Volume 9, Number 3
WELCOME to Review
of Ophthalmology's Retina
Online e-newsletter. Each month, Medical Editor Philip Rosenfeld,
MD, PhD, and our editors provide you with this timely and easily
accessible report to keep you up to date on important information
affecting the care of patients with vitreoretinal disease.
Visual Outcome Following Treatment With Ranibizumab or
Bevacizumab in Neovascular AMD
The current accepted standard treatment for neovascular age-related macular degeneration (AMD) consists of
anti-vascular endothelial growth factor agents including ranibizumab and bevacizumab. In the following
prospective, randomized, parallel group multicenter trial, Austrian scientists examined whether bevacizumab
is inferior to ranibizumab with respect to maintaining/improving visual acuity (VA).
They included patients aged more than 50 years with treatment-naïve neovascular AMD at 10 centers.
They randomized patients to treatment either with 0.5 mg ranibizumab or 1.25 mg bevacizumab. Both groups
received three initial monthly injections and thereafter, monthly evaluation of VA and the activity of the lesion.
They scheduled re-treatment as needed. Outcome measures were Early Treatment of Diabetic Retinopathy Study (ETDRS)
VA, retinal thickness, lesion size and safety evaluation.
The scientists recruited 321 patients, of which four had to be excluded. They randomized 154 of the 317
remaining patients into the bevacizumab group and 163 into the ranibizumab group. At month 12, they found a
mean increase of ETDRS VA of 4.9 letters in the bevacizumab and 4.1 letters in the ranibizumab group
(p=0.78). Furthermore, they noted no significant differences in the decrease of retinal thickness,
change of lesion size and number of adverse events between the groups.
Bevacizumab was equivalent to ranibizumab for VA at all time points over one year, the study scientists
concluded. They reported no significant difference of decrease of retinal thickness or number of adverse events.
Source: Krebs I, Schmetterer L, Boltz A, et al; for the MANTA Research Group. A randomized
double-masked trial comparing the visual outcome after treatment with ranibizumab or bevacizumab
in patients with neovascular age-related macular degeneration. Br J Ophthalmol. 2013; 97(3):266–271.
VA Changes in Patients With Wet AMD Treated With Intravitreal Ranibizumab
To survey compliance with recommended intravitreal ranibizumab treatment protocols in daily clinical
practice in France, with reference to outcomes, investigators conducted a retrospective,
descriptive, observational study in patients with subfoveal wet age-related macular degeneration
(AMD) treated with ranibizumab.
They recorded all historical data for the study period, including demographic, treatment
and disease details, as well as visual acuity (VA) measurements (baseline, month three and month 12) at least 12 months
after the beginning of treatment.
In 551 patients followed by 16 ophthalmologists, the investigators noted that 12 months of intravitreal
ranibizumab treatment induced a mean VA gain of 3.2 ± 14.8 Early Treatment Diabetic Retinopathy
Study–equivalent letters. They also reported that less than 40% of patients received the recommended
treatment of initial three monthly injections and that more than 50% had to wait more than eight days
between diagnosis and treatment. According to the investigators, at month three, VA gain was greater in
patients who had received recommended induction and in whom treatment was initiated quickly. They observed
that, at month 12, the induction-related effect had largely disappeared, but that the time-to-treatment
effect persisted. Patients had an average of 5.1 injections (2.6 during induction period). No patients
were monitored monthly as stipulated in the guidelines.
Although poor compliance with recommendations has been reflected in mediocre outcomes, there
is evidence that practice is improving.
Source: Cohen SY, Mimoun G, Oubraham H, et al; for the LUMIERE Study Group. Changes in visual
acuity in patients with wet age-related macular degeneration treated with intravitreal ranibizumab
in daily clinical practice: The LUMIERE Study. Retina. 2013; 33(3):474–481.
Predicting Retreatment With Anti-VEGF Therapy Based on
Quantitative Changes in RPE Detachments
Researchers sought to determine whether quantitative changes in retinal pigment epithelial detachments
(PEDs) predict the need for retreatment in eyes undergoing spectral domain optical coherence
tomography (SD-OCT)-guided, as-needed therapy with anti-vascular endothelial growth factor (anti-VEGF) drugs.
They found that quantitation of the change in the PED volume and area may be useful in determining when
to retreat eyes undergoing SD-OCT-guided, as-needed anti-VEGF therapy.
