Genetic investigations have garnered a wealth of information about glaucoma, the third most inherited human disease, which has pinpointed specific genes involved in early-onset familial disease with autosomal dominant or recessive inheritance as well as genetic risk factors for common glaucoma types with complex inheritance patterns.

Janey Wiggs, MD, PhD, the Paul Austin Chandler Professor of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, in Boston, said the major goal of genetic research is to put that genetic information to work clinically to identify at-risk individuals and use the knowledge about disease-causing genes to develop novel therapies. 

Optogenetic therapy: Gene-independent therapeutic strategies for retinal degeneration

She reported how current studies have set out to evaluate the risk and clinical outcomes in primary open-angle 

(POAG) based on development of a polygenic risk score (PRS) applied to data in genome-wide association studies (GWASs).


Multiple gene variants are needed to lead to greater disease risk and greater impact on disease outcomes; the contribution of a single genetic variant is small.

To assess the genetic risk for POAG, Wiggs said, multiple variants must be tested simultaneously using a genetic risk score, such as the recently developed PRS, to measure the genome-wide genetic risk for an individual. 

This score determines the total number of genetic risk variants for each person, and individuals in a population are scored based on the number of DNA risk variants they have.

The individuals with the highest number of variants have the highest genetic burden that is likely to have the greatest impact on disease risk and outcome. 

In analyses, the outcomes of individuals with the highest PRS (highest percentile) are often compared with the overall population distribution or with individuals with the lowest genetic burden.

To develop this valuable tool, 2 requirements must be met: a GWAS that is large enough to facilitate identifying all potential variants to be included in the PRS and use of computational methods that can manage large data sets and create the score, Wiggs said.

International Glaucoma Genetics Consortium


The consortium, which included investigators worldwide, was formed to complete the GWASs to identify all genetic risk variants for POAG. Each research group contributed its clinical and genetic data from POAG cases and controls. 

 was performed using all data sets that resulted in identification of 127 different chromosomal regions significantly associated with the risk for POAG. 

Each region contains hundreds to thousands of genetic variants individually associated with disease risk, Wiggs reported.

All the information from the participating groups worldwide was used to create a POAG PRS, which was applied to different populations and data sets to evaluate the clinical outcomes, she said.

Restoring vision in glaucoma: more than meets the eye


When the investigators evaluated the impact of the PRS on disease risk, they found that individuals in the upper decile (the top 10% of the PRS) had a 15 times greater risk of developing disease compared with individuals in the lower decile.

“This supported the concept that the PRS is associated with greatly increased risk,” Wiggs pointed out.

The results also showed that individuals with the highest genetic burden as defined by the PRS had a 5- to 10-year earlier disease onset compared with individuals in the bottom PRS distribution.

The PRS was also found to be associated with increased IOP. A recent Australian study

showed individuals with the highest PRS had higher IOP throughout the day, which was especially true in the morning, and these individuals with the highest PRS had increased IOP spikes.

“These results suggested that home tonometry would be useful in patients with high PRS to accurately assess the IOP burden,” Wiggs said.

Factors to consider in IOP elevations associated with vitreoretinal treatments

The highest PRS is also associated with aging, thinner retinal nerve fiber layers, and the proportion of patients requiring trabeculectomy to control IOP.

Shifting to myocilin-related glaucoma, a recent study

 mutations can cause juvenile AOG and early POAG, and the most common mutation was found to be 

Two hundred carriers were identified in this study who had IOP measurements and fundus photographs. The goal was to determine the disease rate (penetrance), diagnosis rate, and effect of the POAG PRS among mutation carriers.

Wiggs reported the PRS influenced both the disease penetrance and disease severity, which supported the use of PRS in optimizing risk stratification among 

“People who were mutation carriers were much more likely to have evidence of disease as defined by elevated IOP and disc-defined glaucoma if they were also in the high PRS percentiles,” she said.

