John F. Payne

Macular thickness assessment in healthy eyes based on ethnicity using Stratus OCT optical coherence tomography.

PURPOSEnTo assess the variation in macular thickness measurements in healthy Caucasian and African American men and women through Stratus OCT optical coherence tomography (OCT-3).nnnMETHODSnOne hundred sixty-six eyes of 83 healthy patients underwent complete ophthalmologic examination in this prospective study. Exclusion criteria included a diagnosis of diabetes mellitus, hypertension, intraocular pressure (IOP) greater than 21 mm Hg, history of eye surgery or trauma, or evidence of eye disease. For analysis purposes, the authors excluded those participants in whom OCT signal strength was <7 in each eye. A fast macular thickness protocol consisting of a 6-mm radial scan centered on the fovea was used for the analysis, and the data were analyzed using the t-test for independence and linear regression. Both eyes of each patient were analyzed using the OCT-3, and analysis showed a statistically significant correlation between right and left eyes. Therefore, only one eye from each patient was randomly selected for final correlation and analysis.nnnRESULTSnMean foveal thickness (MFT) for Caucasians was 32 microm greater than for African Americans (217 vs. 185 microm, respectively; P < 0.001). The MFT was significantly thicker in males than in females (220 vs. 197 microm, respectively; P < 0.001).nnnCONCLUSIONSnThe fovea is significantly less thick in African Americans and females than in Caucasians and males. Racial and sexual differences should be considered when interpreting an OCT scan.

Macular Atrophy in Neovascular Age-Related Macular Degeneration with Monthly versus Treat-and-Extend Ranibizumab: Findings from the TREX-AMD Trial

PURPOSEnTo compare the enlargement rate of macular atrophy (ERMA) in eyes treated with ranibizumab monthly or using a treat-and-extend (TREX) regimen for neovascular age-related macular degeneration (AMD) or fellow control eyes, as well as analyze risk factors for macular atrophy (MA) development and progression.nnnDESIGNnEighteen-month, multicenter, randomized, controlled clinical trial.nnnPARTICIPANTSnSixty patients with treatment-naïve neovascular AMD in 1 eye randomized 1:2 to monthly or TREX ranibizumab.nnnMETHODSnPatients study and fellow eyes were followed for 18 months using spectral-domain optical coherence tomography (SD OCT) and fundus autofluorescence (FAF) imaging. The MA was quantified on FAF images using Heidelberg Region Finder software (Heidelberg Engineering, Heidelberg, Germany), with suspected areas of atrophy confirmed by SD OCT and infrared reflectance imaging. For eyes without baseline MA yet developed MA by 18 months, intervening visits were assessed to determine the first visit at which MA appeared to define progression rates. Foveal choroidal thickness (FCT), subretinal hyperreflective material (SHRM), and pigment epithelial detachment (PED), were assessed at baseline to determine whether they influenced MA progression.nnnMAIN OUTCOME MEASURESnMean ERMA at 18 months. Relationship between visual acuity and MA, and the baseline risk factors for ERMA were also assessed.nnnRESULTSnThe final analysis cohort included 88 eyes in 3 groups: monthly (nxa0= 19), TREX (nxa0= 30), and control fellow eyes (nxa0= 39). Mean ERMA over 18 months was 0.39±0.67 (monthly), 1.1±1.9 (TREX), and 0.49±1 mm2 (control, Pxa0= 0.12). Mean ERMA per group among the 40.9% (nxa0= 36) of baseline patients with MA was 0.9±1, 1.9±2.2, and 1±1.3 mm2, respectively (Pxa0= 0.31). The incidence rate of MA in the 3 groups was 40%, 0%, and 8.3%, respectively. Mann-Whitney U test revealed a statistically significant association between baseline FCT (127±46 vs. 155±55 μm, Pxa0= 0.01) and SHRM thickness (106±131 vs. 50±85 μm, Pxa0= 0.02) on MA. In eyes with no baseline MA, presence of SHRM, SHRM, and PED thickness, and presence of baseline hemorrhage were all significant predictors of new MA development (Pxa0= 0.04, 0.01, 0.04, 0.004, 0.01, respectively).nnnCONCLUSIONSnRanibizumab did not show a statistically significant influence on new MA development inxa0eyesxa0with neovascular AMD, whether dosed monthly or per TREX regimen. The FCT, SHRM thickness, andxa0hemorrhage at baseline were all significant predictors of new MA.

Logarithmic transformation of spectral-domain optical coherence tomography data in uveitis-associated macular edema.

