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All ophthalmology briefings

The edition · Ophthalmology

Nine years after ranibizumab or laser for ROP, vision and refraction were similar

A small randomised cohort followed to school age found no difference in acuity or refraction, with some structural differences of uncertain meaning. Plus the yield of 30-2 fields in neuro-ophthalmic referrals, a generic acetazolamide supplement, erectile dysfunction treatment and glaucoma, and an eye drop for dim-light vision.

The edition in brief

In a single-centre trial that randomised 50 infants with zone II ROP to ranibizumab or laser in 2014, 29 children were examined at nine years. Mean spherical equivalent (−1.90 vs −1.22 D) and visual acuity (0.21 vs 0.15 logMAR) did not differ significantly; ranibizumab-treated eyes had thinner lenses, steeper corneas and thinner central retinas. Loss to follow-up was large and uneven. In a central Indian tertiary centre, reliable 30-2 visual fields were abnormal in 58% of neurological referrals, and confirmed neurological disease in 52%, against 2% of other referrals. The FDA lists a supplement to a generic acetazolamide application, an administrative action. In UK primary care data on 218,056 men with glaucoma and 876,872 controls, prescribed erectile dysfunction medication was associated with slightly higher glaucoma risk (OR 1.17 to 1.29). In the phase 3 LYNX-1 trial, phentolamine 0.75% drops improved mesopic low-contrast acuity in 21% versus 3% on placebo at day 15.

In this edition
01
Clinical update

30-2 visual fields confirmed neurological disease in half of neuro referrals

Use a reliable 30-2 field in unexplained visual loss, and image the brain when the defect respects the vertical meridian.

1 min · Indian journal of ophthalmologyRead →
Primary outcome
Diagnostic yield for neurological disease
Effect
Confirmed neurological disease 52.2% vs 1.9%; abnormal fields 58.4% vs 26.8%, OR 3.84 (2.48–5.95)
02Regulatory

FDA: supplement to a generic acetazolamide application

Treat this as an administrative update; prescribing acetazolamide does not change.

1 minRead →
03Research

Erectile dysfunction treatment was linked to slightly higher glaucoma risk

Consider erectile dysfunction as a vascular risk marker; it is not a reason to change its treatment.

1 min · The British journal of ophthalmologyRead →
04Research

Phentolamine drops improved dim-light vision in a phase 3 trial

Note pupil-narrowing drops as an emerging option for dim-light symptoms, pending longer data and local availability.

1 min · American journal of ophthalmologyRead →
05Pearl

Acetazolamide: check potassium, kidneys and sulfonamide allergy

Check allergy, kidneys and potassium when using acetazolamide, and plan for it to be short term.

1 minRead →
06
Practice changer

Ranibizumab and laser for ROP gave similar vision at nine years

Choose ROP treatment on zone, access and follow-up needs; in this small cohort, vision at nine years did not differ.

2 min · European journal of pediatricsRead →
Primary outcome
Refraction, visual acuity, biometry, OCT and electroretinography at 9 years
Effect
Spherical equivalent −1.90 vs −1.22 D, difference 0.68 D (−2.26 to 3.62); acuity 0.21 vs 0.15 logMAR

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