Margherita Casciano

Microperimetry And Fundus Autofluorescence In Diabetic Macular Edema: Subthreshold Micropulse Diode Laser Versus Modified Early Treatment Diabetic Retinopathy Study Laser Photocoagulation

Purpose:The purpose of this study was to evaluate and compare microperimetry and fundus autofluorescence (FAF) after subthreshold micropulse diode laser versus modified Early Treatment Diabetic Retinopathy Study photocoagulation for clinically significant diabetic macular edema. Methods:A prospective randomized clinical trial including 62 eyes (50 patients) with untreated, center-involving, clinically significant diabetic macular edema was performed. All patients underwent best-corrected visual acuity determination (logarithm of the minimum angle of resolution), slit-lamp biomicroscopy, FAF, optical coherence tomography, microperimetry (macular sensitivity), and fluorescein angiography before and after treatment. Best-corrected visual acuity, optical coherence tomography, microperimetry, and FAF were repeated at 1-, 3-, 6-, 9-, and 12-month follow-up examinations. Fluorescein angiography was performed at baseline and at 6 and 12 months. Results:Before treatment, demographic and macular parameters were not different between the two treatment groups. At 12 months, best-corrected visual acuity remained stable in both groups (P = 0.41 and P = 0.82), mean central retinal thickness decreased in both groups (P = 0.0002 and P < 0.0001), and mean central 4° and 12° retinal sensitivity increased in the micropulse diode laser group (P = 0.02 and P = 0.0075) and decreased in the Early Treatment Diabetic Retinopathy Study group (P = 0.2 and P = 0.0026). There was no significant difference in either best-corrected visual acuity or central retinal thickness between the 2 treatment groups (P = 0.48 and P = 0.29), whereas there was a significant difference in 4° and 12° retinal sensitivity (P = 0.04 and P < 0.0001). Fundus autofluorescence never changed in the micropulse diode laser group even after retreatment. In the Early Treatment Diabetic Retinopathy Study group, FAF increased up to 9 months and decreased in 6 eyes (20%) at 12 months. Discussion:Micropulse diode laser seems to be as effective as modified Early Treatment Diabetic Retinopathy Study laser photocoagulation in the treatment of clinically significant diabetic macular edema. Micropulse diode laser treatment does not determine any change on FAF showing (at least) nonclinically visible damage of the retinal pigment epithelium. Microperimetry data encourage the use of a new, less aggressive laser therapeutic approach in the treatment of clinically significant diabetic macular edema.

Diabetic Macular Edema: Fundus Autofluorescence and Functional Correlations

PURPOSE Diabetic macular edema (DME) shows variable clinical characteristics with unpredictable results to local treatment, probably reflecting different phenotypes. The purpose of this study was to evaluate the role of structural and functional macular imaging in the characterization of DME patterns. METHODS One hundred fifty-one eyes of 92 diabetic patients with untreated clinically significant macular edema (CSME) underwent best corrected visual acuity (BCVA) determination (logMAR), slit lamp biomicroscopy; fluorescein angiography; optical coherence tomography (OCT; mean central retinal thickness [CRT], volume, and DME pattern); fundus autofluorescence (FAF; absent or increased [i]FAF, single or multiple spots; iFAF area quantification); and microperimetry. Linear correlation, data agreement and three-way analysis of covariance were used for statistics. RESULTS Thirty-five (23.2%) eyes had normal FAF; and 116 eyes had iFAF: 48 (31.8%) single-spot iFAF, 68 (45%) multiple-spot iFAF. Retinal sensitivity in areas with iFAF was 11.5±5.3 dB (vs. 15.1±3.9 dB in normal areas, P<0.005). Retinal sensitivity of the central field was 15.1±3.9 dB in normal FAF, 12.4±4.8 dB in single-spot iFAF and 11.4±4.9 dB in multiple-spot iFAF (P<0.05). OCT CRT and volume were not significantly different between the FAF groups. OCT volume correlated to OCT CRT (r=0.68), retinal sensitivity in iFAF (r=-0.50) and BCVA (r=0.42). Cystoid OCT pattern and FA edema patterns correlated with iFAF presence (P<0.0001). CONCLUSIONS In CSME, FAF correlates better with OCT patterns and central field microperimetry rather than with visual acuity. FAF is a rapid, noninvasive technique that may give new insight into the evaluation of DME. The validity of FAF in the follow-up and treatment outcomes in DME remain to be assessed.

