Journal Highlights NEW FINDINGS FROM THE PEER-REVIEWED LITERATURE

Ophthalmology semi-quantitative food-frequency ques- Long-Term Outcomes of Boston Selected by George B. Bartley, MD tionnaire, from which the MDS (on a Keratoprosthesis Type II scale of 0-9) was determined. Multi- January 2017 Mediterranean Diet Score and variable logistic regression was used to AMD: The European Eye Study investigate the association between the Lee et al. conducted a retrospective re- January 2017 MDS score and AMD. Among other view of a consecutive clinical case series factors, the researchers also looked for to assess long-term visual outcomes Hogg et al. performed a population- possible links between the MDS and and complications after implantation based epidemiologic study to examine the Y204H risk allele in AMD. of the Boston Keratoprosthesis type II associations between adherence to a The researchers found that a higher (KPro II). It is considered a treatment Mediterranean diet and the MDS was associ- of last resort in patients with severe prevalence of age-related ated with reduced ocular surface disease. Although use of (AMD) odds of nvAMD the KPro II presents short- and longer- in 7 European countries. in both unadjust- term challenges, the researchers found They found that participants ed and confound- that it improved vision in a large pro- with the highest Mediterra- er-adjusted anal- portion of the study patients with oth- nean Diet Score (MDS) had ysis. Compared erwise intractable corneal conditions. the lowest levels of advanced with participants The study—the largest and longest neovascular AMD. with the lowest single-center case series—involved 48 Participants included MDS adherence eyes of 44 patients who underwent 5,060 individuals aged 65 (≤4 score), those KPro type II implantation by 2 sur- years or older (mean age, in the highest geons at Massachusetts Eye and Ear 73.2; 55% women) who were category of MDS between January 1992 and April 2015; randomly selected from (>6 score) showed mean follow-up was 70.2 months. study centers in Norway, lower odds of The most common indications were Estonia, United Kingdom, France, Italy, nvAMD (odds ratio, 0.53). No signifi- Stevens-Johnson syndrome (41.7%) Greece, and Spain. Full dietary data cant association was found with MDS and mucous membrane pemphigoid were available for 4,753. Participants for AMD grades 1-3. The researchers (41.7%). The main outcome measures underwent eye examination and digital noted a weak trend between MDS and were , postoperative com- retinal color photography. Images were large drusen, with those in the highest plications, and device retention. graded at a single center, according to category of MDS having 20% reduced Almost all patients (95.8%; 46 of 48 the International Classification System odds compared with those in the lowest eyes) had a preoperative visual acuity of for age-related , and were category. In this study, the association ≤20/200. At the last postoperative visit, stratified according to the Rotterdam with MDS was not modified by the visual acuity had improved to ≥20/200 staging system into 5 exclusive stages Y204H risk allele for any AMD stage. in 37.5% (18 eyes) and to ≥20/100 in (AMD 0-4) and a separate category In conclusion, this study adds to 33.3% (16 eyes). of large drusen (≥125 µm). AMD 4 the limited evidence of the protective The most common postoperative included neovascular AMD (nvAMD) effect of adherence to a Mediterranean was retroprosthetic mem- and . diet among those with late AMD, but brane formation, occurring in 60.4% Dietary intake during the previ- it does not support earlier reports of a of eyes. The device extruded or had to ous 12 months was assessed with a relationship with genetic susceptibility. be replaced in 50% of eyes. Of partic-

EYENET MAGAZINE • 25 ular concern, progressed in ing GA: older age, hypercholesterol- use and lower odds of bevacizumab 27.1% of eyes and was newly diag- emia, worse visual acuity, larger cho- use; however, this association did not nosed in 8.3%. Other complications roidal neovascularization area, retinal demonstrate cause and effect. were tarsorrhaphy revision (52.1%), angiomatous proliferation lesion, GA Participants in this study were U.S. (18.8%), infectious in the fellow eye, and intraretinal fluid. fee-for-service Medicare beneficiaries (6.3%), and choroidal In contrast, a thicker subretinal tissue and all ophthalmologists who sub- detachment or hemorrhage (8.3%). complex and the presence of subretinal mitted IVI claims for >10 Medicare The researchers concluded that de- fluid were associated with lower risk of beneficiaries between Aug. 1, 2013, and spite