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Age-related macular degeneration masqueraders: From the obvious to the obscure
Manuel Paez-Escamilla,Mahima Jhingan,Denise S. Gallagher,Sumit Randhir Singh,Samantha Fraser-Bell,Jay Chhablani
doi : 10.1016/j.survophthal.2020.08.005
REVIEW| VOLUME 66, ISSUE 2, P153-182, MARCH 01, 2021
Age-related macular degeneration (AMD) is one of the leading causes of blindness worldwide with increasing prevalence owing to increased life expectancy. Intravitreal injections of antivascular endothelial growth factor agents are commonly used in exudative AMD and oral antioxidant medication for nonexudative AMD; however, many disorders mimic exudative and nonexudative AMD, and misdiagnosis can seriously affect the management of these patients. We summarize the demographics and clinical and imaging characteristics of each of the conditions that masquerade as AMD. As some of the conditions have features of AMD, a short update on the classical features of AMD is also included.
Serum vitamin D and age-related macular degeneration: Systematic review and meta-analysis
André Ferreira,Nisa Silva,Maria Jo?o Furtado,?ngela Carneiro,Miguel Lume,José P. Andrade
doi : 10.1016/j.survophthal.2020.07.003
REVIEW| VOLUME 66, ISSUE 2, P183-197, MARCH 01, 2021
Vitamin D may be implicated in the pathophysiology of several ocular diseases, but its role in age-related macular degeneration (AMD) remains uncertain. We sought to review systematically the existing evidence to evaluate the association between serum 25-hydroxyvitamin D 25(OH)D levels and AMD. A four-database search (PubMed, ISI Web of Science, Cochrane, and Scopus) was performed from inception to May 2020 using the MeSH terms: (“Macular Degeneration” OR “Age-related macular degeneration” OR “Retinal degeneration” OR “Macula lutea”) AND (“Vitamin D” OR “Ergocalciferols” OR “Cholecalciferol” OR “25-Hydroxyvitamin D”). Random-effects meta-analyses were performed to compute 1) the standard mean difference in 25(OH)D concentration between AMD and non-AMD patients and 2) the AMD risk according to serum 25(OH)D levels. Eighteen observational studies enrolling 75,294 patients after a selection process among 375 original abstracts were selected. No significant differences were found, but there appears to exist a trend for late AMD among subjects with a serum 25(OH)D level below 50 nmol/L (odds ratio, 1.8; 95% confidence interval: 1.00–3.24, P = 0.05). There is no clear evidence of a definitive association between serum 25(OH)D and AMD risk, mainly due to heterogeneity in study procedures and lack of longitudinal designs.
Endoscopic vitreoretinal surgery: Review of current applications and future trends
Frank Hiu Ping Lai,Eva Wai Nam Wong,Wai Ching Lam,Sui Chien Wong,Aaron Nagiel,Robert Fung Lam
doi : 10.1016/j.survophthal.2020.11.004
REVIEW| VOLUME 66, ISSUE 2, P198-212, MARCH 01, 2021
Endoscopy provides unique optical properties to circumvent anterior segment opacities and visualize difficult-to-access anatomical regions, including retroirideal, retrolental, ciliary body, and anterior retinal structures. We summarize the basic principles and utilization of endoscopic vitreoretinal surgery, along with recent technological advances in the field base on a structured literature search in Pubmed, Embase, and Google Scholar database up to February, 2020. Endoscopy has been used in the management of retinal detachment, ischemic retinopathies with neovascular glaucoma, severe ocular trauma, endophthalmitis, lens-related disorders in the posterior segment, pediatric vitreoretinal diseases, and implantation of retinal prostheses. Ongoing development of endoscopic technology aims to provide higher resolution images with endoscopes of smaller diameter. New surgical techniques supported by the adoption of endoscopy are available to manage challenging surgical scenarios. Endoscopy can be a useful adjunct to microscope wide-angle viewing systems in the management of complex vitreoretinal diseases.
A critical review: Psychophysical assessments of diabetic retinopathy
Xing D. Chen,Thomas W. Gardner
doi : 10.1016/j.survophthal.2020.08.003
REVIEW| VOLUME 66, ISSUE 2, P213-230, MARCH 01, 2021
Diabetic retinal disease remains a leading cause of vision loss despite currently available screening methods, ocular treatments, and efforts to control metabolic dysfunction. It is now understood that diabetes damages the entire retina and the cellular components of the neurovascular unit. Multiple studies have demonstrated impairment of various aspects of retinal function across the spectrum of retinopathy severity. Here we review these tests, the principles underlying their use, clinical data from multiple publications, the strengths and limitations of the studies, and prospects for their application to understand the pathophysiology of diabetic retinal disease and monitor its response to therapy. We focus on visual acuity, contrast sensitivity, color vision, visual field, and dark adaptation and their use to understand the pathophysiology of diabetic retinopathy and as potential endpoints for clinical trials.