Detection of Macular Function Changes in Early (AREDS 2) and Intermediate (AREDS 3) Age-Related Macular Degeneration

Background/Aim: To evaluate if retinal sensitivity values obtained with a dedicated (screening) device can be used to functionally identify early and intermediate age-related macular degeneration (ARMD). Methods: A fully automatic fundus perimeter combined with an image-stabilized scanning laser ophthalmoscope was used in 200 ARMD patients (319 eyes) in 5 study sites. The age-matched control group consisted of 200 normals. Sensitivity point values (S values), mean retinal sensitivity, number of points below 24 dB (K value, cutoff for normal values) and fixation stability were recorded. Results: Of 319 eyes, 164 were classified as early (AREDS 2) and 155 as intermediate (AREDS 3) ARMD. Mean retinal sensitivity was significantly reduced in ARMD patients versus normals (p < 0.001). K values were different between normals and ARMD patients (p < 0.001). Fixation stability did not differ between early and intermediate ARMD patients. Conclusions: Macular sensitivity is reduced in patients with early and intermediate ARMD when compared to age-matched normals. These changes may be detected with a screening device.

HYPERREFLECTIVE RETINAL SPOTS AND VISUAL FUNCTION AFTER ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR TREATMENT IN CENTER-INVOLVING DIABETIC MACULAR EDEMA.

Background: To assess and correlate early modifications in hyperreflective retinal spots (HRS), retinal sensitivity (RS), fixation stability, and best-corrected visual acuity (BCVA) after anti-vascular endothelial growth factor treatment in naive center-involving diabetic macular edema. Methods: Cross-sectional comparative case–control series. Twenty diabetic patients underwent 3 consecutive intravitreal anti-vascular endothelial growth factor injections in the study eye (20 fellow eyes served as control), full ophthalmologic examination including spectral domain optical coherence tomography (Retinascan RS-3000; Nidek, Gamagori, Japan), and microperimetry (MP1; Nidek) at baseline (Visit-V1), 1 month after each injection (V2, V3, V4), and at 6 months (V5). Central retinal thickness, inner and outer retinal thickness, number of HRS, BCVA, RS, and bivariate contour ellipse area were evaluated by analysis of variance test with Bonferroni post hoc test. Correlation analyses were performed by Spearman correlation. Results: In treated eyes, central retinal thickness and inner retinal thickness significantly decreased at V2, V3, V4 versus V1 (P < 0.03 at least for all); the mean number of HRS significantly decreased in both inner and outer retina at all follow-up visits versus V1 (P < 0.008 at least for all); mean RS and bivariate contour ellipse area remained statistically unchanged during the follow-up; BCVA significantly improved at V3, V4, and V5 versus V1 (P = 0.009 at least for all). In fellow eyes, central retinal thickness, HRS, RS, and BCVA did not change at any follow-up. The number of HRS correlated inversely with RS, directly with bivariate contour ellipse area, and not significantly with BCVA. Conclusion: A significant decrease in HRS in the retina after anti-vascular endothelial growth factor treatment is documented. A decrease in HRS correlates with functional parameters, specifically RS. New parameters may be used for treatment evaluation in center-involving diabetic macular edema.

A decade-long telemedicine screening program for diabetic retinopathy in the north-east of Italy

