EyeWorld Weekly Update, February 23, 2018

February 23, 2018
Volume 24 , Number 6

Phase 3 trial for myopia treatment by Eyenovia slated for 2019

Based on discussions with the U.S. Food and Drug Administration (FDA), Eyenovia (New York) has learned that it only requires one Phase 3 pivotal study instead of two trials to advance its MicroPine program to treat progressive myopia into Phase 3 clinical development. The trial is slated to start in the first half of 2019. MicroPine is the company's proprietary microtherapeutic formulation of atropine to slow myopia development. Eyenovia recently published results from the second Phase 2 trial of its myopia treatment, according to a company press release.

More complications, failures associated with Boston KPro use in children

The use of a Boston type 1 keratoprosthesis (KPro, Massachusetts Eye and Ear Infirmary, Boston) in children had a significantly higher rate of complications, a greater chance of device failure, and worse visual outcomes when compared with adults, according to Simon S.M. Fung, MA, and coauthors in their retrospective, multicenter case series published in Ophthalmology. In the study, the KPro was implanted in 11 eyes of 11 patients from 0.9 to 15.5 years of age. The main outcome measures were intraop and postop complications, device retention, and best corrected visual acuity (BCVA). All patients had glaucoma, and six of them had a glaucoma drainage device inserted before the KPro. The preop BCVA ranged from 20/600 to light perception; vision in two eyes was fix and follow. At the last follow up (mean, 41.8 months), two eyes maintained a BCVA of 20/400 or better, but five eyes lost light perception. Postop complications included retroprosthetic membrane (nine eyes), corneal melt (five eyes), infectious keratitis (three eyes), endophthalmitis (three eyes), glaucoma drainage device erosion (two eyes), and retinal detachment (five eyes). The KPro was kept in four eyes. The authors concluded that they do not recommend KPro use in children.

Burnout common among physicians, study finds

More than a third of physicians experience burnout, according to a study of the correlates and outcomes of physician burnout in a single health system led by Amy Windover, PhD, and published in JAMA Internal Medicine. The sample studied included 1,145 physicians from the Cleveland Clinic Health System. Among them, 35% had experienced burnout, including emotional exhaustion and/or depersonalization. Burnout also led some of the physicians to leave the profession or receive ombudsman complaints.

Cast your vote in the Voice of Ophthalmology

The Voice of Ophthalmology will premiere on April 15 at the 2018 ASCRS/ASOA Annual Meeting in Washington, D.C. This new session, based on the popular television talent show, will be featured as Part 2 of the Sunday Summit General Session and promises to be an exciting addition to this year's Annual Meeting. Before ASCRS unveils the contestants on show day, they need your help in choosing the six topics that will be debated during the inaugural season. Voting is now open. You will have 2 weeks to make your voice heard. Cast your vote today.


  • Recurrent anterior uveitis is more likely to lead to an increased chance of experiencing ankylosing spondylitis (AS), according to Baek-Lok Oh and coauthors. Anterior uveitis is a common extra-articular manifestation of ankylosing spondylitis, and AS-related anterior uveitis can present as an acute and recurrent iridocyclitis. For this reason, ophthalmologists often will suspect AS before the patient has seen or been referred to a rheumatologist. The authors' study looked at a national sample cohort of 10,483 patients with new onset uveitis between 2004 and 2013 as well as 52,415 matched control subjects. The incidence rate of AS per 100,000 person-years after the first episode of uveitis was 121.5 compared with 16.0 in the control group. The incidence rate ratio in patients under the age of 40 was 46.78, but there was not a major difference in patients over the age of 59 compared with the control group. The results could lead to a rationale for an ancillary workup for possible systemic associations in patients with recurrent uveitis, the authors concluded. The research is published in Arthritis Research & Therapy.
  • Specialists should try to avoid primary evisceration in infections limited to the anterior segment, according to Rajat Jain, MS, and coauthors in their study of therapeutic keratoplasty outcomes in cases with severe microbial keratitis that were otherwise advised evisceration. The retrospective clinical audit included 28 patients with severe microbial keratitis from one center between April 2014 and April 2016. Included cases had microbial keratitis that affected more than two quadrants of the limbus and/or cases with infections that involved more than 180 mm2 of the cornea that were advised to have evisceration. Endophthalmitis cases were excluded. A success was considered when the infection resolved within 3 months and evisceration was not required. A failure occurred when infection recurred in the graft or if the eye was eviscerated. Ultimately, evisceration was required in two of 28 eyes. Success occurred in 22 (78.6%) eyes. Outcomes were generally poorer in cases of fungal keratitis (n=16) compared with bacterial keratitis. The study is published in Cornea.
  • Tear film breakup time assessment measured with an automated noninvasive keratograph did a better job at detecting dry eye compared with the conventional fluorescein method, according to Michael T.M. Wang, MBChB, and co-researchers. Their investigator-masked randomized crossover trial included 74 participants who were divided into two equally sized age, sex, and race/ethnicity-matched groups. Patients received a noninvasive keratography evaluation and topical fluorescein instillation in a randomized order. Breakup time was significantly longer with the keratography in patients with dry eye (median, 6.3 seconds versus 4.3 seconds) and healthy participants (median, 11.9 seconds versus 5 seconds). The measurements of fluorescein breakup time were more narrowly distributed in dry eye and control groups. The research appears in JAMA Ophthalmology.
  • In a study of the expected versus actual position and dimension of cornea incisions during femtosecond laser-assisted cataract surgery (FLACS), primary incisions were close to the expected dimensions, according to Chandra Bala, PhD, and coauthors. Their retrospective case series reviewed video recordings of FLACS performed with a LenSx laser (Alcon, Fort Worth, Texas). Deviations of the main and two secondary incisions from the expected position were correlated with globe tilt, globe displacement, and biometric data. Primary incision internal and external exits were within 142 microns and 150 microns of the planned position. A multivariate analysis showed that the external and internal exits of the superior and inferior secondary incisions correlated with globe tilt and displacement. Secondary incision positions were affected by eye tilt and eccentric docking, but this could be improved with OCT guidance, the authors concluded. The research appears in the Journal of Cataract & Refractive Surgery.

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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