In this population-based cohort study, researchers examined associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG). The Blue Mountains Eye Study examined 3,654 persons at baseline and 2,461 persons at either five years, 10 years or both times. After excluding 44 subjects with OAG at baseline, 2,417 participants at risk of OAG at the five- or 10-year examinations were included.

The researchers measured retinal vessel calibers of baseline retinal photographs using a computer-based program and summarized them as central retinal artery and vein equivalents (CRAE, CRVE). They defined incident OAG as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the two eyes (≥0.3) at either the five- or 10-year examination. Additionally, they used generalized estimating equation models to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP). The researchers assessed the 10-year incidence of OAG as the main outcome measure.

They reported that 82 persons (104 eyes) developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12–2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14–3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11–2.78), and remained significant when analyses were confined to eyes with IOP <20 mmHg and C:D ratio <0.6 at baseline. Furthermore, there were no independent associations between CRVE and incident OAG.

Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma.

To determine whether adherence and convenience of once-daily glaucoma medication is greater in the morning or the evening, the following prospective, randomized crossover treatment trial was conducted.

A total of 30 patients newly diagnosed with glaucoma or ocular hypertension requiring intraocular pressure (IOP) reduction were started on travoprost eye drops and randomized to either morning or evening administration for one month. They were then crossed over to the opposite dosing schedule for the following month. Adherence was monitored using an automated dosing aid. Adherence was compared between morning versus evening dosing and first- versus second-month dosing. Demographic characteristics were obtained, treatment effect was measured and patients completed a post-study questionnaire regarding the convenience of the two dosing regimens.

It was reported that patient adherence overall was good (89.3%). There was no statistically significant difference (p=0.07) in adherence between morning dosing (90.9%) and evening dosing (87.3%) and adherence in the first month (91.7%) was superior to the second month (86.5%). Moreover, there was no significant difference in IOP response between morning and evening dosing. Patients found morning dosing more convenient than evening dosing.

In conclusion, early adherence to treatment with a prostaglandin analogue is good, but patients prefer morning administration to evening administration. This may lead to greater adherence with morning administration, particularly among men. Adherence decreases from the first to second month after initiation of treatment. IOP response to this treatment is not significantly affected by morning versus evening administration.

The authors of this German double-masked study evaluated intravitreal VEGF Trap-Eye (VTE) in patients with macular edema secondary to central retinal vein occlusion (CRVO). They found that VTE 2 mg every four weeks was efficacious in CRVO with an acceptable safety profile.

They randomized 177 patients (3:2 ratio) to intravitreal injections of VTE 2 mg or sham procedure every four weeks for 24 weeks. The authors evaluated best-corrected visual acuity using the Early Treatment Diabetic Retinopathy Study chart and measured central retinal thickness (CRT) with optical coherence tomography.

They noted that 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). VTE patients gained a mean of 18.0 letters compared with 3.3 letters with sham injections (p<0.0001). 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%).

The study authors found 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.