EyeWorld Weekly Update, August 25, 2017

August 25, 2017
Volume 23 , Number 29

Use of AREDS supplements in certain patients could be a cost-saving measure

The use of Age-Related Eye Disease Study (AREDS) supplements in category 4 age-related macular degeneration (AMD) patients is both cost saving and more effective than no supplement use at all, according to a U.K. study led by Aaron Y. Lee. Researchers evaluated the cost effectiveness of AREDS 1 and 2 supplements in bilateral intermediate AMD, AREDS category 3, or unilateral neovascular category 4 patients. The study setting was the U.K. National Health Service (NHS), and the study model was populated with data from AREDS and real-world outcomes and resource use from a neovascular AMD study with 92,976 ranibizumab (Lucentis, Genentech, South San Francisco) treatment episodes. Researchers compared immediate intervention with AREDS supplements or no supplements and analyzed quality-adjusted life years and healthcare costs for each strategy. For AREDS category 4 patients, the supplements were more effective and less costly over the lifetime of the patients. A recommendation to publicly fund category 3 patients would depend on the healthcare system willingness to pay, the researchers concluded. The study appears in the British Journal of Ophthalmology.

Poor visual function associated with poor cognitive function

Poor distance acuity was associated with poor cognitive function in a study of a representative sample of U.S. Medicare beneficiaries using self-reported visual function. Led by Stephanie Chen, BS, this cross-sectional analysis included patients from the National Health and Nutrition Examination Survey (NHANES), 1999-2002 (2,975 respondents age 60 years and older), and the National Health and Aging Trends Study (NHATS), 2011-2015 (30,202 respondents age 65 and older with dementia status assessment). In the NHANES group, distance visual impairment and subjective visual impairment were associated with lower Digit Symbol Substitution Test (DSST) scores. Near visual impairment was associated with lower DSST scores, but there were not higher odds of DSST impairment. Similar results were found with the NHATS data. Although more studies are needed, the study highlights the potential importance of visual screening to identify patients with eye disease and cognitive performance deficits, the authors concluded. The study appears in JAMA Ophthalmology.


  • Patients with impaired fasting glucose have IOP levels higher than those in patients with normal serum glucose, reported Eytan Cohen, MD, and co-researchers. Their results are similar to what is found in patients with diabetes mellitus. They also found a direct correlation between fasting serum glucose levels and IOP changes. The researchers' cross-sectional sample analyzed 18,406 subjects who had routine annual screening at a tertiary medical center between 2000 and 2013. The mean subject age was 46 years, and most patients were male. The mean confidence interval IOP was 13.1 mm Hg in subjects with normal glucose levels compared with 13.7 mm Hg in subjects with impaired fasting glucose and 14.3 mm Hg in those with diabetes. The differences were significant even after researchers adjusted for age, body mass index, and hypertension. The IOP increased by 0.09 mm Hg in men and 0.11 mm Hg in women for every 10 mg/dL increase in fasting serum glucose. The findings illustrate another end-organ effect of uncontrolled blood sugar levels, they concluded. The research appears in the Journal of Glaucoma.
  • A risk stratification from baseline ulcer characteristics can help surgeons identify patients at the highest risk for corneal perforation development and who may require a therapeutic penetrating keratoplasty (TPK) in infectious keratitis, according to N. Venkatesh Prajna, MD, and co-researchers. Their work was a secondary analysis of the Mycotic Ulcer Treatment Trial II, a multicenter, double-masked, placebo-controlled trial with 240 patients with smear-positive filamentous fungal corneal ulcers. Patients had a baseline visual acuity of 20/400 or worse. They were randomized to receive oral voriconazole or a placebo, but all patients received topical voriconazole, and after 39 participants were enrolled, topical natamycin 5% was added. The mean patient age at enrollment was 49 years. The presence of hypopyon at baseline increased the odds of corneal perforation or the need for TPK by 2.28 times. Another factor that increased the need included an infiltrate involving the posterior one-third. For each 1-mm increase in the geometric mean of the infiltrate, there was a 1.37 odds increase for perforation development or the need for TPK. Visual acuity, baseline culture positivity, type of filamentous fungal organism, and other factors were not significant predictors. The research appears in JAMA Ophthalmology.
  • Good visual acuity and refraction occurred after multifocal IOL implantation after cataract surgery, although results were less predictable in myopia larger than 6.0 D, reported Violette Vrijman, MD, and co-researchers. Their retrospective cohort study analyzed multifocal IOL implantation in 77 eyes (43 patients) that had corneal refractive laser surgery for myopia. Primary outcome measures included corrected distance visual acuity, uncorrected distance visual acuity (UDVA), and refraction. Lens extraction occurred in 29 eyes because of cataract, and 48 eyes had a refractive lens exchange. The mean postop UDVA was 0.14 logMAR, and the mean postop spherical equivalent was -0.38 D. Fifty-seven percent of eyes were within 0.50 D of emmetropia; 86% were within 1.0 D. About 21% of eyes had a laser enhancement for residual refraction, and 18.2% had a neodymium:YAG laser capsulotomy because of posterior capsule opacification. The study is published in the Journal of Cataract & Refractive Surgery.
  • The anticipation of potential challenges and difficulties with Descemet's membrane endothelial keratoplasty (DMEK) can help surgeons to modify potential strategies for predisposed eyes, according to Ruth Quilendrino, and co-researchers. Their retrospective study reviewed 500 consecutive eyes with DMEK (393 patients) for intraop and postop complications for up to 2 years and corresponding management. In 16.2% of eyes, intraop challenges occurred, including difficulty with graft unfolding/positioning, high vitreous pressure, iris root hemorrhage, and Descemet's membrane remnants. The most common postop complication was visually significant graft detachment (6.8%). Other postop complications included an increase in IOP, significant cataract, allograft rejection, cystoid macular edema, microbial keratitis, and retinal detachment, although many of these occurred in a small percentage of eyes. In 1.6% of eyes, graft failure occurred. The research appears in the journal Cornea.

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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