Retinal injury from handheld lasers: a review
Kavita V. Bhavsar,Zachary Michel,Miles Greenwald,Emmett T. Cunningham Jr.,,K. Bailey Freund
doi : 10.1016/j.survophthal.2020.06.006
REVIEW| VOLUME 66, ISSUE 2, P231-260, MARCH 01, 2021
Retinal photic injury induced by handheld lasers is a burgeoning public health concern due to the wider accessibility of high-powered devices. Retinal damage from thermal energy can cause potentially severe and permanent vision loss in children and young adults who are particularly vulnerable because of comorbid behavioral, learning, and psychiatric impairments. Understanding the spectrum of specific clinical and imaging features of such laser injuries aids in prompt and accurate diagnosis. Multimodal retinal imaging is important for the identification of the outer retinal abnormalities that characterize this condition. We reviewed 171 reported cases in the English and non-English language literature published from 1999, when handheld laser injury was first described, to December, 2018. Risk factors, demographic and clinical characteristics, as well as multimodal imaging findings, were collected and summarized. These findings both provide insights for public health awareness and guide areas of future investigation.
Choroidal thickness and ocular growth in childhood
Efthymia Prousali,Anna Dastiridou,Nikolaos Ziakas,Sofia Androudi,Asimina Mataftsi
doi : 10.1016/j.survophthal.2020.06.008
REVIEW| VOLUME 66, ISSUE 2, P261-275, MARCH 01, 2021
The involvement of the choroid in ocular growth regulation has been postulated in studies showing that refractive errors correlate with alterations in choroidal thickness (ChT). The advent of optical coherence tomography imaging has enabled qualitative and quantitative assessment of the choroid. In children, ChT changes correlate with a number of ocular pathologies, including myopia, retinopathy of prematurity, and amblyopia. We synthesize mechanisms and evidence regarding choroidal thickness variation during childhood. Subfoveal ChT is influenced by a number of factors including age, ethnicity, gender, axial length, and intraocular pressure. Myopic eyes have thinner choroids compared to emmetropic and hyperopic eyes. ChT may in fact serve as a marker of myopic progression, as ChT thinning occurs early during myopic development, but this association has not been established quantitatively. In addition, subfoveal ChT appears thicker in amblyopic eyes, while prematurity and retinopathy of prematurity may be associated with thinner ChT. Overall, both animal models and clinical research indicate that ChT induces or reflects physiological changes in the eye pertaining to ocular growth or maturation.
Surgery for glaucoma in modern corneal graft procedures
Ahmed A. Abdelghany,Francesco D'Oria,Jorge L. Alio
doi : 10.1016/j.survophthal.2020.08.002
REVIEW| VOLUME 66, ISSUE 2, P276-289, MARCH 01, 2021
Glaucoma is a common cause of vision loss after corneal transplantion and is considered a major risk factor for graft failure. Glaucoma may be present before corneal transplant surgery, or increased intraocular pressure may develop after keratoplasty in up to one-third of patients. Pre-existing glaucoma should be controlled before keratoplasty, either medically or surgically. For postkeratoplasty increase in intraocular pressure; identifying the risk factors allows appropiate follow-up and management. Patients undergoing anterior lamellar keratoplasty may take advantage of reduced rates of postkeratoplasty glaucoma. Glaucoma also complicates eyes with endothelial keratoplasties, mostly related to management of intraocular pressure spikes derived from anterior chamber air bubbles. Nevertheless, the severity is less, and the intraocular pressure is more easily controlled when compared with penetrating keratoplasty. Adequate management of glaucoma that develops before or after keratoplasty may save eyes from irreversible damage to the optic nerve and increase graft survival.
Surgical alternatives to keratoplasty in microbial keratitis
Deepali Singhal,Ritu Nagpal,Prafulla K. Maharana,Tushar Agarwal,Namrata Sharma,Jeewan S. Titiyal
doi : 10.1016/j.survophthal.2020.08.004
REVIEW| VOLUME 66, ISSUE 2, P290-307, MARCH 01, 2021
Penetrating keratoplasty is often required in microbial keratitis not responding to the standard treatments available or the development of complications like corneal perforation. Performing keratoplasty in microbial keratitis has several challenges, the major ones being the availability of donor corneal tissue and the poor success of the corneal graft performed in such a setting. For overcoming these challenges, several alternatives to keratoplasty have been described. Broadly, these options could be categorized into autologous tissues such as conjunctival and tenon tissue, synthetic products like tissue adhesives and therapeutic contact lenses, or biological tissues like amniotic membrane graft. These alternative modalities are not universal. They have their specific indications in microbial keratitis. Most of these alternatives are useful only for small corneal perforations. While autologous tissues are cost-effective and readily available, lack of tectonic support is a significant limitation. Tissue adhesives are excellent alternatives in terms of tectonic support, but surface irregularity and tissue reaction are their potential limitations. The amniotic membrane is useful for small corneal perforations, but availability, cost, and poor tectonic support restrict its use. Herein, we discuss these various alternatives to keratoplasty in microbial keratitis, their indications, advantages, disadvantages, and the various techniques of performing these procedures.
