OD research addresses all areas of the eye

Optometrists shared study results at the ARVO meeting that may influence the future of clinical care for eye care providers.

Optometry was well represented at the annual meeting of the Association for Research in Vision and Ophthalmology in Denver, where OD clinicians and researchers presented findings to improve patient care in the areas of ocular surface, retina and contact lenses.

Successful ABMD treatment

PCON Editorial Board member Scott G. Hauswirth, OD, FAAO, reported on two patients with anterior basement membrane dystrophy (ABMD) who were successfully treated with débridement and amnion tissue.

“My poster looked at a very small set of patients where the treatment for visually significant but nonerosive ABMD was performed using epithelial débridement and polishing of Bowman’s membrane with a diamond burr, followed by placement of cryopreserved amnion tissue, with topical azithromycin twice daily and artificial tears,” he explained.

In the retrospective case series, the two patients were followed up to 5 months, according to the abstract.

The patients showed an average improvement of nearly two lines of best corrected visual acuity, Hauswirth said.

As detailed in the abstract, topographic assessment before and after treatment showed a reduction of surface irregularity.

“No complications were noted, specifically no corneal haze, out to 3 months,” Hauswirth said. “Because it’s a combination therapy, the question arises: Which part of this treatment is most effective? I think all of the components are beneficial in obtaining an optimal outcome.”

Hauswirth also told PCON that his research was the first portion of a large database from which he is attempting to pinpoint the most effective treatments within the scope of optometry for recurrent corneal erosion (RCE).

He said he has further data on treatment with and without azithromycin, on the use of cryopreserved amnion tissue vs. bandage contact lens, and treatment with and without epithelial débridement and Bowman’s membrane polishing.

“To this date there is no peer-reviewed published literature on using topical azithromycin in this patient population, although it’s an acceptable practice,” Hauswirth said. “Even the Cochrane database, which does a meta-analysis of the literature, indicates that success rates vary widely in the RCE population, and no good comparative studies exist. Thus, there is a knowledge gap that can be filled.”

ELM a biomarker for Stargardt’s

PCON Editorial Board member Jerome Sherman, OD, FAAO, presented his continued research on Stargardt’s disease.

Danica Yang, an OD, MS, candidate at the SUNY College of Optometry and a graduate student under Sherman, spoke with PCON about the study.

“Stargardt’s disease is the most common form of macular degeneration that occurs early in life,” Yang said. “At this moment in time, it is difficult to diagnose the disease before symptoms arise and the vision becomes reduced. In addition, there is little that can be done for patients with the disease.”

She continued: “Recent observations using technology such as spectral-domain optical coherence tomography (SD-OCT) and ultra-widefield autofluorescence (UWF-AF), allows us to detect novel structural abnormalities of the retina never before reported. In the pedigree we studied, the increased thickness and reflectivity of the external limiting membrane (ELM) was a prominent but transient biomarker for Stargardt’s disease.”

Sherman, Yang and colleagues evaluated three siblings who had genetically confirmed Stargardt’s disease, according to the study abstract. The siblings were first seen at ages 4, 5 and 8 years old.

Researchers utilized OCT, fundus photography, UWF-AF, genetic testing and full field electroretinography to assess the children.

Results showed a thickening of the ELM before symptoms and loss of visual acuity. As detailed in the abstract, the 8-year-old participant had a visual acuity of 20/200 in each eye as well as significant macular thinning and significant loss of the outer retina. Additionally, in the central 4 mm of the SD-OCT scans, the child had no detectable ELM or ellipsoid zone (EZ) (a.k.a. photoreceptor integrity line or PIL). Researchers also reported that genetic testing identified a mutation of ABCA4 (Pro1380Leu). During 2 years of follow-up, the participant experienced a worsened visual acuity to 20/400 OU and a worsening of abnormalities found on OCT and UWF-AF scans.

At the beginning of their evaluations, the younger two siblings had no visual symptoms and visual acuities of 20/25 in both eyes. SD-OCT revealed an attenuated EZ/PIL and a hyper-reflective, thickened ELM in both participants. At the 2-year follow up, the middle sibling showed a nearly depleted ELM in the central macula, with the exception of the fovea, where there was a concave protuberance representing the ELM, the abstract stated.

Furthermore, all three participants had progressive autofluorescence changes.