The researchers retrospectively identified patients with vascularized PEDs undergoing SD-OCT-guided treatment
with anti-VEGF drugs and decided to retreat these cases based on qualitative assessments of fluid in the macula.
They retrospectively analyzed SD-OCT images from visits in which the treatment was withheld. They then used a
novel algorithm to measure the area and volume of PEDs at these visits.
The study researchers identified 14 eyes and withheld retreatment at 57 visits. They noted that when they used
the SD-OCT algorithm to evaluate the scans from these visits, the PED volume increased at eight visits. At all
of these eight visits, a treatment was needed at the next follow-up visit. For the remaining 49 visits in which
the treatment was withheld, the PED volume did not increase and no treatment was needed at the next follow-up visit.
Source: Penha FM, Gregori G, Garcia Filho CA, et al. Quantitative changes in retinal pigment
epithelial detachments as a predictor for retreatment with anti-VEGF therapy. Retina. 2013;33(3):459–466.
Impact of Beta-blockers on the Need for Repeated Intravitreal
Injections in Wet AMD Treated by Bevacizumab
The authors of this retrospective, nonrandomized, single-center, consecutive interventional case series
study sought to evaluate the effect of concomitant systemic therapy in patients with choroidal
neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated by intravitreal
bevacizumab and to propose a mechanism for different inter-individual response.
They treated 46 eyes from 46 patients with CNV secondary to AMD by monthly intravitreal 1.25 mg bevacizumab
injections on a pro re nata regime. They then recorded changes in Early Treatment Diabetic Retinopathy
Study best-corrected visual acuity (BCVA), central foveal thickness as determined by spectral domain optical
coherence tomography, number of injections performed, occurrence of severe adverse effects and systemic
concomitant medication. Additionally, they evaluated the effect of systemic medication on final BCVA, central
foveal thickness and number of injections performed.
The most frequent systemic medications recorded were angiotensin-converting-enzyme inhibitors in 19
patients; beta-adrenergic blocking agents (n=18); nonsteroidal anti-inflammatory drugs (n=17); diuretics
(n=16); calcium channel blockers (n=14); benzodiazepines (n=11); proton-pump inhibitors (n=9); and statins (n=8).
The study authors noted that 32 patients had arterial hypertension. Average follow-up was 25.1 months
(standard deviation [SD]=8.9) and average gain in BCVA was 0.9 (SD=13.6) and –2.1 letters (SD=15.9) at
12 months and 24 months, respectively. The average reduction in central foveal thickness was 111 µm (SD=54)
and 105 µm (SD=71) at 12 months and 24 months, respectively. The average number of intravitreal injections
required was 6.7 (SD=3.2). Furthermore, patients on treatment with systemic beta-adrenergic blocking agents
required fewer intravitreal injections (5.2, SD=2.4 vs. 7.9, SD=3.4) and this difference was statistically
significant (p=0.0068, multiple linear regression).
In conclusion, concomitant systemic beta-adrenergic blocking agents treatment may reduce the need for
repeated intravitreal injections of bevacizumab in patients with CNV associated with AMD.
Source: Montero JA, Ruiz-Moreno JM, Sanchis-Merino E, Perez-Martin S. Systemic beta-blockers may
reduce the need for repeated intravitreal injections in patients with wet age-related macular
degeneration treated by bevacizumab. Retina. 2013; 33(3):508–512.
Pharmacogenetics for Genes Related to AMD
Researchers conducted this clinical trial to evaluate the pharmacogenetic relationship between genotypes of
single nucleotide polymorphisms (SNPs) known to be associated with age-related macular degeneration (AMD) and
response to treatment with ranibizumab (Lucentis, Genentech) or bevacizumab (Avastin, Genentech) for neovascular AMD.
They recruited 834 (73%) of 1,149 patients participating in the Comparison of AMD Treatments Trials (CATT)
through 43 CATT clinical centers. They genotyped each patient for SNPs rs1061170 (CFH), rs10490924 (ARMS2),
rs11200638 (HTRA1) and rs2230199 (C3) using TaqMan SNP genotyping assays (Applied Biosystems). Additionally,
the researchers compared genotypic frequencies with clinical measures of response to therapy at one year, including
mean visual acuity (VA); mean change in VA; 15-letter or more increase in VA, retinal thickness, mean change in
total foveal thickness, presence of fluid on OCT, presence of leakage on fluorescein angiography (FA); mean change
in lesion size and mean number of injections administered. They evaluated differences in response by genotype
with tests of linear trend calculated from logistic regression models for categorical outcomes and linear
regression models for continuous outcomes. To adjust for multiple comparisons, they considered
p≤0.01 statistically significant.
