STUDIES

Question 1

What are the 3 main findings of the ETDRS study?

Answer 1

1. Focal macula laser benefit for clinically significant macula oedema
2. Scatter laser PRP delayed until severe NPDR or early PDR for reduction of disease progression and vision loss
3. Aspirin has NO ROLE in preventing progression of diabetic retinopathy

Current NICE guidelines recommend scatter laser PRP for PDR, not severe NPDR**

Question 2

What are the two main findings in the DRS study?

Answer 2

1. PRP is safe and effective at preventing risk of visual loss and blindness in patients with advanced DR
2. PRP reduces incidence of severe visual loss (5/200 or worse) by 50% at 5 years

Question 3

What are the main findings of the UKPDS study (3)

Answer 3

1. Importance of good blood glucose control in T2DM
2. Progression of DR was reduced by 21% and need for PRP by 29% in intensive control group
3. Patients with tight BP control had 34% reduction in the progression of DR, and 47% reduced risk of losing 3 or more lines

Question 4

What were the main findings of the DCCT study? (2)

Answer 4

1. Importance of good blood glucose control in T1DM to lower risk of diabetic neuropathy and nephropathy
2. Intensive control reduced incidence of DR by 74% and reduced progression of DR by 54%

Question 5

In the DRS, what are the high-risk PDR features?

Answer 5

1. NVD: NVD > one third of disc area or any size of NVD with vitreous/pre-retinal haemorrhage
2. NVE: NVE > 1/2 disc area with vitreous haemorrhage and/or preretinal haemorrhage.

Question 6

What are the main findings in the GENEVA study? (3)

Answer 6

1. Higher percentage of eyes with improvement by 15+ letters in OZURDEX groups compared to control injection group (sham injection)
2. IOP rise to 25mmHg or more peaked at 16% day 60 but no difference to control group at day 180
3. No significant difference between cataract occurence in OZURDEX group vs control group

Question 7

What ingredients are in the AREDS formula?

Answer 7

1. Vitamin C
2. Vitamin E
3. Beta-carotine
4. Zinc
5. Copper (cupric oxide)

Question 8

What are the main findings in AREDS?

Answer 8

1. Slowed risk of developing advanced AMD by 25% and central vision loss by 19%

–> recommended for use in intermediate AMD in either eye or advanced AMD in one eye.

Question 9

What are the main findings in AREDS 2 (2006) ? (3)

Answer 9

1. Adding omega-3 fatty acids or lutein + zeaxanthin to AREDS formula had no additional overall effect on risk of advanced AMD
2. Eliminating beta carotene or reducing zinc had no significant change in effectiveness
3. Lutein and zeaxanthin could be an appropriate beta carotene substitution in smokers. (beta carotene associated with increased lung cancer in smokers).

Question 10

The ETDRS study showed that focal macular laser reduced risk of moderate vision loss by how much?

Answer 10

50%

Question 11

What was the aim of the DCCT trial? What were the two groups?

Answer 11

DCCT aim: T1DM looking at blood glucose control

Group 1: Intensive diabetes treatment: Received 3 insulin shots/day or insulin pump with self monitoring 4 times/day

Group 2: Conventional: 1-2 insulin shots/day or daily self monitoring of urine/blood glucose

Question 12

What was the main findings in the ACCORD study (Action to Control Cardiovascular Risk in Diabetes) (3)

Answer 12

1. Intensive glycaemic control slowed down progression of retinopathy but did not signfiicantly reduce major cardiovascular events
2. Intensive lipid control did slow down progression of retinopathy but did not significantly reduce rate of fatal cardiovascular events
3. Intensive blood pressure control (<120mmHg) did not reduce progression of retinopathy nor reduce rate of outcome of major cardiovascular events.

Question 13

What were the three populations / study arms in the ACCORD study?

Answer 13

1. Intensive glycaemia control - target glycated haemoglobin <6% vs standard therapy
2. Intensive lipid control - combination therapy with statin plus fibrate vs statin monotherapy
3. Intensive blood pressure control - targetting systolic blood pressure < 120mmHg vs <140mmHg

Question 14

What were the main findings of IVAN?
What were the main findings of ANCHOR?
What were the main findings of VIEW 1/VIEW 2?

Answer 14

IVAN: inconclusive evidence that bevacizumab was non-inferior to ranibizumab

ANCHOR: Monthly ranibizumab is better than PDT for classic CNV

VIEW 1/2 : Aflibercept was non-inferior to ranibizumab

Question 15

What where the findings of the 3 groups in HEDS 1 stromal keratitis?