Intraoperative optical coherence tomography in anterior segment surgery
Jeewan S. Titiyal,Manpreet Kaur,Sridevi Nair,Namrata Sharma
doi : 10.1016/j.survophthal.2020.07.001
REVIEW| VOLUME 66, ISSUE 2, P308-326, MARCH 01, 2021
Intraoperative optical coherence tomography (iOCT) enables real-time visualization of ocular structures during surgery and enhances our understanding of intraoperative dynamics. iOCT aids in decision-making during various anterior segment surgeries, and its efficacy and feasibility in anterior lamellar keratoplasty and endothelial keratoplasty is well established. The landmark DISCOVER study observed that iOCT altered the surgeon decision in 38% of cases undergoing lamellar keratoplasty and provided guidance regarding the need for secondary surgical intervention. iOCT also finds an application in phacoemulsification wherein it helps to assess corneal incisions, intralenticular pressure, and posterior capsule integrity during nuclear emulsification. iOCT aids in the visualization of angle structures during placement of tubes and shunts in glaucoma surgeries and allows precise creation of partial thickness scleral flaps. In addition, iOCT helps in establishing a diagnosis, as well as provide intraoperative guidance, in pediatric patients who are not cooperative for examination. The role of iOCT in refractive surgeries and ocular surface disorders is increasingly being evaluated. The limitations of present-day iOCT systems are related to instrument compatibility, automated tracking of the surgical field, and on-table volumetric analysis of the real-time images. Technological advances may facilitate complete integration of OCT in the surgical microscopes for all surgical procedures.
Cannabinoids and the eye
Michael T.M. Wang,Helen V. Danesh-Meyer
doi : 10.1016/j.survophthal.2020.07.002
REVIEW| VOLUME 66, ISSUE 2, P327-345, MARCH 01, 2021
Cannabis ranks among the most commonly used psychotropic drugs worldwide. In the context of the global movement toward more widespread legalisation, there is a growing need toward developing a better understanding of the physiological and pathological effects. We provide an overview of the current evidence on the effects of cannabinoids on the eye. Of the identified cannabinoids, ?9-tetrahydrocannabinol is recognized to be the primary psychotropic compound, and cannabidiol is the predominant nonpsychoactive ingredient. Despite demonstrating ocular hypotensive and neuroprotective activity, the use of cannabinoids as a treatment for glaucoma is limited by a large number of potential systemic and ophthalmic side effects. Anterior segment effects of cannabinoids are complex, with preliminary evidence showing decreased corneal endothelial density in chronic cannabinoid users. Experiments in rodents, however, have shown potential promise for the treatment of ocular surface injury via antinociceptive and antiinflammatory effects. Electroretinography studies demonstrating adverse effects on photoreceptor, bipolar, and ganglion cell function suggest links between cannabis and neuroretinal dysfunction. Neuro-ophthalmic associations include ocular motility deficits and decrements in smooth pursuit and saccadic eye movements, although potential therapeutic effects for congenital and acquired nystagmus have been observed.
Vision therapy: Occlusion, prisms, filters, and vestibular exercises for mild traumatic brain injury
Jason J.S. Barton,Paul J. Ranalli
doi : 10.1016/j.survophthal.2020.08.001
REVIEW| VOLUME 66, ISSUE 2, P346-353, MARCH 01, 2021
no abstract
A virtual COVID-19 ophthalmology rotation
Sydney Wendt,Zainub Abdullah,Spencer Barrett,Zachary Elkin,Grace Sun,Andrew G. Lee
doi : 10.1016/j.survophthal.2020.10.001
REVIEW| VOLUME 66, ISSUE 2, P354-361, MARCH 01, 2021
The coronavirus (COVID-19) pandemic temporarily suspended medical student involvement in clinical rotations, resulting in the need to develop virtual clinical experiences. The cancellation of clinical ophthalmology electives and away rotations reduces opportunities for exposure to the field, to network with faculty, conduct research, and prepare for residency applications. We review the literature and discuss the impact and consequences of COVID-19 on undergraduate medical education with an emphasis on ophthalmic undergraduate medical education. We also discuss innovative learning modalities used from medical schools around the world during the COVID-19 pandemic such as virtual didactics, online cases, and telehealth. Finally, we describe a novel, virtual neuro-ophthalmology elective created to educate medical students on neuro-ophthalmology foundational principles, provide research and presentation opportunities, and build relationships with faculty members. These innovative approaches represent a step forward in further improving medical education in ophthalmology during COVID-19 pandemic and beyond.