Moreover, among patients with glaucoma who were mutation carriers, those in the highest percentiles were far more likely to have received a diagnosis, suggesting that having the myocilin mutation and a high PRS causes more severe disease that is evident to the patient.

Study: Lower IOP, medication burden in OAG patients


A study of increased caffeine consumptio

 and the PRS interaction on IOP and the risk of POAG found that caffeine only caused IOP elevations in patients with the highest PRS. 

The individuals with higher IOP resulting from higher caffeine intake also had a higher risk of glaucoma.

The main takeaways from this line of research are that a large GWAS made the development of a PRS for POAG possible. 

A high genetic burden defined by the POAG PRS is associated with early disease onset by 10 to 15 years, higher IOP, thinner nerve fiber layer, and a greater need for surgery. 

The PRS can modify disease outcomes due to other genes, such as 

; and the PRS can interact with environmental factors to influence the disease risk, Wiggs said.

--


This article was adapted from Wiggs’ presentation at the Women in Ophthalmology 2021 Summer Symposium. She has no financial interest in this subject matter.


1. Gharahkhani P, Jorgenson E, Hysi P, et al. Genome-wide meta-analysis identifies 127 open-angle glaucoma loci with consistent effect across ancestries. 

. 2021;12(1):1258. doi:10.1038/s41467-020-20851-4

2. Qassim A, Mullany S, Awadalla MS, et al. A polygenic risk score predicts intraocular pressure readings outside office hours and early morning spikes as measured by home tonometry. 

. 2021;4(4):411-420. doi:10.1016/j.ogla.2020.12.002

3. Craig JE, Han X, Qassim A, et al. Multitrait analysis of glaucoma identifies new risk loci and enables polygenic prediction of disease susceptibility and progression. 

. 2020;52(2):160-166. doi:10.1038/s41588-019-0556-y

4. Zebardast N, Sekimitsu S, Wang J, et al. Characteristics of p.Gln368Ter myocilin variant and influence of polygenic risk on glaucoma penetrance in the UK Biobank. 

5. Kim J, Aschard H, Kang JH, et al. Intraocular pressure, glaucoma, and dietary caffeine consumption: a gene–diet interaction study from the UK Biobank. 

. 2021;128(6):866-876. doi:10.1016/j.ophtha.2020.12.009

Articles

PRS can modify disease outcomes due to other genes, such as MYOC.

Genetics give investigators a risk stratification in glaucoma     

IOLs introduced into the US market during the last 2 years offer cataract surgeons an almost dizzying array of options for pseudophakic correction, said Priyanka Sood, MD.

Sood described the technologies and offered insights shared with her by colleagues who had experience with the various lenses.

At bottom, there are pros and cons to consider for each IOL, and achieving patient satisfaction depends on careful selection and thorough preoperative counseling.

Examining stability of aspheric IOL in cataract patients

“The reality is that none of these lenses is the holy grail able to restore prepresbyopic quality vision,” said Sood, an assistant professor of ophthalmology at Emory University in Atlanta, Georgia.


The monofocal category was expanded recently with 2 novel aspheric hydrophobic acrylic lenses—the TECNIS Eyhance (ICB00, Johnson + Johnson Vision) and the Clareon (Alcon). 

The Eyhance IOL has extended depth of focus (EDoF)-like qualities through the design of the central 1 mm of its optic. However, the Eyhance was not approved as an EDoF lens and surgeons cannot charge a premium fee for it. 

Outside the central 1 mm, the Eyhance optic is similar to the monofocal ZCB00 (Tecnis, Johnson + Johnson Surgical Vision), which explains its good contrast sensitivity, Sood said.

Katie Petro, MD, told Sood she has had good results with the Eyhance and that patients who have received implants are happy. 

Analyzing comparative lens rotations in toric IOL platforms

Petro noted that the extra range of vision it provides is for fingertip or computer distance. Using a mini-monovision approach targeting approximately –0.5 D in the nondominant eye can give more near vision, she said.

