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Highlights from this issue
Frank Larkin
doi : 10.1136/bjophthalmol-2021-319374
British Journal of Ophthalmology 2021;105:i-ii.
Artificial intelligence and machine learning for Alzheimer’s disease: let’s not forget about the retina
Wei Yan Ng, Carol Y Cheung, Dan Milea, Daniel Shu Wei Ting
doi : 10.1136/bjophthalmol-2020-318407
British Journal of Ophthalmology 2021;105:593-594.
Low systemic vitamin D as a potential risk factor in primary open-angle glaucoma: a review of current evidence
Brandon Huynh, Peter Shah, Freda Sii, Damien Hunter, Nicole Carnt, Andrew White
doi : 10.1136/bjophthalmol-2020-316331
British Journal of Ophthalmology 2021;105:595-601.
Currently, intraocular pressure is the only modifiable risk factor for glaucoma; thus, identifying other modifiable determinants may have far-reaching outcomes. There has been increasing interest in vitamin D status and glaucoma pathogenesis as low vitamin D has been identified by some studies as an independent risk factor for glaucoma. Although the exact mechanism of vitamin D in glaucoma remains uncertain, there is sufficient evidence to continue research in this area. There is a potential physiological role for vitamin D as an anti-inflammatory agent in the oxidative stress-driven pathogenesis of primary open-angle glaucoma, and further studies are required to evaluate the temporal and causal relationship. Ocular vitamin D status in the tear, aqueous and vitreous fluid is a prospective gap in research.
Health economic evaluation in ophthalmology
Alp Atik, Keith Barton, Augusto Azuara-Blanco, Nathan M Kerr
doi : 10.1136/bjophthalmol-2020-316880
British Journal of Ophthalmology 2021;105:602-607.
Health economic evaluation is the application of economic theories, tools and concepts to healthcare. In the setting of limited resources, increasing demand and a growing array of intervention options, economic evaluation provides a framework for measuring, valuing and comparing the costs and benefits of different healthcare interventions. This review provides an overview of the concepts and methods of economic evaluation, illustrated with examples in ophthalmology. Types of economic evaluation include cost-minimisation, cost-benefit, cost-effectiveness, cost-utility and economic modelling. Topics including utility measures, the quality-adjusted lifeyear, discounting, perspective and timeframe are discussed. Health economic evaluation is important to understand the costs and value of interventions in ophthalmology and to inform health policy as well as guide clinical decision-making.
Long-term follow-up of cystinosis patients treated with 0.55% cysteamine hydrochloride
Hong Liang, Antoine Labbé, Christophe Baudouin, Celine Plisson, Vincenzo Giordano
doi : 10.1136/bjophthalmol-2020-316450
British Journal of Ophthalmology 2021;105:608-613.
Background/Aims Cystinosis is a rare, autosomal recessive disorder causing defective transport of cystine out of lysosomes. Cystadrops (0.55% cysteamine hydrochloride in viscous solution) has been used on a named-patient basis to treat the accumulation of cystine crystals in the cornea in patients with cystinosis.
Late-term topical tacrolimus for subepithelial infiltrates resistant to topical steroids and ciclosporin secondary to adenoviral keratoconjunctivitis
Ceyhun Arici, Burak Mergen
doi : 10.1136/bjophthalmol-2020-316196
British Journal of Ophthalmology 2021;105:614-618.
Purpose Investigation of the efficacy and safety of 12 months of topical tacrolimus 0.03% ointment treatment against the subepithelial infiltrates (SEIs) due to adenoviral keratoconjunctivitis (AKC) resisting at least 2 years was aimed.
Fifteen-year incidence rate and risk factors of pterygium in the Southern Indian state of Andhra Pradesh
Rohit C Khanna, Srinivas Marmamula, Maria Vittoria Cicinelli, Asha Latha Mettla, Pyda Giridhar, Seema Banerjee, Konegari Shekhar, Subhabrata Chakrabarti, Gudlavalleti V S Murthy, Clare E Gilbert, Gullapalli Nageswara Rao
doi : 10.1136/bjophthalmol-2020-316359
British Journal of Ophthalmology 2021;105:619-624.
