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This Issue At A Glance
This Issue At A Glance
Ophthalmology Volume 117, Number 6, June 2010
Vitrectomy for Diabetic Macular Edema May Reduce Retinal Thickening The Diabetic Retinopathy Clinical Research Network (p. 1064) has found that performing vitrectomy on patients with diabetic macular edema (DME) may reduce retinal thickening. The primary cohort included 87 eyes with DME, vitreomacular traction, visual acuity 20/63–20/400, and optical coherence tomography (OCT) central subfield ⬎300 microns. Cataract extraction was not performed at the time of vitrectomy. At 6 months, the median change in visual acuity involved an improvement of 3 letters, with visual acuity improving 10 or more letters in 38% of patients and worsening 10 or more letters in 22% of patients. Almost half of the patients experienced a reduction in OCT central subfield thickness to ⬍250 microns, and most eyes had a reduction of thickening of at least 50%. In terms of complications, the researchers reported 5 eyes with vitreous hemorrhage, 7 eyes with elevated intraocular pressure, 3 retinal detachments, and 1 case of endophthalmitis. They call for additional studies to determine whether vitrectomy represents an improvement over current treatment alternatives.
Man vs. Machine: Automated Detection of Diabetic Retinopathy Abràmoff et al (p. 1147) hypothesized that current diabetic retinopathy (DR) detection algorithms are close to the sensitivity and specificity of a single human expert and also are close to the measurable performance limit. They compared the performance of the algorithm that won the 2009 Retinopathy Online Challenge Competition (‘Challenge2009’) and the one currently used in EyeCheck, a large computer-aided early DR detection project. Fundus photographic sets, which involved 16 670 people with diabetes who had not previously been diagnosed with DR, were analyzed by a single retinal expert, with 793 containing more than the minimal DR for referral. The outcomes of the 2 algorithmic detectors were applied separately to the dataset and compared. The researchers found that the performance of both algorithmic detectors did not differ and were close to the mathematical limit of detection for this dataset. They make an urgent suggestion to study diverse patients with diabetes and translate these findings into practice, allowing cost-effective early detection of DR in millions of people.
Intravitreal Bevacizumab vs. Laser Therapy in Diabetic Macular Edema A randomized, controlled clinical trial by Michaelides et al (p. 1078) has demonstrated that at 12 months, intravitreal bevacizumab (ivB) has a greater treatment effect than modified Early Treatment of Diabetic Retinopathy Study macular laser therapy (ETDRS MLT) in patients with center-involving persistent clinically significant macular edema (CSME). The study involved 80 eyes of 80 patients with center-involving CSME and at least one prior MLT randomized to ivB or MLT. The baseline
mean ETDRS best corrected visual acuity in the ivB group increased from 55.7⫾9.7 at baseline to 61.3⫾10.4 at 12 months. In contrast, the baseline mean in the MLT group decreased from 54.6⫾8.6 to 50⫾16.6 at 12 months. The ivB group gained a median of 8 ETDRS letters while the MLT group lost a median of 0.5 ERDRS letters. At 12 months, the ivB group experienced a greater decrease in central macular thickness compared with the MLT group. The authors conclude ivB appears to be a viable treatment alternative for CSME.
SSRI Antidepressants May Be Linked to Increased Risk of Cataracts In this nested case-control study, Etminan et al (p. 1251) show that use of selective serotonin reuptake inhibitor (SSRI) antidepressants may be associated with an increased risk of cataracts. The researchers used an administrative data set of Quebec residents who had received a coronary revascularization procedure. Patients diagnosed for cataract were identified, and for each patient, 10 controls were selected and matched to the patient by index date, age, and cohort entry. The adjusted rate ratio (RR) for cataracts among current users of SSRI antidepressants was 1.15. The risk of cataracts was highest with fluvoxamine, followed by venlafaxine and paroxetine. In contrast, citalopram, fluoxtine, paroxetine, and sertraline did not pose a risk for cataracts, possibly suggesting the importance of selectivity of 5-HT receptors cataract formation. While the study indicates a possible association between SSRI use and an increased cataract risk, the possibility this observation may be due to the effect of smoking cannot be excluded as this variable could not be controlled in the study.
Vitamin E Supplementation Has No Effect on AMD Risk in Women Results from a randomized trial by Christen et al (p. 1163) indicate that 10 years of alternate-day treatment with 600 IU of natural source vitamin E alone has no material beneficial or harmful effect on the occurrence of age-related macular degeneration (AMD). These findings come from the vitamin E component of the Women’s Health Study, a large-scale trial of vitamin E and low-dose aspirin among 39 876 healthy women followed up for 10 years. Participants were assigned to take the vitamin E or placebo on alternate days. After 10 years, 117 cases of AMD were reported in the vitamin E group and 128 cases in the placebo group. In addition, it appears vitamin E had no significant effect on the secondary endpoints of advanced AMD and total AMD with or without vision loss. The authors say more research is needed to determine whether vitamin E is a component of an antioxidant combination that can help reduce AMD risks, as suggested in the Age-Related Eye Disease Study.
