The authors of this study evaluated an automated analysis of retinal fundus photographs to detect and classify severity of age-related macular degeneration (AMD) compared with grading by the Age-Related Eye Disease Study (AREDS) protocol.

Following approval by the Johns Hopkins University School of Medicine's Institution Review Board, digitized images of field two (macular) fundus photographs from AREDS obtained over a 12-year longitudinal study were classified automatically using a visual words method to compare with severity by expert graders.

According to the authors, sensitivities and specificities, respectively, of automated imaging, when compared with expert fundus grading of 468 patients and 2,145 fundus images are: 98.6% and 96.3% when classifying categories one and two versus category three; 98.6% and 95.7% when classifying category one vs. category three; 96.0% and 94.7% when classifying category one vs. categories three and four.

To conclude, development of an automated analysis for classification of AMD from digitized fundus photographs has high sensitivity and specificity when compared with expert graders and may have a role in screening or monitoring.

To evaluate aqueous levels of vascular endothelial growth factor (VEGF) and endothelin-1 (ET-1) in patients with branch retinal vein occlusion (BRVO) with and without normal tension glaucoma (NTG), and to assess the therapeutic efficacy of intravitreal bevacizumab (IVB) in these patients, researchers followed 16 eyes with NTG of 48 age- and sex-matched eyes without NTG that had previously received IVB for BRVO for six months.

They measured aqueous VEGF and ET-1 levels by enzyme-linked immunosorbent assay at the time of baseline IVB as well as logarithm of the minimum angle of resolution, best corrected visual acuity (BCVA) and central macular thickness (CMT) at baseline and then at one, three and six months post-injection.

The obstruction site of BRVO was closer to the optic disk in eyes with NTG compared with controls (p=0.001), the researchers noted. They found that baseline BCVA, CMT and VEGF levels were similar between the two groups and that baseline ET-1 levels were significantly higher in eyes with NTG than those without NTG (p=0.009). After IVB, the study authors also observe a significant improvement in both BCVA and CMT at six months, irrespective of the presence of NTG. However, BCVA in the presence of NTG was significantly worse at six months compared with eyes without NTG even though CMT was similarly reduced in both groups (p=0.04).

Aqueous VEGF levels are similar in patients with BRVO with or without NTG, whereas aqueous ET-1 levels are elevated in the presence of NTG. Although IVB may be effective in the treatment of BRVO, the presence of NTG may limit visual recovery despite anatomic recovery of CMT.

Longitudinal testing plays a key role in glaucoma management and variability between visits hampers the ability to monitor progression. It has previously been shown that average intraocular pressure (IOP) exhibits seasonal fluctuations. This comparative case series examines whether visual field (VF) sensitivity also exhibits seasonal fluctuations and seeks to determine whether such fluctuations are correlated to seasonal IOP effects.

This study looked at 33,873 visits by 1,636 participants enrolled in the Ocular Hypertension Treatment Study (OHTS). Participants were split into six geographic zones according to the prevailing climate in their location. At each visit, standard automated perimetry was conducted on each eye, and IOP was measured. With regard to main outcome measures, mixed effects regression models were formed to look for sinusoidal periodic effects on the change in perimetric mean deviation since the last visit (ΔMD) and on IOP, both overall and within each zone.

When all the data were included, a significant seasonal effect on (ΔMD was found with magnitude 0.06 dB, peaking in February (p<0.001). It was reported that five of the six geographic zones exhibited significant seasonal effects on ΔMD, peaking between January and April, with magnitudes ranging from 0.04 dB (p=0.049) to 0.21 dB (p<0.001). Zones with greater climactic variation showed larger seasonal effects on ΔMD. Furthermore, all six zones exhibited a seasonal effect on IOP, peaking in January or February, with magnitudes ranging from 0.14 to 0.39 mmHg (p≤0.02 in all cases). However, there was no evidence of a significant association between the magnitudes or dates of peaks of the two seasonal effects.

In conclusion, the mean deviation was significantly higher in winter than in summer. There is no evidence of an association with seasonal IOP fluctuations and the cause of the seasonal effect on visual field sensitivity is unknown. These findings may help shed light on the glaucomatous disease process and aid efforts to reduce test–retest variability.