these challenges, the Boston KPro developing GA. Dec. 31, 2013. The Sunshine Act Open type II is a viable option to salvage The overall GA growth rate was 0.33 Payments database was searched for all vision in patients who have poor prog- mm/year (standard error, 0.02 mm/ industry financial relationships in oph- nosis with other corneal procedures. year). Eyes treated with ranibizumab in thalmology, and the Medicare Provider the first 2 years of the clinical trial had Utilization and Payment Database was Incidence and Growth of a higher growth rate than those treated searched for all IVI claims and anti- Geographic Atrophy During with bevacizumab (adjusted growth VEGF drug claims. The researchers 5 Years of CATT rate, 0.38 vs. 0.28 mm/year). GA in the used a novel algorithm to merge the January 2017 fellow eye, hemorrhage, and absence of 2 data sets and identify physician- sub-RPE fluid at baseline were associat- specific associations between industry Grunwald et al. estimated the incidence, ed with a higher growth rate. payments and use of anti-VEGF agents. size, and growth rate of geographic In conclusion, development of GA The researchers found that of 3,391 atrophy (GA) during 5 years of follow- is common 5 years after initiation of ophthalmologists who performed IVI, up among participants receiving anti- therapy. In considering risk factors, the 1,187 (35%) received nonresearch VEGF therapy in the Comparison of authors noted that the presence of sub- payments from anti-VEGF industry. Age-Related Macular Degeneration retinal fluid is associated with a lower Of these, 422 (35%) received payments Treatments Trials (CATT). The authors incidence of GA, and the presence of from Regeneron, 363 (31%) from found that development of GA was sub-RPE fluid is associated with slower Genentech, and 402 (34%) from both. common at 5 years, and they identified growth of GA. They stated that further When compared with ophthalmologists several associated risk factors. research is needed to assess whether who perform IVI but do not receive This was a cohort study within CATT. complete eradication of fluid under the anti-VEGF industry payments, those A total of 1,185 CATT participants were should or should not be a goal receiving Genentech payments (me- randomly assigned to ranibizumab or for anti-VEGF therapy. dian, $90; interquartile range [IQR], bevacizumab regimens. They were —Summaries by Marianne Doran $22-$149) were more likely to use released from protocol treatment at ranibizumab (odds ratio [OR], 2.14); 2 years and were examined at approx­ Retina those receiving Regeneron payments imately 5 years (n = 647). Two masked Selected by Andrew P. Schachat, MD (median, $55; IQR, $22-$131) were graders assessed the presence and size more likely to use ranibizumab (OR, of GA in digital color photographs (CPs) Association Between Industry 1.55) and aflibercept (OR, 1.23); those and fluorescein angiograms (FAs) taken Payments and Anti-VEGF Use in with payments from both manufactur- at baseline and at years 1, 2, and 5. Medicare Beneficiaries ers were more likely to use ranibizumab The main outcome measures were January 2017 (OR, 2.69) and aflibercept (OR, 1.53); presence of GA and its growth rate. and all were less likely to use bevaci- Annual change in the square root of Mahr et al. conducted a cross-sectional zumab (OR, 0.33 to 0.64). the total area of GA was the measure database study to test for associations The researchers concluded that of growth. Multivariate linear mixed between anti-VEGF industry payments anti-VEGF industry payments to models, including baseline demograph- to ophthalmologists who provide intra­ ophthalmologists who perform IVI ic, treatment, and ocular characteristics vitreal injections (IVI) and specific anti- are associated with a greater likelihood on CP/FA and optical coherence to- VEGF agent use. They found that such of use of higher-cost ranibizumab mography (OCT) were used to analyze payments were associated with higher and aflibercept; they noted, how­ever, candidate risk factors. odds of ranibiz­umab and aflibercept that the findings demonstrate only an Among the 1,011 participants who did not have GA at baseline and had follow-up images gradable for GA, the cumulative incidence was 12% Introducing Ophthalmology Retina at 1 year; 17% at 2 years; and 38% at 5 years. The authors found that the EyeNet now features summaries from the Academy’s Ophthalmology Retina, a following baseline characteristics were new peer-reviewed journal focused exclusively on retina-related eye diseases associated with higher risk of develop- and conditions. During 2017, Ophthalmology Retina will be issued bimonthly.

