Secondary AREDS2 Supplements Analysis


In a secondary analysis of the effects of lutein/zeaxanthin on the progression of age-related macular degeneration, the Age-Related Eye Disease Study 2 Research Group found that the total evidence on beneficial and adverse effects suggests lutein/zeaxanthin could be more appropriate than beta-carotene in AREDS-type supplements.

AREDS2 is a multicenter, double-masked, randomized trial of 4,203 participants, 50 to 85 years of age, who are at risk for developing late AMD; 66 percent of the patients had bilateral large drusen and 34 percent had large drusen and late AMD in one eye. In addition to taking the original or variation of the AREDS supplement (vitamin C, vitamin E, beta-carotene and zinc with copper), participants were randomly assigned to one of the following four groups: placebo; lutein/zeaxanthin 10 mg/2 mg; omega-3 long-chain polyunsaturated fatty 3 acids, 1 g; or the combination.

In an exploratory analysis of lutein/zeaxanthin vs. no lutein/zeaxanthin, the hazard ratio of the development of late AMD was 0.90 (95 percent CI, 0.82 to 0.99; p=0.04). Exploratory analyses of direct comparison of lutein/zeaxanthin vs. beta-carotene showed hazard ratios of 0.82 (CI, 0.69 to 0.96; p=0.02) for development of late AMD; 0.78 (CI, 0.64 to 0.94; p=0.01) for development of neovascular AMD; and 0.94 (CI, 0.70 to 1.26; p=0.67) for development of central geographic atrophy. In analyses restricted to eyes with bilateral large drusen at baseline, the direct comparison of lutein/zeaxanthin vs. beta-carotene showed hazard ratios of 0.76 (CI, 0.61 to 0.96; p=0.02) for progression to late AMD; 0.65 (CI, 0.49 to 0.85; p=0.002) for neovascular AMD; and 0.98 (CI, 0.69 to 1.39; p=0.91) for central geographic atrophy.
JAMA Ophthalmol 2014;132:142-149.
The Age-Related Eye Disease Study 2 (AREDS2) Research Group.

Temporary Tarsorrhaphy in Children Using Glue
A prospective case
review of children undergoing temporary tarsorrhaphy with cyanoacrylate glue demonstrated that this technique allows a quick and efficient procedure with relatively easy reapplication in a clinic setting, avoiding the need for multiple general anesthetic procedures.

During a three-year period between January 2010 and January 2013 at a British tertiary specialist children’s hospital, seven children underwent temporary tarsorrhaphy with cyanoacrylate glue instead of the conventional suturing technique. Indications were socket expansion (n=4), fornix deepening (n=2), prosthesis repositioning and prolapsed conjunctiva following enucleation (n=1). The age range was 3 weeks to 14 years (mean, 2.7 years). The glue tarsorrhaphy lasted between 0.5 and 13 weeks (mean, 4.5 weeks). There were no adverse outcomes, and the glue tarsorrhaphy was tolerated well in all cases, with relative ease of reapplication of glue in clinic.
Ophthal Plast Reconstr Surg 2014;30:60-63.
Trivedi D, McCalla M, Squires Z, Parulekar M.

Toric IOL Outcomes with Posterior Corneal Astigmatism
Doctors at Baylor
College of Medicine evaluated the impact of posterior corneal astigmatism on toric intraocular lens outcomes and determined that corneal astigmatism was overestimated in with-the-rule eyes by all devices and underestimated in against-the-rule astigmatism in all devices except the Placido-dual Scheimpflug analyzer.

Corneal astigmatism was measured using five devices before and three weeks after cataract surgery. Toric IOL alignment was recorded at surgery and at the slit lamp three weeks postop. The actual corneal astigmatism was calculated based on refractive astigmatism three weeks postop and the effective toric power calculated with the Holladay 2 formula. The prediction error was calculated as the difference between the astigmatism measured by each device and the actual corneal astigmatism. Vector analysis was used in all calculations.

With the IOLMaster, Lenstar, Atlas, manual keratometer and Galilei (combined Placido-dual Scheimpflug analyzer), the mean prediction errors (D) were, respectively, 0.59 @ 89.7, 0.48 @ 91.2, 0.51 @ 78.7, 0.62 @ 97.2 and 0.57 @ 93.9 for WTR astigmatism (60 to 120 degrees) and 0.17 @ 86.2, 0.23 @ 77.7, 0.23 @ 91.4, 0.41 @ 58.4 and 0.12 @ 7.3 for ATR astigmatism (zero to 30 and 150 to 180 degrees). In the WTR eyes, there were significant WTR prediction errors (0.5 D to 0.6 D) by all devices. In ATR eyes, WTR prediction errors were 0.2 D to 0.3 D by all devices except the Placido-dual Scheimpflug analyzer (all p<0.05 with Bonferroni correction).
J Cataract Refract Surg 2013;39:1803-1809.
Koch D, Jenkins R, Weikert M, Yeu E, et al.

