The authors of this prospective, multicenter, observational study sought to determine the sensitivity of time domain optical coherence tomography (OCT) in detecting conversion to neovascular age-related macular degeneration (AMD) in eyes at high risk for choroidal neovascularization (CNV), compared with detection using fluorescein angiography (FA) as the gold standard.

They included individuals aged ≥ 50 years with non-neovascular AMD at high risk of progressing to CNV in the study eye and evidence of neovascular AMD in the fellow eye. The study authors noted that at study entry and every 3 months through 2 years, participants underwent best-corrected visual acuity, supervised Amsler grid testing, preferential hyperacuity perimetry (PHP) testing, stereoscopic digital fundus photographs with FA, and OCT imaging. A central Reading Center graded all images. Main outcome measures included the sensitivity of OCT in detecting conversion to neovascular AMD by 2 years, using FA as the reference standard. Secondary outcomes included comparison of sensitivity, specificity, positive predictive value, and negative predictive value of OCT, PHP, and supervised Amsler grid relative to FA for detecting incident CNV.

The authors enrolled 98 participants; 87 (89%) of these individuals either completed the 24-month visit or exited the study after developing CNV. They noted that 15 (17%) study eyes had incident CNV confirmed on FA by the Reading Center. The sensitivity of each modality for detecting CNV was: OCT 0.40 (95% confidence interval [CI], 0.16–0.68), supervised Amsler grid 0.42 (95% CI, 0.15–0.72), and PHP 0.50 (95% CI, 0.23–0.77). The authors recommended treatment for incident CNV in 13 study eyes. Sensitivity of the testing modalities for detection of CNV in these 13 eyes was 0.69 (95% CI, 0.39–0.91) for OCT, 0.50 (95% CI, 0.19–0.81) for supervised Amsler grid, and 0.70 (95% CI, 0.35–0.93) for PHP. Specificity of the OCT was higher than that of the Amsler grid and PHP.

Time-domain OCT, supervised Amsler grid, and PHP have low to moderate sensitivity for detection of new-onset CNV compared with FA, the authors concluded. They also found that OCT has greater specificity than Amsler grid or PHP. Among fellow eyes of individuals with unilateral CNV, FA remains the best method to detect new-onset CNV.

In the following study, researchers aimed to determine the most cost-effective treatment option for patients with newly diagnosed mild open-angle glaucoma (OAG): observation only, treatment with generic topical prostaglandin analogs (PGAs) or treatment with laser trabeculoplasty (LTP).

Using a Markov model with a 25-year horizon, they compared the incremental cost-effectiveness of the three treatment options listed. The researchers found that the incremental cost-effectiveness of LTP over no treatment is $16,824 per quality-adjusted life year. By comparison, the incremental cost-effectiveness of PGAs over no treatment is $14,179 per quality-adjusted life year, and they provide greater health-related quality of life relative to LTP. If PGAs are 25% less effective owing to poor patient adherence, LTP can confer greater value.

In conclusion, prostaglandin analogs and LTP are both cost-effective options for the management of newly diagnosed mild open-angle glaucoma. Assuming optimal medication adherence, PGAs confer greater value compared with LTP. However, when assuming more realistic levels of medication adherence (making them 25% less effective than the documented effectiveness reported in clinical trials), at current prices for PGAs, LTP may be a more cost-effective alternative.

To present and evaluate a new method of integrating risk factors into the analysis of rates of visual field progression in glaucoma, this study included 352 eyes of 250 glaucoma patients followed up for an average of 8.1 ± 3.5 years.

Slopes of change over time were evaluated by the mean deviation (MD) from standard automated perimetry. For each eye, the follow-up time was divided into two equal periods: the first half was used to obtain the slopes of change and the second period was used to test the predictions. Slopes of change were calculated with two methods: the conventional approach of ordinary least squares (OLS) linear regression and a Bayesian regression model incorporating information on risk factors and presence of progressive optic disc damage on stereophotographs. The mean square error (MSE) of the predictions was used to compare the predictive performance of the different methods.

It was reported that higher mean IOP, thinner central corneal thickness (CCT) and presence of progressive optic disc damage were associated with faster rates of MD change. Additionally, incorporation of risk factor information into the calculation of individual slopes of MD change with the Bayesian method resulted in better prediction of future MD values than with the OLS method (MSE: 4.31 vs. 8.03, respectively; p < 0.001).

A Bayesian regression model incorporating structural and risk factor information into the estimation of glaucomatous visual field progression resulted in more accurate and precise estimates of slopes of functional change than the conventional method of OLS regression.

Investigators conducted a retrospective cohort study using the electronic medical databases of a large health maintenance organization in Israel to examine whether isotretinoin therapy could result in deleterious ocular effects, as previously described in case report studies.

The study population consisted of 14,682 adolescents and young adults who were new users of isotretinoin for acne and 2 age- and sex-matched comparison groups (isotretinoin-naive patients with acne and acne-free patients). Main outcome measures were ocular adverse effects (AEs) or purchases of ophthalmic medications within 1 year after the first dispensed isotretinoin prescription.

The study investigators noted that in total, 13.8% of the isotretinoin group experienced ocular AEs vs 9.6% of the isotretinoin-naive group and 7.1% of the acne-free group. They also found that during a 1-year follow-up period, the isotretinoin group had significantly higher risk for any ocular AEs (hazard ratio, 1.70; p < .001) compared with the acne-free group. They observed no such increased risk for the isotretinoin-naive group. Furthermore, the isotretinoin group had higher relative risks for inflammatory and structural AEs.

According to the investigators, isotretinoin use may be associated with short-term ocular events, especially conjunctivitis, underscoring the importance of educating patients and caregivers about these potentially important AEs of the therapy.