Flash Update

Important notice

The author does not recommend nor endorse the results of these clinical trials. These flash updates are a summary of trending and newly released clinical trails ONLY.

Protocol AB by DRCR network


DRCR network conducted a randomized multi-center clinical trial in 205 patients compared the intravitreal aflibercept (100 patients) with pars plana vitrectomy (PPV) with pan-retinal laser photocoagulation (PRP) (105 patients) to treat diabetic vitreous hemorrhage within 24weeks follow up.

The network concluded that there was no statistical difference in visual acuity among both arms in 24 weeks follow up; however, the study was statistically underpowered to reveal PPV and PRP's usefulness.


Source: Antoszyk AN, Glassman AR, Beaulieu WT, et al. Effect of Intravitreous Aflibercept vs Vitrectomy With Panretinal Photocoagulation on Visual Acuity in Patients With Vitreous Hemorrhage From Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. JAMA. 2020;324(23):2383–2395. doi:10.1001/jama.2020.23027


What are the lifetime results of neovascular AMD treated with AntiVEGF?

Treatment of AntiVEGF was related to preserved beneficial vision in 20 % of patients (12 % of patients can drive, and 15 % can read) in a remaining average lifetime. Still, vision can deteriorate If treatment with Anti-VEGF is stopped. In contrast, 80% of patients can end up with legal blindness within three years in cases without intervention.

Therefore, earlier treatment and easy access to AntiVEGF to manage neovascular AMD may lead to favorable visual outcomes.

Source:Finger RP, Puth M, Schmid M, Barthelmes D, Guymer RH, Gillies M. Lifetime outcomes of anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration. JAMA Ophthalmol. Published online October 15, 2020. doi:10.1001/jamaophthalmol.2020.3989


The association of renal function and vascular density using OCTa in patients with diabetes mellitus type two

A prospective cross-sectional study in a Chinese-based population Of 874 patients with diabetes mellitus type two evaluated the superficial capillary plexus using OCTa and glomerular filtration rate calculated using the Xiangya equation.

The study concluded that capillary density changes are independently correlated to renal function, making OCTa a non-invasive method for quantitive evaluation of vascular changes in the retina and chronic kidney failure in patients with diabetes mellitus type two in Chinese patients.

Source: Wang W, et al. Br J Ophthalmol 2020;0:1–6. doi:10.1136/bjophthalmol-2019-315450

What is the visual prognosis after 12 years of treatment of neovascular ARMD with intravitreal AntiVEGF?


A retrospective real-life cohort evaluated 10744 eyes with neovascular ARMD treated with AntiVEGF for 12 years.


Patients with neovascular ARMD may have improved vision in the first two years of treatment with Anti-VEGF. However, vision may deteriorate within the next 8.7 years. Thus, patients with initial good visual acuity at the baseline and those treated earlier have a better visual prognosis.


Fu DJ, Keenan TD, Faes L, et al. Insights From Survival Analyses During 12 Years of Anti–Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration. JAMA Ophthalmol. Published online November 19, 2020. doi:10.1001/jamaophthalmol.2020.5044

Primary inverted ILM flap is recommended in patients presented with macular hole bigger than 400 microns

A retrospective non-randomized study evaluated the macular hole rate closure, visual acuity, and integrity of ellipsoid zone in primary pars plana vitrectomy for macular hole bigger than 400 microns with an inverted ILM flap or conventional ILM peeling in 117 eyes for 12 months follow up

Primary pars plana vitrectomy for macular hole bigger than 400 microns, with an inverted ILM flap, is associated with a significantly higher closure rate than a conventional ILM peeling.

Best-corrected visual acuity is strongly correlated with the integrity of the ellipsoid zone.

Source: Baumann, Carmen MD, FEBO; Kaye, Stephen BSc, MBBch, FRCS, FRCOphth, MD; Iannetta, Danilo MD; Sultan, Ziyaad BSc, MBBS, FRCOphth; Dwivedi, Rahul Bsc(Hons), MBChB, FRCOphth; Pearce, Ian MBChB, BSc, FRCOphth EFFECT OF INVERTED INTERNAL LIMITING MEMBRANE FLAP ON CLOSURE RATE, POSTOPERATIVE VISUAL ACUITY, AND RESTORATION OF OUTER RETINAL LAYERS IN PRIMARY IDIOPATHIC MACULAR HOLE SURGERY, Retina: October 2020 - Volume 40 - Issue 10 - p 1955-1963 doi: 10.1097/IAE.0000000000002707


What is the long term follow up patients with neovascular ARMD treated with intravitreal VEGF blockade agents?