Answer 15

Group 1: Stromal Keratitis not on steroids –> steroid drops effective in HSV stromal keratitis

Group 2: Stromal Keratitis on steroids –> no benefit to adding aciclovir to topical steroid + topical antiviral in stromal keratitis

Group 3: Iridicylitis receiving topical steroids
Possible benefit in adding oral aciclovir in HSV iritis but non significant due to slow recruitment/small study

Question 16

What were the findings in HEDS 2 Epithelial Keratitis trial?

Answer 16

No benefit in adding oral aciclovir to topical antiviral for epithelial or stromal keratitis

Question 17

What were the 4 findings of the HEDS 2 aciclovir prevention trial?

Answer 17

1. Prophylactic aciclovir effective and well tolerated in patients with previous history of herpetic eye disease
2. Risk of overall recurrence - 19% vs 32%
3. Risk of epithelial keratitis 9% vs 14%
4. Risk of stromal keratitis recurrence 14% vs 28%

Question 18

What were the findings of the Advanced Glaucoma Intervention Study (AGIS)? (2)

Answer 18

1. Black patients had better preservation of fields in ATT group (Argon laser trabeculoplasty –> trabeculectomy –> second trabeculectomy)
2. White patients had better preservation of visual fields in TAT group (trabeculectomy –> ALT –> second trabeculectomy)

Question 19

What were the findings of the ABC (Ahmed Baeveldt comparison) study?

Answer 19

1. IOP of Ahmed group higher than Baerveldt group at one year
2. More patients in Baerveldt group experienced early post-op complications
3. More patient in Baerveldt group experienced ‘serious’ complications - >2 snellen lines of vision

Question 20

What were the findings of the collaborative normal tension glaucoma study (CNTGS) (4)

Answer 20

1. IOP reduction by > 30% slows rate of field loss from 35% to 12%
2. Without treatment, 50% of NTG patients show no progression of field defects at 5 years
3. Risk factors for progression were female, migraine and disc haemorrhage at diagnosis
4. 12% of aggresively treated normal tension glaucoma showed progression (other factors at play)

Question 21

What were the main findings of the tube vs trabeculectomy (TVT) 2009 study?

Answer 21

1. Tube was less likely to fail than trab (45% vs 30% failure rate at 5 years)
2. Trab is better for early pressure control
3. Reoperation rate at 5 years - trab 30%, tube 10%
4. Risk of serious complications roughly same (20% trab vs 22% tube)

Question 22

What is failure defined as in the tube vs trabeculectomy study? (5)

Answer 22

1. Intraocular pressure > 21mmHg
2. <20% reduction of IOP
3. IOP < 5mmHg
4. Additional glaucoma surgery
5. Loss of light perception

Question 23

What were the findings of the ocular hypertension treatment study (3)

Answer 23

1. Treated OHT –> 60% risk reduction of developing POAG.
2. Key risk factors include IOP, Age, cup-disc ratio, PSD, reduced central corneal thickness, increased PSD (pattern standard deviation)
3. Not all OHT needs treatment.

Question 24

What were the key findings of the CNTGS study (collaborative normal tension glaucoma study)

Answer 24

1. 30% IOP reduction in treated eyes
2. 35% disease progression vs 12% disease progression in treated eyes after 5 years
3. 60% of NTG patients had no progression in 5 years

Question 25

What were the key findings of the ZAP trial?

Answer 25

1. PI reduced risk by 47%, but absolute risk low (NTT - 44) 2. Routine prophylactic PI not justified in all PACS

Question 26

What were the key findings of the EAGLE trial?

Answer 26

PAC/PACG patients with IOP >30mmHg --> Clear lens extraction was better than PI + drops for IOP, QoL and fewer meds.

Question 27

What were the key findings of the IATS trial (Infant Aphakia Treatment Study) (IATS)

Answer 27

Unilateral congenital cataract in 1-6 months old who underwent cataract surgery, either phakic or aphakic 1. No difference in glaucoma outcome between groups 2. Small corneal diameter, younger at surgery --> higher risk of glaucoma

Question 28

FAME showed what findings?

Answer 28

Fluocinolone acetonide implant recommended as an option for treating chronic DMO not responded well enough to available treatments in adults

Question 29

MEAD? RIDE? BOLT?

Answer 29

MEAD: Ozurdex in DMO RIDE: Ranibizumab in DMO BOLT: Bevacizumab in DMO

Question 30

Trials involved in BRVO

Answer 30

Question 31

What are the main findings of the AREDS and AREDS 2 trial? (4)

Answer 31

AREDS: 25% risk reduction in advanced AMD progression in categories 3 and 4 AREDS2: Lutein + zeaxanthin - safe effective alternative to beta-carotene Omega-3 : No additional benefit Zinc 25mg: equally effective with fewer side effects vs 80mg.