26 • JANUARY 2017 association. They suggested that their cidence of TIA/stroke within 3 months tions from baseline were less than 1.5 algorithm could be used in future stud- after onset was 6% (95% CI, 2%-17%) (mean) letters at all assessment points ies of physician payments and prod- for OIS, 3% (95% CI, 0.4%-19%) for of the extension study. IAI treatment uct utilization and may increase our AF, and 1% (95% CI, 0.3%-4.1%) for was well tolerated, and no new safety understanding of the role of payments CRAO. Report of MI before or after signals emerged. The most common on physician decision-making.­ onset of ocular condition was 52% in ocular adverse events were progressive AF, 22% in OIS, 22% in BRAO, 21% in diabetic (n = 7; 12%) and Ocular Arterial Occlusive CRAO, and 6% in NAION patients. worsening (n = 6; 10%). Thir- Disorders and Carotid Artery The authors concluded that the ty-seven patients (62%) met the criteria Disease incidence of carotid artery stenosis and for macular laser treatment, at a mean January 2017 plaques, cardiac embolic source, TIA/ of 19.5 weeks. There was no significant stroke, and MI differ among various difference in the frequency of IAIs Hayreh and Zimmerman carried out ocular arterial occlusive disorders. before and after laser treatment. a large cohort study to compare the Further, they noted that embolism and prevalence of carotid artery disease hemodynamic disturbances are inde- CMV in Pediatric (CAD) and its various manifestations pendently associated with these ocular Patients After Stem Cell in patients with specific types of ocular disorders. —Summaries by Peggy Denny Transplantation arterial occlusive disorders. They found January 2017 that the incidence of carotid artery American Journal of stenosis and plaques, cardiac embolic Ophthalmology As part of their regimen for allogeneic source, transient ischemic attack (TIA)/ Selected by Richard K. Parrish II, MD hematopoietic stem cell transplantation stroke, and myocardial ischemia (MI) (HSCT), patients must take immuno- differ among various ocular arterial As-Needed Aflibercept After suppressant drugs. Thus, they have a occlusive disorders. the Phase 3 VISTA DME Trial: high risk of reactivation of previously The study included 614 patients 12-Month Extension Study subclinical cytomegalovirus (CMV) (728 eyes) with an ocular arterial occlu- January 2017 infection, which may lead to CMV sive disorder: nonarteritic anterior isch- retinitis. Larochelle et al. conducted emic (NAION; 266 Wykoff et al. conducted a 12-month a cross-sectional study of pediatric eyes), central retinal artery occlusion extension study to determine whether patients who received allogeneic HSCT (CRAO; 203 eyes), branch retinal artery the results achieved with aflibercept at Children’s Hospital of Colorado and occlusion (BRAO; 127 eyes), ocular for diabetic (DME) identified a cluster of CMV retini- ischemic syndrome (OIS; 80 eyes), in the 3-year VISTA DME trial could tis among patients treated in 2014, and (AF; 52 eyes). All be maintained with individualized although no cases had been seen in the patients also had CAD. At first visit, as-needed (PRN) treatment. They previous 4 years. patients had a detailed ophthalmic and found that vision gains were main- The authors retrospectively exam- medical history, ophthalmic evaluation, tained throughout the extension period ined the records of 28 children who carotid artery evaluation (by Doppler/ and that aflibercept was well tolerated. underwent allogeneic HSCT in 2014 angiography) on the side of ocular arte- Sixty patients entered the ENDUR- and compared their rates of CMV rial occlusion, and echocardiography. ANCE extension study, in which they viremia and CMV retinitis with those The same ophthalmic evaluation was received PRN intravitreal aflibercept of 101 pediatric patients who had the performed at each follow-up visit. injections (IAIs) for clinically relevant same procedure between 2010 and The authors found that carotid DME. Patients were observed at inter­ 2013. Thirty-two patients (32%) in the artery stenosis on the involved side was vals of 4, 8, or 12 weeks, depending earlier group tested positive for CMV worse in AF and OIS compared with on their need for treatment. Outcome viremia, but no cases of CMV retinitis BRAO, CRAO, and NAION; whereas measures