JOURNAL CLUB

RECENT NOTEWORTHY STUDIES TO STIMULATE DISCUSSION AND DEBATE

■ OCT in macular hole outcomes. Ophthalmologists in France undertook a study to determine the changes detected with microperimetry and SD-OCT following successful macular hole surgery (Figure).

In a retrospective study, the authors investigated 23 eyes of patients with idiopathic macular hole for whom closure was successful. They recorded pre- and postoperative VA, retinal sensitivity values per microperimetry, and macular and foveal thickness, as well as the presence of lesions, on spectral-domain OCT.

Poorer VA was significantly correlated with lower macular sensitivity and foveal sensitivity and more lesions on OCT. Better postoperative VA correlated with better preoperative VA and better macular and foveal sensitivity.

The authors concluded that outer retinal integrity was linked to better final retinal sensitivity, although they cautioned against generalizing the findings of a small retrospective study.

Bonnabel A, Bron AM, Isaico R, Dugas B, Nicot F, Creuzot-Garcher C. Long-term anatomical and functional outcomes of idiopathic macular hole surgery. The yield of spectral-domain OCT combined with microperimetry. Graefes Arch Clin Exp Ophthalmol. 2013;251:2505-2511.

■ NHS and inherited eye disease. A study from the United Kingdom has found that patients with inherited retinal diseases strongly support public funding for testing.

Conducting telephone interviews with 200 participants, the study authors found that the patients had variable knowledge of their conditions. The vast majority (90%) said they would undergo genetic testing if offered. A similar percentage supported publicly funded testing, although fewer supported it if coupled with reproductive planning.

The study was funded in part by the UK’s National Health Service, so some possibility exists that the results could contribute to future policy.

Figure. Optical coherence tomography image (top) showing full thickness macular hole with sharp margins and irregular surface of surrounding retina. OCT after vitrectomy (bottom) reveals a closed macular hole with a BCVA of 0.7.

COURTESY: HINDAWI PUBLISHING CO.

Willis TA, Potrata B, Ahmed M, et al. Understanding of and attitudes to genetic testing for inherited retinal disease: a patient perspective. Br J Ophthalmol. 2013;97:1148-1154.

■ Race, ethnicity, and AMD. While researchers have identified genes involved in the AMD disease process, it remains unclear whether race and ethnicity play roles in the expression of these genes.

In a cross-sectional study, retinal physicians collaborating among several medical centers in the United States, Australia, and Singapore studied genetic data from 2,456 people who had participated in the Multi-Ethnic Study of Atherosclerosis (MESA).

Analyzing 12 single-nucleotide polymorphisms (SNPs) from 233 candidate genes, the authors found few statistically significant associations that were consistent across all races/ethnicities. White patients were the most likely to have early AMD (6% vs 4% on average). In addition, they found higher risk allele frequencies in patients of Chinese ancestry.

While none of the SNPs examined could solely explain the rates of AMD, the authors stated that genetic susceptibility could partially account for the variations.

Klein R, Li X, Kuo JZ, et al. Associations of candidate genes to age-related macular degeneration among racial/ethnic groups in the Multi-Ethnic Study of Atherosclerosis. Am J Ophthalmol. 2013;156:1010-1020.

■ Data on fall-related traumas. A team of retinal physicians from the New Jersey Medical School in Newark reviewed the charts of 602 patients with open globe injuries to describe the characteristics and outcomes of the injuries.

Eighty-five of the injuries were fall-related, constituting the primary study group. This group had a mean age of 65.8 years old, nearly twice the age of the control group. VA was worse in the elderly group at both admission and at the final follow-up.

Based on regression analysis to determine factors associated with no light perception and enucleation, the study authors found that zone III injuries were associated with higher rates of NLP vision, which in turn were associated with higher rates of enucleation.

Among other conclusions, the authors suggested that elderly patients experiencing zone III injuries might benefit from vitrectomy to diminish the risk of NLP vision. RP

Emami-Naeini P, Ragam A, Bauza AN, et al. Characteristics, outcomes, and prognostic indicators of fall-related open globe injuries. Retina. 2013;33:2075-2079.