April 2019

OUTSIDE THE OR

News in brief


Sleep and DED

A good night’s sleep may play a role in dry eye disease, according to research1 published in the journal Cornea. Researchers looked at more than 100 consecutive patients with dry eye disease, evaluating tear breakup time, corneal staining, Schirmer I tests, symptom severity using a visual analog scale, and Pittsburgh Sleep Quality Index scores, as well as the Patient Health Questionnaire and results of the General Anxiety Disorder Scale. They found that the Pittsburgh Sleep Quality Index score was higher in those with dry eye disease, compared to controls without dry eye disease. According to Wu et al., patients who had poorer quality sleep had more severe dry eye. There was also a correlation between sleep quality and mood status, the investigators found, in addition to a higher level of anxiety being experienced by patients with dry eye disease.

Vitamin D supplementation enhances artificial tears

Recent research2 suggests that vitamin D supplements can enhance the effect of artificial tears, adding to the body of research that has already linked vitamin D deficiency to dry eyes. One hundred and sixteen patients with dry eye disease were divided into vitamin D deficiency and non-vitamin D deficiency groups, based on their serum 25-hydroxyvitamin D levels. Various dry eye disease tests were performed before and 2 weeks after supplementation. Ultimately, the research found that the efficacy of topical artificial tears was dependent on serum 25-hydroxyvitamin D levels, and supplementation of vitamin D could enhance the efficacy of these treatments.

Evidence links Mediterranean diet to lower AMD risk

The evidence associating a so-called Mediterranean diet—a diet rich in fruit, vegetables, and fish—to lower AMD risk is growing. Two European-based prospective cohort studies for a total of nearly 5,000 participants were included in research,3 which was published in the journal Ophthalmology. The study found that those who more tightly adhered to a Mediterranean diet were 41% less likely to get advanced AMD.

Spectacle independence achieved with IC-8

The IC-8 small aperture IOL (AcuFocus) achieved complete spectacle independence in more than half of the patients who received it in a study4 published in the journal Eye. The multicenter, nonrandomized, retrospective case series included 126 patients and found that more than 90% of patients without preexisting ocular pathology achieved UDVA of 6/12 or better in the IC-8 eye. Ninety-eight percent achieved UCDVA of 6/9 binocularly. Of those who did not achieve complete spectacle independence, glasses were only needed for near vision tasks or dim-light reading, according to the investigators.

FLACS shows benefit in eyes with shallow ACs

A prospective, randomized, masked clinical study5 out of India compared FLACS and traditional phaco cataract surgery in eyes with shallow anterior chambers (less than 2.5 mm). The research evaluated central corneal thickness, corneal clarity, anterior chamber cells and flare, endothelial cell density, and other factors at 1 day, 1 week, and 1, 3, and 6 months postop. The average central corneal thickness was significantly lower in the FLACS group at 1 day and 1 week postop and fewer eyes had higher than Grade 2 anterior chamber cells and flare in this group. Endothelial cell density was higher in the FLACS group by 6 months postop, but the difference was not statistically significant. Overall, the study authors concluded that FLACS “maintained clearer corneas, showed a lesser increase in central corneal thickness, lower anterior chamber inflammation and better unaided visual acuity in the early postoperative period.”

Epithelial remodeling at 2 years: LASIK vs. SMILE

A contralateral eye study6 of LASIK vs. SMILE in 21 patients found similar results in epithelial remodeling at 2 years postop. OCT images showed significant epithelial thickening in the corneas regardless of the refractive surgery technique, which A. John Kanellopoulos, MD, wrote “suggests that epithelial remodeling may correlate with relative curvature changes resulting after both techniques, rather than the obvious difference of subepithelial corneal denervation changes.” The preoperative and postoperative differences in central epithelial thickness were statistically significant, but there was not a significant difference in this measurement between the two techniques.

Increased risk of COPD in patients with exfoliation syndrome

Patients with exfoliation syndrome (XFS) are already at increased risk for glaucoma, cataracts, and other ocular issues, and recent research7 is showing that they also have increased risk for chronic obstructive pulmonary disease (COPD). Despite this increased risk, the research found that those with exfoliation syndrome and COPD seem to live longer than those with just COPD. “This work strongly suggests that XFS provides some factor, as yet to be discovered, which prolongs life and counterbalances the presence of the diseases mentioned above,” Robert Ritch, MD, said in a press release statement.

OCT-A scan used to detect retinal differences in patients with Alzheimer’s

Research suggests that a loss of retinal blood vessels, as viewed through an OCT-angiography (OCT-A) image, could indicate early Alzheimer’s disease. According to a study by researchers at Duke Eye Center that compared OCT-A retinal images of healthy patients and patients with Alzheimer’s disease, there was a statistically significant reduction in retinal blood vessel density in the latter group. “We’re measuring blood vessels that can’t be seen during a regular eye exam and we’re doing that with relatively new noninvasive technology that takes high-resolution images of very small blood vessels within the retina in just a few minutes,” Sharon Fekrat, MD, said in a press release statement. “It’s possible that these changes in blood vessel density in the retina could mirror what’s going on in the tiny blood vessels in the brain, perhaps before we are able to detect any changes in cognition.”

References

1. Wu M, et al. Association between sleep quality, mood status, and ocular surface characteristics in patients with dry eye disease. Cornea. 2019;38:311–317.

2. Hwang JS, et al. Vitamin D enhances the efficacy of topical artificial tears in patients with dry eye disease. Cornea. 2019;38:304–310.

3. Merle BMJ, et al. Mediterranean diet and incidence of advanced age-related macular degeneration: the EYE-RISK consortium. Ophthalmology. 2019;126:381–390.

4. Hooshmand J, et al. Small aperture IC-8 intraocular lens in cataract patients: achieving extended depth of focus through small aperture optics. Eye (Lond). 2019. Epub ahead of print.

5. Vasavada VA, et al. A comparative evaluation of femtosecond laser assisted cataract surgery and conventional phacoemulsification in eyes with shallow anterior chamber. J Cataract Refract Surg. 2019. Epub ahead of print.

6. Kanellopoulos AJ. Comparison of corneal epithelial remodeling over 2 years in LASIK versus SMILE: a contralateral eye study. Cornea. 2019;38:290–296.

7. Taylor SC, et al. Association between chronic obstructive pulmonary disease and exfoliation syndrome. Ophthalmology Glaucoma. 2019;2:3–10.

8. Yoon SP, et al. Retinal microvascular and neurodegenerative changes in Alzheimer’s disease and mild cognitive impairment compared with control participants. Ophthalmol Retina. 2019. Epub ahead of print.

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