Purpose To report 15-year incidence rate and associated risk factors of pterygium among people aged 30 years and above at baseline in the rural clusters of longitudinal Andhra Pradesh Eye Disease Study (APEDS III).
Four-year observation of the changes in corneal endothelium cell density and correlated factors after Implantable Collamer Lens V4c implantation
Wen Yang, Jing Zhao, Ling Sun, Jiao Zhao, Lingling Niu, Xiaoying Wang, Xingtao Zhou
doi : 10.1136/bjophthalmol-2020-316144
British Journal of Ophthalmology 2021;105:625-630.
Background To evaluate the changes in corneal endothelium cell density (ECD) and the correlated factors after Implantable Collamer Lens (ICL) V4c implantation.
A randomised controlled trial comparing femtosecond laser-assisted cataract surgery versus conventional phacoemulsification surgery: 12-month results
Nick Stanojcic, Harry William Roberts, Vijay K Wagh, Ji-Peng Olivia Li, Khayam Naderi, David P O’Brart
doi : 10.1136/bjophthalmol-2020-316311
British Journal of Ophthalmology 2021;105:631-638.
Aims To report 12-month outcomes of randomised controlled trial comparing conventional phacoemulsification surgery (CPS) with femtosecond laser-assisted cataract surgery (FLACS).
Evolving consensus for immunomodulatory therapy in non-infectious uveitis during the COVID-19 pandemic
Rupesh Agrawal, Ilaria Testi, Cecilia S Lee, Edmund Tsui, Marian Blazes, Jennifer E Thorne, Annabelle A Okada, Justine R Smith, Peter J McCluskey, John H Kempen, Christoph Tappeiner, Manisha Agarwal, Bahram Bodaghi, Quan Dong Nguyen, Vishali Gupta, Marc D De Smet, Manfred Zierhut, Carlos Pavesio
doi : 10.1136/bjophthalmol-2020-316776
British Journal of Ophthalmology 2021;105:639-647.
Background Immunomodulatory therapy (IMT) is often considered for systemic treatment of non-infectious uveitis (NIU). During the evolving coronavirus disease-2019 (COVID-19) pandemic, given the concerns related to IMT and the increased risk of infections, an urgent need for guidance on the management of IMT in patients with uveitis has emerged.
OCT changes in peri-tumour normal retina following ruthenium-106 and proton beam radiotherapy for uveal melanoma
Rumana Hussain, Florian Moritz Heussen, Heinrich Heimann
doi : 10.1136/bjophthalmol-2019-314802
British Journal of Ophthalmology 2021;105:648-652.
Introduction Uveal melanoma is most commonly treated with radiotherapy, destroying the tumour cells with adequate safety margins and limiting collateral damage to surrounding structures to preserve maximal vision. We used optical coherence tomography (OCT) to study the effects of radiotherapy on the retina.
Impact of myopia on the association of long-term intraocular pressure fluctuation with the rate of progression in normal-tension glaucoma
Jinho Lee, Eun Jung Ahn, Yong Woo Kim, Ahnul Ha, Young Kook Kim, Jin Wook Jeoung, Ki Ho Park
doi : 10.1136/bjophthalmol-2019-315441
British Journal of Ophthalmology 2021;105:653-660.
Background/Aims To investigate whether the association of long-term intraocular pressure (IOP) fluctuation with the rate of progression of normal-tension glaucoma (NTG) differs between myopia and non-myopia.
Use of a novel telemetric sensor to study interactions of intraocular pressure and ganglion-cell function in glaucoma
Khaldoon O Al-Nosairy, Jacqueline J O N van den Bosch, Vincenzo Pennisi, Kaweh Mansouri, Hagen Thieme, Lars Choritz, Michael B Hoffmann
doi : 10.1136/bjophthalmol-2020-316136
British Journal of Ophthalmology 2021;105:661-668.