The study researchers identified no statistically significant differences in response by genotype for any
of the clinical measures studied. Specifically, there were no high-risk alleles that predicted final VA or
change in VA, the degree of anatomic response (fluid on OCT or FA, retinal thickness, change in total foveal
thickness, change in lesion size), or the number of injections. Furthermore, a stepwise analysis failed to
show a significant epistatic interaction among the variants analyzed; that is, response did not vary by the
number of risk alleles present. The lack of association was similar whether patients were treated with
ranibizumab or bevacizumab or whether they received monthly or pro re nata dosing.
To conclude, although specific alleles for CFH, ARMS2, HTRA1 and C3 may predict the development of AMD, they
did not predict response to anti-vascular endothelial growth factor therapy.
Source: Hagstrom SA, Ying G, Pauer GJ, et al; Comparison of AMD Treatments Trials Research
Group. Pharmacogenetics for genes associated with age-related macular degeneration in the Comparison
of AMD Treatments Trials (CATT). Ophthalmology. 2013;120(3):593–599.
New Loci Linked to AMD
To accelerate the understanding of age-related macular degeneration (AMD) biology and to help design
new therapies, the authors of this letter executed a collaborative genome-wide association study that
included more than 17,100 advanced AMD cases and more than 60,000 controls of European and Asian ancestry.
They identified 19 loci associated at p<5 x 10–8 and noted that these loci show
enrichment for genes involved in the regulation of complement activity, lipid metabolism, extracellular
matrix remodeling and angiogenesis. Their results include seven loci with associations reaching
p<5 x 10–8 for the first time, near the genes COL8A1-FILIP1L, IER3-DDR1, SLC16A8,
TGFBR1, RAD51B, ADAMTS9 and B3GALTL. The study authors reported that a genetic risk score combining SNP
genotypes from all loci showed similar ability to distinguish cases and controls in all samples examined.
Their findings provide new directions for biological, genetic and therapeutic studies of AMD.
Source: Fritsche LG, Chen W, Schu M, et al. Seven new loci associated with age-related macular
degeneration. Nat Genet. 2013; March 3 [Epub ahead of print]. DOI: 10.1038/ng.2578.
Secondary Outcomes of Carotenoids With Co-antioxidants vs.
Placebo in Early AMD
The following randomized, double-masked placebo-controlled clinical trial reported the secondary outcomes
in the Carotenoids with Co-antioxidants in Age-Related Maculopathy trial.
Participants included 433 adults 55 years of age or older with early age-related macular degeneration (AMD) in one
eye and late-stage disease in the fellow eye (group one) or early AMD in both eyes (group two). Intervention
consisted of an oral preparation containing lutein (L), zeaxanthin (Z), vitamin C, vitamin E, copper, and zinc or placebo. Best-corrected visual acuity (BCVA), contrast sensitivity (CS), Raman spectroscopy, stereoscopic colour
fundus photography and serum sampling were performed every six months with a minimum follow-up time of
12 months. Secondary outcomes included differences in BCVA (at 24 and 36 months), CS, Raman counts, serum
antioxidant levels and progression along the AMD severity scale (at 12, 24 and 36 months).
It was reported that the differential between active and placebo groups increased steadily, with average BCVA
in the former being approximately 4.8 letters better than the latter for those who had 36 months of follow-up,
and this difference was statistically significant (p=0.04). In the longitudinal analysis, for a
1-log-unit increase in serum L, visual acuity was better by 1.4 letters (95% confidence interval,
0.3–2.5; p=0.01), and a slower progression along a morphologic severity scale (p=0.014)
Functional and morphologic benefits were observed in key secondary outcomes after supplementation with L, Z
and co-antioxidants in persons with early AMD.
Source: Beatty S, Chakravarthy U, Nolan JM, et al. Secondary outcomes in a clinical trial of
carotendoids with coantioxidants versus placebo in early age-related macular degeneration.