PURPOSEnTo determine the utility of logarithmic transformation of spectral-domain optical coherence tomography (logSD-OCT) retinal thickness data for assessment of clinically meaningful changes in uveitis-associated macular edema.nnnMETHODSnPatients with noninfectious uveitis-associated macular edema at our institution between August 2010 and March 2011 were identified. Only those with SD-OCT imaging were included. The clinical diagnoses, visual acuities, and central subfield thickness (CST) measurements were recorded. Logarithmic transformation of the retinal thickness was performed and frequency histograms plotted. A linear mixed-effects model of the logarithm minimum angle of resolution (logMAR) visual acuity on logSD-OCT was created to account for within-patient correlation among visits and between eyes.nnnRESULTSnA total of 98 SD-OCT images from 34 patients were analyzed. The mean age at examination was 40 years (range, 11-69 years). Anatomic diagnoses included anterior/intermediate uveitis (23%), intermediate uveitis (21%), posterior uveitis (12%), and panuveitis (44%). LogSD-OCT data provided a more normal distribution than standard CST. Skewness and kurtosis of CST data were 1.04 and 0.37, respectively, and skewness and kurtosis of logSD-OCT data were 0.40 and -0.48, respectively. There was a positive correlation between logSD-OCT and logMAR visual acuity. Specifically, for each 0.1-unit increase in logSD-OCT, the logMAR visual acuities increased (worsened) by 0.082 units (95% CI: 0.057-0.107, P < 0.001).nnnCONCLUSIONSnLogarithmic transformation of SD-OCT measurements provided a more normal distribution and positively correlated with logMAR visual acuity. This transformation of retinal thickness may be valuable for assessing clinically significant changes in SD-OCT measurements in future uveitis studies.

Randomized Trial of Treat and Extend Ranibizumab with and without Navigated Laser for Diabetic Macular Edema: TREX-DME 1 Year Outcomes

PURPOSEnTo compare monthly dosing with a treat and extend algorithm using ranibizumab 0.3 mg with and without angiography-guided macular laser photocoagulation for center-involving diabetic macular edema (DME).nnnDESIGNnMulticenter, prospective, randomized clinical trial.nnnPARTICIPANTSnA total of 150 eyes from 116 subjects were randomized into 3 cohorts: Monthly (nxa0= 30), TReat and EXtend without macular laser photocoagulation (TREX; nxa0= 60), and treat and extend with angiography-GuIded macular LAser photocoagulation (GILA; nxa0= 60).nnnMETHODSnMonthly cohort eyes received ranibizumab 0.3 mg every 4 weeks. Eyes in the TREX and GILA cohorts received 4 monthly injections of ranibizumab 0.3 mg followed by a treat and extend algorithm based on disease activity. Eyes in the GILA cohort also received angiography-guided macular laser photocoagulation at month 1 and again every 3 months for microaneurysm leakage.nnnMAIN OUTCOME MEASURESnChange in mean best-corrected visual acuity (BCVA), mean central retinal thickness (CRT), number of injections from baseline to 1 year, and percentage gaining/losing 2 and 3 lines of vision.nnnRESULTSnBaseline demographics were well balanced among the cohorts. A total of 137 eyes (91%) completed the 1-year end point visit. At 1 year, the mean BCVA improved by 8.6, 9.6, and 9.5 letters in the Monthly, TREX, and GILA cohorts, respectively (Pxa0= 0.8). There was no significant difference between the cohorts in the percentage gaining/losing 2 and 3 lines of vision. The CRT improved by 123 μm, 146 μm, and 166 μm in thexa0Monthly, TREX, and GILA cohorts, respectively (Pxa0= 0.47). The mean number of macular laser treatments in thexa0GILA cohort at 1 year was 2.9 (range, 1-4). The number of injections was significantly reduced in both the TREX (10.7) and GILA (10.1) cohorts compared with the Monthly cohort (13.1, P < 0.001). There were no cases of endophthalmitis, and the total incidence of Anti-Platelet Trialists Collaboration events was 4.7%.nnnCONCLUSIONSnThis prospective, randomized trial found that treat and extend dosing of ranibizumab 0.3 mg with and without angiography-guided macular laser photocoagulation significantly decreased the number of injections given while providing similar visual and anatomic outcomes compared with monthly dosing at 1 year. Adding angiography-guided laser photocoagulation to this dosing algorithm did not significantly improve outcomes at 1 year.