Lori Baker Schena and John Kerrison, MD
Ophthalmology Volume 117, Number 6, June 2010
Vitrectomy for Diabetic Macular Edema May Reduce Retinal Thickening The Diabetic Retinopathy Clinical Research Network (p. 1064) has found that performing vitrectomy on patients with diabetic macular edema (DME) may reduce retinal thickening. The primary cohort included 87 eyes with DME, vitreomacular traction, visual acuity 20/63–20/400, and optical coherence tomography (OCT) central subfield ⬎300 microns. Cataract extraction was not performed at the time of vitrectomy. At 6 months, the median change in visual acuity involved an improvement of 3 letters, with visual acuity improving 10 or more letters in 38% of patients and worsening 10 or more letters in 22% of patients. Almost half of the patients experienced a reduction in OCT central subfield thickness to ⬍250 microns, and most eyes had a reduction of thickening of at least 50%. In terms of complications, the researchers reported 5 eyes with vitreous hemorrhage, 7 eyes with elevated intraocular pressure, 3 retinal detachments, and 1 case of endophthalmitis. They call for additional studies to determine whether vitrectomy represents an improvement over current treatment alternatives.
Man vs. Machine: Automated Detection of Diabetic Retinopathy Abràmoff et al (p. 1147) hypothesized that current diabetic retinopathy (DR) detection algorithms are close to the sensitivity and specificity of a single human expert and also are close to the measurable performance limit. They compared the performance of the algorithm that won the 2009 Retinopathy Online Challenge Competition (‘Challenge2009’) and the one currently used in EyeCheck, a large computer-aided early DR detection project. Fundus photographic sets, which involved 16 670 people with diabetes who had not previously been diagnosed with DR, were analyzed by a single retinal expert, with 793 containing more than the minimal DR for referral. The outcomes of the 2 algorithmic detectors were applied separately to the dataset and compared. The researchers found that the performance of both algorithmic detectors did not differ and were close to the mathematical limit of detection for this dataset. They make an urgent suggestion to study diverse patients with diabetes and translate these findings into practice, allowing cost-effective early detection of DR in millions of people.
Intravitreal Bevacizumab vs. Laser Therapy in Diabetic Macular Edema A randomized, controlled clinical trial by Michaelides et al (p. 1078) has demonstrated that at 12 months, intravitreal bevacizumab (ivB) has a greater treatment effect than modified Early Treatment of Diabetic Retinopathy Study macular laser therapy (ETDRS MLT) in patients with center-involving persistent clinically significant macular edema (CSME). The study involved 80 eyes of 80 patients with center-involving CSME and at least one prior MLT randomized to ivB or MLT. The baseline
mean ETDRS best corrected visual acuity in the ivB group increased from 55.7⫾9.7 at baseline to 61.3⫾10.4 at 12 months. In contrast, the baseline mean in the MLT group decreased from 54.6⫾8.6 to 50⫾16.6 at 12 months. The ivB group gained a median of 8 ETDRS letters while the MLT group lost a median of 0.5 ERDRS letters. At 12 months, the ivB group experienced a greater decrease in central macular thickness compared with the MLT group. The authors conclude ivB appears to be a viable treatment alternative for CSME.
SSRI Antidepressants May Be Linked to Increased Risk of Cataracts In this nested case-control study, Etminan et al (p. 1251) show that use of selective serotonin reuptake inhibitor (SSRI) antidepressants may be associated with an increased risk of cataracts. The researchers used an administrative data set of Quebec residents who had received a coronary revascularization procedure. Patients diagnosed for cataract were identified, and for each patient, 10 controls were selected and matched to the patient by index date, age, and cohort entry. The adjusted rate ratio (RR) for cataracts among current users of SSRI antidepressants was 1.15. The risk of cataracts was highest with fluvoxamine, followed by venlafaxine and paroxetine. In contrast, citalopram, fluoxtine, paroxetine, and sertraline did not pose a risk for cataracts, possibly suggesting the importance of selectivity of 5-HT receptors cataract formation. While the study indicates a possible association between SSRI use and an increased cataract risk, the possibility this observation may be due to the effect of smoking cannot be excluded as this variable could not be controlled in the study.
Vitamin E Supplementation Has No Effect on AMD Risk in Women Results from a randomized trial by Christen et al (p. 1163) indicate that 10 years of alternate-day treatment with 600 IU of natural source vitamin E alone has no material beneficial or harmful effect on the occurrence of age-related macular degeneration (AMD). These findings come from the vitamin E component of the Women’s Health Study, a large-scale trial of vitamin E and low-dose aspirin among 39 876 healthy women followed up for 10 years. Participants were assigned to take the vitamin E or placebo on alternate days. After 10 years, 117 cases of AMD were reported in the vitamin E group and 128 cases in the placebo group. In addition, it appears vitamin E had no significant effect on the secondary endpoints of advanced AMD and total AMD with or without vision loss. The authors say more research is needed to determine whether vitamin E is a component of an antioxidant combination that can help reduce AMD risks, as suggested in the Age-Related Eye Disease Study.
Lori Baker Schena and John Kerrison, MD