included the number of IAIs were identified. Of the 28 patients who the presence of carotid artery plaques given through month 12, the propor- received HSCT in 2014, 13 patients on the involved side was significantly tion of patients not requiring any IAI, (46%) had CMV viremia. Five cases higher in OIS, AF, and CRAO com- assessment of adverse events, and the of CMV retinitis were identified in pared with NAION. Echocardiography use of macular laser. this group, representing a significant revealed an embolic source in 61% The mean number of IAIs admin- increase from the previous 4 years. of CRAO and 53% of BRAO patients istered in the extension study was 4.5. Based on these findings and those of compared with only 3% of NAION Eighteen patients (30%) required no a multidisciplinary team that reviewed patients. TIA/stroke occurred before or IAI. Among patients who met the current literature, the authors developed after onset of the ocular condition in criteria for IAI retreatment, the mean a more aggressive ophthalmic screen- 17% of OIS, 11% of AF, 7% of CRAO, number of IAIs was 6.0. The best-cor- ing protocol aimed at earlier detection 6% of NAION, and 3% of BRAO pa- rected visual acuity achieved during of retinitis—while still asymptomat- tients. Kaplan-Meier estimate of the in- VISTA DME remained stable; fluctua- ic—among pediatric HSCT recipients.

EYENET MAGAZINE • 27 As part of this protocol, patients who Only 39 (22%) of the 176 partici- microscope to assess re-epithelializa- become viremic or have CMV organ pants in the binocular group with log tion and dimensions of the infiltrate disease receive dilated eye exams start- file data available performed more and scar. Levels of liver enzymes also ing within 2 weeks of viremia onset than 75% of their assigned treatment were determined. Intention-to-treat and continuing every 6-8 weeks until (median, 46%). Many lost interest in statistical analysis was used. viremia is no longer detected. the game after several days or weeks. Supplementing topical antifungal The authors concluded that the Among younger participants (from age treatment with oral voriconazole did burden of more-frequent exams is 5 to 7 years) with no previous ambly- not reduce the likelihood of corneal balanced by the benefits of earlier opia treatment, visual acuity of the perforation (voriconazole vs. placebo, identification of CMV retinitis in this amblyopic eye improved by a mean of 35 vs. 30 perforations) or the need vulnerable patient population. Further, 2.5 lines in the binocular group and 2.8 for PK (49 vs. 56 PKs). These findings application of the protocol will help re- lines in the patching group. remained robust on sensitivity analyses. searchers determine whether the cluster Although the primary noninferi- After correcting for baseline param- was an anomaly or represents an actual ority analysis was indeterminate, a eters, no between-group differences increase in incidence of CMV. post hoc analysis indicated that the were noted in visual acuity, infiltrate or —Summaries by Lynda Seminara improvement in visual acuity attained scar size, or rate of re-epithelialization. with this particular binocular game However, the patients who received oral JAMA Ophthalmology was not as good as that achieved by voriconazole were significantly more Selected by Neil M. Bressler, MD patching. In conclusion, the low rate likely to experience adverse events (58 of adherence to binocular treatment vs. 28 events in placebo group), which Binocular iPad Game vs. suggests that greater emphasis be given included visual hallucinations and Part-Time Patching for to adherence and to developing binoc- elevated levels of aspartate aminotrans- in Children ular apps that are more appealing to ferase and alanine aminotransferase. December 2016 children, such as movies and first- When patients were subgrouped by person action games. infecting fungal genera, no significant There is a need for more effective, child- difference in culture positivity was ob- friendly options to treat amblyopia. Oral Voriconazole for Fungal served between oral voriconazole and Traditional therapies are disliked by in the MUTT II Trial placebo in any subgroup. patients and are associated with inade- December 2016 The authors concluded that oral quate adherence. Holmes et al. com- voriconazole, when