The high concentration of carotenoids in the macula, combined with evidence linking oxidative stress to age-related macular degeneration (AMD) and carotenoids to antioxidation, generated the hypothesis that higher antioxidant intakes can prevent AMD. The authors of the following multicenter, prospective, open-label, randomized study randomly assigned 145 patients to 2 different treatment groups to determine whether nutritional supplementation with a targeted nutritional supplement improves visual acuity and visual function in AMD.

Interventions were lutein (10 mg), zeaxanthin (1 mg), astaxanthin (4 mg), and antioxidants/vitamins supplementation formula or no dietary supplementation for 2 years. Primary outcome was mean changes in visual acuity (VA) at 12 and 24 months. Other measures included contrast sensitivity (CS) and National Eye Institute visual function questionnaire (NEI VFQ-25) scores at 12 and 24 months.

The study authors reported that patients in the treated group showed stabilization of VA with significantly (p=0.003) better VA scores (81.4 ± 7.2) compared to the nontreated group (76.8 ± 8.9) at 24-month follow-up. They also observed an improvement in CS (p=0.001) and final mean NEI VFQ-25 composite scores at 12 and 24 months higher in treated group compared to nontreated group (p<0.001).

They concluded that patients treated with lutein/zeaxanthin and astaxanthin together with other nutrients were more likely to report clinically meaningful stabilization/improvements in VA, CS, and visual function through 24 months compared with nontreated subjects. Further studies are needed with more patients and for longer periods of time.

To report the incidence of glaucoma and glaucoma suspects in the Infant Aphakia Treatment Study (IATS), and to evaluate risk factors for the development of a glaucoma-related adverse event in patients in the IATS in the first year of follow-up, the authors of this study assigned 114 infants between 1 and 6 months of age with a unilateral congenital cataract to undergo cataract surgery either with or without an intraocular lens implant.

They created standardized definitions of glaucoma and glaucoma suspect, which they used in the IATS. According to the authors, of the 114 patients, 10 (9%) developed glaucoma and 4 (4%) had glaucoma suspect, for a total of 14 patients (12%) with a glaucoma-related adverse event in the treated eye through the first year of follow-up. They also observed that of the 57 patients who underwent lensectomy and anterior vitrectomy, 5 (9%) developed a glaucoma-related adverse event; of the 57 patients who underwent an intraocular lens implant, 9 (16%) developed a glaucoma-related adverse event. The odds of developing a glaucoma-related adverse event were 3.1 times higher for a child with persistent fetal vasculature and 1.6 times higher for each month of age younger at cataract surgery.

In conclusion, modern surgical techniques do not eliminate the early development of glaucoma following congenital cataract surgery with or without an intraocular lens implant. Younger patients with or without persistent fetal vasculature seem more likely to develop a glaucoma-related adverse event in the first year of follow-up. Vigilance for the early development of glaucoma is needed following congenital cataract surgery, especially when surgery is performed during early infancy or for a child with persistent fetal vasculature. Five-year follow-up data for the IATS will likely reveal more glaucoma-related adverse events.

To clarify the efficacy of combined therapy with intravitreal ranibizumab injections and photodynamic therapy (PDT) in patients with symptomatic polypoidal choroidal vasculopathy, 28 naive eyes of 28 patients (17 men, 11 women; mean age, 73.4 years; range, 55–85 years) with 20/40 or less baseline visual acuity treated with 3 consecutive monthly intravitreal injections of ranibizumab (0.5 mg/0.05 mL) and photodynamic therapy and followed-up for at least 12 months were retrospectively reviewed. PDT was administered 1 or 2 days after the initial injection of ranibizumab.

The mean best-corrected visual acuity (BCVA) levels significantly (p< 0.0001) improved from 0.33 at baseline to 0.61 at 12 months and the mean improvement in BCVA 12 months from baseline was 2.65 lines. The BCVA at 12 months improved in 15 eyes (53.6%) by ≥ 3 lines and was stable (defined as a loss of <3 lines of vision) in 13 eyes (46.4%). The central retinal thickness significantly (p<0.0001) decreased from 366 µm to 151 µm at 12 months. The mean numbers of PDT treatments and injections during 12 months including the treatments during the initial regimen were 1.1 and 3.7, respectively. It was noted that no complications developed.

To conclude, combined intravitreal ranibizumab and PDT for polypoidal choroidal vasculopathy maintained or improved visual acuity and reduced the exudation without adverse events.

U.S. investigators examined relationships between contrast sensitivity (CS), color vision and retinal nerve fiber layer (RNFL) among people with human immunodeficiency virus (HIV) infection and evaluated the effect of time since diagnosis of HIV infection on RNFL thickness.

In this noninterventional cross-sectional study, they evaluated 102 eyes of 57 HIV-infected individuals without ocular opportunistic infections. They determined peripapillary RNFL thickness with spectral-domain optical coherence tomography (SD-OCT) in 4 quadrants and measured CS with the Pelli-Robson technique (expressed as logCS). Additionally, they measured color vision with the Lanthony desaturated 15-hue technique (expressed as color confusion index [C-index], with higher scores indicating worse color vision) and assessed correlations between values using Spearman correlation coefficients.

According to the investigators, median RNFL thickness (average of 4 quadrants) was 102.9 µm (range, 75.0–134.7 µm) and median logCS was 1.90 (range, 1.250–1.95). The study investigators also reported that median C-index was 1.58 (range, 0.960–4.07) and that temporal RNFL thickness was correlated with logCS (r = 0.295, p = .003) and C-index (r = 0–0.338, p = .0005). Furthermore, time since diagnosis of HIV infection was shorter for those with thick average RNFL than for those with thin average RNFL (p = .18).

The investigators determined that both worse CS and worse color vision are correlated with thinning of the temporal RNFL, with possible threshold effects. Increased prevalences of abnormal CS and abnormal color vision in this population are therefore likely attributable to neuroretinal compromise. This pattern of structural and functional losses may reflect preferential damage to small-caliber axons in the maculopapillary bundle, possibly associated with mitochondrial dysfunction, providing a potential disease mechanism for HIV-associated “neuroretinal disorder.”