• Age-related macular degeneration (AMD) accounts for 8.7% of blindness worldwide, making it a leading cause of blindness in western countries. In the next 20 years, the prevalence of AMD is expected to rise by 47%.
• It is crucial to identify causal, modifiable risk factors for advanced AMD before applying preventative measures.
• A two-sample mendelian randomisation (MR) was conducted; summary-level data of genetic variants were obtained from study samples that did not overlap with those for advanced AMD and its subtypes associated with certain genetic variants (Figure 1).

• The largest genome-wide association studies (GWAS) for these exposures yielded summary-level statistics for smoking features, alcohol intake, body mass index (BMI), blood pressure, and glycaemic traits.
• The study outcomes are explained in Figure 2.

AMD: Age-related macular degeneration; CI: Confidence interval; GA: Geographic atrophy; OR: Odds ratio; SD: Standard deviation.

• There was insufficient data to demonstrate that genetically predicted blood pressure, BMI, or glycaemic traits were related to advanced AMD.

Conclusion

In conclusion, according to genetic data:
• Increased alcohol consumption has a potential causal association with the risk of geographic atrophy (GA).
• Smoking initiation and lifetime smoking behaviour may be causally associated with the risk of advanced AMD.
• Smoking cessation reduces the risk of advanced AMD compared to continuing to smoke.
• These associations were stronger in the case of neovascular AMD than in the case of GA.

To lower the prevalence of advanced AMD in the elderly, public health campaigns and programmes promoting smoking cessation and reduced alcohol consumption should include information that these behaviours can lead to blindness.

Source:
Kuan V, Warwick A, Hingorani A, et al. Association of Smoking, Alcohol Consumption, Blood Pressure, Body Mass Index, and Glycemic Risk Factors With Age-Related Macular Degeneration: A Mendelian Randomization Study. JAMA Ophthalmol. 2021;139(12):1299–1306. doi:10.1001/jamaophthalmol.2021.4601

NON-2022-15053 - Date of creation January 2023

A variety of ocular diseases can cause serous subretinal fluid (SRF) in the macula, which might mimic central serous chorioretinopathy clinically (CSC). A wide variety of diseases and conditions can also present with SRF in the macula and can therefore clinically mimic CSC.

Since distinguishing between these diseases and CSC might be difficult, the author provides an extensive differential diagnosis of CSC. The study highlights the pathogenic mechanisms specific to each disease, which aid in the differential diagnosis. These diseases can be broadly categorised into 12 main pathogenic subgroups (Figure 1).

The study also includes:

• The diseases, clinical characteristics, differential diagnostic aspects, and treatment options pertaining to the diseases.
• Two new clinical pictures associated with macular subretinal fluid accumulation, namely serous maculopathy with the absence of retinal pigment epithelium and serous maculopathy due to aspecific choroidopathy.

RRD: Rhegmatogenous retinal detachment; TRD Tractional retinal detachment.

Serous maculopathy with the absence of retinal pigment epithelium and serous maculopathy due to aspecific choroidopathy (Figure 2, A and B).

In conclusion, serous SRF in the macula can mimic CSC and manifest with a wide range of diseases and conditions. Inflammatory diseases and malignancies are on one end of the spectrum, while genetic diseases and ocular developmental anomalies are on the other. However, each of these conditions can be distinguished diagnostically from CSC using the appropriate clinical tools and ophthalmological examinations.

Source:
van Dijk EHC, Boon CJF. Serous business: Delineating the broad spectrum of diseases with subretinal fluid in the macula. Prog Retin Eye Res. 2021 Sep;84:100955. doi: 10.1016/j.preteyeres.2021.100955.

NON-2022-15053 - Date of creation January 2023

• Glaucoma is a progressive optic neuropathy with the potential to cause blindness. The most important and most modifiable risk factor for the development of glaucoma is raised intraocular pressure (IOP).
• Phacoemulsification-endocyclophotocoagulation (phaco-ECP) provided IOP lowering or reduction of topical therapy use in heterogenous glaucoma populations.

Objective

To assess the safety and efficacy of endocyclophotocoagulation with phacoemulsification (phaco-ECP) in surgically naive, primary open-angle glaucoma (POAG).

IOP: Intraocular pressure; SD: Standard deviation.

Figure 1 shows the changes in intraocular pressure over the time of study

Intraocular pressure outcomes showing (a) mean IOP (±95% CI) per year and (b) mean number of ocular hypotensive agents (±95% CI) per year.
Significant change from baseline in both outcomes was seen at all timepoints, corrected for multiple comparisons (****p<0.0001).

Table 1 shows the annual summary measures of all study eyes (final visit per year).

Last pre-operative observation was carried in the case of subsequent filtration surgery (n=1).
IOP: Intraocular pressure; MD: Mean deviation; PSD: Pattern standard deviation; SD: Standard deviation.

The study concludes that ECP combined with phaco-ECP lowers IOP and reduces the need for topical medication. It also provides an excellent safety profile in a unique, surgically naive POAG population, and so it should be explored as an alternative to minimally or micro-invasive glaucoma surgery devices.

Source:
Yap, T.E., Zollet, P., Husein, S. et al. Endocyclophotocoagulation combined with phacoemulsification in surgically naive primary openangle glaucoma: three-year results. Eye (2021). https://doi.org/10.1038/s41433-021-01734–4

NON-2022-15053 - Date of creation January 2023

• The aim of the European Glaucoma Society Guidelines (EGS) is to support the ophthalmologists in managing people with, or at risk of, glaucoma and to provide useful information to trainees.
• Guidelines emphasises on patients’ care, well-being, and optimal personalised care.
• Decision-making ultimately should be individualised to the patient's needs and circumstances, ideally guided by the best available evidence.

ONH: Optic nerve head; RNFL: Retinal nerve fibre layer.

GRADE: Grading of recommendations, assessment, development, and evaluations; IOP: Intraocular pressure; OCT: Optic coherence tomography; PACG: Primary angle closure glaucoma;
RNFL: Retinal nerve fibre layer; VF: Visual field.

Guidelines recommend an effective communication with patients to understand their history, which can be vital for prognosis. Direct questions at follow-up are highly essential to treat and manage patients. It is recommended to educate the patient about the disease condition and treatment and provide support and care.

Figure 1 shows that recommended evaluation of functional loss over time guides individualised treatment.

IOP: Intraocular pressure (IOP) level causing damage; L: Difference of visual function between the age-matched normal and the function at the time of diagnosis;
RoP: Angle representing physiological loss and disease progression; T: Time interval between birth and the time of diagnosis.

Source:
Azuara-Blanco A, Bagnasco L, Bagnis A, et al. European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition. Br J Ophthalmol. 2021;105(Suppl 1):1–169. doi: 10.1136/bjophthalmol-2021-egsguidelines.

NON-2022-15053 - Date of creation January 2023