prescribed to pared visual acuity results for children Topical antifungals often are sup- patients with as an ad- treated with either part-time patching plemented with oral medication for juvant to topical antifungal treatment, or a binocular iPad game and found treatment of fungal keratitis, despite confers no additional benefit but poses that binocular treatment was less effec- insufficient supporting evidence. significant risks. tive than patching. Prajna et al. conducted a randomized This multicenter randomized non- controlled trial to determine whether OCT Findings in Retinal Lesions inferiority trial included 385 children the combination of topical antifungal of Infants With Zika Syndrome (aged 5-12 years) whose amblyopia re- eyedrops and oral voriconazole is more December 2016 sulted from , anisometropia, effective than topical antifungals alone. or both. Patients in the binocular group They found that oral voriconazole con- Maternal intrauterine infection with (n = 190) were instructed to play the ferred no added benefit and increased Zika virus (ZIKV) can cause severe iPad game for 1 hour a day; those in the the likelihood of adverse events. ocular abnormalities in offspring. patching group (n = 195) were to wear This multicenter double-masked Ventura et al. performed a prospective a patch over their unaffected eye for 2 placebo-controlled randomized trial cross-sectional study of 8 consecutive hours daily. Follow-up visits occurred included 240 patients from India and infants with congenital Zika syndrome at 4-week intervals through week 16. Nepal with severe filamentous fungal (CZS) who were evaluated with optical By 16 weeks, the mean visual acuity keratitis and visual acuity of 20/400 or coherence tomography (OCT). In of the amblyopic eye had improved worse. All patients were treated with addition to CZS manifestations that are 1.05 lines (2-sided 95% CI, 0.85-1.24 voriconazole (1%) and natamycin typical of intrauterine ZIKV infection lines) in the binocular group and 1.35 (5%) eyedrops and were randomized to (e.g., microcephaly, hearing loss, limb lines in the patching group (2-sided receive oral voriconazole (119 patients) malformations, and ocular anomalies), 95% CI, 1.17-1.54 lines), with an or placebo (121 patients). The main the authors found that CZS involves adjusted treatment group difference of outcomes evaluated were rate of corne- discontinuity of the ellipsoid zone, 0.31 lines favoring patching (upper lim- al perforation and need for therapeutic with retinal and choroidal thinning and it of 1-sided 95% CI, 0.53 lines). This penetrating keratoplasty (PK) during hyperreflectivity beneath the retinal upper limit exceeded the prespecified 3 months of follow-up. Corneal lesions pigment epithelium (RPE). noninferiority limit of 0.5 lines. were examined with a slit-lamp bio­ The 8 patients (5 females, 3 males;

28 • JANUARY 2017 mean age, 4.1 months) were born in with -correcting intraocular between serum thyroid-stimulating Pernambuco, Brazil, and received lenses (PC-IOLs). They found that the hormone (TSH) and free thyroxine serologic testing to rule out other major causes of dissatisfaction were (FT4) measurements, as well as thyroid congenital infections. All patients had and dry eye. dysfunction (hyperthyroidism and retinal lesions (determined by indirect The study was a retrospective review hypothyroidism) and the incidence ophthalmoscopy), and fundus exam- of clinical records of patients seen at of AMD. They found an independent inations were performed at the initial Bascom Palmer Eye Institute between association between overt hyperthy- visit. Cerebrospinal fluid samples were January 2009 and December 2013, whose roidism and the incidence of AMD; obtained from 7 of the 8 patients to primary complaint was dissatisfaction thyroxine usage was also associated determine whether ZIKV-specific IgM with visual performance after PC-IOL with AMD. was present; all 7 had positive results. implantation (74 eyes of 49 patients). Categories of thyroid dysfunction Seven patients were imaged by Fouri- A single treating physician determined were defined according to a serum TSH er-domain OCT, and 1 patient under- the probable cause of dissatisfaction screen followed by serum FT4 assess- went spectral-domain OCT. Because of and the intervention to address it. ment, and