Ophthalmology Studies

Front 1

Study: Herpetic eye disease Study (HEDS)

Back 1

1. Is oral acyclovir effective in treating stromal keratitis in addition to topical steroids and antivirals? NO
2. Is topical steroids effective in treating stromal keratitis with viroptic? YES, decreases persistence and progression of stromal keratitis by 68% and shortens duration.
3. does oral acyclovir help HSV keratouveitis? NOT CONCLUSIVE
4. Does oral acyclovir in epithelial keratitis help progression of stromal keratitis or iritis? NO
5. Does oral acyclovir help prevent recurrent ocular HSV? YES, especially those with previous stromal keratitis
6. What are the determinants for recurrent HSV keratitis: Hx stromal keratitis increases risk of subsequent stromal keratitis. NOT epithelial keratitis.

Front 2

Study: Collaborative Corneal Transplant treatment study

Back 2

ABO blood typing to check for incompatability, possible risk of rejection

HLA matching not cost effective or advantageous

high risk rejection:
vascularization of 2 quadrants of cornea
preveous graft rejection
glaucoma
extensive PAS
trauma
a hereditary surface disorder

Front 3

1. Study: North American symptomatic carotid endarterectomy trial collaborators
2. Study: European carotid surgery trial colloarative group

Back 3

1. symptomatic patients (hx amaurosis fugax, TIA, CVA) with 70%-94% carotid artery stenosis have 2 years of stroke rate. 9% endarterectomy group vs. 26% control antiplatelets only
2. symptomatic group carotid stenosis 0-29% no benefit to carotid stenosis, symptomatic 50-69% stenosis 5 year stroke rate 16% endarterectomy va 22% treated medically

Front 4

Study: Glaucoma Laser Trial

Back 4

Evaluated the efficacy treating POAG initially with ALT vs timolol
1. initial treatment of POAG w/ ALT is at least as effective as initial treatment with timolol.
2. 2 years into study 56% laser treated eyes needed supplemental medical control of IOP.
-laser treated eyes had lower mean IOP

Front 5

Study: Collaborative initial glaucoma treatment study

Back 5

Evaluate effectiveness of medical treatment vs. trab for treatment of newly diagnosed open angle glaucoma (primary, pigmentary, PXE)
Visual field loss not significantly different with either treatment. Trabeculectomy has initial increase in significant visual loss but by the 4th year the VA was equal in both groups.
IOP avg is lower in surgicla group
cataract rate is higher in surgical group.

Front 6

Study: Advanced Glaucoma Intervention Study

Back 6

Evaluated ALT vs. Trab as initial surgery in patients with advanced open angle glaucoma.
1. african americans best result with ATT
2. Caucasians best result with TAT
3. Visual field was more severe in African Americans.
4. Eyes with IOP <18mmhg at all visits had no progression of VF loss
5. Trab increased risk cataract by 78%
6. risk faliure ALT: young age, high IOP
7. risk failure trab: young age, high IOP, DM, post op complications
8. Bleb encapsulation, male sex, previous ALT

Front 7

Study: Ocular Hypertension Treatment Study

Back 7

Evaluate effect of topical medication in delaying or preventing POAG in patients with ocular hypertension.
Goal was to reduce IOP at least 20% from baseline, taget pressure of at least <24mmhg.
primary outcome measure: VF loss, ON damage
IOP reduction 22% in medicine group vs 4% observed
At 5 years risk of developing POAG treated 4.4% vs. Observed 9.5%
Conclusion: topical hypotensive is effective in preventing POAG in eyes with ocular HTN.

Predictive factors to develop POAG:
1. baseline IOP
2. Age
3. C/D ratio
4. CCT

Front 8

Study: Early Manifest Glaucoma Trial

Back 8

Evaluate effectiveness of reducing IOP on progression of newly diagnosed open angle glaucoma.
treated group recieved ALT and betaxolol. treated gropu had 5.1mmhg (25%) reduction rate. progression is less in the treated (45% vs 62%)
Each 1mmhg of IOP lowering from baseline reduce risk progression by 10%

Treatment halves risk of progression.
risk factors for progression: higher baseline IOP, exfoliation, bilateral disease, old age, disc heme