Relationship Between Visual Acuity and Retinal Thickness During Anti–Vascular Endothelial Growth Factor Therapy for Retinal Diseases

PURPOSEnTo investigate the relationship between best-corrected visual acuity (BCVA) and central retinal thickness (CRT) in eyes receiving ranibizumab for 3 common retinal diseases.nnnDESIGNnRetrospective analysis of clinical trial data.nnnMETHODSnEarly Treatment Diabetic Retinopathy Study BCVA and spectral-domain optical coherence tomography-measured CRT of 387 eyes of 345 patients enrolled in 6 prospective clinical trials for management of neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) were evaluated by Pearson correlation and linear regression.nnnRESULTSnAt baseline, there was a small correlation between BCVA and CRT in pooled AMD trial data (rxa0=xa0-0.24). A medium correlation was identified in pooled DME trial data (rxa0=xa0-0.42). No correlation was found in pooled RVO trial data. At month 12, no correlation was found between changes from baseline in BCVA and CRT in pooled AMD trial data. Medium correlations were identified in both pooled DME (rxa0=xa0-0.45) and pooled RVO (rxa0=xa0-0.35) trial data at month 12. Changes in BCVA and CRT associated with edema recurrence upon transition from monthly to pro re nata (PRN) dosing were correlated in AMD (rxa0=xa0-0.27) and RVO (rxa0=xa0-0.72) trials, but not in DME trial data.nnnCONCLUSIONnDME demonstrated a convincing relationship between BCVA and CRT. Correlations appear to be more complex in AMD and RVO. At the inflection point between monthly and PRN dosing, when recurrence of edema is anticipated in many patients, CRT appears strongly correlated with loss of BCVA in RVO.

Neovascular age-related macular degeneration management in the third year: Final results from the TREX-AMD randomised trial

Background/Aims Prospectively evaluate outcomes in the third year of neovascular age-related macular degeneration (AMD) management using ranibizumab with continued treat and extend (TREX) dosing compared with monthly visits with retreatment upon evidence of exudative disease activity (PRN, pro re nata). Methods Subjects with treatment-naïve neovascular AMD were randomised 1:2 to Monthly or TREX and managed through 2u2009years. In the third year, subjects randomised to Monthly were managed PRN while subjects randomised to TREX were continued on TREX dosing or transitioned to PRN after achieving an interval of 12u2009weeks between visits. Results Sixty subjects enrolled and 46 (77%) completed month 36 (M36). Transition from Monthly to PRN was associated with a decline in best corrected visual acuity (BCVA) (+10.5 letters (month 24) to +5.4 (M36, p=0.09)); three (15%) subjects required no dosing during year 3, and 47% (114/243) of possible PRN injections were delivered, yielding a mean of 6.1 injections during year 3. Among the 9 (23%) TREX subjects transitioned to PRN, the need for ongoing anti-vascular endothelial growth factor retreatments was small, with 4 (4%) intravitreal injections being delivered among 106 PRN visits; this subgroup displayed an inferior BCVA trajectory compared with the remainder of subjects. Outcomes among subjects continued on TREX were more favourable, with a mean gain of +5.0 letters at M36. Conclusions Upon transition to PRN, subjects randomised to monthly dosing experienced a decline in BCVA. Among subjects initially randomised to TREX who transitioned to PRN after achieving a 12-week interval between visits, the overall need for additional treatment was low. Trial registration number NCT01748292, Results.

SEVERE PANUVEITIS, RETINAL VASCULITIS, AND OPTIC DISK GRANULOMA SECONDARY TO SARCOIDOSIS.

PURPOSEnTo report a case of panuveitis, retinal vasculitis, and optic disk granuloma due to sarcoidosis.nnnMETHODSnCase report and literature review.nnnRESULTSnA 26-year-old previously healthy African American male presented with four months of gradual progressive visual decline in the right eye. Clinical examination revealed severe panuveitis, retinal vasculitis, and large optic nerve mass lesion. Diffuse supraclavicular lymphadenopathy was also present. Histopathologic examination of the lymph node biopsy revealed granulomatous inflammation with some areas of caseous necrosis consistent with sarcoidosis.nnnCONCLUSIONnSarcoidosis is a common cause of uveitis and retinal vasculitis. In rare cases, an optic disk granuloma may occur and can be treated with immunosuppressive therapy.