Aims (1) To test the feasibility of simultaneous steady-state pattern electroretinogram (ssPERG) and intraocular pressure (IOP) measurements with an implanted IOP sensor. (2) To explore the scope of this approach for detecting PERG changes during IOP manipulation in a model of lateral decubitus positioning (LDP; lateral position).
Albuminuria and Primary Open-Angle Glaucoma: the Singapore Chinese Eye Study (SCES)
Zhi Wei Lim, Miao-Li Chee, Sahil Thakur, Xiaoling Fang, Zhi Da Soh, Shivani Majithia, Zhen Ling Teo, Charumathi Sabanayagam, Tien Yin Wong, Ching-Yu Cheng, Yih-Chung Tham
doi : 10.1136/bjophthalmol-2020-315920
British Journal of Ophthalmology 2021;105:669-673.
Aims To determine the association between albuminuria and primary open-angle glaucoma (POAG).
Progressive retinal nerve fibre layer thinning and choroidal microvasculature dropout at the location of disc haemorrhage in glaucoma (1 July, 2020)
Chung Young Kim, Eun Ji Lee, Ji-Ah Kim, Hyunjoong Kim, Tae-Woo Kim
doi : 10.1136/bjophthalmol-2020-316169
British Journal of Ophthalmology 2021;105:674-680.
Background/Aims To investigate whether parapapillary choroidal microvasculature dropout (MvD) is associated with progressive retinal nerve fibre layer (RNFL) thinning in eyes with primary open-angle glaucoma (POAG) and disc haemorrhage (DH).
Using an open-source tablet perimeter (Eyecatcher) as a rapid triage measure for glaucoma clinic waiting areas
Pete R Jones, Dan Lindfield, David P Crabb
doi : 10.1136/bjophthalmol-2020-316018
British Journal of Ophthalmology 2021;105:681-686
Background Glaucoma services are under unprecedented strain. The UK Healthcare Safety Investigation Branch recently called for new ways to identify glaucoma patients most at risk of developing sight loss, and of filtering-out false-positive referrals. Here, we evaluate the feasibility of one such technology, Eyecatcher: a free, tablet-based ‘triage’ perimeter, designed to be used unsupervised in clinic waiting areas. Eyecatcher does not require a button or headrest: patients are simply required to look at fixed-luminance dots as they appear.
Reduced vessel density in deep capillary plexus correlates with retinal layer thickness in choroideremia
Alessandro Arrigo, Francesco Romano, Maurizio Battaglia Parodi, Peter Charbel Issa, Johannes Birtel, Francesco Bandello, Robert E Maclaren
doi : 10.1136/bjophthalmol-2020-316528
British Journal of Ophthalmology 2021;105:687-693.
Background To assess retinal layer thickness in choroideremia (CHM) and to reveal its correlation with optical coherence tomography (OCT) angiography (OCTA) findings.
USH2A variants in Chinese patients with Usher syndrome type II and non-syndromic retinitis pigmentosa
Tian Zhu, De-Fu Chen, Lei Wang, Shijing Wu, Xing Wei, Hui Li, Zi-Bing Jin, Ruifang Sui
doi : 10.1136/bjophthalmol-2019-315786
British Journal of Ophthalmology 2021;105:694-703.
Aims To reveal the Usher syndrome type IIA (USH2A) gene variant profile in a large cohort of Chinese patients with non-syndromic retinitis pigmentosa (RP) or Usher syndrome type II (USH2) and to explore the genotype–phenotype correlation.
Changes in choroidal structure following intravitreal aflibercept therapy for retinal vein occlusion
Yoshinori Mitamura, Tserennadmid Enkhmaa, Hiroki Sano, Masanori Niki, Fumiko Murao, Mariko Egawa, Shozo Sonoda, Taiji Sakamoto
doi : 10.1136/bjophthalmol-2020-316214
British Journal of Ophthalmology 2021;105:704-710.