Front 9

Study: Collaborative Normal Tension Glaucoma Study

Back 9

Evaluate if IOP is a factor in NTG.
goal for treatment group was to reduce IOP by 30% (either with meds, laser, or surgery)
Lowering of IOP 30% is beneficial, IOP is a factor in NTG
factors that increase rate progression: female, migraine, disc heme

Front 10

Study: Optic neuritis treatment trial (ONTT)

Back 10

Evaluated the role of steroids in treatment of optic neuritis.
patients assigned to 3 groups:
1. IV steroids followed by oral pred.
2. Oral pred Only
3. Placebo
Results: IV streoid more rapid recovery of vision. decrease incidence of MS in 2 years vs placebo, but no difference after 2 years. Oral pred only have higher recurrence rate. 30% develop MS within 4 years, 38% in 10years. Higher risk of developing MS if previous neuro symptoms and hx of optic neuritis in fellow eye

Front 11

Study: Ischemic optic neuropathy decompression trial (IONDT)

Back 11

Results showed that:
1. ON sheath fenestration is not effective
2. surgery has higher risk of loss 3 lines vision. 24% surgical vs. 12% obs
3. at 6 months the observation group have 43% regain 3 lines or more while only 34% surgery patient regained 3 lines or more of VA.

Front 12

Study: Controlled High risk avonex MS prevention study (CHAMPS)

Back 12

Ramdomized trial of inferferon B1a. For prevention of MS after demyelinating episode and abnormal MRI.
3 year result, risk of MS lower and fewer MRI lesions in treatment group.

Front 13

Study: Cryotherapy for ROP Study (CRYO-ROP)

Back 13

Evaluated whether cryo for ROP in preterm <1251g prevented complicatons.
-cryo preserved VA in eyes with threshold disease. initial exam is 4-6 weeks post birth or 36 weeks gestaton. then every 2 weeks until vessels with zone 3.
If prethrehold exam every week until regression or threhold reached.
If threshold, treat with cryo within 72hours. 90% regression, retreat in 1 week if worsens.

Front 14

Study: Central vein occlusion study

Back 14

1. No benefits from early PRP in non-perfused CVO, wait for NVI then PRP
2. PRP when 2 clock hours of NVI
3. monthly follow up of gonio in 1st 6 months
4. no benefit from focal laser for macular edema

Front 15

Study: Branch vein occlusion study

Back 15

Objective: evaluate PRP and grid in preventing neo, preveint vit heme, improving VA in eyes with macular edema
conclusions: grid laser recommended in BVO eyes
1. within 3-18mo
2. VA 20/40 or worst
3. FA documents macular edema without foveal heme
Perform PRP when NVI develops

Front 16

Study: ARED study

Back 16

evaluated the effect of supplement (Vit C, Vit E, b carotene, zinc, copper) on AMD progression, also cataract development.
Conclusion: Found that supplements where beneficial for category 3. extensive intermediate drusun or 1 large and 4. VA loss doe to AMD (foveal geographical atrophy, exudative).
It does not affect cataract development of progression. Caution in smokers, beta carotine can increase lung Cancer

Front 17

Study: Macular photocoagulation study (MPS)

Back 17

Objective was to evaluate laser treatment in preventing VA loss in CNV.
Conclusion:
1. treat extrafoveal CNV (200-2500)
2. juxtafoveal CNV benefit from krypton laser except HTN AMD patients.
3. AMD patients with subfoveal CNV benefit from argon or krypton laser
4. Classic juxtafoveal CNV, in AMD is beneficial.
5. Unilateral CNV with large drusen, focal hyperpigmentation is risk factor to develop CNV in fellow eye.

Front 18

Study: Treatment of ARMD with photodynamic therapy trial (TAP)

Back 18

Objective to evaluate verteporfin photodynamic therapy in treating subfoveal classic CNV.
conclusion- PDT is recommended for subfoveal predominantly classic CNV. 34% more likely to retain vision

Front 19

Study: Verteprofin in photodynamic therapy trial in photodynamic therapy pathologic myopia

Back 19

Objective to evaluate visudyne PDT in management of subfoveal CNV not included in original TAP sudy
Conclusion: Treatment is recommended in treating subfoveal occult but not classic CNV when there is progression. lesion size <4MPS DA
Baseline VA < 20/50

Front 20

Study: Diabetic retinopathy vitrectomy study (DRVS)

Back 20

evaluated early surgical intervenstion vs. dealyed surgery in patients with severe NPDR or early PDR.
conclusion: early vitrectomy in eyes with severe VA loss due to nonclearing heme was helpful in type 1 DM patients. Also useful in eyes with useful VA and advanced PDR.

