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Research suggests RVO linked to heart disease, stroke

Meta-analysis finds increase in adverse cardiac events for these patients.

By Robert Stoneback, associate editor

One of the first large-scale analysis of medical research shows a correlation between retinal vein occlusion (RVO) and adverse cardiac events, including heart disease and stroke.

When compared to patients who do not have RVO, according to the study, RVO patients were at an increased risk of stroke (risk ratio [RR] of 1.45), heart attack (RR of 1.26), heart failure (RR of 1.53), peripheral arterial disease (RR of 1.26) and all-cause mortality (RR of 1.36).

The research, conducted by physicians at Mount Sinai and published in Retina, was conducted through analyzing 15 manuscripts that contained data on nearly 475,000 patients. Of these, 60,069 had RVO while 414,397 did not.

The study’s authors recommend that ophthalmologists refer RVO patients to cardiologists and/or neurologists due to the higher risk of cardiovascular disease, instead of referring them to a general practitioner.

“This study suggests that we as retina specialists should probably be far more aggressive in referring our RVO patients out for specifically cardiac and neurological evaluation,” said senior study author Avnish Deobhakta, MD, assistant professor of Ophthalmology at the Icahn School of Medicine at Mount Sinai, via press release. “Ideally, we should be even more communicative with the primary care physician about these sorts of cardiac and neurological risks that these patients face.”

Pravin Dugel, MD, clinical professor of ophthalmology at the USC Roski Eye Institute, Keck School of Medicine in Los Angeles, was more cautious about the results, saying the nature of the study’s methodology meant there were some limits for its practical application.

“Mount Sinai’s research is excellent for a meta-analysis, but meta-analyses also rarely change how physicians treat patients; that is simply due to the fact that it is not a ‘higher level’ of data that shows a direct causal link,” says Dr. Dugel.

In the case of RVO and ailments such as heart disease and stroke, it may be that people with one disease may be more likely to have a second or third, perhaps due to age or sickness, he points out.

While the study “doesn’t change my behavior, I don’t ignore it, either.” OM

Study proposes link between air pollution, AMD

Research examined exposure to nitrogen dioxide and carbon monoxide.

By Robert Stoneback, associate editor

A recent study out of Taiwan suggests a link between increased air pollution and the likelihood of developing AMD.

Conducted by members of Taiwan’s China Medical University and published in the BMJ Journal of Investigative Medicine, the research concluded that chronic exposure to high amounts of nitrogen dioxide (NO2) and carbon monoxide (CO) can significantly increase the risk of AMD.

The study, “Traffic-related air pollutants increase the risk for age-related macular degeneration,” was a longitudinal population-based study that used medical data from 2000 to 2010 provided by the Taiwan National Health Insurance Program.

A total of 39,819 subjects age 50 or older were enrolled from that dataset; of those subjects, all of whom were AMD-free at the time of enrollment, 1,442 developed AMD during the study’s 11-year follow-up.

The annual total exposure to NO2 and CO from 1998 to 2010 for each subject was calculated using the Cox proportional hazard model. The adjusted hazard rate for developing AMD was 1.91 times greater for people in the highest NO2 quartile, and 1.84 times greater for those in the highest CO quartile.

Daniel Su, MD, a retina specialist at Retina-Vitreous Associates Medical Group, in Los Angeles, notes that the findings are consistent with the effects of cigarette smoking on AMD, which is “the single most important modifiable risk factor for AMD”; both CO and NO2 are found in cigarettes.

Dr. Su says that the Taiwanese study did not control for cigarette smoking; however, “despite the lack of causative data, there certainly is a strong association between air pollution and AMD.”

It is still helpful for patients to avoid areas of heavy air pollution, says Dr. Su, as in addition to the risks of lung disease and lung cancer, air pollutants can cause surface eye irritation and dry eye. OM

QUICK BITS

Allergan began a voluntary recall of the XEN 45 glaucoma drainage device on Oct. 30, after a small number of units in an unreleased lot had trace amounts of polishing compounds. Allergan has also issued a product hold of XEN 45 while investigating. Physicians are advised to continue routine postoperative follow-up and report adverse events to Allergan at 1-800-433-8871.

Norlase announced the commercial launch of its LEAF laser photocoagulator for the treatment of retina and glaucoma disease. LEAF can be attached to an existing slit lamp; the unit uses a wireless tablet for a user interface and an optional voice control feature.

Optos launched the Silverstone, a combination ultra-widefield (UWF) retinal imaging device and UWF-guided swept-source OCT. The Silverstone produces a 200° single-capture optomap image and the ability to perform advanced OCT imaging anywhere across the retina.

Allergan introduced three new over-the-counter artificial tear products: REFRESH RELIEVA, REFRESH RELIEVA PF (preservative-free) multidose and REFRESH RELIEVA FOR CONTACTS.

Global eye bank Eversight and supply chain data company LLamasoft launched a partnership to better predict need and availability of donated eye tissue and to efficiently deliver corneas to transplant recipients. Eversight’s end-to-end supply chain model will allow it to more easily identify operation inefficiencies and evaluate contingency plans.

Eyevance Pharmaceuticals acquired TOBRADEX ST (tobramycin/dexamethasone ophthalmic suspension) 0.3%/0.05% and NATACYN (natamycin ophthalmic suspension) 5% from Novartis. TOBRADEX ST is a fixed-dose topical antibiotic and corticosteroid, for steroid-responsive inflammatory ocular conditions; NATACYN is the only FDA-approved ocular antifungal.

The AAO and Verana Health are now facilitating no-cost genetic testing and counseling for patients with certain inherited retinal diseases; the service is being performed through Verana Trial Connect, a cloud-based application that pulls data from the IRIS registry and is used to link patients and physicians for clinical trials.

Under a recent licensing deal, Bausch + Lomb will commercialize and develop XIPERE in the United States and Canada. XIPERE, created by Clearside Biomedical, is a triamcinolone acetonide suprachoroidal injectable suspension, developed as a treatment for macular edema associated with uveitis; Clearside plans to submit an NDA in Q1 2020.

Horizon Therapeutics announced the results of its Phase 3 OPTIC confirmatory clinical trial; the trial demonstrated that teprotumumab provided improved outcomes, compared to placebo, in treating the effects of active thyroid eye disease (TED). If approved, teprotumumab would be the first FDA-approved medicine for the treatment of active TED.

Genentech and Roche completed enrollment for two Phase 3 trials, YOSEMITE and RHINE, which are investigating faricimab in diabetic macular edema. RHINE and YOSEMITE will each use more than 900 patients and evaluate safety and efficacy of faricimab for DME treatment compared to aflibercept injection.