The Clareon is built on the AcrySof IQ IOL platform. It features a precision edge design to decrease photic phenomena. A new biomaterial and manufacturing process aim to decrease the development of nanoparticle glistenings.

Sumitra Khandelwal, MD, told Sood the long history of good quality vision with the AcrySof platform is an advantage for the Clareon lens. In addition, as a monofocal lens, it avoids the drawbacks of diffractive multifocals. 

Only time will tell if the design and material innovations achieve their respective goals of decreasing photic phenomena and nanoglistenings.


Uptake of the light adjustable lens (LAL) has been slow but is picking up momentum. 

Some reasons for its late adoption, according to Neda Shamie, MD, may include the equipment cost and the workflow related to extra visits needed to perform the adjustments. 

The advantage of the LAL is that it gives clinicians the ability to customize and accurately titrate the refractive power to the target for each patient.


The new IOL in the EDoF category is the AcrySof IQ Vivity (Alcon). The Vivity uses wavefront-shaping technology on its anterior surface that elongates the depth of focus, giving about a 1.5 D range of vision. 

Because it is a nondiffractive lens, risks of glare and halos are minimized and quality of vision is better than with a multifocal IOL. 

Depth-of-focus enhancement makes target easier to hit

However, results from the FDA clinical trial showed some loss of contrast sensitivity with the Vivity lens, and it does not give good reading vision.

Pearls shared from colleagues for improving outcomes include targeting –0.25 D in the dominant eye and –0.5 to –0.65 D in the nondominant eye, intraoperatively ensuring the IOL is centered and patients have time to neuroadapt.


The 2 newest multifocal IOLs—AcrySof IQ PanOptix (Alcon) and Tecnis Synergy (Johnson + Johnson Vision)—almost guarantee a broader range of vision than EDoF IOLs but not the avoidance of photic phenomena, Sood said.

The PanOptix is a trifocal lens with negative spherical aberration on its anterior surface that has diffractive rings in the central 4.5 mm of its optic. For users’ perspective, Sood turned to several colleagues.

Light adjustable IOLs: Treat patients with Star Trek-like technology

According to Dee Stephenson, MD, her patients are achieving great uncorrected vision at all distances. They are truly glasses-free as long as they have a healthy eye and astigmatism is corrected. 

Audrey R. Talley Rostov, MD, added that the IOL has to be perfectly centered. The downsides of the PanOptix include the potential for glare, halos, and decreased contrast sensitivity at night. 

Talley Rostov advised avoiding this IOL for patients younger than age 65. They tend to dislike the decrease in contrast sensitivity.

The Synergy features a hybrid of trifocal and EDoF optic technologies. Experience with this IOL, which is very new to the market, is limited, although early results seem good. 

Looking at technological advancements in cataract surgery


Additionally, colleagues outside the United States who have had access to the lens for a longer period of time say that the reading and intermediate vision it provides are better than that provided by other technologies. 

Distance vision may not be as good as with the PanOptix, however, according to anecdotal reports.

Sood has no relevant financial interests to disclose.

“Real talk” on new devices gives surgeons, patients decision-making insights

Physicians sort out pros and cons of several new IOLs on the market

The recent progress made for patients with uveitis range from better diagnostics to newer formulations of steroids to systemic immunosuppressants, and these are leading to better outcomes, according to Olivia L. Lee, MD, an associate professor of ophthalmology and director of the Anterior Segment Imaging Laboratory at the Gavin Herbert Eye Institute at the University of California, Irvine.

Lee recently discussed the progress that has been made in patients with uveitis from better diagnostics to newer formulations of steroids to systemic immunosuppressants.

Tackling the challenge of noninfectious uveitis 


Lee detailed a complex case of a 35-year-old woman with unilateral hypertensive iridocyclitis in the left eye. 

The anterior uveitis was chronic and was associated with very subtle changes in the iris stroma at the pupillary margin. 

