Ophthalmology Month in Review: January 2023

At the end of each month, our editorial team compiles a list of our most popular ophthalmology-focused content from the past month for a month in review recap. The January 2023 ophthalmology month in review features modifications in age-related macular degeneration (AMD) risk, links between ophthalmic disease and quality of life, and complications during cataract surgery.

Trending News in AMD

Metformin Use Not Linked to AMD Development

Research published in JAMA Ophthalmology¹ indicates a lack of association between long-term metformin use and lifestyle changes initiated for diabetes prevention with the presence and severity of AMD. The association was evaluated during the Diabetes Prevention Program Outcomes Study, with nearly 1600 participants randomized to metformin over 20 years.

The data report no significant difference in the presence of AMD between the 3 groups with 152 (29.6%) in the lifestyle arm, 165 (30.2%) in the metformin arm, and 162 (30.7%) in the placebo arm. There was also no difference in the distribution of early, intermediate, and advanced AMD between the intervention groups.

Investigators note that “until randomized data are available, the DPPOS provides strong evidence that does not support the use of metformin in the treatment of any stage of AMD.”

Dietary Nitrate Intake and Risk of AMD

Data from the Age-Related Eye Disease Study (AREDS) and AREDS2 suggest dietary nitrate intake may be a modifiable risk factor for AMD progression.² Specifically, an increased dietary nitrate intake was associated with a decreased risk of late AMD, with a hazard ratio (HR) of 0.77 (95% confidence interval [CI], 0.69 - 0.86), as well as a decreased risk of geographic atrophy (GA).

However, the association disappeared after adjusting for Mediterranean dietary patterns. Investigators noted these results are subject to potential bias and are hypothesis-generating, making them “insufficient to support new clinical recommendations.” They call for further randomized research to assess the role of dietary nitrate in reducing the risk of AMD progression.

Subretinal Fluid Protective in nAMD Eyes

Subretinal fluid appeared protective against macular atrophy in a multicenter, observational study.³ Treatment-naive eyes with nAMD without subfoveal MA or subretinal fibrosis at baseline were recruited and grouped based on their predominant activity status.

Eyes with mostly active subretinal fluid only had a lower risk of developing subfoveal MA and extrafoveal MA than eyes with mostly intraretinal fluid, which reported lower lower visual acuity. A greater understanding of the protective role of retinal fluid against MA may be key to providing better results in eyes with AMD, investigators say.

Ongoing Challenges

Thyroid Eye Disease and QoL Measurements

A study from JAMA Ophthalmology⁴ suggests moderate to severe thyroid eye disease (TED) is associated with worse utility values. The lowest mean value, representing the worst quality of life outcome, was observed for the most severe health state in large proptosis and constant diplopia.

Meanwhile, the highest mean value was observed for the least severe health state with low proptosis and no diplopia. In all, investigate cite patients with active, moderate-severe TED may have substantial disutility and represent a substantial quality of life burden.

Based on these findings, investigators cite a need for additional studies in the area. They add that their data might serve as a baseline for prospectively assessing improvements with therapies.

Uveitis Complicates Cataract Surgery Risk

Uveitis was associated with higher risks of complications during cataract surgery as well as in the post-operative period, cites new research from the Swedish National Cataract Register.⁵ There was an association between uveitis and poorer best-corrected visual acuity preoperatively and postoperatively. However, visual improvement was slightly better in uveitic eyes, despite the challenges.

Investigators from the analysis indicated the need for guidelines to better define how uveitic patients are treated when undergoing cataract surgery. They add that multicenter randomized trials are needed to further to assess the optimal anti-inflammatory treatment in patients with uveitis undergoing cataract surgery.

References

1. Domalpally A, Whittier SA, Pan Q, et al. Association of Metformin With the Development of Age-Related Macular Degeneration. JAMA Ophthalmol. Published online December 22, 2022. doi:10.1001/jamaophthalmol.2022.5567

2. Broadhead GK, Agrón E, Peprah D, et al. Association of Dietary Nitrate and a Mediterranean Diet With Age-Related Macular Degeneration Among US Adults: The Age-Related Eye Disease Study (AREDS) and AREDS2. JAMA Ophthalmol. Published online December 22, 2022. doi:10.1001/jamaophthalmol.2022.5404

3. Sánchez‐Monroy J, Nguyen V, Puzo M, et al. Subretinal fluid may protect against macular atrophy in neovascular age‐related macular degeneration: 5 years of follow‐up from Fight Retinal Blindness Registry. Acta Ophthalmologica. December 2022. doi:10.1111/aos.15309

4. Smith TJ, Cockerham K, Lelli G, et al. Utility Assessment of Moderate to Severe Thyroid Eye Disease Health States. JAMA Ophthalmol. Published online December 29, 2022. doi:10.1001/jamaophthalmol.2022.3225

5. Pålsson S, Pivodic A, Grönlund MA, et al. Cataract surgery in patients with uveitis: Data from the Swedish National Cataract Register. Acta Ophthalmologica. December 2022. doi:10.1111/aos.15308