Are intravitreal injections essential during the COVID-19 pandemic? Global preferred practice patterns and practical recommendations.

Tertiary outpatient ophthalmology clinics are high-risk environments for COVID-19 transmission, especially retina clinics, where regular follow-up is needed for elderly patients with multiple comorbidities. Intravitreal injection therapy (IVT) for chronic macular diseases, is one of the most common procedures performed, associated with a significant burden of care because of the vigorous treatment regimen associated with multiple investigations. While minimizing the risk of COVID-19 infection transmission is a priority, this must be balanced against the continued provision of sight-saving ophthalmic care to patients at risk of permanent vision loss. This review aims to give evidence-based guidelines on managing IVT during the COVID-19 pandemic in common macular diseases such as age-related macular degeneration, diabetic macula edema and retinal vascular disease and to report on how the COVID-19 pandemic has affected IVT practices worldwide.To illustrate some real-world examples, 18 participants in the International Retina Collaborative, from 15 countries and across four continents, were surveyed regarding pre- and during- COVID-19 pandemic IVT practices in tertiary ophthalmic centers. The majority of centers reported a reduction in the number of appointments to reduce the risk of the spread of COVID-19 with varying changes to their IVT regimen to treat various macula diseases. Due to the constantly evolving nature of the COVID-19 pandemic, and the uncertainty about the normal resumption of health services, we suggest that new solutions for eye healthcare provision, like telemedicine, may be adopted in the future when we consider new long-term adaptations required to cope with the COVID-19 pandemic.

Editorial - Suboptimal response to intravitreal anti-VEGF treatment for patients with diabetic macular edema: is there any point in switching treatment?

To investigate if there is any point in switching treatment in patients with diabetic macular edema (DME) showing suboptimal response to anti-vascular endothelial growth factor (anti-VEGF) treatment. The standard of care for DME is anti-VEGF agents. Although anti-VEGF agents seem to be effective for the treatment of DME, there is a proportion of patients, showing a suboptimal response to anti-VEGF treatment. In such patients, switching treatment to another anti-VEGF agent or to intravitreal dexamethasone implant may provide favorable anatomical and functional results. However, without a control group, it is impossible to compare the effect of switching treatment with the effect of continuing the original administered treatment. Switching treatment in patients with DME remains challenging. Further studies with a control group are needed to reach a safe conclusion.

The effect of fish consumption on macula structure and function of healthy individuals: an OCT and mfERG study.

OBJECTIVE: The study was designed to investigate the potential effect of fish consumption on macular structure and function of healthy individuals. PATIENTS AND METHODS: The participants were Greek, who used to consume less than one portion of fish per week since their childhood. All participants underwent body mass index (BMI) measurements and ophthalmological examination. At their first examination, they were asked to consume at least 2 portions of fish per week over a period of 8 weeks, after which all the measurements were repeated. RESULTS: Eighteen healthy individuals (36 eyes) participated in this study. The central macular thickness was reduced, while the amplitudes in the foveal and parafoveal area were increased after the fish consumption. However, all measurements remained within the normal range at both visits. CONCLUSIONS: Regular fish consumption could enhance the structural and functional status of the macula.

Identification of time point to best define 'sub-optimal response' following intravitreal ranibizumab therapy for diabetic macular edema based on real-life data.

PurposeTo determine the average time-point at which it is best to define 'sub-optimal response' after ranibizumab treatment for diabetic macular edema (DME) based on the data obtained from real-life clinical practice.MethodsIn this retrospective observational study, 322 consecutive treatment naïve eyes with DME were treated with three loading doses of intravitreal ranibizumab followed by re-treatment based on decision of the treating physician on a case-by-case basis. The demographic data, clinic-based visual acuity measurements and central subfield thickness (CST) assessed on spectral domain optical coherence tomography (OCT) were evaluated at baseline (month 0), 1, 2, 3, 6, and 12 months.ResultsOn an average, the improvement in visual acuity and CST was first seen after the loading dose. However, the maximal response in terms of proportion of patients with improvement in visual acuity and/ or CST in this cohort was observed at 12 months. Patients who presented with low visual acuity at baseline (<37 ETDRS letters) were unlikely to attain driving vision with ranibizumab therapy.ConclusionsOn an average, a 'sub-optimal response' after ranibizumab therapy is best defined at month 12 as patients may continue to improve with treatment.

