The field of ophthalmology started to gain useful insights into the state of clinical practice, as data emerged from the world’s largest, dedicated ophthalmology clinical registry.
Several studies based on data from the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) registry were reported during 2017. Others are expected to follow in the near future, providing information that has the potential to shape clinical practice today and for years to come.
One of several IRIS-based studies reported at the 2017 AAO annual meeting suggested that diabetic macular edema (DME) is vastly undertreated. Even when patients are treated, many receive a suboptimal number of injections of anti-VEGF therapy.
Another study based on data from IRIS showed that use of anti-VEGF agents in clinical practice leads to better control of intraocular pressure (IOP) than was suggested by clinical trials. Mathew MacCumber, MD, of Rush University Medical Center in Chicago, reported rates of clinically significant IOP elevation of 2% to 3%. In contrast, clinical trials of aflibercept (Eylea) and ranibizumab (Lucentis) showed rates of sustained, clinically significant IOP elevation as high as 24%.
Comparisons with untreated eyes also showed variation among the available anti-VEGF agents with respect to the rates of sustained, clinically significant elevations in IOP. Specifically, ranibizumab and bevacizumab (Avastin) were associated with higher rates of clinically significant IOP elevation than with aflibercept.
A study involving patients with moderate to severe nonproliferative diabetic retinopathy showed that three-fourths of them had at least a two-step improvement in disease status when treated with ranibizumab. Patients with more severe disease tended to derive more benefit from the anti-VEGF therapy.
Following the success of bevacizumab, another cancer drug showed potential as an effective and potentially less expensive treatment for diabetic macular edema. A randomized trial showed that patients treated with small doses of ziv-aflibercept (Zaltrap) had greater improvement in visual acuity than did patients treated with bevacizumab.
Data from another randomized trial involving patients with DME showed that adding dexamethasone to ranibizumab did not improve visual acuity over the use of ranibizumab alone. Many patients with DME have persistent retinal thickening and associated vision deterioration despite having anti-VEGF therapy. Dexamethasone has both anti-VEGF and anti-inflammatory properties, leading to the hypothesis that using it as an add-on to primary anti-VEGF therapy would lead to better results, said Raj Maturi, MD, of the Midwest Eye Institute in Indianapolis.
Possibly an underappreciated risk associated with diabetic retinopathy is an increased risk of falling.
Several notable studies focused on eye infections and antibiotic therapy. An analysis of bacterial isolates from patients with endophthalmitis revealed a high proportion of antibiotic-resistant organisms; half of coagulase-negative staphylococci and 40% of Staphylococcus aureus demonstrated methicillin resistance.
Patients with adenoviral conjunctivitis had high rates of clinical resolution and viral eradication when treated with SHP640 (dexamethasone/povidone-iodine ophthalmic suspension). The therapy had a rapid onset of activity, as a third of patients had clinical resolution within 6 days of starting treatment and 80% had virus eradication. A substantial proportion of patients had virus eradication within 3 days, with or without dexamethasone.
Prophylactic intracameral antibiotic therapy has proven to be safe and efficacious for patients undergoing cataract surgery and may have advantages over other options for prophylaxis. On the other hand, transzonular antibiotic delivery also has its share of supporters.
The U.S. Preventive Services Task Force recommended vision testing for preschoolers ages 3 to 5 but found the evidence insufficient to make a recommendation for screening younger children.
Another study added fuel to the controversy over whether vitamins or nutrients can help prevent age-related macular degeneration (AMD). A systematic review found evidence lacking to support the use of vitamin E, beta-carotene, vitamin C, or a widely used multivitamin to prevent AMD.
A glaucoma expert warned of the risks posed by corticosteroid therapy, regardless of the route of administration.
Laser treatment showed potential as an option for managing eye “floaters.” One small randomized trial showed that more than half of patients who underwent laser treatment had symptomatic improvement compared with 9% of patients who underwent a sham procedure.
A trial of gene transfer for an inherited retinal disorder led to vision improvement in 93% of patients. The investigators reported that 27 of 29 patients with Leber congenital amaurosis could see well enough to navigate a maze in moderate to low light after treatment with voretigene neparvovec (Luxturna).