Seven years of a retrospective cohort evaluated 533 eyes with neovascular ARMD treated with intravitreal VEGF blockade agents.

Concluded that patients with baseline vision of 20/40 and more did better than patients with baseline vision of 20/40 and less. However, patients who received significantly more intravitreal VEGF blockade agents did better than those who had an an inconsistent follow-up.

Source: Kung FF, Starr MR, Bui YT, Mejia CA, Bakri SJ. Long-Term Follow-up of Patients with Exudative Age-Related Macular Degeneration Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Injections. Ophthalmol Retina. 2020 Nov;4(11):1047-1053. doi: 10.1016/j.oret.2020.05.005. Epub 2020 May 19. PMID: 32439455.

Agreement of SD-OCT with FFA Leakage in Neovascular AMD

A post hoc analysis of the HARBOR Study has evaluated 1094 patients for 24 months. They concluded that Spectral-domain OCT alone could be relied upon to detect CNV activity (Sensitivity 91%) during follow up patients with neovascular AMD. However, FFA plays a valuable role in occult lesions that appear quiescent on SD-OCT, as FFA may show leakage.

Source: Khurana RN, Hill L, Ghanekar A, Gune S. Agreement of Spectral-Domain OCT with Fluorescein Leakage in Neovascular Age-Related Macular Degeneration: Post Hoc Analysis of the HARBOR Study. Ophthalmol Retina. 2020 Nov;4(11):1054-1058. doi: 10.1016/j.oret.2020.04.016. Epub 2020 Apr 28. PMID: 32353536.

Do vitamin D3 and marine ω-3 fatty acids affect the reduction of age macular degeneration incidence or progression?

In a large randomized trial in 25871 participants of initially healthy men and women, supplementation with vitamin D3 2000 IU and marine ω-3 fatty acids 1 mg daily for a median of 5.3 years had no significant overall effect on age macular degeneration progression or incidence.

Source: Christen WG, Cook NR, Manson JE, et al. Effect of Vitamin D and ω-3 Fatty Acid Supplementation on Risk of Age-Related Macular Degeneration: An Ancillary Study of the VITAL Randomized Clinical Trial. JAMA Ophthalmol. Published online October 29, 2020. doi:10.1001/jamaophthalmol.2020.4409

Can autologous neurosensory retinal transplantation be used in primary chronic large macular holes?

A case series report studied repair of seven cases of primary large (600 microns and more for hole diameter and 1000 microns and more for basal diameter) chronic macular hole (more than one year) with autologous neurosensory retinal transplantation and observed improved integrity of outer retinal layers with improvement in visual acuity and function on microperimetry without any significant complications.

They concluded that this procedure might also have a role in selected cases of large chronic primary macular holes.

Source:

Tanaka, Shin MD*; Inoue, Maiko MD*; Inoue, Tatsuya MD*; Yamakawa, Tadashi MD†; Uchio, Eiichi MD‡; Grewal, Dilraj S. MD§; Mahmoud, Tamer H. MD, PhD¶; Kadonosono, Kazuaki MD* AUTOLOGOUS RETINAL TRANSPLANTATION AS A PRIMARY TREATMENT FOR LARGE CHRONIC MACULAR HOLES, Retina: October 2020 - Volume 40 - Issue 10 - p 1938-1945 doi: 10.1097/IAE.0000000000002693

The continued Intravitreal AntiVEGF for treatment neovascular ARMD is important!

A retrospective cohort study evaluated the presence of the visual outcome in patients with active neovascular age-related macular degeneration (ARMD) treated with intravitreal AntiVEGF for ten years.

The study concluded that continuous intravitreal AntiVEGF for at least once annually provided visual stability in patients suffering from active neovascular ARMD for ten years.

Source: Starr, Matthew R. MD*; Kung, Felix F. BA†; Mejia, Camilo A. BA†; Bui, Yvonne T. BS†; Bakri, Sophie J. MD* TEN-YEAR FOLLOW-UP OF PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION TREATED WITH INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR INJECTIONS, Retina: September 2020 - Volume 40 - Issue 9 - p 1665-1672 doi:10.1097/IAE.0000000000002668

Ischemia is associated with the thinning of inner retinal layers


The study evaluated the relation of extramacular retinal thickness changes in diabetic retinopathy and perfusion status.

