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Dr Laura Downie
BOptom PhD(Melb) PGCertOcTher FACO FAAO DipMus(Prac) AMusA


Link between low-dose oral anti-inflammatory therapy and improvement in inner retinal function

A ‘proof of concept’ randomised, double-masked clinical trial involved 30 patients with one or more eyes having severe NPDR or PDR less than Early Treatment Diabetic Retinopathy Study (ETDRS)-defined high-risk PDR. Subjects were randomised to receive daily doxycycline monohydrate (50 mg) or placebo for two years.

From baseline to 24 months, the mean frequency doubling perimetry (FDP) sensitivity decreased in the placebo group (-1.9 dB) and increased in the doxycycline group (+1.2dB, p = 0.02). Compared with controls, a higher mean FDP foveal sensitivity in the doxycycline group was detected at six months (p < 0.05); this effect persisted at 12 and 24 months. There were no differences between groups detected for other functional parameters.

The authors claim this study is the first observation suggesting a link between low-dose anti-inflammatory therapy and sub-clinical improvement in inner retinal function.

The study results also suggest that FDP, which primarily measures inner retinal function, is responsive to intervention and may be useful as clinical trial endpoint for proof-of-concept studies in patients with DR.

JAMA Ophthalmol 2014; Mar 6. Epub ahead of print.


Choroidal thinning in Alzheimer’s disease

Patients with Alzheimer’s disease have been found to have a thinner choroid than healthy age-matched controls. A prospective, cross-sectional study involved 21 patients (mean age 73.1 ± 6.9 years) with mild to moderate Alzheimer’s disease and 21 age-matched controls (mean age 70.3 ± 7.3 years). All subjects underwent neuropsychological and ophthalmological examination.

Choroidal thickness was measured using spectral domain optical coherence tomography (SD-OCT) with manual segmentation of the choroid. Choroidal thickness was found to be significantly thinner in patients with Alzheimer’s disease than in control eyes (p < 0.05). No significant difference in central retinal thickness or peripapillary retinal nerve fibre layer thickness was found between groups (p > 0.05).

It was suggested that choroidal thinning may represent an adjunctive biomarker for the diagnosis and follow-up of patients with Alzheimer’s disease.

J Alzheimer’s Dis 2014; Feb 20. Epub ahead of print.


Dermal injection of cosmetic fillers can lead to irreversible blindness

Cosmetic facial fillers are not approved for use in the forehead; however, off-label use for enhancement in this region is common. A recent paper describes the first reports of blindness in patients caused by the procedure.

The case series describes irreversible vision loss from central retinal artery occlusion in three patients and partial vision recovery in one patient, following cosmetic facial enhancement. It is hypothesised that the filler enters the central retinal artery via the rich external-internal carotid anastomoses and becomes embedded in the retinal tissues, potentially leading to irreversible and severe vision loss.

The authors emphasise the need for physicians performing cosmetic enhancement procedures involving facial fillers to be aware of this potential complication and to inform patients of such risks.

JAMA Ophthalmol 2014; Mar 6. Epub ahead of print.


Needle contamination with intra-vitreal injections: speak or stay silent?

Speaking versus remaining silent makes no significant difference with regard to needle contamination with oral flora during intra-vitreal injection.

A prospective study evaluated the risk of intra-vitreal needle contamination through speaking versus breathing in an ophthalmologic office setting.

Participant physicians (n = 10) held a sterile 30-gauge half-inch needle 25 centimetres from their mouth for 30 seconds under two conditions: while speaking and while breathing silently. Each physician was sampled 15 times. Needles were then cultured and assayed after six days of incubation. Absolute colony-forming units (CFUs) were compared between the two conditions and against control sterile needles and oral swab cultures.

Participants were found to grow an average of 0.21 colonies (median = 1 CFU) from their talking samples and 0.07 colonies (median = 1 CFU) from their silent breathing samples. Oral swab plates grew an average of 373.4 colonies. None of the control needle plates grew CFUs. A nominal regression analysis showed no significant difference in contamination between samples that were collected with a physician talking compared with remaining silent (p = 0.48).

Retina 2014; Feb 6. Epub ahead of print.


Donor health may disturb corneal biochemistry

A small pilot study conducted in Poland has found that some chronic systemic diseases, which do not obviously impact ocular function, may significantly and permanently disturb corneal metabolism.

The content of selected low molecular weight metabolites were compared in corneas harvested from donors who died suddenly from accidental causes or non-poisoning suicide (n = 4), or from chronic cardiovascular or liver disease (n = 4). Metabolite contents were assessed using high-resolution magic angle spinning proton spectroscopy.

Significant differences in corneal biochemical profiles were evident between the study groups. Some of the alterations were described to be most likely related to permanent aberrations in corneal metabolism. The authors concluded that these findings justify the need for a study in larger donor groups to assess the potential impact of liver cirrhosis and cardiovascular disease on corneal metabolism.