Current and emerging treatments for albinism
Siyin Liu,Helen J. Kuht,Emily Haejoon Moon,Gail D.E. Maconachie,Mervyn G. Thomas
doi : 10.1016/j.survophthal.2020.10.007
REVIEW| VOLUME 66, ISSUE 2, P362-377, MARCH 01, 2021
Albinism is a group of rare inherited disorders arising from impairment of melanin biosynthesis. The reduction of melanin synthesis leads to hypopigmentation of the skin and eyes. A wide range of ophthalmic manifestations arise from albinism, including reduction of visual acuity, nystagmus, strabismus, iris translucency, foveal hypoplasia, fundus hypopigmentation, and abnormal decussation of retinal ganglion cell axons at the optic chiasm. Currently, albinism is incurable, and treatment aims either surgically or pharmacologically to optimize vision and protect the skin; however, novel therapies that aim to directly address the molecular errors of albinism, such as l-dihydroxyphenylalanine and nitisinone, are being developed and have entered human trials though with limited success. Experimental gene-based strategies for editing the genetic errors in albinism have also met early success in animal models. The emergence of these new therapeutic modalities represents a new era in the management of albinism. We focus on the known genetic subtypes, clinical assessment, and existing and emerging therapeutic options for the nonsyndromic forms of albinism.
Revisiting the role of factor H in age-related macular degeneration: Insights from complement-mediated renal disease and rare genetic variants
Nikolaos Tzoumas,Dean Hallam,Claire L. Harris,Majlinda Lako,David Kavanagh,David H.W. Steel
doi : 10.1016/j.survophthal.2020.10.008
REVIEW| VOLUME 66, ISSUE 2, P378-401, MARCH 01, 2021
Ophthalmologists are long familiar with the eye showing signs of systemic disease, but the association between age-related macular degeneration and abnormal complement activation, common to several renal disorders, has only recently been elucidated. Although complement activation products were identified in drusen almost three decades ago, it was not until the early 21st century that a single-nucleotide polymorphism in the complement factor H gene was identified as a major heritable determinant of age-related macular degeneration, galvanizing global efforts to unravel the pathogenesis of this common disease. Advances in proteomic analyses and familial aggregation studies have revealed distinctive clinical phenotypes segregated by the functional effects of common and rare genetic variants on the mature protein and its splice variant, factor H–like protein 1. The predominance of loss-of-function, N-terminal mutations implicate age-related macular degeneration as a disease of general complement dysregulation, offering several therapeutic avenues for its modulation. Here, we explore the molecular impact of these mutations/polymorphisms on the ability of variant factor H/factor H–like protein 1 to localize to polyanions, pentraxins, proinflammatory triggers, and cell surfaces across ocular and renal tissues and exert its multimodal regulatory functions and their clinical implications. Finally, we critically evaluate key therapeutic and diagnostic efforts in this rapidly evolving field.
A child with unilateral disk elevation
Danny A. Mammo,Polly A. Quiram,Michael S. Lee,R. Michael Siatkowski
doi : 10.1016/j.survophthal.2019.05.004
CLINICAL CHALLENGES| VOLUME 66, ISSUE 2, P402-406, MARCH 01, 2021
A healthy 7-year-old girl underwent a routine eye examination and was referred for unilateral, left optic nerve swelling. Best-corrected visual acuity in the affected eye was 20/20 with full Ishihara color plates and no relative afferent pupillary defect. Initial extensive workup was normal for any cause of unilateral disk swelling. When the patient returned a few years later with decreased vision, a thickened, gray-white preretinal tissue with surrounding retinal contraction and a surrounding charcoal gray lesion had developed in her optic nerve. Spectral-domain optical coherence tomography over the optic nerve demonstrated distortion of the inner retinal architecture, a dense epiretinal membrane, and high internal reflectivity. Clinical examination and imaging revealed a diagnosis of combined hamartoma of the retina and retinal pigment epithelium.
Comment re: Commonly used intracameral antibiotics for endophthalmitis prophylaxis: A literature review.
Mark J. Walland
doi : 10.1016/j.survophthal.2020.10.006
LETTER| VOLUME 66, ISSUE 2, P407-409, MARCH 01, 2021
Authors’ Response
Andrzej Grzybowski,Piotr Brona,Luis Zeman,Michael W. Stewart
doi : 10.1016/j.survophthal.2020.11.003
LETTER| VOLUME 66, ISSUE 2, P409, MARCH 01, 2021
Table of Contents
doi : 10.1016/S0039-6257(21)00013-8
CONTENTS LIST| VOLUME 66, ISSUE 2, PA2-A4, MARCH 01, 2021
