Prevalence of Myopia in Europe
As educational levels rise in Europe, is the prevalence of myopia rising as well? Williams et al. investigated this question and found that myopia is indeed becoming more common among Europeans. However, higher education seems to be one of several factors contributing to the condition, rather than the sole cause.
For this meta-analysis, the researchers evaluated 15 population-based cross-sectional studies from the European Eye Epidemiology Consortium. The studies were conducted between 1990 and 2013, and data were available for 61,946 participants aged 44 to 78.
The results indicate that myopia is becoming more common across Western and Northern Europe, with a clear trend toward higher prevalence in younger participants. Education had a strong effect: Myopia was twice as common in those who had achieved higher educational levels than in those who left school before they turned 16. However, increasing levels of myopia were not explained by education alone, and other factors—such as increased computer time and longer school days with less time outside—may play a role, the authors noted.
Kinetics of Geographic Atrophy Progression in AMD
Lindner et al. described the directional kinetics of the spread of geographic atrophy (GA) in eyes with age-related macular degeneration (AMD) and foveal sparing. They found a faster centrifugal than centripetal GA spread.
This prospective, noninterventional natural history study involved 47 eyes (36 patients) with foveal sparing in GA. They were examined via fundus autofluorescence and near-infrared reflectance imaging. Areas of foveal sparing and GA were measured by 2 independent readers, and a linear mixed-effect model was used to model GA kinetics over time.
Data analysis revealed a 2.8-fold faster progression of atrophy toward the periphery than toward the fovea during follow-up (range, 5.9-74.6 months). Although the underlying mechanisms for this differential progression remain unclear, the findings may be of use to researchers who are studying strategies to prolong foveal survival in eyes with GA.
Phantom Eye Syndrome
In the largest study to date on the topic, Hope-Stone et al. investigated the prevalence and features of phantom eye syndrome (PES) after enucleation for uveal melanoma. They found that a significant number of patients experience PES and suggest that those who are slated for enucleation should be routinely informed about this possibility.
For this cross-sectional study, the researchers evaluated 179 patients with uveal melanoma. Enucleation had taken place 4 to 52 months before this study began. The patients answered a questionnaire that asked about 3 symptoms: pain, visual sensations, and a feeling of seeing through the removed eye. In addition, the participants’ mood was assessed using a standard anxiety and depression evaluation scale.
Of the 179 participants, 108 (60.3%) experienced symptoms, with 86 (48%) reporting visual sensations, 50 (28%) reporting a feeling of seeing, 42 (23%) reporting pain, and 14 (7.8%) reporting all 3 symptoms. The researchers also investigated potential triggers of PES; the most common were darkness and fatigue.
Because the symptoms can cause distress, PES should be discussed before surgery, the researchers said. They added that patients who reported postsurgical pain in this study were more likely to be anxious and depressed.
AMD, Intravitreal Injections, and IOP
Freund et al. assessed changes in IOP in patients who received intravitreal injections for wet age-related macular degeneration (AMD). They found that, through 96 weeks of treatment, aflibercept was less likely than ranibizumab to cause a rise in IOP.
This study analyzed data on 2,457 patients in the phase 3 VIEW 1 and 2 trials. Participants were randomized to 1 of 4 treatment regimens for 52 weeks; 3 of these groups received aflibercept in different dosing regimens, while the fourth group received 0.5 mg of ranibizumab every 4 weeks. From week 52 through week 96, treatment continued on a variable basis with at least quarterly dosing; interim injections were allowed based on anatomic and visual assessment.
Mean change in IOP from baseline was consistently lower for all 3 aflibercept regimens than for the ranibizumab regimen, the researchers found. Through week 96, 6.4% of those receiving ranibizumab experienced a rise in IOP of 10 mm Hg or more, compared with 2.9% to 3.8% of those receiving aflibercept. Moreover, through week 96, 20.2% of the patients treated with ranibizumab had an IOP of 21 mm Hg or greater, compared with 12.5% to 14.2% of those receiving aflibercept. Notably, a personal history of glaucoma at baseline did not correlate with these outcomes.
The researchers noted that the mechanism underlying these findings was unclear; hypotheses include possible differences in the size of protein aggregates the 2 drugs form in the vitreous, as well as the inflammatory propensity of their source molecules.
Ophthalmology summaries are written by Jean Shaw and edited by Susan M. MacDonald, MD.
More from this month’s Journal Highlights
American Journal of Ophthalmology
Roundup of Other Journals