Examining poster themes at ARVO 2017

This year’s Association for Research in Vision and Ophthalmology (ARVO) annual meeting in Baltimore brought together 12,000 researchers from 75 countries.

Whoever said that spending five days walking around a massive indoor convention center looking at cardboard posters is boring hasn’t lived and breathed an ARVO meeting.

Besides improving one’s Fitbit scores (I logged 10,000 strides [three miles] per day), this meeting is like no other-it provides the opportunity for one-on-one interaction with scientists. It’s speed dating for science geeks.

No one individual can digest the 5,647 posters and myriad oral presentations and panel discussions, but certain themes emerged, even to the casual observer. Poster numbers are included.

Previously from Dr. Richer: Sunlight and its effect on eye health

Non–invasive vascular imaging, blood flow, and chronic eye disease

There’s a wealth of new information on ocular coherence tomographic angiography (SD-OCTA) and the newer swept source (SS-OCT) imaging of the choroid-the latter providing even faster scanning, higher sensitivity, better penetration with better signal to noise ratio. #49

The further commercial realization of Doppler SD-OCT modes provide non-invasive visualization and quantitative analysis of the blood flow to the retina, optic nerve, and choroidal vasculature. #3040

Qualitative vascular images of hidden ocular tissue as well as quantitative blood flow analysis will drive the future of primary eye care because diabetic retinopathy, glaucoma, and age-related macular degeneration (AMD) all involve early subclinical disruption of circulation and subsequent pathophysiology tissue damage, now managed by the subspecialist. #712

A State University of New York (SUNY) study showed AMD eyes have an enlarged foveal avascular zone area (FAZ). This decreased capillary vascularity could not be explained by age or thinner para-foveal ganglion cell complex thickness. #36

There is a relatively strong correlation of approximately r=0.45 between enlarged FAZ and choroid vascular density in AMD. #1659

For optometrists who have yet to purchase an SD-OCTA system, consider the Vessel Analysis System Program (VASP), a neat HIPAA-compliant program from Commonwealth Scientific and Industrial Research Organisation (www.csiro.au), Australia’s equivalent to our National Institutes of Health. #655

This magnificent telehealth program allows optometrists to upload ordinary fundus images and obtain back automated quantitative analysis of 61 retinal vascular parameters. These include a/v and arteriolar light reflex ratios (ALR), fractal segmentation and analysis of the “big six” vessels off the optic nerve. Here is an inexpensive way to merge retinal vascular health change analysis with preventative ocular medicine strategies. Using this system, Australian neurologists found that the ALR correlates with Alzheimer’s disease amyloid accumulation. Remember that the eye has the same embryonic origin as the brain. #656

Related: Why ODs should care about sugar

Hypertension medications may worsen glaucoma

In a 10-year retrospective study of 6,625 patients prescribed systemic anti-hypertension medications, 32 percent of patients showed progression compared to 23 percent of diet-managed hypertensives. Beta-blockers were the worst offenders, especially when taken before bed where higher intraocular pressure (IOP) and lower blood pressure conspire to dampen optic nerve vascular perfusion. #730  

Related: Bad blue light, macular pigment, and prescriptive carotenoids

Vitamin D, uveitis, and your patient’s micro-biome

In a 12-month study of 35 patients with relapsing uveitis, 35 percent of patients stabilized and 65 percent showed improvement (P=0.0001) with high-dose vitamin D supplementation. #1095

Vitamin D deficiency and uveitis relapse had a whopping odds ratio of 7.7, P=0.024 for recurrence. This simple oral supplement might compare favorably to the use of anti-TNF alpha immune modulator injections (such as adalimumab [Humira, AbbVie]) for non-infectious uveitis if evaluated head to head. #511

The gastrointestinal microbiome has been found to be altered in patients with acute anterior uveitis, so think about probiotics the next time you treat an iritis. #2166

The microbiome of the nose and throat is also distinctly different from that of the ocular microbiome. #3821

Apps everywhere

Some 30 percent of diabetes worldwide occurs in China, and it is not uncommon for Chinese males to discover that they have advanced blinding diabetic retinopathy at their first eye exam. #79

One scientist told me this is likely due to the newfound cultural desirability of fast food, higher meat consumption, and avoidance of “peasant vegetables.” Other emerging countries like Mexico have similar concerns as they plan for the expected public health care explosion in diabetes. #4837

