CLINICAL CORNER – JULY 2010

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ANTIDEPRESSANTS LINKED TO CATARACTS. Center for Clinical Epidemiology and Evaluation at the Vancouver Coastal Health Research Institute quantified the risk of cataracts with the use of selective serotonin reuptake inhibitors (SSRIs). A possible association was found between SSRIs, especially fluvoxamine and venlafaxine, and a future diagnosis of cataracts. The average time of cataract diagnosis while on SSRI therapy was 656 days. The possibility this observation may be the result of smoking, which could not be controlled in the study, cannot be excluded.

BEVACIZUMAB FOR NEOVASCULAR AMD. The efficacy and safety of intravitreous bevacizumab injections for the treatment of 126 patients with wet age-related macular degeneration was evaluated in the ABC Trial. It was concluded that bevacizumab 1.25mg intavitreous injections given as part of a six-weekly variable retreatment regimen is superior to standard care (pegaptanib sodium, verteporfin, sham) with low rates of serious ocular adverse events. Bevacizumab treatment also improved visual acuity on average at 54 weeks over standard care.

OPTICAL QUALITY AND EYEDROPS IN DRY EYE SYNDROME. University of Valencia’s Optometry Research Group studied the effect of blink® intensive tears on the optical quality of the air-tear film interface at the anterior cornea in cases of dry eye. Wavefront higher-order aberrations decreased significantly after artificial tear use with both pupil diameters. Eye drops increased the tear breakup time values significantly (by approximately 60%). The study established that after eye drops were given, the increasingly regular tear film decreased higher-order aberrations, improving optical quality.

ANCESTRY DIFFERENCES IN VISUAL FUNCTION. Visual function was assessed in the healthy eyes of 393 African-descent participants and 367 European-descent participants selected from the African Descent and Glaucoma Evaluation Study and the Diagnostic Innovations in Glaucoma Study. The African-descent participants had worse mean deviation and pattern standard deviation and more points triggered as abnormal on the total and pattern deviation plots compared with European participants on all tests. It was concluded that people of African descent have significantly worse performance than people of European descent on all tests of visual function. Researchers recommended additional research using longitudinal data to determine the cause of these small but significant ancestry differences in visual function.

CORRECTING MODERATE-TO-HIGH MYOPIA. London’s Moorfields Eye Hospital conducted a systematic review that compared the effect of excimer laser refractive surgery versus phakic intraocular lenses (IOLs) for the correction of moderate-to-high myopia. According to researchers’ results, phakic IOLs are safer than excimer laser surgical correction for moderate-to-high myopia in the range of -6.00D to -20.00D. Results also showed that phakic IOLs are preferred by patients. While phakic IOLs might be accepted clinical practice for higher levels of myopia (greater than or equal to 7.00D of myopic spherical equivalent with or without astigmatism), researchers advised that it may be worth considering phakic IOL treatment over excimer laser correction for more moderate levels of myopia (less than or equal to 7.00D of myopic spherical equivalent with or without astigmatism).

AMD RISK FACTORS. With 2,810 people aged 21 to 84 participating in the Beaver Dam Offspring Study, researchers sought to determine the prevalence of age-related macular degeneration (AMD) and to examine the risk factors for early AMD. It was found that early AMD is infrequent before age 55 but increases with age thereafter. Early AMD was related to modifiable risk factors like higher serum high-density lipoprotein cholesterol level, smoking, and hearing impairment. There were no early AMD associations with blood pressure level, body mass index, physical activity level, history of heavy drinking, white blood cell count, hematocrit level, platelet count, serum total cholesterol level, or carotid intimal-medial thickness.

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