Adverse Effects and Short-term Results After SLT
A prospective study
of 64 eyes of 64 patients not sufficiently treated with local anti-glaucoma therapy indicates that selective laser trabeculoplasty has a good ability to reduce intraocular pressure with a minor risk of adverse effects and no significant increase in macular thickness.

IOP, anterior chamber cells, anterior chamber flare and vitreous haze (according to the Standardization of Uveitis Nomenclature Working Group) were examined before SLT, as well as 24 hours, 14 days, six weeks and three months after SLT. Macular thickness measurements in nine Early Treatment Diabetic Retinopathy Study subfields, including central subfield (measured by Spectralis OCT), were also performed.

The average mean preoperative IOP measurement was 19.1 ±3.972 mmHg compared to 12.9 ±2.514 at 24 hours after SLT (p<0.001); 13.2 ±3.331 mmHg 14 days after SLT (p<0.001); 14.1 ±2.731 mmHg six weeks postop (p<0.001); and 13.9 ±2.922 mmHg three months post-SLT. The central subfield preoperatively was 278.14 ±74.355 μm compared with 277.14 ±71.461 (p=0.177); 277.14 ±71.461 (p=0.354); 287.34 ±74.363 (p=0.414); and 257.45 ±68.431 μm (p=0.214) at 24 hours; 14 days; six weeks; and three months after treatment, respectively. Anterior chamber cells, anterior chamber flare and vitreous haze were not noted at any time of examination.
J Glaucoma 2014;23:105-108.
Klamann M, Maier AK, Gonnermann J, Ruokonen P.

Femto Laser Can Effectively Reduce Phaco Time
German researchers have
concluded that femtosecond laser-assisted cataract surgery allows a significant reduction in effective phacoemulsification time compared to manual phacoemulsification, which correlates positively with preoperative lens opacity.

In this intervention, 88 eyes (Group 1) underwent femtosecond laser-assisted surgery (corneal incisions, capsulotomy, lens fragmentation) using the LenSx platform (Alcon) and residual lens workup with pulsed ultrasound energy (Infiniti Vision System; Alcon). In 62 eyes (Group 2), complete cataract removal was performed with phacoemulsification only, using pulsed ultrasound energy with the same device (Infiniti). Pentacam nucleus staging (PNS) was evaluated using Pentacam HR (Oculus); endothelial cell density was measured using specular microscopy (NonCon Robo). The main outcome measures were mean preoperative PNS staging using an automatic ordinal scaling (PNS-O, grades 0 through 5) and a manually defined density grid derived from Scheimpflug imaging (PNS-P). Effective phacoemulsification time and endothelial cell loss were evaluated in both groups.

Preoperative PNS-O and PNS-P showed no significant difference between the groups (p=0.267). Effective phacoemulsification time was significantly lower in Group 1 for all PNS-O stages (p<0.001), and overall mean effective phacoemulsification time was significantly lower in Group 1 (1.58 ±1.02 seconds vs. 4.17 ±2.06; p=0.0001). With increasing preoperative PNS-P, effective phacoemulsification time increased in both groups; however, this gain was noticeably, but not significantly, lower in Group 2. Endothelial cell loss was significantly lower in Group 1 (p=0.02).
Am J Ophthalmlol 2014;157:426-432.
Mayer W, Klaproth O, Hengerer F, Kohnen T.

Thin-flap LASIK Safe in Thin Corneas
Researchers in a
private center in Tokyo have concluded that LASIK in eyes with thin corneas shows similar long-term stability, safety and efficacy as LASIK in eyes with a central corneal thickness of 500 μm or greater.

Patients were divided into two groups based on CCT. The thin-cornea group (291 eyes of 146 patients) had a CCT of less than 500 μm with normal topography, while the control group (371 eyes of 193 patients) had a CCT of 500 μm or greater. Patients were evaluated to six years postop. Analysis was performed to determine whether there were differences between the groups at the last checkup three to four years postoperatively.

In the thin-cornea group, no significant differences were observed in LASIK outcomes when eyes were subdivided by the time of final checkup (three, four and greater than five years). There was a significant difference in visual and refractive outcomes between three months postoperatively and the last checkup in the thin-cornea group and the control group. No significant difference in visual, refractive or topographic outcomes were observed between the two groups at the last checkup.
J Cataract Refract Surg 2014;40:239-250.
Tomita M, Watabe M, Mita M, Waring G.