This Issue at a Glance
Authors: Jean Shaw
Journal: Ophthalmology (2015)

Impact of Generic Latanoprost on ComplianceHas the introduction of generic latanoprost had any effect on patient compliance? In a longitudinal cohort analysis, Stein et al (p. 738) evaluated 8427 patients who had open-angle glaucoma and were enrolled in a nationwide managed care network from 2009−2012. They found that those patients who were switched to the generic formulation were more likely to comply with their prescribed regimen. Moreover, those who were maintained on the brand-name products were 28% less likely to improve—and 39% more likely to decrease—their level of adherence. As cost is often a significant barrier to adherence, clinicians should consider switching patients to generic latanoprost when necessary, the researchers said. Additionally, as other brand-name products make the transition to generic status in the future, ophthalmologists should be aware that a significant subset of (7%) of the patients in this study simply stopped taking their glaucoma medications altogether as generic latanoprost became available. Although it is impossible to determine why this occurred, it may be that they ran into reimbursement difficulties, the researchers said.Vitreoretinal Interface Abnormalities on SD OCTMeuer et al (p. 787) estimated the prevalence and interrelationships of several vitreoretinal interface abnormalities. They found that epiretinal membranes (ERMs) and vitreomacular traction increase with age and are associated with macular cysts, lamellar macular holes (Figure), and visual impairment. This population-based study involved 1913 participants in the Beaver Dam Eye Study. Of these, 1540 patients had gradable spectral-domain ocular coherence tomography (SD OCT) scans in at least one eye. Prevalence rates were as follows: ERMs, 34.1%; vitreomacular traction, 1.6%; paravascular cysts, 20%; macular cysts, 5.6%; lamellar macular holes, 3.6%; and full-thickness macular holes, 0.4%. The prevalence of macular cysts, ERMs, and lamellar macular holes increased with age, while that of paravascular cysts decreased with age. Eyes with a history of cataract surgery were more likely to have macular cysts, lamellar macular holes, and ERMs; in addition, macular cysts and ERMs were more common in eyes with retinal diseases such as proliferative diabetic retinopathy.Postinjection Endophthalmitis in CATTMeredith et al (p. 817) set out to describe the incidence and outcomes of endophthalmitis after intravitreal injections of anti-VEGF drugs in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) and to assess whether the prophylactic use of topical antimicrobials had any impact on incidence. In this cohort study within a randomized clinical trial, the researchers found that endophthalmitis developed among 11 of 1185 patients (0.93%) and after 11 of 18 509 injections (0.06%) during 2 years, which is in keeping with incidence rates found in other large clinical trials of anti-VEGF agents. In addition, the use of topical antibiotics used before or after injection did not result in a statistically or clinically significant reduction in endophthalmitis risk. Of the 11 patients who were affected, the final visual acuity was 20/40 or better in 4 eyes, 20/50−20/80 in 2 eyes, 20/100−20/160 in 3 eyes, and <20/800 in 2 eyes. All of these patients were treated with intravitreal antibiotics, and 4 underwent vitrectomy.Preserved Outer Retinal Structure in Leber's Congenital AmaurosisAboshiha et al (p. 862) described data collected from 42 patients with Leber's congenital amaurosis (LCA). They found promising evidence that the foveal outer retinal structure was relatively preserved in the youngest patients. The 42 patients described in this report had molecularly confirmed AIPL1 mutations and an LCA4 phenotype. Their ages ranged from 6 months to 43 years, and 10 of the patients were younger than age 5. Although good quality, high-resolution optical coherence tomography images could be obtained for only 13 patients, 3 of these 13 demonstrated significant outer retinal structure, with relative preservation of the inner segment ellipsoid layer and outer nuclear layer at the fovea. All 3 patients were 1 year old or younger. The results suggest that a clinical study of gene therapy may be worth considering for patients who have the AIPL1 mutation and are quite young, the researchers said. Impact of Generic Latanoprost on ComplianceHas the introduction of generic latanoprost had any effect on patient compliance? In a longitudinal cohort analysis, Stein et al (p. 738) evaluated 8427 patients who had open-angle glaucoma and were enrolled in a nationwide managed care network from 2009−2012. They found that those patients who were switched to the generic formulation were more likely to comply with their prescribed regimen. Moreover, those who were maintained on the brand-name products were 28% less likely to improve—and 39% more likely to decrease—their level of adherence. As cost is often a significant barrier to adherence, clinicians should consider switching patients to generic latanoprost when necessary, the researchers said. Additionally, as other brand-name products make the transition to generic status in the future, ophthalmologists should be aware that a significant subset of (7%) of the patients in this study simply stopped taking their glaucoma medications altogether as generic latanoprost became available. Although it is impossible to determine why this occurred, it may be that they ran into reimbursement difficulties, the researchers said. Has the introduction of generic latanoprost had any effect on patient compliance? In