Aims To examine the choroidal change accompanying retinal vein occlusion (RVO) in detail, we measured changes in choroidal structure after intravitreal aflibercept (IVA) injections for RVO using binarisation of enhanced depth imaging optical coherence tomographic (EDI-OCT) images and assessed associations with clinical outcome.
Examining the added value of microperimetry and low luminance deficit for predicting progression in age-related macular degeneration
Zhichao Wu, Chi D Luu, Lauren AB Hodgson, Emily Caruso, Fred K Chen, Usha Chakravarthy, Jennifer J Arnold, Wilson J Heriot, Jim Runciman, Robyn H Guymer
doi : 10.1136/bjophthalmol-2020-315935
British Journal of Ophthalmology 2021;105:711-715.
Purpose To examine the added predictive value of microperimetric sensitivity and low luminance deficit (LLD; difference between photopic and low luminance visual acuity (VA)) to information from colour fundus photography (CFP) for progression to late age-related macular degeneration (AMD) in individuals with bilateral large drusen.
APEX: a phase II randomised clinical trial evaluating the safety and preliminary efficacy of oral X-82 to treat exudative age-related macular degeneration
Michael N. Cohen, Denis O’Shaughnessy, Kate Fisher, Jennifer Cerami, Carl C Awh, Daniel E Salazar, Philip Rosenfeld, Jeffrey S Heier
doi : 10.1136/bjophthalmol-2020-316511
British Journal of Ophthalmology 2021;105:716-722.
Purpose The safety and efficacy of X-82, an orally administered inhibitor of vascular endothelial growth factor (VEGF) and platelet-derived growth factor, was investigated for treatment of wet age-related macular degeneration (AMD) in a phase II clinical trial.
Prospective evaluation of an artificial intelligence-enabled algorithm for automated diabetic retinopathy screening of 30 000 patients
Peter Heydon, Catherine Egan, Louis Bolter, Ryan Chambers, John Anderson, Steve Aldington, Irene M Stratton, Peter Henry Scanlon, Laura Webster, Samantha Mann, Alain du Chemin, Christopher G Owen, Adnan Tufail, Alicja Regina Rudnicka
doi : 10.1136/bjophthalmol-2020-316594
British Journal of Ophthalmology 2021;105:723-728.
Background/aims Human grading of digital images from diabetic retinopathy (DR) screening programmes represents a significant challenge, due to the increasing prevalence of diabetes. We evaluate the performance of an automated artificial intelligence (AI) algorithm to triage retinal images from the English Diabetic Eye Screening Programme (DESP) into test-positive/technical failure versus test-negative, using human grading following a standard national protocol as the reference standard.
Epidemiology of visual impairment, sight-threatening or treatment-requiring diabetic eye disease in children and young people in the UK: findings from DECS
Maria Carolina Ibanez-Bruron, Ameenat Lola Solebo, Phillippa Cumberland, Jugnoo S Rahi
doi : 10.1136/bjophthalmol-2020-315886
British Journal of Ophthalmology 2021;105:729-734.
Background We investigated the incidence and causes of sight-threatening diabetes-related eye disease in children living with diabetes in the UK, to inform the national eye screening programme and enable monitoring of trends.
Optical coherence tomography-angiography for monitoring neovascularisations in macular telangiectasia type 2
Simone Tzaridis, Kristina Hess, Martin Friedlander, Frank G Holz
doi : 10.1136/bjophthalmol-2020-316021
British Journal of Ophthalmology 2021;105:735-740.
Purpose To evaluate the utility of optical coherence tomography-angiography (OCT-A) for monitoring activity, progression and response to therapy of neovascularisations (NVs) secondary to macular telangiectasia type 2 (MacTel).