A retrospective cross-sectional study evaluated 77 eyes in 55 patients using swept-source OCT angiography.

The study concluded that inner retinal thinning could be related to ischemic changes, and a topographical map may help to reflect the perfusion status.


Source: Hirotaka Ito Yasuki Ito Keiko Kataoka Hiroki Kaneko Takeshi Iwase Hiroko Terasaki Association Between Retinal Layer Thickness and Perfusion Status in Extramacular Areas in Diabetic Retinopathy Published: March 26, 2020, DOI: https://doi.org/10.1016/j.ajo.2020.03.019

Smoking may lead to worse visual outcomes in patients with neovascular ARMD treated with Anti-VEGF


A retrospective multicenter observational study evaluated the effect of smoking in visual outcomes in patients with neovascular age-related macular degeneration treated with intravitreal AntiVEGF for twelve months.

The study concluded that smoking individuals have worse visual outcomes than non-smokers while treating neovascular age-related macular degeneration with intravitreal AntiVEGF within twelve months of follow-up.


Source: Vittorio, Alexander F. MBBS*; Nguyen, Vuong PhD†; Barthelmes, Daniel MD, PhD‡; Arnold, Jennifer J. MBBS (Hons)§; Cheung, Chui M. G. MBBS¶; Murray, Neil MBChB**; Gillies, Mark C. MBBS, PhD†; the Fight Retinal Blindness! Study Group SMOKING STATUS AND TREATMENT OUTCOMES OF VASCULAR ENDOTHELIAL GROWTH FACTOR INHIBITORS FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION, Retina: September 2020 - Volume 40 - Issue 9 - p 1696-1703 doi: 10.1097/IAE.0000000000002679

A cross over from microsecond laser to Half-dose PDT yelled with better results in treating CSCR


A multicenter interventional case series report evaluated the cross over to PDT or microsecond laser after treatment failure for central serous chorioretinopathy (CSCR) for 42 patients.


When treating persistent CSCR after microsecond laser with half-dose PDT, a resolved subretinal fluids with increased retinal sensitivity was observed. In contrast, when treating persistent CSCR after half-dose PDT with a microsecond laser, there was a subretinal fluid resolution without functional improvement.


Source: Thomas J. van Rijssen, Elon H.C. van Dijk, Paula Scholz, Myrte B. Breukink, Greet Dijkman, Petrus J.H. Peters, Roula Tsonaka, Robert E. MacLaren, Susan M. Downes, Sascha Fauser, Camiel J.F. Boon, Carel B. Hoyng,

Crossover to Photodynamic Therapy or Micropulse Laser After Failure of Primary Treatment of Chronic Central Serous Chorioretinopathy: The REPLACE Trial, American Journal of Ophthalmology, Volume 216,2020, Pages 80-89, ISSN 0002-9394,https://doi.org/10.1016/j.ajo.2020.04.007.


Primary inverted ILM flap is recommended in patients presented with macular hole bigger than 400 microns


A retrospective non-randomized study evaluated the macular hole rate closure, visual acuity, and integrity of ellipsoid zone in primary pars plana vitrectomy for macular hole bigger than 400 microns with an inverted ILM flap or conventional ILM peeling in 117 eyes for 12 months follow up

Primary pars plana vitrectomy for macular hole bigger than 400 microns, with an inverted ILM flap, is associated with a significantly higher closure rate than a conventional ILM peeling.

Best-corrected visual acuity is strongly correlated with the integrity of the ellipsoid zone.

Source: Baumann, Carmen MD, FEBO; Kaye, Stephen BSc, MBBch, FRCS, FRCOphth, MD; Iannetta, Danilo MD; Sultan, Ziyaad BSc, MBBS, FRCOphth; Dwivedi, Rahul Bsc(Hons), MBChB, FRCOphth; Pearce, Ian MBChB, BSc, FRCOphth EFFECT OF INVERTED INTERNAL LIMITING MEMBRANE FLAP ON CLOSURE RATE, POSTOPERATIVE VISUAL ACUITY, AND RESTORATION OF OUTER RETINAL LAYERS IN PRIMARY IDIOPATHIC MACULAR HOLE SURGERY, Retina: October 2020 - Volume 40 - Issue 10 - p 1955-1963 doi: 10.1097/IAE.0000000000002707

Flat irregular PED may indicted presence of CNVm in CSC cases

A retrospective observational study evaluated the outcomes and changes in OCT angiography of natural course vs. intravitreal Bevacizumab in patients with central serous chorioretinopathy (CSCR)presented according to pigment epithelial detachment (PED) type.

