EW Weekly, March 20, 2020

ASCRS cancels Annual Meeting
ASCRS is cancelling its Annual Meeting originally scheduled for May 15–19. ASCRS came to this decision in the interest of public safety, after monitoring daily recommendations from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), the Massachusetts Department of Public Health (DPH), and the City of Boston. ASCRS continues to be an important resource for ongoing education, advocacy, and philanthropic efforts. ASCRS is exploring the possibility of rescheduling the meeting and will continue to offer online resources to support members’ ongoing clinical and networking needs. No action is needed on the part of members at this time.

Thoughts from EyeWorld Chief Medical Editor Eric Donnenfeld, MD
Serious times call for serious decisions, and this is most definitely a serious time for all of us. We who practice ophthalmology have a wonderful profession where we improve patient lives in extraordinary ways. I think now is the time to take action to do what is best for the people we care so deeply about. Both the CDC and the U.S. Surgeon General have recommended that elective, non-urgent procedures be delayed. In some locations, the government has mandated the postponement of elective surgery in hospital outpatient clinics. It is also my opinion that it is time for us to exercise due caution. In the ASC that I use, we have made the decision to close the center to all but emergency cases, and we are closing our offices for routine visits as well. I think our mutual, overwhelming obligation now is to the community in which we live. As we move through uncharted waters, I wish all of you the wisdom to make the correct decisions in the days to come.

COVID-19: Conjunctival congestion may have diagnostic significance
Conjunctival congestion may have clinical diagnostic significance as a COVID-19 related ocular symptom, reported Liwen Chen and researchers, who investigated the ocular manifestations and clinical characteristics of COVID-19 in a report for medRxiv. They included 534 Chinese patients and collected various information on demographics, exposure history, and ocular health. SARS-CoV-2 detection also was performed via nasopharyngeal swabs. Among the patients, 4.68% (25 patients) had conjunctival congestion, three of whom had it as their initial symptom. The top three COVID-19 related symptoms were dry eye (20.97%), blurred vision (12.73%), and foreign body sensation (11.80%). Sixty-two percent of patients had hand/eye contact history. There also was a history of prior eye disease in some patients, including conjunctivitis (6.18%), dry eye (4.49%), keratitis (2.62%), cataract (1.69%), and diabetic retinopathy (0.94%). The most common clinical symptoms were fever, cough, and fatigue. More protective eyecare equipment and education on eye protection are needed as dirty hand/eye contact might be a risk factor for COVID-19, the researchers concluded.

Study: More adults at risk for vision loss in 2017 compared with 2002
There were more U.S. adults at risk for vision loss in 2017 compared with 2002, according to Sharon Saydah, PhD, and coresearchers in their survey study using data from the 2002 (n=30,920) and 2017 (n = 32,886) National Health Interview Survey. Participants were U.S. noninstitutionalized civilians who were over age 18. The survey asked if participants had visited an eyecare professional, received a dilated eye exam, and needed but were unable to afford eyeglasses, all in the past 12 months. Those considered at high risk for vision loss included those who were age 65 or older, had a self-reported diabetes diagnosis, or those with vision or eye problems. In 2002, 16% were age 65 and older. In 2017, 20% were age 65 or older. Study researchers calculated that there were more than 93 million U.S. adults in 2017 at high risk for vision loss compared with almost 65 million in 2002, a difference of 6.4 percentage points. However, only 56.9% reported visiting an eyecare professional each year; 56.9% received a dilated eye examination. Nine in 100 adults who said they needed eyeglasses could not afford them, which was a slight increase from 2002. The study appears in JAMA Ophthalmology.

Study enrollment complete for ARGOS-SC01 for IOP monitoring
Enrollment is complete in the ARGOS-SC01 study, a first-in-human clinical study to validate the suprachoroidal EYEMATE-SC sensor implant (Implandata Ophthalmic Products) that can continually monitor IOP, according to a company press release. The study has a total of 24 patients. The company already has its CE-marked EYEMATE-IO implant for use in glaucoma patients having cataract surgery. The EYEMATE-SC is geared toward patients not yet having cataract surgery.

Research briefs
  • When comparing 250 micrograms and 500 micrograms of intracameral moxifloxacin, clinical and corneal endothelial cells were comparable, and both doses were well tolerated clinically, reported David Chang, MD, and coresearchers in their prospective, masked, randomized study. The researchers focused on whether intracameral moxifloxacin 500 micrograms is noninferior to 250 micrograms for central endothelial cell loss after phaco. Fifty eyes of 25 patients between ages 48 and 69 years at Aravind Eye Care System were included. Eyes included had bilateral nuclear cataracts, a central endothelial cell density (ECD) of more than 2000 cells/mm2, and an endothelial cell density that did not differ more than 200 cells/mm2. The included eyes had phaco at least 14 days apart. The first eye was randomized to receive a 500 or 250 microgram dose of moxifloxacin intracamerally and received the other dose for the second eye surgery. The preop and 30-day and 90-day postop central ECD was determined by a reading center for a masked analysis of endothelial cell loss at 3 months postop. The point estimate and 95% CI for the mean difference in percentage of endothelial cell loss between 500 and 250 microgram doses at 3 months postop was 0.8%. After identifying and removing two outliers, noninferiority was proven with a mean difference of the point estimate, –2.2%. The findings support the use of a higher dose for improved antimicrobial coverage to help prevent postop endophthalmitis, the researchers concluded. The study appears in the Journal of Cataract & Refractive Surgery.
  • More ophthalmologic symptoms were found in patients with Parkinson’s disease compared with controls in an observational, cross-sectional, multicenter study, reported Carlijn Borm and coresearchers. A total of 848 patients with Parkinson’s disease and 250 healthy controls completed the Visual Impairment in Parkinson’s Disease Questionnaire (VIPD-Q), which addresses the ocular surface, intraocular, oculomotor, and optic nerve. The questionnaire also focuses on the effect of ophthalmic symptoms on daily activities. In 82% of patients, there were one or more ophthalmologic symptoms compared with 48% of controls (P˂0.001). There also were more ophthalmologic symptoms across all domains compared with the controls, reflected by a higher VIPD-Q total score among patients than controls. The eye symptoms interfered with daily activities in 68% of patients compared with 35% of controls (P˂0.001). A screening questionnaire like the VIPD-Q may help to pinpoint eye symptoms in Parkinson’s disease and lead to more timely treatment, the researchers concluded. The study is published in Neurology.

Product news
Avellino Labs announced that it was temporarily suspending sequencing operations of AvaGen, which tests for risk of keratoconus and corneal dystrophies, in order to produce AvellinoCoV2, an ultra-rapid genetic test for SARS-CoV-2.

This issue of EyeWorld Weekly was edited by Stacy Jablonski and Vanessa Caceres.

EyeWorld Weekly (ISSN 1089-0319), a digital publication of the American Society of Cataract and Refractive Surgery (ASCRS), 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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