Week in review: Inhaled steroids raise IOP, antioxidants appear safe in AMD patients, brolucizumab approved for DME

A weekly roundup of ophthalmic news from around the web.

A side effect of steroids for asthma? Increased IOP. A systematic literature review and meta-analysis assessed data from 41 studies of ocular outcomes in patients treated with inhaled and/or intranasal corticosteroids. The use of corticosteroids did not increase the risk of developing either glaucoma or ocular hypertension. When comparing steroid users to controls, however, those given steroids had significantly higher IOP (+0.69 mm Hg vs controls). Given that inhaled and intranasal steroids are used extensively to treat asthma and other respiratory conditions, the authors conclude that “awareness of the potential risk of glaucoma may be an important consideration for patient-informed consent and recommendations for patient management.” Clinical Ophthalmology

Lutein/zeaxanthin supplements for slowing AMD progression are safer than beta-carotene. In the original iteration of the Age-Related Eye Disease Study (AREDS), beta-carotene was included in the dietary supplement formulation. As published data now indicate that beta-carotene supplements can increase the risk of lung cancer, the formulation used in the second AREDS trial (AREDS2) substituted the antioxidants lutein and zeaxanthin for beta-carotene. This switch led to rates of progression to late AMD similar to those seen in AREDS, but fewer patients developed lung cancer. "Because beta-carotene increased the risk of lung cancer for current smokers in 2 NIH-supported studies, our goal with AREDS2 was to create an equally effective supplement formula that could be used by anyone, whether or not they smoke," said Emily Chew, MD, director of the Division of Epidemiology and Clinical Application at the National Eye Institute (NEI), and lead author of the study report. “This 10-year data confirms that not only is the new formula safer, it's actually better at slowing AMD progression." JAMA Ophthalmology, National Institutes of Health

Brolucizumab approved for diabetic macular edema. On June 1, the US FDA approved brolucizumab-dbll (Beovu) for the treatment of diabetic macular edema (DME). This new indication is based on positive data from the phase 3, randomized, double-masked KITE and KESTREL clinical trials, comparing the efficacy and safety of brolucizumab 6 mg vs. aflibercept 2 mg over 2 years. Brolucizumab was first approved in 2019 for the treatment of wet AMD and received a DME indication in Europe in April 2022. Ophthalmology Times