They concluded that falt irregular PED might respond to intravitreal AntiVEGF with favorable visual outcomes compared to the natural course when the presence of CNV is confirmed using OCTa. However, irregular flat PED associated with CSCR may be a sign of the existence of CNVm.

Source:Hwang, Hyeseong MD*; Kim, Jin YOUNG MD†; Kim, Kyung TAE MD*,‡; Chae, Ju BYUNG MD, PhD*; Kim, Dong YOON MD, PhD* FLAT IRREGULAR PIGMENT EPITHELIUM DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY, Retina: September 2020 - Volume 40 - Issue 9 - p 1724-1733 doi: 10.1097/IAE.0000000000002662


Long time follow up is required after effective treatment of intravitreal AntiVEGF or laser in ROP

A retrospective study evaluated the ROP recurrence rate's risk factors when treating ROP type one using a laser, intravitreal Ranibizumab, and intravitreal Bevacizumab.

The study concluded that laser, intravitreal Ranibizumab, and intravitreal Bevacizumab effectively treated ROP type one. Still, the recurrence can occur within 50 weeks postmenstrual age when treated with intravitreal Ranibizumab (20.8%) and intravitreal Bevacizumab (10%) postmenstrual and earlier laser (18%). Therefore, a long-term follow-up is required, especially in initial treatment cases with early postmenstrual age, low Apgar score, multiple births, and ROP zone one.

Source:Ling, Kiet-Phang MD*; Liao, Pei-Ju PhD†; Wang, Nan-Kai MD, PhD*,‡; Chao, An-Ning MD*,‡; Chen, Kuan-Jen MD*,‡; Chen, Tun-Lu MD*,‡; Hwang, Yih-Shiou MD, PhD*,‡; Lai, Chi-Chun MD*,‡; Wu, Wei-Chi MD, PhD*,‡ RATES AND RISK FACTORS FOR RECURRENCE OF RETINOPATHY OF PREMATURITY AFTER LASER OR INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR MONOTHERAPY, Retina: September 2020 - Volume 40 - Issue 9 - p 1793-1803 doi: 10.1097/IAE.0000000000002663

Impact of macular thickness fluctuations in neovascular ARMD

Are fluctuations in macular thickness when treating neovascular ARMD have to impact in visual acuity?

A comparison from CATT (1165 eyes) and IVAN (566 eyes) study

measuring central foveal thickness and changes of best-corrected visual acuity, subretinal fibrosis, and geographic atrophy

After two years of treatment with VEGF-blockade agents, eyes with more fluctuation in retinal thickness had worse best-corrected visual acuity. They had more chance to develop fibrosis and geographic atrophy in the macula than eyes that had less fluctuation.

Source: Evans RN, Reeves BC, Maguire MG, et al. Associations of Variation in Retinal Thickness With Visual Acuity and Anatomic Outcomes in Eyes With Neovascular Age-Related Macular Degeneration Lesions Treated With Anti–Vascular Endothelial Growth Factor Agents. JAMA Ophthalmol. Published online August 20, 2020. doi:10.1001/jamaophthalmol.2020.3001

The quality of life post pneumatic Retinopexy vs Vitrectomy in repairing RRD

A post hoc analysis of the Pneumatic Retinopexy vs Vitrectomy for the Management of Primary Rhegmatogenous Retinal Detachment Outcomes trial evaluated the postoperative vision-related quality of life.

The analysis concluded that patients who underwent Pneumatic Retinopexy had a better score in visual function outcomes and mental health during the first six months postoperatively compared with Vitrectomy.

Source: Muni RH, Francisconi CLM, Felfeli T, et al. Vision-Related Functioning in Patients Undergoing Pneumatic Retinopexy vs Vitrectomy for Primary Rhegmatogenous Retinal Detachment: A Post Hoc Exploratory Analysis of the PIVOT Randomized Clinical Trial. JAMA Ophthalmol. 2020;138(8):826–833. doi:10.1001/jamaophthalmol.2020.2007

Comparing visual outcome post SB and PPV on cases of RRD

A retrospective multicenter study compared scleral buckle vs. pars plana vitrectomy vs. combined pars plana vitrectomy and scleral buckle to repair medium complexity, rhegmatogenous retinal detachment in 715 phakic patients

The study concluded that scleral buckle alone is superior to both pars plana vitrectomy and combined pars plana vitrectomy and a scleral buckle in terms of visual acuity outcome where pars plana vitrectomy had the worse.