Two-Year Results of Treatment With As-needed Ranibizumab for PCV
To investigate the two-year outcomes of three monthly intravitreal ranibizumab injections followed by
as-needed reinjections to treat polypoidal choroidal vasculopathy (PCV), the authors of this Japanese
study prospectively examined 75 consecutive eyes with naïve symptomatic PCV with two years of follow-up
The mean (±SD) numbers of injections were 4.2 ± 1.3 that included three monthly injections in the
loading phase and 1.6 ± 1.7 during years one and two, respectively (mean two-year total,
5.6 ± 1.9). Additionally, the baseline logarithm of the minimum angle of resolution (logMAR) visual acuity
(VA) was 0.59 ± 0.51 that improved significantly (p=0.001 for both comparisons) to 0.37 ± 0.33
and 0.41 ± 0.40 at one and two years, respectively, after the first injection. Although the authors found
no significant difference between years one and two after the first injection, they noted that the VA tended to
decrease slightly during year two. They also reported that improved foveal thickness was maintained during year
two and that 30 (40%) eyes and 19 (25%) eyes, respectively, at years one and two after the first injection
had no polypoidal lesions on indocyanine green angiography. A branching vascular network (BVN) remained in all
eyes two years after the first injection and tended to increase in size during year two.
According to the study authors, the two-year outcomes showed significant VA and foveal thickness improvements
in eyes with PCV. During year two, the magnitude of the improvement was lower compared with year one. An
as-needed reinjection schedule might not prevent polypoidal lesions or BVNs from regrowing. Further
investigations should establish a treatment strategy for PCV.
Source: Hikichi T, Higuchi M, Matsushita T, et al. Results of 2 years of treatment with
as-needed ranibizumab reinjection for polypoidal choroidal vasculopathy. Br J Ophthalmol. 2013; Feb 21.
[Epub ahead of print]. DOI: 10.1136/bjophthalmol-2012-302652.
Treatment Effect of PDT for PCV After Five Years
This Korean retrospective study aimed to evaluate the five-year efficacy of photodynamic therapy (PDT)
in patients with polypoidal choroidal vasculopathy (PCV).
A total of 42 eyes of 36 patients with PCV followed up for at least 60 months after PDT were reviewed.
All eyes were primarily treated with PDT and the main outcome measure was best-corrected visual acuity
(BCVA; logarithm of minimal angle of resolution [logMAR]) at baseline and at each follow-up visit. The eyes
were also classified into three groups: improved (improvement ≥0.3 logMAR), decreased
(deterioration ≥0.3 logMAR) and stable.
During the mean follow-up duration, 73.64 ± 13.47 months, the mean number of PDT was 2.21 ± 1.62
treatments. Recurrence was noted in 33 eyes (78.6%) during follow-up. The mean baseline BCVA was 0.78 ±
0.48 logMAR (20/120 Snellen equivalent), and the final BCVA at 60 months was 0.67 ± 0.52 logMAR (20/93
Snellen equivalent) (p=.050, paired t test). On the final evaluation at 60 months, the mean BCVA
was improved in 14 eyes (33.3%), stable in 23 eyes (54.8%) and decreased in five eyes (11.9%).
To conclude, 88.1% of PCV patients showed stable or improved BCVA after PDT at 60 months following initial
PDT. Despite a high recurrence rate, PDT remained effective for five years and represents a good therapeutic
approach to PCV.
Source: Kang HM, Kim YM, Koh HJ. Five-year follow-up results of photodynamic therapy for
polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013; 155(3):438–447.
OCT-defined Predictive Value in RVOs of Early vs. Late or
Incomplete Ranibizumab Response
A post hoc analysis from two prospective, randomized, controlled clinical trials sought to determine whether
optical coherence tomography (OCT) at baseline or month three in the Treatment of Macular Edema following
Branch Retinal Vein Occlusion: Evaluation of Efficacy and Safety (BRAVO) and Treatment of Macular Edema
following Central Retinal Vein Occlusion: Evaluation of Efficacy and Safety (CRUISE) studies provides information
that predicts visual outcome.
Included were 397 patients from the BRAVO study and 392 patients from the CRUISE study. Time-domain OCT imaging
data were analyzed and the main outcome measure was the mean change from baseline best-corrected visual acuity
(BCVA) letter score at month six and month 12.