Absent optometrists, one solution is the combined and coordinated use of smartphone camera attachments such as CellScope and VisionQuest Eyestar Pictor, automated retinal analysis algorithms, and telemedicine. #659, #4837

Yet, consumer telemedicine may not be ready for prime time. A Johns Hopkins (remote vs. office) autorefractor comparison study showed that only 75 percent of participants were successfully refracted remotely using an SSVone smartphone autorefractor now marketed in more than 100 optician establishments on the East Coast. #2393

Related: ODs must teach patients about proper nutrition

Marijuana, pregnant mice, and your glaucoma patient

While marijuana may not be good for pregnant mice, causing lasting retinal effects to offspring, the general public believes that marijuana can be an effective means to treat glaucoma. #271

Denise Valenti, OD, presented U.S. statistical use data emphasizing that patients electing to use marijuana as their sole treatment for glaucoma-related vision loss risked blindness because of an absence of adequate medical monitoring, follow-up, and guidance. #4614

Marijuana also has deleterious short timeframe effects on the visual field, so ask your patients to bring a designated driver or walk to your practice.

Related: Insulin resistance is more important than you think

AMD diagnosis and staging

It’s assumed that about 12 percent of patients over age 60 have abnormal dark adaptation (DA). One ophthalmologist found that more than 50 percent of his 200 patients thus far actually have an abnormal DA with or without a family history of AMD. #1553

Absent a billing code, National Eye Institute scientists presented use of a nifty $65 opaque filter for using visual function to stage AMD with a strong correlation of r=0.85, p<0.001. This low luminance test involves testing Early Treatment Diabetic Retinopathy Study (EDTRS) visual acuity with and without a 2.0 neutral density filter and recording the difference in the number of letters correctly identified with and without the opaque filter. The greater the difference, the more severe the photoreceptor retinal pigment epithelium dysfunction and AMD. This is a simple technique to add to your routine examination of patients 50 years or older and correlates with a validated low luminance questionnaire. #1526, #2334

Speaking of low vision, a new wide-angle intraocular lens called Eyemax (London Eye Hospital Pharma, UK) is capable of providing both AMD and cataract patients an additional 2⁺ lines of Snellen visual acuity upon implantation. #2730

Omega 3 fatty acids and acne rosacea

Use of omega 3 supplementation improves goblet cells function, tear break-up time, lacrimal meniscus, and Ocular Surface Disease Index (OSDI) burning and foreign body sensation scores at 1 month of use. #2707

My friend and colleague Kerry Gelb, OD, reminded me that he treats acne rosacea using fish oil combined with probiotics and B complex vitamins for an even greater therapeutic effect. These are the type of great clinical conversations that occur at ARVO.

Related: Details matter when prescribing meso-zeaxanthin

Where does meso-zeaxanthin come from?

Meso-zeaxanthin is a macular-specific carotenoid with no common dietary source, and RPE65 is the key enzyme of the vertebrate visual cycle for converting all-trans to 11–cis-Retinoids. Retinal specialist Paul Bernstein, MD, PhD, and his team of scientists from the Moran Eye Center in Salt Lake City have determined that RPE65 has a secondary function converting lutein to meso-zeaxanthin. Eat spinach or consume lutein supplements, and make mesozeaxanthin. #3579

Related: Improve and protect the next patient with diabetes

Auto fluorescence and alternative methods

After much basic science work, we now have a commercial device (Heidelberg qAF) for automatic quantification of lipofuscin induced autofluorescence of the human retina. #4853

In a 50-patient study, smoking has been quantitatively found to significantly age the human retina. #4854

In the future, primary-care optometrists will use such instruments to combine quantitative imaging with anti-aging health counseling, following the lead of chiropractic medicine. For example, Temple University ophthalmologists have shown that foot reflexology is superior to alternate nostril breathing to lower IOP in patients with ocular hypertension. #4615

“Further studies will be necessary to determine the optimal treatment parameters in the hope that this form of alternative medicine may be an additional IOP lowering option,” according to these ARVO scientists.

We will need high-quality sleep to take in everything that ARVO has to offer optometry. Narrow blue blockers 480±20 nm worn for a few hours before bed limit melatonin suppression and improve sleep quality #4134

There is a lot of work to be done by optometrists of the future, even in the United States. A study on trends in eyecare workforce over two decades shows that even in the United States, 62 percent of counties have no ophthalmologist. #5088

Read more from Dr. Richer here