Ann Transplant 2014; Mar 12; 19: 129-137.


Possible association between pseudoexfoliation syndrome and coronary artery ectasia

A cross-sectional study was undertaken at Bulent Ecevit University’s Ophthalmology and Cardiology Departments, Turkey. Eighty consecutive patients who underwent coronary angiography were classified into one of two groups: normal coronary arteries (n = 40) and coronary artery ectasia (n = 40).

PXF was diagnosed ophthalmologically through the observation of typical exfoliative material on the anterior surface of the lens, iris or pupillary border. Age, sex, presence of pseudoexfoliative material, hypertension, diabetes mellitus, hyperlipidaemia rates, cigarette smoking history and family history of coronary artery disease were compared between groups.

There were no significant differences in demographic data between groups. PXF was found to be significantly more common in patients with coronary ectasia compared with controls (n = 21 (52.5 per cent) vs n = 8 (20 per cent), p = 0.005).

This is the first study to show a potential relationship between coronary artery ectasia and PXF. Future studies in larger populations are needed to clarify this relationship and other potentially unknown systemic associations of PXF.

Eye (Lond) 2014; Mar 7. Epub ahead of print.


Travoprost therapy for glaucoma can compromise the ocular surface

A study investigated corneal epithelial and Langerhans cell (LC) densities, along with dry eye parameters, in patients with primary-open angle glaucoma (POAG) using one of two commercially-available Travoprost 0.004 per cent topical medications with differing preservatives: benzalkonium chloride 0.015 per cent (TravBAK), or polyquaternium-1 0.001 per cent (TravPQ).

The consecutive case series consisted of 19 POAG patients using TravBAK (age: 64.8 ±?13.6 years), 19 POAG patients using TravPQ (age: 66.8?±?11.3 years) and 19 age-matched healthy controls (age: 63.8?±?8.2 years). Ocular surface disease index, lid parallel conjunctival folds, Schirmer test and tear break up time (TBUT) were assessed. Corneal epithelial and Langerhans cell densities were investigated using confocal microscopy.

Tear production was significantly reduced and Langerhans cell densities were greater in both POAG groups compared with controls (p < 0.05). TBUT was significantly reduced and epithelial cell densities were significantly greater in TravBAK eyes compared with healthy individuals (p < 0.05).

TravPQ eyes demonstrated relatively less disturbance to the ocular surface and more controlled corneal homeostatis than TravBAK eyes.

Pathol Oncol Res 2014; Mar 13. Epub ahead of print.


Use of statistical analyses in the ophthalmic literature

A recent cross-sectional study of the peer-reviewed ophthalmic literature has found that readers of clinical journals in ophthalmology need to possess substantial knowledge of statistical methodology to understand the results of published studies.

All articles published in 2012 in the journals Ophthalmology, American Journal of Ophthalmology and Archives of Ophthalmology were reviewed. A total of 780 peer-reviewed publications were included. Two reviewers examined each article and assigned categories to each one depending on the type of statistical analyses that were used. Discrepancies between reviewers were resolved by consensus.

It was found that readers with little or no statistical knowledge would be expected to be able to interpret the statistical methods in only 20.8 per cent of studies. To understand more than half of the published articles, readers would be expected to be familiar with at least 15 different statistical methods. Articles related to retina and glaucoma sub-specialities showed a tendency for using more complex analyses when compared with articles from the cornea subspeciality.

The results of the study can also be used to provide guidance to direct the training of optometrists, ophthalmologists, researchers and clinical educators in the area of statistics.

Ophthalmology 2014; Mar 5. Epub ahead of print.


Alterations to choroidal thickness during migraine

Choroidal thickness has been found to be significantly increased in migraine patients during the attack period when compared with basal levels.

An observational, cross-sectional study involved 58 eyes of 29 subjects with a diagnosis of migraine with or without visual aura. Using the enhanced depth imaging mode, two optical coherence tomography scans were performed for each patient: one during the peak period of the migraine attack and other during a headache-free interval.

In patients with unilateral headaches, choroidal thickness measurements during the attack period were significantly increased only in eyes on the headache side (p < 0.001) compared with baseline. Foveal choroidal thickness in the pain-free interval was 373.45 ± 76.47 (mean ± SD) µm and increased to 408.80 ± 77.70 µm during the attack period (p < 0.001). When the choroidal thickness of patients with bilateral headaches were compared to basal levels, a statistically significant increase was observed at five out of seven measured points in right eyes and at all seven measured points in left eyes (p < 0.05).

The authors acknowledge that this study is a preliminary report with some limitations. Larger studies investigating the neurovascular structures of the eye during migraine may provide further insights into both the pathogenesis of migraine and the association between migraine and glaucoma.

Br J Ophthalmol 2014; Feb 26. Epub ahead of print.

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