Among ranibizumab-treated patients, 71.2% (0.3 mg) and 78.5% (0.5 mg) in the CRUISE study and 79.1%
(0.3 mg) and 84.7% (0.5 mg) in the BRAVO study had central foveal thickness (CFT) of 250 µm or less at
month three and therefore were categorized as early ranibizumab responders. Early ranibizumab responders had
excellent visual outcomes regardless of ranibizumab dose; mean improvement in BCVA letter score at six and 12
months was 15.0 to 16.5 (central retinal vein occlusion [CRVO]) and 17.4 to 19.1 (branch retinal vein occlusion
[BRVO]). Late or incomplete ranibizumab responders with CRVO (CFT >250 µm at month three) did not fare
as well as early responders if they were treated with 0.3 mg ranibizumab (month six, p=0.012). At month
six, compared with ranibizumab-treated CRVO patients with resolved cystoid macular edema (CME) at month three,
those with persistent CME did worse, on average, and significantly so for 0.5 mg (13.1 vs. 18.6; p=0.027).
At baseline, subretinal fluid (SRF) was present in 57% of patients with CRVO and in 45% of patients with
BRVO; its presence did not portend a poor outcome in patients treated with ranibizumab for whom SRF was eliminated
in almost all by month three.
At month three of ranibizumab treatment, OCT images provide predictive information for patients with CRVO, but not
for those with BRVO. Visual outcome at months six and 12 was reduced in 0.5 mg ranibizumab-treated patients with
CRVO who had persistent CME at month three. It also was reduced in CRVO for those with CFT of more than 250 µm
at month three who were treated with 0.3 mg ranibizumab. The findings suggest that late or incomplete responders
may need careful follow-up.
Source: Bhisitkul RB, Campochiaro PA, Shapiro H, Rubio RG. Predictive value in retinal vein occlusions
of early versus late or incomplete ranibizumab response defined by optical coherence
tomography. Ophthalmology. 2013;Feb 15. [Epub ahead of print]. DOI: 10.1016/j.ophtha.2012.11.011.
Use of VEGF Trap-Eye for Macular Edema Secondary to CRVO
To evaluate intravitreal VEGF Trap-Eye (VTE) in patients with macular edema secondary to central retinal
vein occlusion (CRVO), the authors of this double-masked study randomized 177 patients (3:2 ratio) to
intravitreal injections of VTE 2 mg or sham procedure every four weeks for 24 weeks.
They evaluated best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy
Study chart and they measured central retinal thickness (CRT) with optical coherence tomography (OCT).
According to the authors, from baseline until week 24, more patients receiving VTE (60.2%) gained ≥15
letters compared with those receiving sham injections (22.1%) (p<0.0001). They also found that
VTE patients gained a mean of 18.0 letters compared with 3.3 letters with sham injections (p<0.0001)
and that mean CRT decreased by 448.6 and 169.3 µm in the VTE and sham groups (p<0.0001). The
most frequent ocular adverse events in the VTE arm were typically associated with the injection procedure or
the underlying disease, and included eye pain (11.5%), increased intraocular pressure (9.6%) and
conjunctival hemorrhage (8.7%).
VTE 2 mg every four weeks was efficacious in CRVO with an acceptable safety profile, the study authors concluded.
They noted that vision gains with VTE were significantly higher than with observation/panretinal photocoagulation
if needed. Based on these data, VTE may provide a new treatment option for CRVO.
Source: Holz FG, Roider J, Ogura Y, et al. VEGF Trap-Eye for macular edema secondary to central
retinal vein occlusion: 6-month results of the phase III GALILEO study. Br J Ophthalmol.
Treatment of Macular Edema Secondary to CRVO With
Intravitreal Aflibercept Injection
Scientists performed a controlled, multicenter trial to evaluate intravitreal aflibercept injections (IAI;
also called VEGF Trap-Eye) for patients with macular edema secondary to central retinal vein occlusion (CRVO).
They randomized 189 patients (one eye/patient) with macular edema secondary to CRVO to receive six monthly
injections of either 2 mg intravitreal aflibercept (IAI 2.q.4.) (n=115) or sham (n=74). From week 24 to week 52,
all patients received 2 mg intravitreal aflibercept as needed (IAI 2.q.4. + p.r.n. and sham + IAI p.r.n.) according
to retreatment criteria. The primary endpoint was the proportion of patients who gained ≥15 ETDRS letters
from baseline at week 24. Additional endpoints included visual, anatomic and quality-of-life NEI VFQ-25 outcomes
at weeks 24 and 52.
At week 24, the study scientists reported that 56.1% of IAI 2.q.4. patients gained ≥15 letters from
baseline compared with 12.3% of sham patients (p<.001). At week 52, they noted that 55.3% of
IAI 2.q.4. + p.r.n. patients gained ≥15 letters compared with 30.1% of sham + IAI p.r.n. patients
(p<.001). At week 52, IAI 2.q.4. + p.r.n. patients gained a mean of 16.2 letters of vision versus
3.8 letters for sham + IAI p.r.n. (p<.001). The most common adverse events for both groups were
conjunctival hemorrhage, eye pain, reduced visual acuity and increased intraocular pressure.