Source: Edwin H. Ryan, MD Claire M. Ryan, BA Nora J. Forbes, MS Omesh P. Gupta, MD Jason Hsu, MD Carl D. Regillo, MD

Primary Retinal Detachment Outcomes Study Report Number 2

Phakic Retinal Detachment Outcomes

Published:March 09, 2020 DOI:https://doi.org/10.1016/j.ophtha.2020.03.007

Real world data evaluating Anti-VEGF vs steroids vs laser in treating ME related to BRVO

Real-world data of treating 5661 patients with macular edema related to branch retinal vein occlusion with Anti-VEGF, dexamethasone implant or macular laser

The largest real-life study in the UK evaluates the treatment efficacy of three treatment modalities outside the clinical trials environment with follow up to three years.

Anti-VEGF showed more improvement with more cost burden than with dexamethasone implant or macular laser, which did not improve or failed to maintain improvement. It may be due to different mean visual acuities

Source: Gale R, Pikoula M, Lee AY on behalf of UK EMR Users Group, et al Real world evidence on 5661 patients treated for macular oedema secondary to branch retinal vein occlusion with intravitreal anti-vascular endothelial growth factor, intravitreal dexamethasone or macular laser British Journal of Ophthalmology Published Online First: 12 June 2020. doi: 10.1136/bjophthalmol-2020-315836

Additional Anti-VEGF maybe needed in cases of persisted or recurrent DME post fluocinolone acetonide implant

Evaluate an additional Anti-VEGF injection for persistent or recurrent diabetic macular edema after one year of injection of fluocinolone acetonide 0.19 mg implant

A prospective cohort single-center study of Ninety-four eyes in sixty-six patients received fluocinolone acetonide 0.19 mg implant for diabetic macular edema.

Anti-VEGF is effective for residual and recurrent diabetic macular edema after fluocinolone acetonide 0.19 mg implant; however, patients didn't receive PRP, and higher central macular thickness had a greater chance to receive additional Anti-VEGF injection. In contrast, eyes received dexamethasone implant before fluocinolone acetonide 0.19 mg implant had less chance of BCVA decline to those who shifted directly from AntiVEGF to fluocinolone acetonide 0.19 mg implant.

Source: Maria Vittoria Cicinelli, Alessandro Rabiolo, Piero Zollet, Luigi Capone, Rosangela Lattanzio, Francesco Bandello Persistent or Recurrent Diabetic Macular Edema After Fluocinolone Acetonide 0.19 mg Implant: Risk Factors and Management Published: March 21, 2020 DOI:https://doi.org/10.1016/j.ajo.2020.03.016

To evaluate extended dosing of Faricimab in patients with neovascular ARMD?

A randomized multicenter double-masked phase two study compared the multiple-dose regimen comparing intravitreal Ranibizumab, 0.5 mg, every four weeks or faricimab, 6.0 mg, every 12 or 16 weeks. Participants in the faricimab arms initially received four monthly injections of faricimab. In a total of 76 patients for 52 weeks, follow up.

Every 12 or 16 weeks dosing of Faricimab maintained anatomical and visual gains compared to monthly Ranibizumab at 52 weeks follow up due to simultaneous neutralization of angiopoietin-2 and VEGF A capabilities of Faricimab

Source: Khanani AM, Patel SS, Ferrone PJ, et al. Efficacy of Every Four Monthly and Quarterly Dosing of Faricimab vs Ranibizumab in Neovascular Age-Related Macular Degeneration: The STAIRWAY Phase 2 Randomized Clinical Trial. JAMA Ophthalmol. Published online July 30, 2020. doi:10.1001/jamaophthalmol.2020.2699

Is Faricimab superior to Ranibizumab in terms of visual acuity and anatomical improvements in patients with neovascular ARMD?

A randomized multicenter double-masked phase two study compared the multiple-dose regimen comparing monthly receive Ranibizumab, 0.5 mg every four weeks; faricimab, 1.5 mg every four weeks; faricimab, 6.0 mg every four weeks; faricimab, 6.0 mg every four weeks until week 12, then faricimab, 6.0 mg every eight weeks; and Ranibizumab, 0.5 mg every four weeks until week 8, then faricimab, 6.0 mg every four weeks. In a total of 263 patients for 36 weeks, follow up.

