in macular oedema due to branch retinal vein occlusion (BRVO).MethodsForty‐four eyes of 44 consecutive patients with macular oedema secondary to BRVO were included. Treatment arms comprised standard care (StCARE, n = 15), intravitreal ranibizumab (RNB, n = 14) and dexamethasone implant (DEX, n = 15). No rescue laser was performed in DEX and RNB groups. Main outcome measures were mean change in visual acuity (VA) and the percentage of patients who gained 10 or more letters from baseline to six months and central retinal thickness (CRT).ResultsImprovements in mean logMAR VA (p = 0.642) and letter score from baseline to month 6 were not statistically significantly different in all three groups. Mean follow‐up was 13.9 ± 10.7 months in RNB, 11.9 ± 6.3 in DEX and 11.4 ± 6.6 in StCARE. Mean number of injections was 2.4 ± 1.4 (range: 1–6) in RNB and 1.9 ± 0.7 (range: 1–3) in DEX group over the follow‐up period. Mean letter gain was 13.5 in DEX (p = 0.067), 7.1 in RNB (p = 0.553) and 4.5 in StCARE (p = 0.362). Mean CRT at baseline was 512.8 μm in DEX, 505.1 μm in RNB and 345.5 μm in the StCARE group. At the last visit, RNB provided the maximum reduction in CRT. Mean CRT decrease was −146.5 μm (28.6 per cent) in DEX, −241.3 μm (47.8 per cent) in RNB and −45.6 μm (13.2 per cent) in StCARE (p = 0.030). A statistically significant intraocular pressure elevation occurred in the DEX group (p = 0.005).ConclusionBoth RNB and DEX provided a significant resolution in macular oedema. Low frequency injections limited the visual gain in ranibizumab therapy. Visual results could be better with higher frequency injections and early start of treatment. Dexamethasone implants may be preferable in terms of visual improvement under low frequency injection conditions. Close follow‐up is mandatory for detection of intraocular pressure elevations. Laser monotherapy is not a reasonable first‐line option in the era of injection therapies.

Dexamethasone implant (0.7 mg) in Indian patients with macular edema: Real-life scenario.

Context:Role of Ozurdex in macular edema due to various posterior segment pathologies.AIM:The aim of this study is to report outcome of Ozurdex implant in macular edema (ME) secondary to various posterior segment pathologies.SETTINGS AND DESIGN:This was a single-center, retrospective, interventional study.SUBJECTS AND METHODS:Patients of ME were treated with one or more Ozurdex implants (0.7 mg). Data collection included demographic details, best-corrected visual acuity (BCVA), central foveal thickness (CFT), duration of efficacy, and record of adverse events (if any) within 24 weeks.STATISTICAL ANALYSIS USED:Paired sample t-test, Stata data analysis, and statistical software, version 12.1, StataCorp, College Station, TX, USA, were used in the study.RESULTS:One hundred and sixteen eyes of 104 patients were studied which had a diagnosis of diabetic ME (n = 46), retinal vein occlusion (n = 40), and uveitis (n = 30). The average age of patients (mean ± standard deviation) was 50.2 ± 21.9 years. Baseline mean ± SD (standard deviation) logMAR BCVA, CFT, and intraocular pressure (IOP) were 0.636 ± 0.4, 527.8 ± 210.1 μm, and 15.3 ± 3.8 mmHg, respectively. The reinjection interval was around 12–18 weeks. Ozurdex proved its efficacy in improving mean logMAR visual acuity and reduction of CFT from baseline till 12 weeks' follow-up period (0.414 ± 0.5 and 301.5 ± 278.5, respectively; P < 0.05), and after 12 weeks' follow-up, it started worsening (0.530 ± 0.9 and 444.8 ± 375.2, respectively; P > 0.05). The most common reported adverse event was significant rise of IOP (>5 mmHg), with a total of 12 cases followed by cataract 9 cases.CONCLUSION:Ozurdex implant leads to a significant improvement in BCVA and CFT values till 12 weeks, followed by a gradual decline for all the pathologies studied together. No new safety concerns were observed with the Ozurdex implant. The duration of efficacy was found to be <24 weeks.

Normal Tritan Discrimination in Amblyopia Suggests Preservation of Koniocellular Function