“Importantly, we noted abnormalities in the ELM in two sisters, ages 4 and 5, who were pre-symptomatic,” Yang said. “If an abnormally thickened hyperreflective ELM is shown to be an early indicator of Stargardt’s disease, clinicians may be able to detect the disease earlier and possibly before symptoms arise. With the possibility of a treatment for the disease in the near future, early detection could be key in preventing vision loss in Stargardt’s patients.”

Researchers also noted in the abstract that knowledge of the biomarker, as well as its progression, could ultimately prove helpful in determining treatment and efficacy in the future.

“Finding an early biomarker for Stargardt’s disease may allow optometrists to diagnose the disease earlier and prevent patients from undergoing unnecessary expensive neurological procedures such as MRIs,” Yang noted. “In a majority of patients, the fundus appears normal in early Stargardt’s disease even though patients may have complaints of blurred vision, and best corrected visual acuity may be reduced. Such patients often get referred to a neurologist to rule out disorders such as brain tumors and demyelinating disorders.”

VAST Study

Julie Rodman, OD, MS, FAAO, presented results from the VAST study, which investigated the prevalence of vitreomacular adhesion (VMA) in patients at least 40 years old.

She told Primary Care Optometry News that secondary analyses will include correlations between the presence of VMA and gender, ethnicity and/or refractive error.

Rodman and colleagues assessed 2,179 eyes of 1,120 subjects, she told PCON. The participants had a mean age of 59 years, and 57% were female. Additionally, 57% of participants were identified as hyperopes, 35% as myopes and 8% as emmetropes.

As detailed in the abstract, researchers divided the participants into categories by age to evaluate their data. Patients underwent a comprehensive eye examination and SD-OCT to determine VMA status.

Results showed a presence of VMA in 31% of eyes. Prevalence was highest in the group of participants that were 50 to 59 years old. The researchers reported that prevalence decreased with increasing age. Also, African-American and Hispanic patients were less likely to have VMA.

Rodman explained that understanding VMA, specifically its prevalence among particular groups, could help clinicians better identify and manage patients.

“With the emergence of high-resolution scanning devices such as OCT over the past 2 decades, there is a greater understanding of the pathophysiology of the disorders of the vitreomacular interface and their role in the development of various maculopathies,” she said. “Detection, management and proper treatment of these patients is crucial in securing an optical outcome for our patients.

“Up to this point,” Rodman continued, “there have been limited epidemiological studies reported in the literature on the prevalence of VMA, resulting in a significant gap in the literature regarding this entity.”

As noted in the abstract, researchers are continuing collecting data in order to increase the sample size.

Peroxide vs. multipurpose solutions

Other researchers found that a peroxide contact lens care solution was superior to biguanide-preserved multipurpose solutions.

Christopher W. Lievens, OD, MS, FAAO, the chief of staff of the Eye Center at Southern College of Optometry, discussed his work with PCON.

“As an optometrist I have a particular interest in contact lens research that focuses on symptomatic wearers, because contact lens dropout has adversely affected our patient base consistently over the past 2 decades,” he explained.

As detailed in the study abstract, Lievens and colleagues conducted a randomized, investigator-masked, controlled, parallel group, multisite study to evaluate symptom changes and lid papillae following a switch in contact lens care solution.

“This 12-center U.S. study targeted symptomatic wearers of silicone hydrogel contact lens wearers with notable eyelid papillae,” Lievens said.

The 128 study participants were randomly selected to continue use of their biguanide-preserved multipurpose solution or switch to a hydrogen peroxide contact lens care solution (Clear Care, Alcon), according to the abstract.

“To avoid complexity, their habitual contact lenses were not changed, nor was their wearing schedule, but they were dispensed new lenses,” Lievens added.

Researchers assessed the participants at baseline and 3 months later. They utilized fluorescein to grade lid papillae as well as several scales, including the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8), to measure symptoms.

Results showed that all measurements improved in 90 days in patients who switched to the hydrogen peroxide contact lens care solution. As detailed in the abstract, Clear Care participants experienced a significant improvement in lid papillae, significantly lower mean CLDEQ-8 scores and significantly fewer symptoms in terms of intensity and frequency. Researchers evaluated end-of-day dryness, burning or stinging, blurry vision, grittiness, irritation and itchiness.

“A key finding was noticeable (and statistically significant) reduction in the eyelid papillae with a corresponding improvement in symptomatology,” Lievens told PCON. “As such, hydrogen peroxide as a disinfection system recommendation by the eye care practitioner might be a key to alleviate symptoms in this problematic contact lens patient base.”