Risk factors for intraoperative floppy iris syndrome: a prospective study.

PurposeTo evaluate risk factors for intraoperative floppy iris syndrome (IFIS) in patients undergoing phacoemulsification.MethodsParticipants in the study were 1274 consecutive patients, who underwent routine phacoemulsification cataract surgery. The following data were recorded and evaluated as possible risk factors: ophthalmological conditions, axial length of the eye, sociodemographic features, clinical data (hypertension and diabetes mellitus), medications being taken at the time of surgery, and duration of their intake. Cases were characterized intraoperatively as IFIS and non-IFIS. Univariate and multivariate logistic regression analysis were performed.ResultsIFIS was observed in 63/1274 eyes (4.9%, 95% CI: 3.9-6.7%). Current use of tamsulosin, alfuzosin, terazosin, benzodiazepines, quetiapine, and finasteride, as well as hypertension, were all independently associated with IFIS. Significant associations were noted for male sex, rivastigmine, and short axial length, which did not reach significance at the multivariate analysis. Duration of α-blockers intake was not found to be associated with IFIS.ConclusionApart from the well-established associations with α-blockers, this prospective study points to benzodiazepines, quetiapine, finasteride, and hypertension as potential risk factors for IFIS. Short axial length and rivastigmine were significantly associated with IFIS only at the univariate analysis.

Visual problems in young adults due to computer use.

BACKGROUND: Computer use can cause visual problems. The purpose of our study was to evaluate visual problems due to computer use in young adults. PATIENTS AND METHODS: Participants in our study were 87 adults, 48 male and 39 female, mean aged 31.3 years old (SD 7.6). All the participants completed a questionnaire regarding visual problems detected after computer use. RESULTS: The mean daily use of computers was 3.2 hours (SD 2.7). 65.5 % of the participants complained for dry eye, mainly after more than 2.5 hours of computer use. 32 persons (36.8 %) had a foreign body sensation in their eyes, while 15 participants (17.2 %) complained for blurred vision which caused difficulties in driving, after 3.25 hours of continuous computer use. 10.3 % of the participants sought medical advice for their problem. There was a statistically significant correlation between the frequency of visual problems and the duration of computer use (p = 0.021). 79.3 % of the participants use artificial tears during or after long use of computers, so as not to feel any ocular discomfort. CONCLUSIONS: The main symptom after computer use in young adults was dry eye. All visual problems associated with the duration of computer use. Artificial tears play an important role in the treatment of ocular discomfort after computer use.

Frequency of fundus pathology related to patients' dissatisfaction after phacoemulsification cataract surgery.

PURPOSE: The benefit of cataract surgery in the general population concerning visual acuity and subjective visual function has been well established. However, a small proportion of patients are dissatisfied after cataract surgery. Our study aims to evaluate patients' dissatisfaction after phacoemulsification cataract surgery related to low visual function and to analyze the factors associated with this outcome. METHODS: 397 patients, who underwent uneventful phacoemulsification cataract surgery, participated in the study. All the participants completed a self-administered questionnaire which evaluated their visual function pre- and post-operatively. Best Corrected Visual Acuity (BCVA) was measured before and after cataract surgery and patients' contentment if they were satisfied or not with the result of the surgery was also recorded. RESULTS: Macular disease, diabetic retinopathy and glaucoma were the main factors limiting the final visual result after phacoemulsification cataract surgery. CONCLUSIONS: It is very important for the patients to be preoperatively fully aware of the presentation of the aforementioned fundus pathology and to be warned about the predicted visual outcome after cataract surgery.