were available for 906 par- the challenges associated with perform- The most common cause of dissat- ticipants aged 55 years or older (the age ing OCT in infants, some images could isfaction was blurred or foggy vision group at risk for AMD). These param- not be acquired. for both distance and near (68%). eters were not recorded at the original On fundus examination, macular The authors attributed most of these BMES baseline. Thus, the time frame findings were chorioretinal scarring complaints to residual refractive error for this study spanned BMES-2, 1997- (10 of 16 eyes) and pigment mot- (57%) or dry eye (35%). The most 1999, to BMES-3, 2007-2009. AMD tling (7 eyes). Retinal abnormalities common interventions were manage- was assessed from retinal photographs. were observed in 11 of 16 eyes (69%). ment of residual refractive error with The researchers also studied covariates, Of these 11 eyes, 9 were successfully glasses or contact lenses (46%) and including history of smoking, frequen- scanned with OCT (1 unaffected eye treatment for dry eye (24%). Corneal cy of consuming fish, and the presence was scanned). OCT of all 9 eyes (100%) laser vision correction was performed of an AMD susceptibility gene. indicated discontinuity of the ellipsoid in 8% of eyes, and 7% of eyes required After adjusting for covariates, the zone and hyperreflectivity underlying an IOL exchange. After the interven- researchers found that participants the RPE. In addition, 8 eyes (89%) tions, 45% of patients had complete with overt hyperthyroidism (low TSH exhibited retinal thinning, 7 eyes (78%) resolution of symptoms; 23% were and high FT4 levels) had a 3-fold had choroidal thinning, and 4 eyes partially satisfied with the results; and increased risk of developing incident (44%) showed colobomatous-like exca- 32% remained completely dissatisfied. AMD compared with participants with vations of the retina, RPE, and . The authors noted that most pa- normal thyroid function (odds ratio Less common OCT findings included tients who undergo PC-IOL implanta- [OR], 3.51). Thyroxine usage was also hyperreflective dots on the inner retinal tion are satisfied with the results. They positively associated with the incidence layers (1 eye) and possible cleft (3 eyes). concluded that the best ways to avoid of AMD; those who reported current To the authors’ knowledge, this patient dissatisfaction are 1) education use of thyroxine had increased risk of study is the first to employ OCT in the on the risks and benefits so that patients incident AMD compared with nonusers evaluation of retinal abnormalities in will have reasonable expectations about (OR, 1.68). Similarly, participants who infants with presumed intrauterine outcomes, 2) aggressive identification had ever taken thyroxine medication ZIKV infection. They concluded that and treatment of ocular surface disease, had a higher risk of AMD (OR, 1.91) CZS is associated with severe damage to 3) selection of an appropriate refractive than those who had never taken the the choroid and to internal and exter- target, and 4) avoidance of patients drug. However, baseline serum TSH nal layers of the neurosensory retina. with significant preexisting pathology. or FT4 levels per se did not show an —Summaries by Lynda Seminara association with 5- or 10-year incidence Thyroid Dysfunction and 10-Year of AMD. OTHER JOURNALS Incidence of AMD The researchers concluded that im- Selected by Deepak P. Edward, MD Investigative Ophthalmology & Visual proved knowledge of risk factors could Science help to develop comprehensive screen- Causes and Correction of Dis- 2016;57(13):5273-5277 ing strategies for AMD. They suggested satisfaction With Presbyopia- that consideration of thyroid disease Correcting IOLs Epidemiological evidence on the might contribute to a better profiling of Clinical Ophthalmology possible relationship between thyroid AMD in clinical practice. 2016;10:1965-1970 dysfunction and age-related macular —Summaries by Marianne Doran degeneration (AMD) is unclear. Thus, Gibbons et al. assessed the causes and Gopinath et al. analyzed data from the MORE ONLINE. See this article potential solutions for patients who Blue Mountains Eye Study (BMES) at aao.org/eyenet for additional were dissatisfied after implantation to assess the prospective associations summaries.

