EW Weekly, May 27, 2016

May 27, 2016
Volume 21 , Number 18

Visual impairment, blindness to double in next 35 years

An aging baby boomer population in the U.S. will contribute to an expected doubling of the prevalence of visual impairment (VI) and blindness in the next 35 years, according to an American Medical Association press release. Rohit Varma, MD, Keck School of Medicine, University of Southern California, Los Angeles, and colleagues examined the demographic and geographic variations in VI and blindness in adults in the U.S. population in 2015 and estimated the projected prevalence through 2050. Data were pooled from adults 40 years and older from 6 major population-based studies on VI and blindness in the United States. Prevalence of VI and blindness were reported by age, sex, race/ethnicity, and per capita prevalence by state using the U.S. Census projections (January 1, 2015, through December 31, 2050). In 2015, a total of 1.02 million people were blind, and approximately 3.22 million people in the United States had VI (best corrected visual acuity in the better-seeing eye), whereas up to 8.2 million people had VI due to uncorrected refractive error. By 2050, the numbers of these conditions are projected to double to approximately 2.01 million people with blindness, 6.95 million people with VI, and 16.4 million with VI due to uncorrected refractive error. The highest numbers of these conditions in 2015 were among non-Hispanic white individuals, women, and older adults, and these groups will remain the most affected through 2050. However, African American individuals experience the highest prevalence of visual impairment and blindness. By 2050, the highest prevalence of VI among minorities will shift from African American individuals (15.2% in 2015 to 16.3% in 2050) to Hispanic individuals (9.9% in 2015 to 20.3% in 2050).

Zika virus linked to more eye problems

At the recent ASCRS/ASOA Symposium & Congress, Camila Ventura, MD, presented "Fundus Abnormalities in Infants with Microcephaly Associated with Presumed Zika Virus Congenital Infection in Brazil." Dr. Ventura and colleagues conducted a study that included 26 eyes of 13 newborns with microcephaly and presumed Zika infection. Both infants and mothers underwent ophthalmic examinations. Results indicated that, though some of the mothers had various symptoms during pregnancy, all had normal ocular examinations. Meanwhile, ocular findings were seen in 20 eyes (76.9%) of the 13 infants, with 7 infants having bilateral fundus alterations. These alterations included pigment mottling in the macular region, chorioretinal atrophy in the macular region, and optic nerve abnormalities. The study concluded that infants with microcephaly and presumed Zika may have vision-threatening fundus findings. In addition, researchers studying babies with a Zika virus-related birth defect say they have found previously unreported eye problems possibly linked to the virus, according to a news release from the American Academy of Ophthalmology (AAO, San Francisco). In 3 Brazilian infants with microcephaly, researchers observed retinal lesions, hemorrhaging and abnormal blood vessel development not noted before in relation to the virus, AAO said about the published study. In this small case series of 3 infant boys from Northern Brazil born in late 2015 (all to mothers with suspected Zika virus), researchers now found abnormal vasculature in the retina and torpedo maculopathy. All 3 infants showed signs of pigmentary maculopathy, lesions that appear as speckles of pigment on the macula. Four eyes had symptoms of chorioretinal atrophy marked by a darkly pigmented ring.

Botox cleared for additional use in Japan

The Japanese Ministry of Health, Labour and Welfare has approved Botox Vista (botulinum toxin type A product) for the temporary improvement in the appearance of lateral canthal lines in adult patients under the age of 65, Allergan (Dublin) said in a press release. The approval is based on results from a 300-patient phase 3 study in Japan. Of the patients who received a single dose of Botox Vista at 12 units or 24 units, more than 56.5% and 68.3%, respectively, achieved an improvement of the appearance of lateral canthal lines at day 30, compared to those patients who did not receive botulinum toxin type A treatment (8.2% with placebo). In a second phase 3 study patients received concurrent treatment of lateral canthal lines (12 units or 24 units) and glabellar lines (20 units) with Botox Vista in up to 4 treatment cycles. More than 80% of patients reported an improvement in the appearance of the lateral canthal lines at day 30 after each treatment cycle, according to Allergan. In both studies, adverse reactions were limited and Botox Vista was generally well tolerated.


