In this issue, Michael Glanzer—my OD colleague from our office in Great Falls, Montana—and I have synthesized some articles that we felt would be helpful. With National Diabetes Month being November, and Glaucoma Awareness Month coming in January, we all want to give a little extra attention to this type of care.

All the best!

Ben Stoebner, OD
Editor

Results from the Ocular Hypertension Treatment Study, supported by the National Eye Institute, are in. They show that topical ocular hypotensive treatment of patients with elevated IOP was effective in delaying or preventing onset of primary open angle glaucoma (POAG).

Study:
Conducted at 22 clinical centers across the country, including the Pennsylvania College of Optometry

• 1636 randomized ocular hypertensive participants
• either undergo observation or treatment with any commercially available topical ocular hypotensive medication
• goal of treatment was to reduce IOP by 20% or more and to reach 24mm Hg or less
• primary outcome measures were the development of either reproducible visual field abnormalities or reproducible optic disc deterioration attributed to POAG

Findings:
After 5 years of follow up, the probability of developing POAG was found to be 4.4% in the treatment group compared with 9.5% in the observation group.

• Researchers also found that age, cup to disc ratio, pattern standard deviation on visual field testing, and intraocular pressure were good predictors for the onset of POAG.
• Another powerful predictor was central corneal thickness. Participants with corneal thickness values less than 555 micrometers had a three fold greater risk of developing POAG than those with 588 or higher.
• No significant increased ocular or systemic risk was noted in the medication group.

Conclusion:
While it should not be implied that all patients with borderline or elevated IOP should receive medication, clinicians should consider initiating treatment for patients with ocular hypertension who are at moderate or high risk for developing POAG.

Sources

Approximately 16 million Americans have diabetes and many eventually have cataract surgery. Studies suggest that diabetic retinopathy—particularly macular edema—may progress following cataract surgery. In fact, with diabetics, diabetic macular edema is the most frequent cause of poor visual acuity after cataract surgery.

Patients with diabetic retinopathy who exhibit clinically significant macular edema (CSME), severe non-proliferative retinopathy, or proliferative retinopathy should have fluorescein angiography and retinal evaluation prior to cataract removal. If the cataract is so dense that adequate pre-op evaluation of the retina is impossible, prompt post-op evaluation and treatment should be carried out. In general, all diabetics should be carefully screened pre-op for diabetic retinopathy then carefully followed after cataract surgery.

Two articles in the August 2002 issue of Journal of Cataract and Refractive Surgery discuss related issues.

• demographics
• level of retinopathy,
• pre-op glycosylated hemoglobin (HbA(1c))
• surgical duration
• pre-op best corrected visual acuity (BCVA)
• visual potential

Findings:
BCVA was worse in the diabetic group throughout the post-op period. Also, at 4 years post-op, diabetic patients were less likely to achieve BCVA better than or equal to their pre-op visual potential. The researchers concluded the most important predictors of visual outcome were coexisting diabetes and the extent of pre-op retinopathy.

Article Two
Prediction of macular edema exacerbation after phacoemulsification in patients with nonproliferative diabetic retinopathy—by Funatsu, et.al.

• vascular endothelial growth factor (VEGF)
• interlukin-6 (IL-6)
• protein

Finding:
Exacerbation of macular edema occurred in 29% of eyes. The researchers concluded that high levels of VEGF at the time of surgery predicted a significant risk for post-op exacerbation of macular edema.

As primary eye care providers, it is important that we take extra care in managing diabetic patients. Special consideration should be given before and after cataract surgery to insure the best possible outcomes.

Our mission at PCLI is to serve optometry. We very much enjoy working alongside you give your patients their best possible vision. In addition, our Professional Relations team is constantly developing materials and services to benefit your practice. To access some of these services, click here or on the links at the top of this page. Below are some new items you may find interesting:

• New cataract surgery patient education booklet
  Just off the press, this beautiful color publication about treatment at PCLI is now available to share with patients. Click to request copies for your office.
• New LASIK courtesy fee for clergy
  PCLI is pleased to offer LASIK surgical care at the reduced fee of $600 per eye to referred clergy members without insurance coverage who receive 90% or more of their income from church pastoring. Click to request our updated Refractive Surgery Fee schedule.
• New office in Great Falls, Montana
  We are pleased to announce the establishment of our newest surgery center in Great Falls, Montana. This beautiful facility is staffed and equipped to provide cataract surgery, LASIK and other specialty eye care to referred patients. Click to view photos.
• Visit us at our Hospitality Suites
  • GWCO—Portland
    Thursday, October 17 from 5-10:00 pm
    DoubleTree Portland Lloyd Center
    Suite #1455
    Take the elevator to the 14th floor
  • Idaho Optometric Association Convention—Coeur d’Alene
    Thursday, October 24 from 5-10:00 pm
    The Coeur d’Alene Resort
    Casco Bay Room
    On the main floor across from the convention rooms