Current Issue

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In this week’s issue

• A personalized glaucoma coaching program significantly improved medication adherence and reduced related distress compared with standard written education.
• Modified chitosan medical membrane may decrease post-operative inflammation in pterygium excision.
• Trauma-related enucleation and evisceration were associated with higher rates of post-operative depression and anxiety.

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JAMA Ophthalmology 

Personalized coaching improves glaucoma medication adherence

SEE-ing with support. Glaucoma is a leading cause of irreversible vision loss that affects over three million Americans. To address poor adherence to daily eye drops, investigators conducted a 1:1 randomized clinical trial in which 235 participants were enrolled in a personalized coaching program versus mailed educational resources (117 SEE, 118 control). Patients from the University of Michigan and Henry Ford Health System were recruited between 2021 and 2023. Over 6 months, patients participated in motivational interviewing-based coaching, received medication reminders, and monitored for adherence. Mean baseline adherence was 63.9%. At 6 months, adherence increased to 77.6% in the SEE group versus 58.0% in controls. 54.9% of intervention participants achieved ≥80% adherence compared with 23.7% of controls. Participants in the SEE group also reported decreased glaucoma-related distress and demonstrated a greater reduction in intraocular pressure in the better eye (-0.84 mmHg vs -0.38 mmHg). Overall, the SEE program demonstrated considerable efficacy, producing clinically significant improvements in medication adherence and decreasing disease-related distress.

American Journal of Ophthalmology (AJO)

Chitosan membrane use in pterygium management

Some backup in the fight against post-op recurrence. Pterygium, a common fibrovascular conjunctival growth, can cause ocular irritation, astigmatism, and has frustratingly high recurrence rates after excision. Because postoperative inflammation is thought to contribute to recurrence, there is ongoing interest in adjuncts that provide anti-inflammatory benefits without the risks associated with standard antimetabolite therapies. Modified chitosan medical membrane (MCMM), a biodegradable and biocompatible material, has recently emerged as a potential option. In this prospective randomized controlled trial, 54 patients with primary pterygium underwent excision with amniotic membrane transplantation (AMT) alone or with added subconjunctival MCMM implantation, and were followed for three years to assess recurrence and relevant tear cytokine profiles. MCMM significantly reduced postoperative tear IL-8 and TNF-α levels at both 1 and 3-6 months compared with AMT alone. However, pterygium recurrence rates were similar between groups (19.2% AMT vs. 14.3% MCMM; P = 0.903). Although MCMM appears to be effective in reducing postoperative inflammation, it did not lower recurrence rates, though it may still represent a safer alternative to antimetabolites and warrants further investigation.

British Journal of Ophthalmology

Psychiatric burden following eye removal is highest in trauma cases

The psychological impact of losing an eye may depend on the context in which it happens. Enucleation and evisceration (EE) are eye removal surgeries reserved for end-stage eye conditions, including malignancy, severe infection, trauma, and blind painful eye. Using the TriNetX Health Research Network, investigators conducted a large retrospective cohort study of 20,109 patients who underwent EE and compared psychiatric outcomes with those of matched patients undergoing other major ocular surgeries, as well as whether outcomes varied by indication. At one year, patients who underwent EE had higher rates of antidepressant and anxiolytic use than matched controls, despite similar rates of depression and significantly lower risk of anxiety. When stratified by surgical indication of EE, trauma-related EE emerged as a uniquely higher risk with these patients having significantly higher rates of depression, antidepressant and anxiolytic use, and substance use disorders compared to controls. Trauma was a significant predictor of postoperative depression even after adjusting for prior psychiatric history, socioeconomic factors, and ocular pain. These findings support proactive, targeted psychological screening and intervention in patients undergoing EE, especially those with trauma-related EE. 

Retina

Socioeconomic factors and visual outcomes in neovascular AMD

What’s the price of sight? By 2050, the number of individuals with neovascular age-related macular degeneration (nAMD) in the United States is projected to more than double, from 2.07 million to 5.44 million. Anti-vascular endothelial growth factor (anti-VEGF) therapy remains the standard of care to slow disease progression, yet outcomes vary by socioeconomic status. In this retrospective study using U.S. census data, investigators analyzed the impact of socioeconomic status (SES) on best-corrected visual acuity (BCVA) and anti-VEGF treatment patterns. Lower income was associated with a significantly worse baseline and final BCVA. Worse baseline BCVA and older age independently predicted worse final BCVA, while higher income was associated with better final BCVA. Treatment patterns also differed by ethnicity: Hispanics or Latinos were less likely to receive aflibercept injections and more likely to receive bevacizumab compared to Non-Hispanic or Latino individuals. This study demonstrates both anti-VEGF selection and final nAMD BCVA results differ by income and ethnicity, highlighting potential areas of inequity in ophthalmic care.

Bevacizumab for Retinopathy of Prematurity (BEAT-ROP)

Can injections alone curb ROP? Retinopathy of prematurity (ROP) is a neovascular retinal disorder and leading cause of childhood blindness, primarily in infants of low birth weight. At the time of BEAT-EOP, laser therapy was the gold standard for treatment of stage 3+ ROP. However, vascular endothelial growth factor (VEGF) inhibitors, including bevacizumab, were often used off-label, with purported benefits. This prospective, multicenter, randomized controlled clinical trial compared intravitreal bevacizumab monotherapy and conventional laser therapy on recurrence rates of ROP in infants with stage 3+ ROP who had zone I or II posterior disease. 143 infants, evaluated at 54 weeks’ postmenstrual age, were included in the primary outcome analyses.

Key Points

• There was significant reduction in rates of ROP recurrence in infants in the bevacizumab group (6 of 140 eyes, 4%) versus infants in the laser-therapy group (32 of 146 eyes, 22%)
• When segmenting by zone, a significant treatment effect was found for zone I retinopathy of prematurity (P = 0.003) but not for zone II disease (P = 0.27)

This landmark study demonstrated that intravitreal bevacizumab monotherapy provided a significant decrease in zone I disease recurrence in infants with stage 3+ ROP when compared with conventional laser therapy. Such findings dramatically altered the treatment protocol and outcomes for many infants with ROP.