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June 2, 2021


The most important ophthalmology research updates, delivered directly to you
 

What is the association between alcohol consumption and cataracts?

Ophthalmology

Red wine has long been regarded as the fountain of youth, but can it prevent cataracts as well? Resveratrol, a strong antioxidant found in highest concentrations in red wine, has been hypothesized to protect against age-related diseases. Researchers in this study investigated the association of self-reported alcohol consumption and incident cataract surgery in two large cohorts, the UK Biobank (n=469,387) and the EPIC-Norfolk (n=23,162), through a longitudinal observational study. After adjusting for covariates, they found that alcohol drinkers in both cohorts were less likely to undergo cataract surgery (HR = 0.89 and HR = 0.90) compared to alcohol nondrinkers. In both cohorts, low to moderate alcohol consumption was associated with a reduced risk of undergoing subsequent cataract surgery. Subgroup analysis indicated that wine consumption was most protective of cataract surgery with 23% and 14% lower cataract surgery rates among those in the highest category of wine consumption in EPIC-Norfolk and UK Biobank, respectively. However, given the observational nature of this study, it is not possible to determine causality between alcohol intake and cataract surgery. Moderation is key, so make sure to counsel your patients on alcohol cessation if they’re drinking 7+ standard drinks weekly for women or 14+ standard drinks weekly for men.

Exploring molecular changes at the corneal epithelium in keratoconus

IOVS

Move over Munson’s sign, the era of -omics research sheds light on molecular pathways implicated in keratoconus. Corneal protrusion, myopia, and astigmatism are classic features of keratoconus (KC). Yet, little is known about what biological pathways are directly involved in the biomechanical failures that contribute to disease progression. Since alterations in the corneal epithelium have been demonstrated in KC, researchers sought to identify global gene expression changes and key regulators of disease using a transcriptomics approach. RNA-sequencing of corneal epithelium obtained from 5 progressive KC patients and 5 myopic controls. Results were validated by qPCR and Western blot using 31 additional independent samples. WNT10A, a molecule important in Wnt signaling, was found to be reduced at the transcript and protein level in KC epithelium and Bowman’s layer (ratio KC/control = 0.59 per RNA-seq; 0.07 per Western blot). Increased transcript levels were also correlated with increased keratometry (Kmax p = 0.57). Over 100 additional samples were used to perform analysis of tissues. Immunohistochemistry revealed decreased WNT10A protein in Bowman’s layer of KC patients compared to controls. WNT10A was also found to positively regulate COL1A1 (collagen type 1) expression in corneal epithelial cells in vitro. These findings suggest that Wnt signaling is important for collagen I production in the corneal epithelium and contributes to increasing tensile strength – a possible pathway to therapeutically manipulate in KC. 

Socioeconomic disparities in access to pediatric diabetic eye examinations

JAMA Ophthalmology

Regular screening of people with diabetes improves visual outcomes in diabetic retinopathy; however, adherence to ophthalmological examination is variable. In this cohort study of children who met criteria for diabetic retinopathy screening, Thomas et al. evaluated what factors influenced whether the children had a previous diabetic ophthalmologic examination prior to the present examination. Overall, 34.2% (n=149) had not had a prior examination. Subsequent evaluation revealed significant differences in this population: patients without previous diabetic eye exams were more likely to be non-white (75% vs 32%), have type 2 diabetes (75% vs 10%), have Medicaid/public insurance (84% vs 32%), have a household income <$25,000 (41% vs 9%), and have parents with education levels of high school or less (67% vs 35%). Patients cited the fact that they did not recall being told to have an exam, had difficulty finding time for an exam, and had transportation issues, as the main reasons for not having previous eye exams. This study is an important example of social determinants of ophthalmologic health and illustrates where current and future ophthalmologists can address inequities in proper screening for diabetic retinopathy in children.

