The edition · Ophthalmology
Low 24-hour blood pressure tracked faster nerve fibre loss in glaucoma
A 24-hour blood pressure study puts the physician's antihypertensive plan into the glaucoma clinic, retreatment after lost follow-up in diabetic macular oedema rarely restored good vision, a South Indian screening study finds a gap between two communities, and a genetic signal on CETP inhibitors and AMD.
The edition in brief
In 79 eyes with primary open-angle glaucoma followed with OCT for about 3.5 years, every 10 mmHg lower minimum 24-hour mean arterial pressure was associated with 0.54 µm a year faster nerve fibre layer loss, after adjustment for IOP and other factors. Eyes in the lowest quartile of 24-hour MAP lost 0.68 µm a year more than the highest. Among 976 patients with diabetic macular oedema who returned after six months or more lost to follow-up, those whose vision had held steady gained vision on retreatment far less often than those whose vision had fallen (32.7% vs 62.0%), and those returning at 20/50 or better did not gain. In 295 adults with type 2 diabetes in Gudalur, Tamil Nadu, retinopathy was more common in Malayalam than Tamil speakers (49.7% vs 30.6%; adjusted OR 1.88). Genetic analyses in UK and Singapore cohorts linked proxied CETP inhibition with higher AMD risk. The FDA database lists an action on 22 October on the aflibercept biosimilar PAVBLU.
Retreating DMO after lost follow-up rarely improved vision that had held steady
For a DMO patient returning with stable vision of 20/50 or better, expect little visual gain from restarting anti-VEGF and decide case by case.
Diabetic retinopathy was more common in Malayalam than Tamil speakers in one Nilgiris taluk
Screen all adults with diabetes in outreach camps with dilated examination; community-level differences in retinopathy risk can be large.
Genetic proxies for CETP inhibition were linked to higher AMD risk
Note a possible retinal safety signal for CETP inhibition, to be tested in trials; it does not change any current prescribing.
FDA database lists an action on PAVBLU, an aflibercept biosimilar
An FDA action on the aflibercept biosimilar PAVBLU is listed; check the label for what changed before acting on it.
Every adult with diabetes needs a dilated retinal check
Do not let good vision delay retinal screening in a person with diabetes.
In glaucoma that is progressing, ask how low the blood pressure goes
When glaucoma progresses despite controlled IOP, consider low systemic blood pressure and raise it with the treating physician.
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