Background: Human stereoscopic vision is a psychological abstraction emerging from sufficiently grouped monocular signals within a broader unity of simultaneous binocular perception. Incongruent central signals inevitably arise when moving through a visual landscape, due to changing asymmetries of perception, producing signal rivalry. Humans have an evolved capacity to dynamically inhibit incongruous or ambiguous signals in order to maintain a coherent unity of stereoscopic perception, a facility sometimes exploited by optical illusions. Unlike the beneficial mental construct that arises from physiological inhibition, the amblyopic inhibition is permanently unilaterally destructive, has a large field size, is associated with irreversible signal inhibition at the dorsal lateral geniculate nucleus (dLGN), and leads to structural alterations in dLGN that can be demonstrated histologically. Recent reports suggest amblyopic signal inhibition at the dLGN may be selective, preferentially involving the parvocellular system and sparing the koniocellular system. It is not yet known whether physiological inhibition is also pathway specific, but it would be surprising if it were not. The two chromatic opponent systems display differing vulnerabilities in a number of disease states, including optic neuritis and toxic neuropathies, and they followed independent evolutionary paths during phylogenetic development from small primates into apes and humans with larger eyes. Tritan contrast is conducted exclusively by the koniocellular system as far as the striate cortex, so clinical tests of tritan contrast may provide information about koniocellular function in humans. If koniocellular function is not inhibited in amblyopia then tritan discrimination tests may be normal in amblyopic eyes. Objective: In this study the C test for tritan discrimination was employed as a proxy for koniocellular function to discover whether tritan discrimination was affected in proportion with achromatic contrast in the amblyopic eye of 18 amblyopic adults. Method: The tritan contrast and logmar visual acuity results were compared between eyes, using two non parametric statistical tests. Results: The C test scores for tritan discrimination were statistically similar in the normal and amblyopic eyes, but mean logmar acuity scores were significantly different, with a mean of 0.76 in the amblyopic eyes compared to 0.18 in the non-amblyopic eyes. Conclusion: This finding is consistent with preservation of koniocellular signal perception despite parvocellular signal inhibition in amblyopic eyes.

Real-World Vision in Age-Related Macular Degeneration Patients Treated with Single Anti–VEGF Drug Type for 1 Year in the IRIS Registry

The purpose of this study is to compare real-world visual acuity (VA) in patients with neovascular age-related macular degeneration (nAMD) treated with a single anti-vascular endothelial growth factor (VEGF) drug monotherapy for 1 year from the American Academy of Ophthalmology (AAO) Intelligent Research in Sight (IRIS) Registry. Retrospective, nonrandomized, comparative study. IRIS Registry patients with nAMD who received bevacizumab, ranibizumab, or aflibercept only for 1 year between 2013-2016. Participants were divided into 3 groups based on monotherapy type. Multivariate analysis of covariance models (ANCOVA) was constructed in a stepwise fashion. The logarithm of the minimum angle of resolution (logMAR) VA at 1 year and mean change in logMAR VA between baseline and 1 year were compared between drug types. Of 13 859 patients, 6723 received bevacizumab, 2749 received ranibizumab, and 4387 received aflibercept only for 1 year. A total of 84 828 injections were performed. The mean number of injections (standard deviation) at 1 year was higher in the ranibizumab (6.4 [±2.4]) and aflibercept groups (6.2 [±2.4]) compared to bevacizumab group (5.9 [±2.4]; P < 0.0001). In the age-adjusted model, both ranibizumab and aflibercept achieved better logMAR VA at 1 year compared with bevacizumab (0.50 [±0.49], 0.49 [±0.44], 0.55 [±0.57]; P<0.0001). However, this difference was not significant after multivariate adjustment (age, baseline VA, diabetes, posterior vitreous detachment, number of injections, race, insurance). There was no statistical difference in the age-adjusted or multivariate-adjusted mean logMAR VA change (standard deviation) at 1 year among treatment groups (-0.048 [0.44] bevacizumab,-0.053 [0.46] ranibizumab,-0.040 [0.39] aflibercept; P= 0.46). A higher percentage of patients achieved a ≥3-line VA improvement at 1 year in the bevacizumab group (22.7%) compared with ranibizumab (20.1%; P= 0.0093) and aflibercept (17.8%; P < 0.0001). However, after multivariate adjustment, aflibercept exhibited a greater log odds of a ≥3-line VA loss compared with bevacizumab only (1.25log odds ratio; P < 0.0016). This study suggests that all 3 drugs improve VA similarly over 1 year of monotherapy.

One-year outcomes of ziv-aflibercept for macular edema in central retinal vein occlusion

PurposeTo report the 12-month efficacy and safety outcomes of intravitreal ziv-aflibercept in macular edema secondary to central retinal vein occlusion (CRVO). MethodsInterventional case series documenting 12-month outcomes of intravitreal ziv-aflibercept (1.25 mg in 0.05 mL) in 6 patients with treatment-naive macular edema secondary to CRVO. All patients had comprehensive ophthalmic examination, spectral domain optical coherence tomography at baseline and all follow-up visits, and fluorescein. Retreatment decisions were based on recurrence or persistence of intraretinal or subretinal fluid, deterioration in visual acuity (VA), increase in central subfield thickness (CST) by ≥ 50 μm from the previous visit, or lowest recorded CST. ResultsParticipants had (2 males, 4 females) an average age of 53.5 years. From baseline to 12 months, the mean logMAR VA improved from 0.86 (Snellen ≈ 20/145) to 0.33 (Snellen ≈ 20/40), central macular thickness decreased from 519 μm to 255 μm, and total macular volume decreased from 14.7 mm3 to 7.1 mm3. No eyes had uveitis, cataract progression, intraocular pressure (IOP) elevations, or systemic adverse events. Conclusions and importanceZiv-aflibercept achieves favorable intermediate-term functional and structural outcomes in macular edema secondary to CRVO. No safety concerns were raised. Low-cost ziv-aflibercept may thus be useful for CRVO in resource-poor countries. Further prospective studies in larger cohorts are needed further establish the efficacy and safety of this agent.