EW Weekly, November 13, 2020

SARS-CoV-2 does not replicate in human cornea
According to research from the Washington School of Medicine in St. Louis, SARS-CoV-2, the coronavirus that causes COVID-19, does not replicate in the human cornea. The study published in Cell Reports by Miner et al evaluated the immune-mediated regulation of SARS-CoV-2, Zika, and herpes simplex virus 1. The study authors wrote that while a SARS-CoV-2 receptor is expressed in the cornea, these results suggest that the cornea doesn’t support infection. Lead author Jonathan Miner, MD, PhD, said in a press release that every donor cornea tested was resistant to the coronavirus. In addition to the findings about SARS-CoV-2, the researchers reported that type III interferon and its receptor were expressed in corneal epithelium, and corneal explants that were treated with type III interferon upregulated the antiviral genes. Type III interferon limited the growth of Zika and the herpes virus in the human cornea. A press release from the university noted that other tissues around the cornea have yet to be assessed for their potential to replicate these viruses and thus eye protection is still merited for SARS-CoV-2.

Permanent CPT code for drug-eluting intracanalicular inserts
Ocular Therapeutix announced the granting of a permanent Category I CPT code for drug-eluting intracanalicular inserts, like the company’s Dextenza (dexamethasone ophthalmic insert, 0.4 mg), indicated for treating inflammation and pain after ophthalmic surgery. The CPT code is effective as of Jan. 1, 2022, to replace the currently available Category III CPT code. Until the new code is effective, the current code (0356T) should be used.

Second Phase 3 trial started for IOP-lowering drug
Nicox began its Denali trial, a second Phase 3 trial for NCX 470, an IOP-lowering drug for open angle glaucoma or patients with ocular hypertension. This drug is the company’s lead product candidate for its novel, second-generation nitric oxide-donating bimatoprost analog, Nicox’s press release reported. This pivotal trial is required for new drug applications in the U.S. and China. The trial is 3 months long, evaluating the safety and efficacy of NCX 470 0.1% vs. latanoprost ophthalmic solution 0.005%. Patient enrollment has begun for the trial, which is expected to randomize more than 650 patients at sites in the U.S. and China.

ASCRS Foundation grant applications closing soon
The application period for two ASCRS Foundation grant opportunities is scheduled to close on November 16. The 2021 ASCRS Foundation Young Eye Surgeon International Service Grant provides up to $5,000 in funding for grantees to initiate a global service project. The funds will allow recipients to begin their project at home in 2021 with the opportunity to travel when safe and feasible, allowing them to see their project in action by the end of 2022. This opportunity is available to ASCRS members who are third-year residents, fellows, or within their first 5 years of practice. More information about the Young Eye Surgeon International Service Grant can be found here. The Chang-Crandall Humanitarian Award, a $50,000 award endowed by David Chang, MD, and his wife, Victoria Chang, was recently renamed in recognition of Alan Crandall, MD, who lived an exemplary life committed to charitable eyecare service. This award is given annually to an individual in recognition of their inspirational accomplishments in the area of humanitarian eyecare with a focus on cataract blindness. The recipient is recognized at the ASCRS Annual Meeting and the prize is awarded to a charitable ophthalmology organization of the recipient’s choosing. Submit a nomination for the Chang-Crandall Humanitarian Award by November 16 here.

Research highlights
  • A randomized clinical trial evaluated intense surgical simulation for training in manual small incision cataract surgery. Participants from Kenya, Tanzania, Uganda, and Zimbabwe were randomized to either receive standard surgical training or standard surgical training with additional simulation training (5 days). Trainees who received the additional simulation training had higher scores (by about 16.6 points) at 3 months, compared to the control group. They also performed more cataract surgeries in the year following than those in the control group (mean 21.5 vs. 8.5, respectively) and had a lower posterior capsule rupture rate (7.8% vs. 26.6%, respectively). This research is published in JAMA Ophthalmology.
  • Three-year outcomes of the HORIZON trial with the Hydrus Microstent (Ivantis) were reported in the journal Ophthalmology. This multicenter, randomized, clinical trial included 556 eyes from 556 patients with cataract and primary open angle glaucoma who were on at least one glaucoma medication and who after washout had a diurnal IOP between 22–34 mmHg. Patients were randomized to either have cataract surgery alone or cataract surgery with the Hydrus Microstent implanted. At 3 years postop, IOP was 16.7±3.1 mmHg vs. 17.0±3.4 mmHg, in the phaco with Hydrus group and phaco-alone group, respectively. Seventy-three percent of eyes that received the Hydrus were medication-free at 3 years, compared to 48% in the phaco-alone group. The Hydrus group also had a higher proportion of eyes with an IOP of less than or equal to 18 mmHg without medications. Incisional glaucoma surgery within this timeframe was 0.6% in the Hydrus group compared to 3.9% in the phaco-alone group. There was no difference in endothelial cell loss between the groups and no procedural or device-related adverse events that resulted in vision loss.

Product news
  • STAAR Surgical announced the commercialization and first patient implantation for its EVO Viva presbyopia-correcting ICL, which received the CE mark earlier this year. The company completed patient enrollment for its FDA clinical trial earlier this year for EVO/EVO+ Visian with 6-month results expected in the second quarter of 2021.
  • Hoya Surgical Optics obtained the CE mark for Qube pro powered by eyeflexa, which the company’s press release explained is a multi-upgrade platform designed to support the needs of surgeons as their expertise and practice demands grow.
  • I-MED Pharma launched tearcheck in Canada as a standalone machine that assesses ocular surface inflammation, tear film stability, non-invasive tear breakup time, redness, meibography, tear meniscus, Demodex, OSDI questionnaire, and abortive blinking.

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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