A posterior subcapsular cataract was present and there is an increased cup-to-disc ratio. Glaucoma drops alone provided suboptimal control of the intraocular pressure (IOP).

Lee performed an anterior chamber tap and obtained a peripheral blood sample; the resultant Goldmann-Witmer coefficient was positive for rubella (19.34), she reported. 

This analysis led to the diagnosis of Fuchs heterochromic iridocyclitis associated with rubella.

“No treatment is needed for rubella and topical steroids are not helpful. Cycloplegia is unnecessary because synechia do not develop,” Lee said. “Treatment was focused on IOP control. In this case, the diagnosis was established with a very small sample of aqueous.”

Lee then discussed other testing that can be done with small aqueous samples to address whether uveitis is infectious or noninfectious. 

Uveitis: A leading, underestimated cause of visual morbidity in patients


In patients with uveitis, polymerase chain reaction (PCR) is superior to cultures, the gold standard, because of its higher sensitivity and the small sample volume needed.

PCR has been used to diagnose many conditions, such as viral anterior uveitis/retinitis, toxoplasma chorioretinitis, ocular tuberculosis, Whipple disease, cytomegalovirus (CMV) endothelitis and anterior uveitis, ocular histoplasmosis syndrome, and endophthalmitis.

All physicians, even those outside large academic institutions, can send ocular specimens for PCR testing. 

A variety of tests on ocular fluid are available through ARUP Labs, University of Washington, and Casey Eye Institute. 

Extensive testing of viruses, mycobacteria, autoimmune retinopathy panels, and cancer- and melanoma-associated panels is available.



Examining new biological treatments in posterior uveitis 


“Multimodal imaging is the current rage,” Lee pointed out.

Multiple imaging techniques are available to diagnose and evaluate uveitis that includes identifying the location and degree of the inflammation. 

These capabilities apply to use in the clinic and to an objective and reproducible way for use in clinical trials, she explained.

can be used, in addition to all of its other uses, to evaluate cells in the anterior chamber and vitreous cavity. 

 performed using the Topcon DRI Titan swept-source (SS) OCT machine to evaluate anterior cells in eyes with uveitis. 

The eyes were graded at the slit-lamp using SUN criteria for anterior chamber cell and flare and then compared to images obtained using SS-OCT. 

Evolution of optical coherence tomography of the human eye

Lee reported that in the 4+ anterior chamber cell group, the particulates were easy to visualize.

“However, in the eyes in which I saw no cells clinically, I was surprised to see that the OCT picked up some small cellular material,” she said.

Lee found that the correlation between the SUN clinical grading and the presence of cells seen by anterior-segment OCT was very good.

“This technology also can be used to look at vitreous cell and haze,” she said.

When considering fundus fluorescein angiography, peripheral vasculitis would have been overlooked if sweeps of the peripheral retina were not done. 

Widefield fundus imaging is important not only in retinal vasculitis but also in a number of other conditions with peripheral pathology, Lee said.

Ultra-widefield imaging improves line of sight in KPro patients


Corticosteroids have been the go-to therapy for uveitis for 70 years. Currently, new steroid formulations provide a variety of routes of administration and sustained drug-delivery devices. 

The choice is made based on the desired potency and location of drug delivery. 

For example, intravitreal steroids can be injected to treat uveitic cystoid macular edema (CME); however, this method is associated with a limited treatment duration and sets the stage for recurrent disease.

The answer to this is use of a sustained-drug delivery devices. Retisert (fluocinolone; Bausch & Lomb), the first to receive FDA approval, lasts 30 months, requires surgical implantation, and frequently results in cataract and glaucoma development. 

Ozurdex (dexamethasone; Allergan), injected during an office procedure, is effective for 4 to 6 months. Yutiq (fluocinolone; EyePoint), approved to treat noninfectious uveitis, has a longer effective treatment duration than Ozurdex, but Lee said she believes Ozurdex is better for treating active disease than Yutiq, which is better for maintenance.