Role of daily lens wear in myopia

In another study presented at ARVO, Monica Jong, PhD, BOptom, and colleagues investigated the possibility of a dose-response relationship in daily contact lens wear.

Researchers conducted a double-masked, prospective, randomized clinical trial at the Brien Holden Vision Institute in China, according to the abstract. Jong told PCON that 270 Chinese children 8 to 13 years old were recruited, of which the results of the first 268 children to reach 6 months were reported. The participants all had a spherical refractive error between -0.75 D and -5.00 D and cylinder of -1.00 D or less; they had not previously been treated for myopia.

As detailed in the abstract, participants were divided into three groups: two groups were fitted with two different daily disposable extended depth of focus (EDOF) contact lenses, indicated by the authors as EDOF1 and EDOF2; the other group was fitted with single vision (SV) contact lenses. There were no significant differences at baseline among the three groups for parental myopia, gender and age as well as refractive error and axial length, Jong noted.

To compare the groups, researchers measured axial length at baseline and after 6 months in addition to obtaining each participant’s duration of daily lens wear at 6 months by survey.

“Results showed that both the EDOF lens designs demonstrated a linear relationship with average daily duration of wear and axial length change; that is, the change in axial length seen in the participants over the 6-month period was less in those who wore their lenses on average for a greater number of hours per day,” Jong said.

When the average daily duration of wear for both EDOF lenses exceeded 14 hours per day, axial length change approached zero, the abstract stated.

“Our 6-month results indicate a strong dose-response relationship whereby greater hours of wear per day was associated with less axial length increase for both types of EDOF lenses. EDOF lenses appear to be more useful for myopia control when worn for longer hours each day,” the authors concluded in the poster.

“We know that the prevalence of myopia is growing worldwide,” Jong said. “Being able to intervene and reduce the rate of progression of myopia has the potential to greatly reduce the risk of future blindness and vision impairment, especially because any amount of increase in myopia can increase the risk of myopic macular degeneration, glaucoma and cataracts.” – by Chelsea Frajerman Pardes

• References:
• Hauswirth SG. The effect of débridement and amnion tissue on vision in patients with anterior basement membrane dystrophy: A short case series. Poster presented at: The Association for Research in Vision and Ophthalmology annual meeting; May 7, 2015; Denver, CO.
• Jong M, et al. A dose-response relationship between duration of daily lens wear and reduction in rate of axial elongation. Poster presented at: ARVO annual meeting; May 5, 2015; Denver, CO.
• Lievens C, et al. Lid papillae improvement with use of a hydrogen peroxide lens care solution. Poster presented at: ARVO annual meeting; May 7, 2015; Denver, CO.
• Rodman J, et al. The prevalence of vitreomacular adhesion in patients 40 years and older — VAST Study. Poster presented at: ARVO annual meeting; May 3, 2015; Denver, CO.
• Sherman J, et al. Exploring the importance of the ELM as a transient biomarker in the natural history of early-onset Stargardt disease with SD OCT and UWF-AF. Poster presented at: ARVO annual meeting; May 4, 2015; Denver, CO.

• For more information:
• Scott G. Hauswirth, OD, FAAO, is a Primary Care Optometry News Editorial Board member. He can be reached at sghauswirth@mneye.com.
• Monica Jong, PhD, BOptom, can be reached at m.jong@brienholdenvision.org.
• Christopher W. Lievens, OD, MS, FAAO, can be reached at clievens@sco.edu.
• Julie Rodman, OD, MS, FAAO, can be reached at rjulie@nova.edu.
• Jerome Sherman, OD, FAAO, is a PCON Editorial Board member. He can be reached at j.sherman@sunyopt.edu.
• Danica Yang can be reached at dyang@sunyopt.edu.

Disclosures: Hauswirth is a consultant for BioTissue. Jong reports no relevant financial disclosures, but her research is funded by Australian Government Vision CRC Program and grants from the Brien Holden Vision Institute and Zhongshan Ophthalmic Centre, Sun Yat Sen University, Guangzhou China. Lievens has received funding from Alcon. Rodman has received funding from Carl Zeiss, Optovue and Thrombogenics. Sherman in the past has consulted and lectured for Topcon and Optos. Yang reports no relevant financial disclosures.