Paradoxical Anatomic Response to Topical Carbonic Anhydrase Inhibitor in X-linked Retinoschisis

An 11-year-old boy presented for central vision blurring in each eye. Visual acuity was 20/80 and examination revealed spoke-wheel foveal schisis and peripheral elevated diaphanous inner retina in each eye. Spectral-domain optical coherence tomography showed inner-retinal, flat-topped cysts in each eye. Electrophysiologic testing was refused, but a clinical diagnosis of X-linked retinoschisis was made. Three months after topical dorzolamide (Trusopt; Santen Pharmaceutical, Osaka, Japan) was started, the macular cysts worsened significantly. The medication was stopped and 3 months later, the macular anatomy returned to baseline. Physicians should be aware of this potential paradoxical anatomic response to topical carbonic anhydrase inhibitor therapy in X-linked retinoschisis. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:142-144.].

Topographic Correspondence of Macular Atrophy With Choroidal Neovascularization in Ranibizumab-treated Eyes of the TREX-AMD Trial

PURPOSEnTo quantify the extent of topographic correspondence between baseline (BSL) choroidal neovascularization (CNV) and macular atrophy (MA) at follow-up in eyes with neovascular age-related macular degeneration (NVAMD).nnnDESIGNnPost hoc analysis of randomized controlled clinical trial data.nnnMETHODSnSixty treatment-naïve NVAMD patients from the TREX-AMD trial were followed for 18xa0months. Regions of month 18 macular atrophy (MA) were graded on fundus autofluorescence (FAF) with guidance of spectral-domain optical coherence tomography (SDOCT). CNV lesions were graded manually on fluorescein angiography (FA) with lesion components including classic and occult CNV delineated. FAF and FA images were registered to quantitate area and location of overlap between CNV and MA. Outcome measures included overlap of month 18 MA to BSL CNV subtype and progression of MA from BSL to month 18.nnnRESULTSnTwenty-six eyes had both MA at month 18 and CNV at BSL. A total of 84.6% of eyes showed evidence of MA and CNV overlap. MA appeared by month 18 in regions corresponding to BSL classic CNV in 36.4% of eyes and occult CNV in 40.9%, and in both regions in 22.7%, with more area of MA (AMA) in regions of occult than classic CNV. MA position at BSL corresponded to BSL classic CNV in 76.9% of eyes and occult CNV in 61.5%, and to both regions in 15.4%, with more AMA in regions of occult than classic CNV. Among eyes with MA and CNV at BSL but with no overlap, 50% progressed to involve regions with BS -CNV. Six eyes had no BSL MA but developed MA at month 18 within regions of BSL CNV.nnnCONCLUSIONSnIn ranibizumab-treated eyes with NVAMD, more MA lesions develop within the region of baseline CNV (type 1, CNV-based MA) than outside (type 2, CNV-independent MA). Baseline-MA also tends to be located within regions of CNV in the pretreatment phase.

Teleophthalmology image-based navigated retinal laser therapy for diabetic macular edema: a concept of retinal telephotocoagulation

BackgroundTo determine the feasibility and efficacy of a retinal telephotocoagulation treatment plan for diabetic macular edema.MethodsProspective, interventional cohort study at two clinical sites. Sixteen eyes of ten subjects with diabetic macular edema underwent navigated focal laser photocoagulation using a novel teleretinal treatment plan. Clinic 1 (King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia) collected retinal images and fundus fluorescein angiogram. Clinic 2 (Palmetto Retina Center, West Columbia, SC, USA) created image-based treatment plans based on which macular laser photocoagulation was performed back at clinic 1. The primary outcome of the study was feasibility of image transfer and performing navigated laser photocoagulation for subjects with diabetic macular edema between two distant clinics. Secondary measures were change in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) by spectral-domain optical coherence tomography at 3xa0months after treatment.ResultsThe teleretinal treatment plan was able to be successfully completed in all 16 eyes. The mean logMAR BCVA at baseline was 0.49xa0±xa00.1, which remained stable (0.45xa0±xa00.1) 3xa0months after treatment (pxa0=xa00.060). The CRT improved from 290.1xa0±xa037.6xa0μm at baseline to 270.8xa0±xa027.7xa0μm 3xa0months after treatment (pxa0=xa00.005). All eyes demonstrated improvement in the area of retinal edema after laser photocoagulation, and no eyes demonstrated visual acuity loss 3xa0months after treatment.ConclusionThis study introduces the concept of retinal telephotocoagulation for diabetic macular edema, and demonstrates the feasibility and safety of using telemedicine to perform navigated retinal laser treatments regardless of geographical distance.