A patient’s eye movements can unlock diagnosis

FDA approval of a suprachoroidal steroid implant, Xipere (triamcinolone acetonide; Bausch & Lomb), is in the offing.

The device, which is contained in a loading system, is inserted by applying pressure perpendicular to the sclera about 4 to 5 mm posterior to the limbus and delivers 4 mg of drug to the suprachoroidal space. 

In the PEACHTREE phase 3 study

 the device met its end points with improvements in vision and macular thickness.

Safety is always an issue. The SITE Cohort Study

included about 8000 patients followed for 26 years to evaluate the safety of systemic immunosuppression. 

The study found no significant increased risk of death among patients treated for uveitis. The cyclophosphamide-treated group had a significant increase in cancer mortality.

Among the immunomodulatory agents, the biologic response modifiers are the newest drug class developed to treat autoimmune diseases. 

Dissecting real-world registry study of YUTIQ for chronic non-infectious posterior uveitis

These agents are derived from or resemble naturally occurring effector molecules in the inflammatory cascade. 



Adalimumab (Humira; Abbott Laboratories) was approved to treat noninfectious intermediate posterior and panuveitis in patients aged 2 years and older. The newest citrate-free formulation is better tolerated by patients.


--


This article is adapted from Lee’s presentation at the Women In Ophthalmology 2021 Summer Symposium. She has no financial interest in any aspect of this report.


1. Baghdasaryan E, Tepelus TC, Marion KM, et al. Analysis of ocular inflammation in anterior chamber-involving uveitis using swept-source anterior-segment OCT. 

. 2019;39(8):1793-1801. doi:10.1007/s10792-018-1005-0

2. Yeh S, Khurana RN, Shah M, et al; PEACHTREE Study Investigators. Efficacy and safety of suprachoroidal CLS-TA for macular edema secondary to noninfectious uveitis. phase 3 randomized trial. 

. 2020;127(7):948-955. doi:10.1016/j.ophtha.2020.01.006

3. Kempen JH, Daniel E, Dunn JP, et al. Overall and cancer related mortality among patients with ocular inflammation treated with immunosuppressive drugs: retrospective cohort study. 

Diagnostics, imaging, and therapeutics pave the way for better outcomes.

Technologies offer options in treatment of uveitis

My partner and I were not early adopters of femtosecond laser technology. We had been running a well-established optometric referral practice at an ambulatory surgery center for more than 30 years before we considered it. Several factors led to our decision.

As ophthalmology section chief, I noticed that many of the younger surgeons we were considering for our staff wanted to join a facility with femtosecond laser capabilities.

Second, a rival practice was performing a high volume of femtosecond laser-assisted cataract surgery (FLACS) cases.

Third, patients would call our practice to find out whether we offered FLACS. We would tell them no but assure them that our doctors have a lot of experience. However, we ended up losing patients to our competitor. 

Because this technology is well adopted in most facilities, we invested in a femtosecond laser (LENSAR).

Cataract surgery pearls for cases with poor mydriasis, zonules

As an experienced surgeon who has performed more than 50,000 procedures, I have a low complication rate with great results. 

After performing FLACS, I realized that there are some things this technology can reproducibly do better than I can. 

Immediately, I began to see tighter, more accurate, and more precise results. 

The fact that I could now have a capsulorhexis and opening of exactly 5 mm and not 4.8 mm or 5.1 mm meant that, when those patients left the operating room, I knew their procedure was 100% accurate.

I also found an improvement in the softening of the lens. The chopping and dicing facilitated the nuclear lens material removal. It required less phaco energy and produced faster phaco times. 

Evaluating dexamethasone intraocular suspension 9% post-cataract surgery

Patients were seeing closer to 20/20 on postoperative day 1 after FLACS than they were with traditional surgery. These were clear advantages.

Occasionally, I get patients with previous trauma or who may have had retinal problems and undergone a pars plana vitrectomy. Their zonular structure and integrity of the eye are often not the same as those of a virgin eye.


