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April 6, 2022


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

In this week's issue
  • Individuals with exfoliation syndrome with the CYP39A1 G204E mutation had a higher risk of developing blindness and glaucoma that individuals with exfoliation syndrome without the mutation
  • In a recent study of salaries of academic ophthalmologists, female academic ophthalmologists were paid a mean of $50,300 less than their male counterparts, again highlighting disparities in ophthalmology practice
  • Are microbiologic cultures necessary in post-intravitreal injection endophthalmitis? A recent study conducted at Wills Eye Hospital suggests not
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It’s in Your Genes: Additional Effects of Exfoliation Syndrome

Ophthalmology

Skincare influencers, exfoliation is not always a good thing. A retrospective case study investigated the effects of the CYP39A1 G204E gene mutation in the development of blindness and glaucoma among patients with exfoliation syndrome (XFS). The clinical outcomes of two cohorts of patients were compared: XFS patients with the gene mutation (n=35) and XFS patients without the mutation (n=150). Individuals in the gene mutation group had a statistically significantly increased risk of developing blindness (p<0.001) and glaucoma (p<0.0001) in at least one eye when compared to those without the mutation. Similarly, individuals in the gene mutation cohort had a significantly higher peak intraocular pressure, larger vertical cup:disc ratio, and worse visual field mean deviation than those in the other cohort (p<0.001). Lastly, a greater proportion of individuals in the gene mutation cohort needed laser or surgical interventions for glaucoma treatment than those without the mutation (p<0.001). While the results of this study confirm the increased risk of blindness and more severe glaucoma among XFS patients with a CYP39A1 G204E gene mutations, the study was only conducted in one ethnic group and only tested for one of the 34 CYP39A1 variants. However, these results do suggest that this mutation is worthwhile to identify during early stages of XFS management.

Sex Differences in Salaries of Academic Ophthalmologists in the United States

JAMA Ophthalmology

Another study highlighting disparities among ophthalmologists. Representation of women in medicine and ophthalmology has increased in recent years. A series of recent studies in general and subspecialty ophthalmology have highlighted that, while representation is increasing, there is still a need for continued emphasis on diversity of all kinds within the field. In this cross-sectional study, Emami-Naeini and colleagues analyzed data for full-time academic physicians from 154 US medical schools for the fiscal year 2019-2020. Female academic ophthalmologists were paid a mean of $50,300 less than their male counterparts, a trend evident across specialties ranging from $25,100 (non surgical specialities, CI $1000-$49,300) to $104,400 (general surgery, CI $61,800-146,600). These differences persist even after adjusting for differences in base salary and productivity; however, not all factors that could contribute were adjusted for. This study highlights an objective measure of disparities in ophthalmology and medicine in general, and a potential target for future efforts at increasing diversity. 

Retina

Do statins help prevent AMD and its progression? A Meta-Analysis

Retina

Statins have become so commonly used there are memes of Oprah shouting, “You get a statin. You get a statin. Everyone gets a statin!” Since age-related macular degeneration (AMD) shares many of the same risk factors as atherosclerosis like smoking, obesity, and cardiovascular disease, there has been an interest in exploring the role of lipid-lowering agents like statins in preventing AMD. The theoretical ability of statins to fend off AMD arise from its anti-inflammatory, antiangiogenic, and lipid-lowering effects, however its clinical impact has yet to be fully illustrated. In a meta-analysis of 21 moderate quality articles (1 randomized control trial and 20 observational studies), no significant difference was found in the incidence or progression of AMD based on statin use, indicating that current research does not support the theorized benefit of statins in preventing AMD. The study also found that in patients with existing AMD, statin use had no significant influence on the development of choroidal neovascularization or geographic atrophy. Some limitations the authors noted were that individuals who were prescribed statins may have been farther along the dyslipidemia disease process, which may have affected their risk of developing AMD even before starting the drug. Additionally, 5 of 21 studies did not adjust for pre-existing medical comorbidities and duration of follow-up was frequently less than 5 years, making it unclear if statin users underwent treatment for long enough to produce a significant effect. More randomized controlled trials are needed to make a stronger and more compelling statement regarding statins impact on AMD.

Uveitis

Post-injection endophthalmitis: Are cultures necessary?

American Journal of Ophthalmology

Can cultures curate a cure? Traditional management of post-injection endophthalmitis includes immediate microbiologic sampling, intravitreal (IV) antibiotics, and often, a pars plana vitrectomy. However, controversy exists on whether there is any benefit to microbiological sampling. Additionally, certain institutions may not have the capability for small sample vitreous cultures. ­­This retrospective cohort study included all eyes that developed endophthalmitis after anti-vascular endothelial growth factor (anti-VEGF) injections at Wills Eye Hospital and satellite locations. They compared eyes that received IV antibiotics along with microbiologic sampling to eyes that received immediate IV antibiotics with no microbiological sampling. Of the 165 endophthalmitis patients, 72% had cultures and 28% did not. At 6 months, the culture group had a mean vision loss of 5.5 lines, compared to 2.5 lines in the no culture group (p=.017). Finally, there was no difference in occurrence of pars plana vitrectomy or secondary retinal detachment between the culture and no culture groups (24% vs 15%, p=.29; 5% vs 0%, p=.143; respectively). Post-injection endophthalmitis has similar visual outcomes and complication rates regardless of whether cultures are taken. Therefore, immediate IV antibiotics and anterior chamber paracentesis for volume control may be sufficient when resources are limited. If patients fail to respond to antibiotics, physicians can consider transferring hospitals for a subsequent culture analysis.

Question of the Week
A 79-year-old male was referred by dermatology to oculoplastics clinic for consideration of excisional biopsy of left lower lid and periorbital lesions. The largest lesion, indicated in the photograph, has been slowly growing and has caused some irritation but no pain, bleeding, or crusting. A polarized contact dermoscopic photograph is captured and demonstrates irregular contour, cloudy yellow intralobular cystic structures, and small hairpin vessels as shown in the image below. 
What is the most likely diagnosis?

a.     Basal cell carcinoma
b.     Seborrheic keratosis
c.     Nodular melanoma
d.     Spitz nevus


 
Keep scrolling for answer or click here
 

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