JOURNAL CLUB

RECENT NOTEWORTHY STUDIES TO STIMULATE DISCUSSION AND DEBATE

■ Beyond AREDS. Physicians collaborating among Ireland, South Africa, the United Kingdom, and the United States undertook a study to compare the effects of three macular carotenoid formulations on macular pigment optical density and visual performance in subjects with early AMD.

Fifty-two subjects received 20 mg/day of lutein and 2 mg/day zeaxanthin or the same zeaxanthin dose with varying doses of lutein plus meso-zeaxanthin, another macular pigment. Heterochromatic flick photometry was used to measure macular pigment optical density, while visual performance was measured with corrected distance VA and letter contrast sensitivity.

At 12 months, the two groups receiving meso-zeaxanthin experienced statistically significant increases in macular pigment optical density, while an increase was seen only at 1.75º. In addition, the group receiving the larger dose of meso-zeaxanthin (17 mg) had greater improvements in letter contrast sensitivity than the other groups.

The authors conclude that high-dose meso-zeaxanthin resulted in significant, positive changes. They recommend a head-to-head comparison of supplementation including meso-zeaxanthin to the AREDS2 formula.

Sabour-Pickett S, Beatty S, Connolly E, et al. Supplementation with three different macular carotenoid formulations in patients with early age-related macular degeneration. Retina. 2014;34:1757-1766.

■ Bevacizumab in ROP. A team of pediatric ophthalmologists in Heidelberg, Germany, has found that a low dose of bevacizumab (Avastin, Genentech, South San Francisco, CA) was highly effective in children with retinopathy of prematurity.

A total of 29 patients with a median gestational age of 25±1 weeks and a median birth weight of 630 g received 0.376 mg of bevacizumab and were followed up for a median of 4.2 months.

All of the eyes experienced regression of plus disease within two to six days. Only one child who had several comorbidities required more than one injection. The authors conclude that the lower dose of bevacizumab might be preferable to the higher dose of 0.625 mg typically used and could prevent dosage-related side effects.

The study adds to past large-cohort studies of European populations, notably the Rotterdam Eye Study, conducted in the Netherlands and the Tromso Eye Study, conducted in Norway, in addition to the US-conducted Beaver Dam and Blue Mountain studies.

The authors intend to present data in the future from the five- and 10-year follow-ups of the Gutenberg Health Study.

Harder BC, von Baltz S, Jonas JB, Schlichtenbrede FC. Intravitreal low-dosage bevacizumab for retinopathy of prematurity. Acta Ophthalmol. 2014;92:577-581.

■ Also from Germany. Retinal physicians in Mainz, Germany, have reported AMD outcomes from the Gutenberg Health Study cohort, to determine the prevalence of AMD in the group, as well as correlations with demographic factors.

Fundus photos of 4,340 patients were graded by the authors. In the youngest subgroup of patients 35 to 44 years old, small, hard drusen were found in 37.4% of the patients, while early AMD was found in 3.8%. In the overall group, advanced AMD was found in 0.2% of patients, with a strong age-relation association.

Korb CA, Kottler UB, Wolfram C, et al. Prevalence of age-related macular degeneration in a large European cohort: Results from the population-based Gutenberg Health Study. Graefes Arch Clin Exp Ophthalmol. 2014;252:1403-1411.

■ More large-cohort data. Chinese physicians have reported data on visual acuity and subfoveal choroidal thickness from the Beijing Eye Study, conducted in 2011 in nearly 3,500 participants.

The volunteers for the study underwent examinations including spectral-domain OCT with enhanced depth imaging to measure choroidal thickness and visual acuity assessments.

After adjustment for several variables, including age, educational level, height, BMI, and the presence of glaucoma, the authors found that better logMAR BCVA was significantly associated with a thicker subfoveal choroid of at least 30 µm.

After omitting eyes with glaucoma, diabetic retinopathy, late AMD, and high myopia, this association was still significant. Moreover, the association was maintained in the reverse, ie, a thicker subfoveal choroid was associated with better BCVA.

The authors suggest that a subfoveal choroidal thickness of 30 µm could constitute a cut-off, beyond which BCVA drops markedly, in parallel to the finding that axial length >26 mm could be used as a cut-off for lower BCVA in high myopia.

Shao L, Xu L, Wei WB, et al. Visual acuity and subfoveal choroidal thickness: the Beijing Eye Study. Am J Ophthalmol. 2014;158:702-709.

■ Ranibizumab in PCV. Retina specialists in Japan recently studied 89 eyes with treatment-naïve polypoidal choroidal vasculopathy, attempting to determine relationships between changes in foveal choroidal thickness and the one-year outcomes of treatment with ranibizumab (Lucentis, Genentech).

The 89 enrolled eyes were submitted to enhanced depth imaging OCT and logMAR visual acuity. At one year after the first injection, the mean logMAR VA improved from 0.42±37 to 0.33±35.

In addition, both choroidal and foveal thickness decreased significantly. Resolution of PCV was correlated with a greater decrease in choroidal thickness. The authors believe that the efficacy of ranibizumab in reducing foveal thickness could have significant implications for the treatment of PCV.

Hikichi T, Kitamei H, Shioya S, et al. Relation between changes in foveal choroidal thickness and 1-year results of ranibizumab therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol. 2014;98:1201-1204.