The primary outcome was not met in 36 weeks follow up, and faricimab was not superior in visual acuity gain nor anatomical improvement compared to monthly Ranibizumab

Source: Sahni J, Dugel PU, Patel SS, et al. Safety and Efficacy of Different Doses and Regimens of Faricimab vs Ranibizumab in Neovascular Age-Related Macular Degeneration: The AVENUE Phase 2 Randomized Clinical Trial. JAMA Ophthalmol. Published online July 30, 2020. doi:10.1001/jamaophthalmol.2020.2685


Does post pars plana vitrectomy face-down positioning improve large macular hole anatomical outcome?

A randomized multicenter cross the UK study compared a face-down positioning and face-forward positioning with a large macular hole ( 400μm and more) for less than one year with the follow-up for three months for 185 participants.

The primary outcome found that face-down positioning is not superior to face-forward positioning in closing large macular hole; however, there is a possibility of better visual outcome with face-down positioning.

Source: Pasu S, Bell L, Zenasni Z, et al. Facedown Positioning Following Surgery for Large Full-Thickness Macular Hole: A Multicenter Randomized Clinical Trial. JAMA Ophthalmol. 2020;138(7):725–730. doi:10.1001/jamaophthalmol.2020.0987

Is IOP a risk factor for developing RRD in myopic patients?

An observational study and two-sample Mendelian randomization used to assess the association between IOP and myopia with retinal detachment.

They concluded the genetic support of both myopia and IOP are associated with increased risk of retinal detachment, which opens the door for more investigation of the role of myopia prevention using atropine to prevent retinal detachment.

Source

Han X, Ong J, An J, et al. Association of Myopia and Intraocular Pressure With Retinal Detachment in European Descent Participants of the UK Biobank Cohort: A Mendelian Randomization Study. JAMA Ophthalmol. 2020;138(6):671–678. doi:10.1001/jamaophthalmol.2020.1231

Patients treated with Anti-VEGF for neovascular ARMD are progressed to geographic and non-geographic atrophy

A post hoc analysis published by the AREDS studied the incidence of progression to non-geographic and geographic atrophy in cases of neovascular age-related macular degeneration treated with intravitreal Anti-VEGF.

AREDS concluded in this post hoc analysis that fifty percent of patients would develop non-geographic atrophy within two years, and fifty percent would develop geographic atrophy within three additional years.

Source

Daniel E, Maguire MG, Grunwald JE, et al. Incidence and Progression of Nongeographic Atrophy in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Clinical Trial. JAMA Ophthalmol.2020;138(5):510–518. doi:10.1001/jamaophthalmol.2020.0437

Saftey update of Brolucizumab after reporting cases of vasculitis and occlusion.

Postmarketing surveillance of Brolucizumab reported a visual loss after injection due to vasculitis and retinal vascular occlusion.

Novartis has updated safety labels for Brolucizumab use to include supplementary information about vasculitis and vascular occlusion.

AREDS repot # 41

A cohort study by AREDS (report #41) concluded that a two-year progression of ARMD score was accompanied by increased progress to advanced ARMD and loss of visual acuity of two or three lines.

The results of this study may be beneficial for clinical trials attempting to treat non-neovascular ARMD.

Vitale S, Agrón E, Clemons TE, et al. Association of 2-Year Progression Along the AREDS AMD Scale and Development of Late Age-Related Macular Degeneration or Loss of Visual Acuity: AREDS Report 41. JAMA Ophthalmol. 2020;138(6):610–617. doi:10.1001/jamaophthalmol.2020.0824

Ischemic changes in retinal periphery may be a prognostic factor for diabetic retinopathy progression

Post hoc analysis ( co-author Ahmed Roshdy) shows that ultra wide-field (UWF) imaging to assess the severity of diabetic retinopathy outside the standard seven fields ETDRS photographs. Increased eccentric microaneurysms and intraretinal hemorrhage along with cotton wool spots may indicate escalating ischemia and may prognostic factors of diabetic retinopathy progression.

The post hoc analysis didn't find a correlation of diabetic retinopathy progression, and peripheral IRMA may be due to poor identification of IRMA in UWF, nor the post hoc analysis studied the peripheral venous beading correlation to the progress of diabetic retinopathy.

Sadda SR, Nittala Mphil MG, Taweebanjongsin W, et al. Quantitative assessment of the severity of diabetic retinopathy [published online ahead of print, 2020 May 21]. Am J Ophthalmol. 2020; S0002-9394(20)30251-8. DOI:10.1016/j.ajo.2020.05.021