ABSTRACT
Macular dystrophies (MDs) constitute a collection of hereditary retina disorders leading to notable visual impairment, primarily due to progressive macular atrophy. These conditions are distinguished by bilateral and relatively symmetrical abnormalities in the macula that significantly impair central visual function. Recent strides in fundus imaging, especially optical coherence tomography (OCT), have enhanced our comprehension and diagnostic capabilities for MD. OCT enables the identification of neurosensory retinal disorganization patterns and the extent of damage to retinal pigment epithelium (RPE) and photoreceptor cells in the dystrophies before visible macular pathology appears on fundus examinations. It not only helps us in diagnostic retinal and choroidal pathologies but also guides us in monitoring the progression of, staging of, and response to treatment. In this review, we summarize the key findings on OCT in some of the most common MD.
ABSTRACT
Geographic atrophy (GA) secondary to age-related macular degeneration is a common cause of blindness worldwide. Given the recent approval of the first therapy for GA, pegcetacoplan, we critically appraise methodological aspects of the phase 3 clinical trials published so far in this disease in relation to their design, analysis and interpretation. We reviewed some of the key attributes of all phase 3 clinical trials in GA available in the main public registry of clinical trials as of 20 May 2023. The topics discussed included types of endpoints, eligibility criteria, p-value and effect size, study power and sample size, the intention to treat principle, missing data, consistency of results, efficacy-safety balance and application of results. Five phase 3 clinical trials have reported results, either partially or completely: GATHER1, DERBY/OAKS, CHROMA/SPECTRI, SEATTLE and GATE. Although there are many similarities between these trials in terms of endpoints or broad eligibility criteria, they differ in several aspects (metric of the primary endpoint, sample size, type of adverse events, etc.) that can influence the results, which are discussed. Readers should understand key methodological aspects of clinical trials to improve their interpretation. On the other hand, authors should adhere to clinical trial reporting guidelines to communicate what was done and how it was done.
ABSTRACT
PURPOSE: To compare the visual disturbances experienced by patients receiving 1 of 3 extended depth-of-focus (EDOF) intraocular lenses (IOLs) or a monofocal IOL as the control. SETTING: OMIQ-Recerca Center. Spain. DESIGN: Prospective comparative randomized double-blind study. METHODS: 22 patients were included per group. The IOLs evaluated were the AcrySof IQ Vivity (Vivity group), AT LARA 829MO (AT Lara group), or TECNIS Symfony ZXR00 (Symfony group) and the monofocal AcrySof IQ SN60WF (Monofocal group). The variables analyzed were the light distortion index (LDI), best-fit circle radius (BFC Rad ), and self-reported vision quality with a questionnaire (QoV). Outcomes were evaluated at the 3-month follow-up visit. RESULTS: Under monocular conditions, no differences between groups were detected for the LDI and BFC Rad . Under binocular conditions, significant differences in both variables were produced. The Monofocal group reported better values than Symfony ( P = .025; P = .024) and AT Lara ( P = .002; P = .002) groups. The Vivity group reported better values than Symfony ( P = .015; P = .014) and AT Lara ( P = .001; P = .001) groups. Halos were not reported by 81.8% (18) of patients in the Vivity group, 90.9% (20) of patients in the Monofocal group, 50% (11) of patients in the AT Lara group, and 59% (13) of patients in the Symfony group. CONCLUSIONS: The diffractive EDOF IOL models examined in this study induced similar visual disturbances, which were worse than those produced by the nondiffractive extended-range IOL and the monofocal IOL. The nondiffractive lens and the monofocal lens did not show differences.