In conclusion, monthly injections of 2 mg intravitreal aflibercept for patients with macular edema secondary
to CRVO resulted in a statistically significant improvement in visual acuity at week 24, which was largely
maintained through week 52 with intravitreal aflibercept p.r.n. dosing. Intravitreal aflibercept injection
was generally well tolerated.
Source: Brown DM, Heier JS, Clark WL, et al. Intravitreal aflibercept injection for macular
edema secondary to central retinal vein occlusion: 1-year results from the Phase III COPERNICUS Study.
Am J Ophthalmol. 2013;155(3):429–437.
DME Treated With Retina Rejuvenation Therapy
The safety and efficacy of a novel frequency-doubled, nanosecond-pulsed laser
with discontinuous beam energy distribution (2RT, Ellex) for the treatment of diabetic macular edema (DME)
were prospectively investigated in this study.
A total of 23 consecutive patients (38 eyes) with newly diagnosed DME were recruited and assessed with logarithm
of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), central macular thickness
measured with optical coherence tomography (OCT/scanning laser ophthalmoscope, OPKO/OTI), microperimetry,
fundus photography and fundus fluorescein angiography. Additionally, macular grid treatments were performed with
2RT laser system by one operator. Patients were examined with logMAR BCVA, central macular thickness, microperimetry
and fundus photography at three weeks and six weeks and three months and six months. Fundus fluorescein angiography
was repeated at three months and six months.
At six months postop, 17 patients (28 eyes) completed the study. No complications were identified after 2RT
therapy; however, intraoperative retinal discoloration was observed in two cases, fully resolved at three months
with no permanent anatomical or functional changes. Mean logMAR VA improved from 20/44 at baseline to 20/27 at
six months. The change in BCVA was significant (p=0.0190). Central macular thickness in the central
1-mm subfield, retinal exudates and vascular leakage decreased in the majority of patients at six months
(46%, 41% and 55%, respectively), although the change from baseline was not statistically significant.
Furthermore, microperimetry confirmed photoreceptor integrity and showed a trend of improvement that correlated
with decreased central macular thickness.
For the first time, a beneficial effect on DME was achieved without the side effects of conventional laser therapy.
The efficacy of this system in comparison with standard argon laser photocoagulation and in the treatment of
other conditions affecting the retinal pigment epithelium needs further investigation.
Source: Pelosini L, Hamilton R, Mohamed M, et al. Retina rejuvenation therapy for diabetic macular
edema: a pilot study. Retina. 2013; 33(3):548–558.
Thickness of Peripapillary RNFL in Children With Iron Deficiency Anemia
Investigators in the following study evaluated peripapillary retinal nerve fiber layer (RNFL) thickness in
children with iron deficiency anemia (IDA) in comparison with healthy controls and investigated the
correlation between peripapillary RNFL thicknesses and the hematologic parameters in these subjects.
They enrolled 40 eyes of 40 children with a diagnosis of IDA (anemic group) and 40 eyes of 40 age- and
sex-matched healthy children (control group). Additionally, they performed peripapillary RNFL thickness
measurements using Cirrus HD optical coherence tomography (OCT).
The mean age of each group was 11.3 ± 2.7 years, the investigators reported. They noted that average RNFL
and RNFLs of superior and inferior quadrants were significantly thinner in the anemic group than in the control group
(p=0.006, p=0.005 and p=0.005, respectively). Moreover, they correlated average peripapillary
RNFL thickness and RNFL thicknesses of superior, inferior and temporal quadrants with hemoglobin levels
(r1=0.734, p1<0.001, r2=0.456, p2=0.005, r3=0.598, p3<0.001, r4=0.349,
p4=0.037, respectively) in anemic group.
They found that children with IDA had different peripapillary RNFL profile measured by Cirrus HD spectral-domain
OCT. The study investigators caution ophthalmologists when they measure RNFL thickness in children to diagnose
glaucoma or other neuro-ophthalmic disorders.
Source: Türkyilmaz K, Öner V, Özkasap S, et al. Peripapillary retinal nerve fiber
layer thickness in children with iron deficiency anemia. Eur J Ophthalmol. 2013;23(2):217–222.