September 2018


News in brief

Herpes zoster vaccination rates “remain relatively low”

Though the U.S. Centers for Disease Control and Prevention recommends healthy adults 50 years and older receive the herpes zoster vaccine, a paper published in Cornea revealed physician attitudes and practices with this vaccination are low compared to other vaccinations recommended for this age group. A cross-sectional online survey of physicians conducted from January–March 2017 at the New York University Langone Hospital Division of General Internal Medicine and Clinical Innovation in five practice settings (response rate 26%; 138 respondents out of 530 contacted) showed that 93% and 94% of physicians agree that influenza and pneumococcal vaccination, respectively, are clinical priorities, while 76% agreed with the clinical priority of zoster vaccination. Only 35% said they “strongly agree” with the importance of zoster vaccination, compared to 68% and 74% who strongly agree with the clinical importance of pneumococcal and influenza vaccination. In terms of the zoster vaccine in practice, the survey found that physicians estimated 43% of healthy patients 60 or older received the zoster vaccine, and 11% of patients 50–60 were vaccinated with it. “[Herpes zoster] vaccination rates remain relatively low compared with rates of influenza and pneumonia vaccination,” Tsui et al. wrote, adding that there is a need for stronger recommendations by primary care physicians for the zoster vaccine.


Tsui E, et al. Evaluating physician attitudes and practices regarding herpes zoster vaccination. Cornea. 2018;37:947–51.

Novel, platelet-rich plasma injections treat severe dry eye

A small study of patients with Sjögren’s syndrome who had severe dry eye evaluated the use of platelet-rich plasma injections, finding them to be “safe and effective in improving tear parameters as well as subjective parameters,” according to Avila et al. The research published in the British Journal of Ophthalmology included 15 patients who received four injections at 0, 30, 60, and 90 days, in addition to daily use (five times daily) of hyaluronic acid, and 15 control patients who only used hyaluronic acid five times per day during the study period. Those who received the platelet plasma injections showed reduced corneal staining, increased Schirmer scores (5.6±0.7 to 9.0±1.1 mm), increased tear break-up time (4.0±0.4 to 6.4±0.4) at 90 days, and improved ocular surface disease index scores. “This [represents] a novel alternative treatment for severe dry eye,” Avila et al. wrote.


Avila MY, et al. Randomised, prospective clinical trial of platelet-rich plasma injection in the management of severe dry eye. Br J Ophthalmol. 2018. Epub ahead of print.

Orange consumption and macular degeneration

A study of Australian adults 50 and older followed over 15 years revealed that those who ate at least one serving of oranges daily had a 60% reduced risk of developing macular degeneration. “The data shows that flavonoids found in oranges appear to help protect against the disease,” Bamini Gopinath, PhD, associate professor, Westmead Institute for Medical Research, said in a press release. “Flavonoids are powerful antioxidants found in almost all fruits and vegetables, and they have important anti-inflammatory benefits for the immune system,” Dr. Gopinath continued. “We examined common foods that contain flavonoids such as tea, apples, red wine, and oranges. Significantly, the data did not show a relationship between other food sources protecting the eyes against the disease.”


Gopinath B, et al. Dietary flavonoids and the prevalence and 15-y incidence of age-related macular degeneration. Am J Clin Nutr. 2018;108:381-387.

Phaco and ECP provides “modest” IOP reduction in uncontrolled glaucoma

Three-year study results of the IOP-lowering effects of phacoemulsification combined with endocyclophotocoagulation (ECP) in eyes that had not had prior glaucoma surgery showed a mean 25% reduction in IOP (18.7 mm Hg preoperatively to 14 mm Hg), according to research published in the Journal of Cataract and Refractive Surgery. Smith et al. described this as a “modest but significant drop in IOP.” This effect, the study authors acknowledged, is less than that of trabeculectomy or tubes and how it compares to microinvasive glaucoma surgery (MIGS) options is “uncertain.” While ECP and phaco did not have any serious side effects, Smith et al. noted that 60% of the procedures were classified as “failures” by the 3-year mark, which meant they either (1) had an IOP higher than 21 mm Hg, an IOP lower than 6 mm Hg, or did not reach at least a 20% reduction from baseline after 1, 2, or 3 years postop; or (2) or needed further surgery to reduce IOP within the study period.


Smith M, et al. Phacoemulsification and endocyclophotocoagulation in uncontrolled glaucoma: Three-year results. J Cataract Refract Surg. 2018. Epub ahead of press.

New technique for lenticule dissection in SMILE

Researchers describe a new lenticule dissection technique for the refractive procedure small incision lenticule extraction (SMILE) in the Journal of Cataract and Refractive Surgery. Typically, the lenticule, which is formed based on two planes created by a femtosecond laser, is dissected with a spatula and removed with forceps. The method described by Weng et al. uses a corneal flap separator and “a trace of balanced salt solution placed on the superficial interface of the lenticule” to separate the anterior plane followed by the posterior plane. Balanced salt solution was also used to wash the ocular surface around the corneal pocket incision before dissecting at each plane. The study, which involved 29 patients who had the traditional dissection technique in one eye and the liquid dissection technique in the other, found the liquid dissection technique resulted in significantly fewer corneal aberrations within 2 hours and 1 month postop, higher contrast sensitivity at postop day 1, and smoother lenticule surfaces. “The balanced salt solution dissection technique in small-incision lenticule extraction contributes to rapid visual recovery,” Weng et al. concluded, adding that it could make surgical time shorter with less force required for dissection.


Weng S, et al. Development of a liquid dissection technique for small-incision lenticule extraction: Clinical results and ultrastructural evaluation. J Cataract Refract Surg. 2018. Epub ahead of press.

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