Because we do not keep the femtosecond laser in our operating room but in a clean area, I thought workflow would slow down. However, we move patients directly from the clean area to the operating room. 

Impact of prior authorization for cataract surgery

When the femtosecond laser is done, the operating room is being turned around and the circulator is ready to bring the patient right back because I am working out of 1 room. 

The entire process from the time of docking is roughly a minute and a half.

FLACS has also improved my patient experience because I no longer do manual marking. 

I use preoperative iris imaging and astigmatism diagnostics technology (Cassini Technologies) that interfaces with my femtosecond technology. 

The manual marking using the Iris registration (even if I do not use the exact number from the imaging and diagnostic technology) allows me to manually enter the number and still have Iris registration. 

Timing and earlier neurolept anesthesia for laser-assisted cataract surgery

I have had cases where I have had a marker using any kind of mechanical device, when suddenly the patient looks up or down and ends up with a corneal abrasion, and I have not even started the case. 

The fact that I no longer must mark the cornea, potentially creating a corneal abrasion and running the risk of patients complaining the next day, is huge.

The IntelliAxis L is a unique feature on our femtosecond laser platform. The femto places a little nick in the capsule at the steep axis. 

When I align a toric lens, whether it is a monofocal toric or a presbyopic toric, that mark is right where the lens toric mark is. There is no parallax. 

I know exactly where that lens is to be aligned. It makes the alignment much more precise and easier. We are getting 20/20 eyes at day 1 on high powered toric IOLs that we were never seeing before.

What patients need to know about cataract surgery


There are patients who want the technology. It is not an uphill sale. It sells itself. 

Clearly, the ability to have a procedure that drops to the bottom line of the practice with a decreasing reimbursement from the federal government, Medicare, and non-

Medicare cases is a challenge. Reimbursements are going to continue to drop. We can balance-bill patients for a premium service when treating presbyopia and/or astigmatism because those are noncovered conditions.


There may be other surgeons like me who have many years of experience and are very happy with their outcomes. 

Cataract surgeons on OR waste: Less is often more

However, if they can avail themselves of femtosecond laser technology, it is worth being open-minded and giving it a shot. In the last 12 months, our premium conversion for toric and presbyopic lenses has been higher than ever. 

As the penetration of premium lenses increases, FLACS will be a further catalyst to drive more business through the premium channel.


Baldinger is an ophthalmologist with Capital Eye Consultants in Fairfax, Virginia. He has no financial disclosures related to this content.

Ophthalmologist outlines his journey with the procedure as a late adopter.

Femtosecond laser-assisted cataract surgery: One physician’s story


Reviewed by Sharon Fekrat, MD, and Dilraj S. Grewal, MD

There is no single diagnostic test for Parkinson disease (PD), and neurologists often rely on the patient’s response to medications to differentiate the disease from conditions with similar symptoms.

Investigators at Duke University have taken a step toward establishing an adjunctive approach using retinal imaging to diagnose PD. 

 as well as OCT angiography (OCTA), both noninvasive technologies, to evaluate patients who had received a clinical diagnosis of PD in order to identify ocular structural differences between patients with PD and healthy controls.

Cason B. Robbins, BS, of the Department of Ophthalmology at Duke University School of Medicine in Durham, North Carolina, lead author of the study, evaluated the retinal microvascular and choroidal structural changes in the eyes of patients with PD.

Previous study results indicated that cerebral small vessel disease may be a potential risk factor for development of PD, and PD has a higher prevalence of cerebral ischemic lesions, Robbins et al noted.


Participants were enrolled at the Duke Neurological Disorders Clinic. The 69 patients (124 eyes; mean age, 71.7 years) had received an established clinical diagnosis of PD. 

There were 137 cognitively healthy controls (248 eyes; mean age, 70.9 years). All patients underwent OCT and OCTA. 