AIM To describe a decade long telemedicine screening for diabetic retinopathy (DR) in the metropolitan area of Padova (North-East Italy) and to report about prevalence/incidence of DR and maculopathy, rate of progression to STDR and optimal screening interval in patients with no DR at first examination. METHODS Observational, longitudinal, cohort study; 9347 patients with Type 1 and Type 2 diabetes mellitus (DM) underwent 17,344 fundus exams (three-45° color photos per eye) in two diabetes clinics and were graded in the Reading Centre, by certified personnel. The incidence of STDR, progression of maculopathy and risk factors were evaluated by log Rank test (Kaplan-Meier method). A receiver operating curve was used to determine the optimal screening interval in patients who at the first examination had no DR. RESULTS The overall prevalence of DR was 27.6%:12.5% mild non proliferative (NPDR), 11.3% moderate NPDR, 2.9% severe NPDR and 0.9% proliferative (PDR). The overall prevalence of maculopathy was 5.7%: 2.8% mild, 2.2% moderate, and 0.7% severe maculopathy. The 10-year incidence of STDR was: 0.6% in no DR, 5.5% in mild NPDR and 21.1% in moderate NPDR at first examination. The 10-year incidence of maculopathy was: 2.1% mild, 1.7% moderate and 0.2% severe. The incidence of STDR in patients with type 1 and type 2 DM and duration>10years was 8.21% and 8.15%;in type 1 DM with duration <10years was 5.5% and in type 2 DM and duration <10years was 1.91%.In patients with no DR at first screening, the best (sensitivity-specificity) follow-up interval is 2.5years. CONCLUSIONS Screening every 2.5-year in patients without DR at the first examination seems to be adequate. Duration of disease is a relevant risk factor for progression to STDR, however patients with type 1 DM and duration <10years have greater incidence of STDR than patients with type 2 DM and similar disease duration. Epidemiologic data from this decade-long screening program in the North East of Italy may serve for implementing a national screening program.

Microperimetry: Technical Remarks

Recently, the advancement in the technology of microperimetry devices has improved the capability to detect and understand visual function alterations. Furthermore, new software allow clinicians to precisely follow the evolution of the disease or the effect of different therapeutic choices or to perform visual rehabilitation for patients with low vision.

Record Attendance at the 10th EURETINA Congress in Paris

NA/ESCRS Symposia and one Clinical Research Symposium anchored the meeting. Other new introductions for 2010 were the French-British and Eire Symposium (CFSR-BEAVRS) and the ARVO symposium on anti-VEGF therapy beyond AMD. The programme also included popular scientific contributions such as the Amsterdam Retina Debate, Eurolam, the Fan Club and the French-Israeli (AFIV SOFI) Symposium. The EURETINA Lecture 2010 was given by Prof. Anthony Moore, Moorfields Eye Hospital, London, who discussed the current state of research into retinovascular disorders of childhood. Dr. Martine Jager was the recipient of the Kreissig Award and made the presentation entitled ‘Immunology in uveal melanoma: friend or foe?’ Not only did the 10th Congress see an increase in attendance, but abstract submission numbers also showed a dramatic increase from previous years. Free paper submissions increased by 30% from the Nice 2009 Congress, while video submissions doubled since last year. While stressing that the organizing committee was extremely gratified in the record attendance and progress displayed in Paris this year, Bill Aylward said that the goal of EURETINA in the years ahead would be to continue to make progress and raise standards: ‘We don’t just want to be big – we also want to be the best.’ The 11th EURETINA Congress will take place in the Queen Elizabeth II Centre in London from the 26th to the 29th May 2011. A record number of medical and surgical retina specialists from all over the world converged on Paris this month to attend the 10th EURETINA Congress, which took place from the 2nd to the 5th September in the Palais des Congrès, Porte Maillot. A total of 2,700 delegates attended the Congress, making it not only the largest EURETINA meeting in the history of the Society, but also establishing it as the largest retina meeting ever convened. The 2010 Congress also saw EURETINA partner with the European Society of Cataract and Refractive Surgeons (ESCRS), drawing a total number of almost 9,000 ophthalmologists to the Palais des Congrès over a 6-day period. Addressing the audience at the official opening ceremony, EURETINA President Bill Aylward welcomed delegates to Paris for what he expected would prove to be the most stimulating and rewarding congress to date: ‘It is truly a great pleasure to welcome all of you to this wonderful city for the 10th EURETINA Congress. We are particularly excited as this is the first time that we have joined forces with the ESCRS for this joint meeting. The early signs of this collaboration are very good.’ At the core of the EURETINA programme were 13 main sessions, comprising presentations from invited speakers, all of whom are leaders in their field. There were also a total of 32 Instructional Courses and Surgical Skills Courses, the former including the daylong Retinal Detachment and Uveitis Courses. Two combined EURETIPublished online: February 3, 2011 Ophthalmologica