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January 5, 2022


The most important ophthalmology research updates, delivered directly to you.
 

In this week's issue
  • Failure to achieve clinician-defined target IOP was associated with worsening visual fields 
  • Racial and ethnic minority patients perceive less respect from providers, but asking patients about their opinions and beliefs may help bridge this divide 
  • Lens epithelial cells became mitotically active for wound healing in a capsular cataract model

Hitting the Target: A Predictor of Disease Control?

Ophthalmology

Have you set goals for the new year? Setting goals helps you to achieve your goals -- but does this apply to glaucoma management as well? In this retrospective analysis of 2,852 eyes treated for glaucoma, failure to achieve clinician-defined target intraocular pressure (IOP) is a significant predictor of worsening visual field (VF) among all severities of glaucoma. Specifically, each 1 mmHg increase above target IOP resulted in a 0.018 dB/year worse mean deviation (MD) slope across all disease stages. This effect was most significant in eyes with moderate glaucoma that failed to meet target IOP. An increased percentage of visits of IOPs within target was associated with less MD progression. The authors argue that achieving target IOP can be used as a surrogate marker for disease control, rather than mean IOP values themselves.

Respect Disparities in Patients with Eye Disease

JAMA Ophthalmology

Aretha Franklin could teach us all a thing or two about Respect. Studies have shown that patients who feel respected by their healthcare providers also perceive greater satisfaction with care and even improved quality of life. Furthermore, disparities in respect have been hypothesized to influence health outcomes. To investigate these disparities in patients with eye disease, researchers queried the National Health Interview Survey database for 5,343 adult patients with macular degeneration, diabetic retinopathy, glaucoma, or cataracts. Multivariable logistic regression analysis showed a positive association between “asking about opinions/beliefs about your medical care or treatment” and answering “always” to “how often were you treated with respect by your health care providers?” (OR 5.80, 95% CI 4.35-7.74). Patients who identified as having racial or ethnic minority status were less likely to answer “always” to the same question (OR 0.64, 95% CI 0.05-0.81). However, in a separate regression model, racial and ethnic minority patients were more likely to be asked for their opinions and beliefs regarding their care by a healthcare provider (OR 1.66, 95% CI 1.39-1.98). These findings indicate that racial and ethnic minority patients perceive less respect from healthcare providers. They also suggest that asking patients’ opinions and beliefs regarding their care may help bridge this divide. While the study itself focuses on whether soliciting patients’ opinions regarding their own care influences perceived respect, the results paint a hopeful picture in which providers’ attitudes and actions can help facilitate compassionate care and improved health outcomes for patients of all backgrounds. 

Glasses vs. Observation for Moderate Bilateral Astigmatism

American Journal of Ophthalmology

To be spectacled or to not be spectacled -- that is the question. Although astigmatism with amblyopia can be corrected by spectacles, there is little empirical evidence to support the use of glasses in astigmatic patients without a diagnosis of amblyopia. In fact, current guidelines for prescribing glasses are only based on provider surveys instead of patient outcomes. Wang et al. sought to compare visual outcomes in children aged 1-7 with moderate bilateral astigmatism who were treated with glasses vs. observed. Using a retrospective case series, investigators included 85 patients who met their criteria and evaluated records to determine the rate of amblyopia development after a four year period. The development of amblyopia was not statistically significant among the glasses vs. observed groups (8.3% vs. 10.3%, p=0.74). According to this finding, glasses may not be more effective than observation in preventing the development of amblyopia in children with moderate bilateral astigmatism. A few limitations of this study include its small sample size, its retrospective design, and the differences among patients with regard to compliance with their glasses. A larger prospective randomized controlled trial is needed to examine the evidence for glasses vs. observation in children with moderate bilateral astigmatism.