  • Latanoprostene bunod 0.024% QD in the evening was non-inferior to timolol 0.5% BID over 3 months of treatment with significantly greater intraocular pressure (IOP) lowering in subjects with open angle glaucoma (OAG) and ocular hypertension (OHT) at all but the earliest time point evaluated and demonstrated a good safety profile, according to Felipe Medeiros and colleagues. In their study, 387 adults with OAG or OHT from 46 clinical sites (United States and European Union) were randomized 2:1 to latanoprostene bunod (LBN) instilled once in the evening and vehicle in the morning (n=259) or timolol instilled BID (n=128) for 3 months. Analysis of covariance showed mean IOP reduction with LBN was not only non-inferior to timolol but significantly greater (P≤0.025) to timolol at all but the first time point in this study (week 2, 8 a.m.). Of LBN- and timolol-treated subjects, respectively, 31.0% and 18.5% (P=0.007) had their IOP reduced ≥25% from baseline, and 17.7% and 11.1% (P=0.084) had their IOP reduced to ≤18 mm Hg over all time points/visits in this study. The study is published in the American Journal of Ophthalmology.
  • Among the risk factors leading to loss of epithelial flap integrity in laser-assisted subepithelial keratectomy (LASEK), age impacts the successful dissection of single-sheet epithelial flap, according to Joanna Galindo, and colleagues. Their retrospective chart review analyzed LASEK surgeries that occurred between January 2009 and October 2013. The study reviewed 1009 eyes of 509 patients with a mean age of 29.1±12.2 years. The mean preoperative spherical refraction was −4.7±2.5 D, and the mean preoperative cylinder was −1.1±0.8 D. The mean preoperative decimal corrected distance visual acuity was 1.01±0.07. Single-sheet mobilization of the loosened epithelium flap was found in 72.3% of cases. Fragmented preservation events occurred in 17.6% of cases; the flap was discarded in 10.0% of cases. Epithelium preservation was significantly correlated with age (P=.048) but not sex, sphere, cylinder, spherical equivalent, keratometry, central corneal thickness, or surgeon experience. Epithelial flap dissection was less likely to lead to a single epithelial sheet in patients older than 50 years than in younger patients (56.3% versus 74.9%). The mean postoperative decimal uncorrected distance visual acuity (UDVA) at 3 months was 0.98±0.08. There was no statistical difference in postoperative UDVA between the undiscarded flap group and discarded flap group. The study is published in the Journal of Cataract & Refractive Surgery.
  • Toric IOL implantation for mild keratoconic patients having rigid gas permeable lens intolerance appears to be effective for reducing refractive astigmatism without a significant induction of corneal higher order aberrations (HOAs), according to K. Kamiya and colleagues. Their study in the Japanese Journal of Ophthalmology examined 19 eyes of 19 consecutive keratoconic patients (mean age 63.1±9.1 years) who underwent phacoemulsification with toric IOL implantation. Logarithm of the minimal angle of resolution (logMAR) uncorrected distance visual acuity (UDVA) was significantly improved from 1.14±0.50 preoperatively to 0.46±0.33 postoperatively (Wilcoxon signed-rank test, p<0.001). LogMAR corrected distance visual acuity (CDVA) was also significantly improved from 0.27±0.45 preoperatively to -0.01±0.09 postoperatively (p<0.001). In 5 of 6 eyes in which the target refraction was emmetropia, postoperative UDVA was better than 20/32. The achieved spherical equivalent correction was within ±0.5 D of the targeted correction in 13 (68%) eyes and 1.0 in 18 (95%) eyes. The refractive astigmatism was significantly decreased from -1.92±1.73 D preoperatively to -0.70±0.60 D postoperatively (p=0.006). The corneal astigmatism changed from 2.89±1.30 D preoperatively to 2.98±1.09 D postoperatively (p=0.492), which was not statistically significant. The corneal HOAs for a 4-mm pupil changed from 0.47±0.23 µm preoperatively to 0.52±0.26 µm postoperatively (p=0.211).

EYEWORLD WEEK Online is edited by Stacy Majewicz and Michelle Dalton.

EyeWorld Week Online (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery and the American Society of Ophthalmic Administrators, is published every Friday, distributed by email, and posted live on Friday.

Medical Editors: Eric Donnenfeld, MD, chief medical editor; Rosa Braga-Mele, MD, cataract editor; Clara Chan, MD, cornea editor; Nathan Radcliffe, MD, glaucoma editor; and Vance Thompson, MD, refractive editor.

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