The investigators assessed the superficial capillary plexus vessel density (VD) and perfusion density (PFD) within the Early Treatment Diabetic Retinopathy Study (ETDRS) 6 × 6-mm circle, 6 × 6-mm inner ring, 6 × 6-mm outer ring, and the foveal avascular zone. 

Early outer retinal findings on en face and cross-sectional OCT



The investigators measured the retinal nerve fiber layer thickness, macular ganglion cell/inner plexiform layer thickness, central subfield thickness, subfoveal choroidal thickness, total choroidal area, luminal area, and choroidal vascularity index (CVI).

The results showed that compared with the healthy sex- and age-matched controls, the VD and PFD were significantly lower in the patients with PD in the 6 × 6-mm ETDRS circle (

 = 0.4, respectively) and in the 6 × 6-mm inner ring (P = .003 and 

The total choroidal area and luminal area were larger in the patients with PD (

 = 0.2, respectively). The CVI was lower in the patients with PD.

The results did not show differences in the retinal nerve fiber layer or ganglion cell layer thickness or the subfoveal choroidal thickness, the latter of which differs from the results of some other studies.

Choroidal hypertransmission defects on en face OCT imaging predict geographic atrophy in patients

Robbins joined Sharon Fekrat, MD, a professor of ophthalmology at Duke University School of Medicine; Dilraj S. Grewal, MD, an associate professor of ophthalmology at Duke University School of Medicine; and the other coauthors in pointing out that the current findings are combined with the clinical history and other tests.

“These choroidal and retinal microvascular imaging findings may hold the potential to improve clinician confidence in the diagnosis of PD,” they wrote.

According to the investigators, the findings highlight the need for further research into retinal imaging as a potential novel biomarker for individuals with neurodegenerative diseases such as PD.

“Future long-term studies that characterize the natural history of microvascular and structural retinal changes in individuals across the clinical spectrum of PD [are] warranted,” they concluded. “Studies may help clarify whether these imaging findings may be useful as biomarkers for the onset of PD.”


Fekrat has no financial interest in this subject matter.


Grewal has no financial interest in this subject matter.

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1. Robbins CB, Thompson AC, Bhullar PK, et al. Characterization of retinal microvascular and choroidal structural changes in Parkinson disease.

 2021;139(2):182-188. doi:10.1001/jamaophthalmol.2020.5730

2. Guan J, Pavlovic D, Dalkie N, et al. Vascular degeneration in Parkinson’s disease. 

 2013;23(2):154-164. doi: 10.1111/j.1750-3639.2012.00628.x

3. Van deer Holst HM, van Uden IWM, Tuladhar AM, et al. Cerebral small vessel disease and incident parkinsonism: the RUN DMC study. 

. 2015;85(18):1569-1577. doi:10.1212/WNL.0000000000002082

4. Song IU, Lee JE, Kwon DY, Park JH, Ma HI. Parkinson’s disease might increase the risk of cerebral ischemic lesions. 

. 2017;14(4):319-322. doi:10.7150/ijms.18025

Retinal and choroidal changes were observed in study.

OCT/OCTA ocular biomarkers may help diagnose Parkinson disease


Reviewed by Andrea Lora Kossler, MD; and Cat Burkat, MD, FACS

Procedure transfers intact donor nerve fibers to the cornea.

Ophthalmology Times: October 15, 2021

Genetics give investigators a risk stratification in glaucoma

Physicians sort out pros and cons of several new IOLs on the market

Technologies offer options in treatment of uveitis

Femtosecond laser-assisted cataract surgery: One physician’s story

OCT/OCTA ocular biomarkers may help diagnose Parkinson disease

Corneal neurotization is effective for restoring sensory innervation

Neuro-ophthalmology: More to offer than just steroids

Ophthalmology in the Big Easy: AAO 2021 welcomes in-person attendees

A closer look at presbyopia options

Improving surgical outcomes for pediatric patients

Landmark treatment: Cell therapy advances options for corneal endothelial disease