Lens wound repair in UVB-induced cataracts

IOVS

Don’t forget to wear sunglasses when you go outside on a sunny day! UV-light mediated damage is a known risk factor for development of age-related cataracts. Accumulated constant exposure to UVB leads to damaged lens proteins, lipids, and DNA. However, as with any insult or injury to the human body, there are mechanisms in place to try to repair such damage. The mechanism of lens epithelial cell repair after UVB exposure or irradiation is not fully understood. Using a mouse model of UVB-induced cataractogenesis, this study aimed to understand the lens epithelial repair process. UVB irradiation led to formation of a ring-shaped capsular cataract and triggered lens epithelial cell apoptosis while cells on the outside edge of the cataract transitioned to mitotically active cells that participate in the wound healing process through epithelialization forming scar-like tissue in the center of the anterior capsule. This process comes to a stop once the epithelial cells make cell-to-cell contact and forms a stack of cells which were analyzed by transmission electron microscopy. These findings are particularly interesting since the lens epithelial cells outside the germinative zone were previously thought to be normally quiescent cells and not mitotically active. Their ability to be reactivated for epithelialization repair in response to UVB damage demonstrates the ability of the anterior lens to respond and try to repair itself after damage.

Financial advisors now available to physicians to learn about student loan repayment

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Cornea

Pterygium recurrence rates in attending physicians and supervised residents 

Cornea

You need a job to get experience, and you need experience to get a job! This retrospective study aimed to evaluate if recurrence rates after pterygium surgery differed when performed by attending physicians or supervised trainee residents. Primary pterygium cases with a minimum postoperative follow-up of 6 months were studied from an academic institution in South Texas from 2008 to 2019. A total of 240 eyes from 229 patients were included (mean age, 55.6 ± 12.3 years; range, 28–91 years). Out of these eyes, 100 surgeries were performed by attending physicians, and 140 surgeries were performed by trainee residents. All residents who performed the surgeries were supervised directly by attending physicians. No statistically significant differences were found in comparing the rate of pterygium recurrence between attending physicians and residents when using conjunctival autograft (6.8% vs. 10.0%, respectively; P = 0.42) or amniotic membrane graft (69.2% vs. 47.6%, respectively; P = 0.22). Overall, pterygium recurrence rates were similar between attending physicians and supervised trainee residents. Acceptable outcomes can be expected when pterygium surgery is performed by a supervised ophthalmology resident. Happy operating! 

Pediatrics

Can PRK lead to developmental improvement in children

American Journal of Ophthalmology

You have to see it to believe it! Most children with anisometropia are able to be corrected with glasses or contact lenses, however those with intellectual disabilities or neurobehavioral disorders may be unable to comply with these methods. Uncorrected high refractive errors can be particularly disabling to these children and detrimental to their day-to-day functioning. Paysse et al. sought to assess whether surgical correction from PRK changes the developmental quotient (DQ) in children with intellectual disability. 16 children with severe anisometropia who had failed conventional treatment and intellectual disability with plateaued development for the past 18 months were examined for uncorrected visual acuity pre- and post-operatively with additional neurobehavior tests performed by a pediatric specialist for the following 3 years after surgery. Children undergoing PRK had statistically significant improvements in expressive communication, interpersonal relationships, and coping skills at 6 months and additionally receptive communication, written communication, and domestic skills at 12 months post-operative. Although not statistically significant, these children also had clinically significant improvements in fine motor skills, visual perception, and motor coordination at 6 months. This study quantifies the significant improvement in developmental skills for anisometropic children undergoing PRK whose development had already plateaued and failed to improve with other measures.  

Question of the Week
A 47-year old male presents with a one-week history of idiopathic uveitis of the left eye and is currently taking prednisolone acetate 1% QID. One week ago, he had an IOP of 33mmHg and had 3+ anterior chamber inflammation. Today, he has an IOP of 26mmHg  and has 1+ anterior chamber inflammation upon slit lamp examination. Which of the following is the next best step?

A. Increase prednisolone acetate to q2H and start brimonidine
B. Increase prednisolone acetate to q2H and start pilocarpine
C. Decrease prednisolone acetate to qdaily and start latanoprost
D. Decrease prednisolone acetate to qdaily and start timolol

 
Keep scrolling for answer or click here

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