Dexamethasone Inserts for Allergic Conjunctivitis

American Journal of Ophthalmology

Spring is finally here, and with it comes a bounty of ocular itching, tearing, and swelling. Allergic conjunctivitis (AC) is reported in up to 40% of the population, with topical therapies being the most common form of management. Unfortunately, the available options still present AC sufferers with suboptimal treatment characteristics (inconsistent efficacy, short duration, unfavorable side effects). In their study, McLaurin et al. conducted a randomized controlled double-blinded study to evaluate the efficacy of a dexamethasone intracanalicular insert in reducing the inflammatory allergic response in 70 patients. The dexamethasone insert is easily inserted in the canaliculi during an office visit and slowly releases medication over the duration of a month. After patients were randomly assigned to the dexamethasone insert or placebo, investigators used a modified Ora-CAC® (conjunctival allergen challenge) to evaluate ocular itching after introduction of an allergen into the eyes. The study found that the dexamethasone insert showed a statistically significant reduction in ocular itching when compared to placebo across 36 distinct time points over 4 weeks. The findings of this study demonstrate the potential of dexamethasone intracanalicular inserts as a safe, efficient solution to persistent allergic conjunctivitis.
The application deadline for the AAO Minority Ophthalmology Mentoring Program is June 15, 2021! Check out the application here, and consider applying today!

Glaucoma

Can early interventions of cardiovascular fitness in adolescence have an impact on glaucoma later in life?

Journal of Glaucoma

We all remember our middle school physical fitness test (I still can’t touch my toes), but who knew they could impact glaucoma risk? Scientists from Western Australia sought to determine the effects of physical activity and cardiovascular fitness on the development of glaucoma through a longitudinal cohort: the Raine Study. Parent-reported physical activity was collected between 8 and 17 years, while physical work capacity (PWC) was assessed at 14- and 17-year follow-ups using a physical fitness test that measured the physical load (watts) it took to increase heart rate to 170 bpm. The participants then underwent a comprehensive eye exam at their 20-year follow-up including ocular coherence tomography (OCT) imaging, focused on peripapillary retinal nerve fiber layer thickness (pRNFL), a sensitive detector of early glaucoma. This study found that per 10 Watt increase in PWC, the participants had a thicker pRNFL globally (0.3 µm), superotemporally (0.4 µm), inferonasally (0.7 µm), and nasally (0.4 µm). Larger effects and clinically significant associations may be found as the cohort in this study reaches later adulthood.

Global Health

Screening from Afar: Teleophthalmology in Underserved Care

Telemed Journal EHealth

Preventative screening can be brought to patients! Globally, access to ocular care remains a key contributor to preventable blindness. A mobile team of an ocular technician, a project manager, and driver, screened 124 members of underserved populations in Israel via visual acuity testing, intraocular pressure measurement, and fundus photography. Remote ophthalmologists interpreted images using vertical cup to disc ratio, rim width, asymmetry, disc hemorrhage, nerve fiber layer defect or beta zone peripapillary atrophy. 26.1% and 38.9% of readable optic disc and macular photos were abnormal, respectively, prompting close follow up. The most common pathologies detected were suspicious optic disks (14.5%), OHTN (12.1%), AMD (12.1%), DR (4.8%) and cataract (4.8%). 41.9% of patients in the study received one ocular diagnosis through this visit, 21% received two, and 4% received three. The results of this study validate an organized approach to underserved teleophthalmology. A workflow was created to prioritize those with the most acute ocular findings, which can be implemented in any area with ability to send information to remote ophthalmologists. Teleophthalmology is bridging the gap between patients and intervention globally, with hopes of incorporating AI in the near future.

Question of the Week
A 9-year-old female is brought into the pediatric ophthalmology office for evaluation of her vision. 3 years ago, she had an upper extremity infection which was treated with trimethoprim sulfamethoxazole. Subsequently, she was admitted to the hospital after developing a significant red rash covering most of her body with minimal bullae. She was discharged a few days after. Today, she complains that something has been obstructing her vision and is worsening. She wants to see if it can be removed. Examination reveals the findings below. Which of the following is the most likely cause of these findings?
A.     Sarcoidosis
B.     Stevens-Johnson Syndrome
C.     UV light exposure
D.     Trauma
 
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Quiz Answer: B
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