Eyes with TRD not involving the fovea can be observed.

Front 21

Study: Diabetic retinopathy study (DRS)

Back 21

evaluate whether laser prevents severe VA loss in diabetic retinopathy.
conclusion- laser decrease risk of severe Va loss. PRP patients with high risk PDR.
(NVD 1/3-1/4 disc, NVD with vit heme, NVE 1DD with vit heme).
There is no clear benefit in treating severe NPDR and PDR without high rick features.

Front 22

Study: Early Treatment diabetic retinopathy study (ETDRS)

Back 22

Study designed to answer
1. laser effective for DME?
2. dose aspirin affect DR course
3. when to start PRP for DR?
Conclusion:
1.Treat all patients with CSME becasue is decrease 50% mod vision loss.
2. immediate PRP for high risk PDR and positive severe NPDR in both eyes.
3. no benefit from ASA

Front 23

Study: Diabetes control and complication trial (DCCT)

Back 23

Evaluated tight vs conventional glucose control in type 1 DM
At 5 years- retinopathy was 50%less with intense therapy. Ha1c less than 8 decrease risk of retinopathy. But intense therapy increase hypoglycemic episodes 2-3x
conclusion - tight control beneficial, but can lead to initial worsening of retinopathy in begining

Front 24

Study: Epidemiology of DM interventions and complications (EDIC) trial

Back 24

A follow up trial of the DCCT. Found that tight control indeed is benficial

Front 25

Study: The United Kingdon Perspective Diabetes study
(UKPDS)

Back 25

Compared intense glucose control with oral hypoglycemic and or insulin control vs. conventional treatment with diet.
1. intensive treatment with either sulfonylurea, metformin, or insulin is all equally effective
2. intensive group have 11% decrease in ha1c compared to conventional
3. intense group decrease risks in DM 12%, 10% in DM related deaths, 6% all cause of mortality.
4. Type 2 diabetic patients benefit from intensive treatment just type 1

Front 26

Study: The United Kingdon Perspective Diabetes study - HTN in DM study (UKPDS-HDS)

Back 26

Does BP control affect type 2 DM complications?
- found that tight control of HTN decreased deaths related DM 32%. reduced vision loss.
can use either captopril or atenolol it made no difference.
conclusion: tight HTN control decrease risk of diabetic retinopathy complications

Front 27

Study: Endophthalmitis Vitrectomy Study

Back 27

To evaluate acute post op endophthalmitis with immediate vitrectomy vs. tap and inject and also if IV antibiotic help.
1. IV antibiotic don't help
2. If vision is better than LP than Tap an Inject (.4mg amikacin and 1.0mg vancomycin)
If vision worst than LP then immediate vitrectomy

Front 28

Study: The Studies of Ocular Complications of Aids (SOCA)

Back 28

reported patiented treated with ganciclovir had 79% higher mortality than those with foscarnet, both drugs equal in controlling CMV retinitis and which tolerable side effects. Retinitis progression best controlled with combo of treatments. Color photography is gold standard in following the diease progression

Front 29

Study: Pneumatic retinopexy
trial comparing Pneumatic retinopexy with scleral buckle

Back 29

no statistical difference between repairs made with pneumatic retinopexy vs scleral buckle. function outcome equivelent in macula on detachments. for patients with macula off RD <14 days, pneumatic retinopexy was superior to scleral buckle in regards to visual outcome.

Front 30

Study: Collaborative Ocular Melanoma Study

Back 30

Evaluate treatment options for choriodal malignant melanoma.
3 groups
1. small: ht 1-3mm base 5-16mm: not randomized, treatment at discretion
2. medium: ht 2.5-10mm, base <16mm, euncleation vs plaque
3. large: ht >10mm, base >16 enucleation vs radiation + enuc

conclusion:
1. small tumors: 5 yr motality rate 6%
2. using plaque therapy there is high risk of VA loss, the survival is unchanged plaque vs. enuc
3. large - preenucleation radiation does not change survival