EyeWorld Weekly Update, June 2, 2017

June 2, 2017
Volume 22 , Number 21

FDA approves cetirizine ophthalmic solution 0.24% for ocular itching

The U.S. Food and Drug Administration (FDA) approved cetirizine ophthalmic solution 0.24% (Zerviate, Nicox, Sophia Antipolis, France) to treat ocular itch associated with allergic conjunctivitis, according to a company press release. Formerly called AC-170, this is the first topical ocular formulation of the well-known antihistamine to treat ocular itching with allergic conjunctivitis, according to a company press release. Cetirizine is the active ingredient in Zyrtec (Johnson & Johnson, New Brunswick, New Jersey), a second-generation antihistamine that binds competitively to histamine receptor sites to reduce swelling, itching, and vasodilation. Nicox established the efficacy of Zerviate with three randomized, double-masked, placebo-controlled conjunctival antigen challenge clinical trials in patients who had a history of allergic conjunctivitis. "Onset and duration were evaluated in two of these trials, in which Zerviate demonstrated statistically and clinically significantly less ocular itching compared to vehicle at 15 minutes and 8 hours after treatment," according to Nicox.

Visual cortex continues to develop until mid-life, researchers find

The visual cortex continues to develop until the late 30s or early 40s of life, according to Kathryn Murphy, and investigators from the Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, Ontario. It was previously thought that the visual cortex matured and stabilized in the first years of life. The research indicates that the visual cortex develops until about age 36, plus or minus 4.5 years. "This is a big gap in our understanding of how our brains function," Ms. Murphy said in a press release. "Our idea of sensory areas developing in childhood and then being static is part of the challenge. It's not correct." The findings may affect future treatment for amblyopia, which traditionally is based on the premise that only children can benefit from corrective therapies. Other areas of the brain may be much more plastic for longer than researchers have thought, according to Ms. Murphy. The research appears in the Journal of Neuroscience.

AMA: Fewer physicians report practice ownership

Fewer than 50% of physicians have an ownership stake in their medical practice, the American Medical Association (AMA) reported in an updated study this week. This is the first time that physician practice owners fell below a majority portion of U.S. patient care physicians since AMA began to track related trends. "The share of patient care physicians with ownership stakes in a medical practice declined 6 percentage points to 47.1% in 2016 from 53.2% in 2012," according to an AMA press release. The percentage of physicians with employed positions rose about 5 percentage points to 47.1% in 2016, compared with 41.8% in 2012. "As a result, there were equal shares of physician employees and physician practice owners in 2016, while 5.9% of patient care physicians were independent contractors," the AMA reported. Almost two-thirds of physicians under age 40 were employees in 2016. Surgical subspecialties had the highest share of owners (59.3%). Emergency medicine had the smallest share of owners (27.9%). Most physicians still work at practices with 10 or fewer physicians, according to the study.


  • In a study focused on the association between visual function and ocular surface regularity in dry eye, investigators found that reduced contrast sensitivity results in part from central superficial punctate keratopathy (SPK) overlying the optical zone and that increased straylight results from tear film instability rather than central SPK. Led by Shizuka Koh, investigators enrolled 52 eyes of 52 dry eye patients (34 patients had dry eyes with SPK in the central corneal region, and 18 had dry eyes without central SPK). The study also enrolled 20 eyes of 20 normal control subjects. Investigators measured contrast sensitivity function under photopic conditions. Straylight was measured with a straylight meter. The dry eyes with central SPK had significantly lower contrast sensitivity function. Although the straylight values in both dry eye groups did not differ, the straylight values were greater than those in normal eyes. The research appears in Investigative Ophthalmology and Visual Science.
  • Intracameral moxifloxacin prophylaxis lowered the overall endophthalmitis rate by 3.5-fold in more than 600,000 cataract surgeries performed at Aravind Eye Hospitals in India during the 29-month period from January 2014 to May 2016. Aravind Haripriya, MD, and co-investigators compared the postoperative endophthalmitis rate before and after intracameral moxifloxacin prophylaxis for phacoemulsification, sutureless manual small-incision cataract surgery and in patients with posterior capsule rupture. Electronic health record data for all eyes in this retrospective study were analyzed. A total of 302,815 eyes did not receive intracameral moxifloxacin, but 314,638 eyes did. With moxifloxacin use, there was a significant drop in the endophthalmitis rate from 0.07% to 0.02%. In the 194,252 phacoemulsification eyes, the endophthalmitis rate was 0.07% without intracameral prophylaxis compared with 0.01% with moxifloxacin. For eyes having sutureless manual small-incision cataract surgery, the endophthalmitis rate was 0.07% compared to 0.02% with moxifloxacin. Investigators also found a statistical benefit for moxifloxacin use in eyes with posterior capsule rupture, leading them to recommend intracameral antibiotic prophylaxis for that high-risk population. The study appears in Ophthalmology.
  • Implantation of a single intracorneal ring segment (ICRS) to treat mild to moderate progressive keratoconus appears to provide positive mid-term outcomes. Mohammad Miraftab, MD, and co-investigators conducted their retrospective study in patients with progressive keratoconus treated with an ICRS for a mean follow-up time of 15.2 months before and 27.8 months after surgery. Fifty-nine of the patients had inferior keratoconus; patients received no other treatment. Corrected distance visual acuity dropped by one line during the preop follow-up and improved by two lines after surgery. Investigators observed significant decreases in anterior elevation at the thinnest point and posterior corneal central elevation. After treatment, corneal thickness at the center and the thinnest point increased. Other changes that took place included postop decreases in the keratoconus index, index of height decentration, and index of surface variance. The research is published in Cornea.
  • Routine testing before cataract surgery is commonly performed in the U.S. Veterans Health Administration, but emerging practices such as femtosecond laser-assisted cataract surgery (FLACS) and immediate sequential bilateral cataract surgery have limited roles, according to a retrospective analysis. Annika Havnaer and fellow investigators emailed surveys to cataract surgery practices within the Veterans Health Administration and had a response rate of 75%. Preop testing was routinely ordered by cataract surgeons; in 22 of 66 Veterans Health sections, cataract surgeons administered intracameral antibiotics. Toric IOLs were used in 61 of 66 sections. Only 6 of 66 sections performed FLACS or immediate sequential bilateral cataract surgery. Nearly 75% of ophthalmology chiefs said they had a high level of satisfaction with Veterans Affairs ophthalmology. "The results of this survey could benchmark future trends in U.S. cataract surgery practices, especially in teaching hospital settings," the investigators concluded. The study appears in the Journal of Cataract & Refractive Surgery. 


  • Beaver-Visitec International (Waltham, Massachusetts) announced the U.S. launch of Extend 180 Absorbable Synthetic Implants. The product is a punctal implant for dry eye symptoms and provides 6 months of relief. The implants are dissolvable and suited for post-ocular surgery, seasonal dry eye, contact lens intolerance, and/or dry eye with digital eye strain.

This issue of EyeWorld Weekly Update was edited by Amy Goldenberg and Vanessa Caceres.

EyeWorld Weekly Update (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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