EYENET MAGAZINE • 29 payments were exclusively for either ment optical coherence tomography American Journal of ranibizumab or aflibercept. Com- with customized software to measure Ophthalmology pared with providers who received no the following: angle opening distance Selected by Richard K. Parrish II, MD payments for these agents, those who (AOD750); trabecular– space area

received >90% of payments from ran- (TISA750); iris thickness (IT750); iris Anti-VEGF Agents: Industry ibizumab were more likely to prescribe curvature (ICURV); iris area (IAREA); Payments to Ophthalmologists ranibizumab than bevacizumab, and anterior chamber depth, area, and vol- January 2017 those who received >90% of payments ume (ACD, ACA, and ACV); anterior from aflibercept were more likely to chamber width (ACW); anterior vault Singh et al. reviewed national databases prescribe aflibercept than bevacizumab. (ACD+LV); vault (LV); and to analyze the characteristics of industry The authors concluded that, as more diameter (PD). A-scan ultrasonography payments made to ophthalmologists longitudinal data become available, was used to measure axial length (AL) related to anti-VEGF drugs and the greater insight may be gained about the and lens thickness (LT). Mean differ- possible effect on prescribing patterns. relationship between provider pay- ences in ocular biometric and anterior They found that providers who received ments and medication, as well as the segment parameters were assessed with >90% of payments related to ranibiz­ cost impact of anti-VEGF agents on the linear mixed model adjustment for PD. umab or to aflibercept were more likely health care system. In this cross-sectional study, 53 to use those branded drugs rather than —Summary by Lynda Seminara participants (36 females, 67.9%) with bevacizumab, compared with those a mean age of 62.7 years were analyzed, who received no payments. after exclusion of 17 patients with Recent data (2013-2014) from the OTHER JOURNALS unanalyzable images in at least 1 eye. Open Payments General Payment data­ Selected by Deepak P. Edward, MD Eyes affected by unilateral APAC had set and the Provider Utilization and a shallower ACD and a smaller ACA, Payments database of the Centers for Biometric Factors Associated ACV, anterior vault, TISA750, AOD750, Medicare & Medicaid Services were With Acute Primary Angle- and ICURV (all comparisons, p < .05). examined to determine characteristics Closure In the affected eyes, IT750 was signifi- of industry payments related to afliber- Investigative Ophthalmology & Visual cantly associated with AOD750, where- cept and ranibizumab, including dollar Science as in the fellow eyes, IT750 and AL were amounts, number and type of pay- 2016;57(13):5320-5325 predictive of AOD750 (all p < .05). ments, and correlations between pay- Axial length, ACW, LV, LT, IAREA, and ments and providers’ use of the medi- Atalay et al. compared ocular biomet- IT750 did not differ between the eyes. cations for their patients. The analysis ric and anterior segment parameters The researchers noted that the mean showed that 3,207 ophthalmologists between the affected eye and fellow ACD was, on average, 11.7% smaller received a total of 13,449 payments eye in 76 subjects with unilateral acute in affected eyes when compared with related to ranibizumab and aflibercept, primary angle closure (APAC) who had fellow eyes, and they suggested that representing a sum of $4,454,325. undergone bilateral laser peripheral narrower angles and smaller anterior The distribution was unequal among iridotomy before enrollment. The au- chamber parameters exacerbate angle recipients: 90% of the payments were thors found that APAC eyes had smaller crowding in such eyes. In addition, they received by 7% of ophthalmologists anterior segment dimensions than the identified a novel association between (Gini index, 0.92). fellow eyes. They also discovered that iris thickness and angle width in this Consulting fees and speaker fees iris thickness is a strong predictor of study, accounting for approximately were associated with the highest pay- angle width in both affected and fellow one-third of the variability in AOD750. ment amounts to the fewest providers. eyes. —Summary by Marianne Doran For 2,383 providers (74%), >90% of The researchers used anterior seg-