a longitudinal cohort analysis, Stein et al (p. 738) evaluated 8427 patients who had open-angle glaucoma and were enrolled in a nationwide managed care network from 2009−2012. They found that those patients who were switched to the generic formulation were more likely to comply with their prescribed regimen. Moreover, those who were maintained on the brand-name products were 28% less likely to improve—and 39% more likely to decrease—their level of adherence. As cost is often a significant barrier to adherence, clinicians should consider switching patients to generic latanoprost when necessary, the researchers said. Additionally, as other brand-name products make the transition to generic status in the future, ophthalmologists should be aware that a significant subset of (7%) of the patients in this study simply stopped taking their glaucoma medications altogether as generic latanoprost became available. Although it is impossible to determine why this occurred, it may be that they ran into reimbursement difficulties, the researchers said. Vitreoretinal Interface Abnormalities on SD OCTMeuer et al (p. 787) estimated the prevalence and interrelationships of several vitreoretinal interface abnormalities. They found that epiretinal membranes (ERMs) and vitreomacular traction increase with age and are associated with macular cysts, lamellar macular holes (Figure), and visual impairment. This population-based study involved 1913 participants in the Beaver Dam Eye Study. Of these, 1540 patients had gradable spectral-domain ocular coherence tomography (SD OCT) scans in at least one eye. Prevalence rates were as follows: ERMs, 34.1%; vitreomacular traction, 1.6%; paravascular cysts, 20%; macular cysts, 5.6%; lamellar macular holes, 3.6%; and full-thickness macular holes, 0.4%. The prevalence of macular cysts, ERMs, and lamellar macular holes increased with age, while that of paravascular cysts decreased with age. Eyes with a history of cataract surgery were more likely to have macular cysts, lamellar macular holes, and ERMs; in addition, macular cysts and ERMs were more common in eyes with retinal diseases such as proliferative diabetic retinopathy. Meuer et al (p. 787) estimated the prevalence and interrelationships of several vitreoretinal interface abnormalities. They found that epiretinal membranes (ERMs) and vitreomacular traction increase with age and are associated with macular cysts, lamellar macular holes (Figure), and visual impairment. This population-based study involved 1913 participants in the Beaver Dam Eye Study. Of these, 1540 patients had gradable spectral-domain ocular coherence tomography (SD OCT) scans in at least one eye. Prevalence rates were as follows: ERMs, 34.1%; vitreomacular traction, 1.6%; paravascular cysts, 20%; macular cysts, 5.6%; lamellar macular holes, 3.6%; and full-thickness macular holes, 0.4%. The prevalence of macular cysts, ERMs, and lamellar macular holes increased with age, while that of paravascular cysts decreased with age. Eyes with a history of cataract surgery were more likely to have macular cysts, lamellar macular holes, and ERMs; in addition, macular cysts and ERMs were more common in eyes with retinal diseases such as proliferative diabetic retinopathy. Postinjection Endophthalmitis in CATTMeredith et al (p. 817) set out to describe the incidence and outcomes of endophthalmitis after intravitreal injections of anti-VEGF drugs in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) and to assess whether the prophylactic use of topical antimicrobials had any impact on incidence. In this cohort study within a randomized clinical trial, the researchers found that endophthalmitis developed among 11 of 1185 patients (0.93%) and after 11 of 18 509 injections (0.06%) during 2 years, which is in keeping with incidence rates found in other large clinical trials of anti-VEGF agents. In addition, the use of topical antibiotics used before or after injection did not result in a statistically or clinically significant reduction in endophthalmitis risk. Of the 11 patients who were affected, the final visual acuity was 20/40 or better in 4 eyes, 20/50−20/80 in 2 eyes, 20/100−20/160 in 3 eyes, and <20/800 in 2 eyes. All of these patients were treated with intravitreal antibiotics, and 4 underwent vitrectomy. Meredith et al (p. 817) set out to describe the incidence and outcomes of endophthalmitis after intravitreal injections of anti-VEGF drugs in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) and to assess whether the prophylactic use of topical antimicrobials had any impact on incidence. In this cohort study within a randomized clinical trial, the researchers found that endophthalmitis developed among 11 of 1185 patients (0.93%) and after 11 of 18 509 injections (0.06%) during 2 years, which is in keeping with incidence rates found in other large clinical trials of anti-VEGF agents. In addition, the use of topical antibiotics used before or after injection did not result in a statistically or clinically significant reduction in endophthalmitis risk. Of the 11 patients who were affected, the final visual acuity was 20/40 or better in 4 eyes, 20/50−20/80 in 2 eyes, 20/100−20/160 in 3 eyes, and <20/800 in 2 eyes. All of these patients were treated with intravitreal antibiotics, and 4 underwent vitrectomy. Preserved Outer Retinal Structure in Leber's Congenital AmaurosisAboshiha et al (p. 862) described data collected from 42 patients with Leber's congenital amaurosis (LCA). They found promising evidence that the foveal outer retinal structure was relatively preserved in the youngest patients. The 42 patients described in this report had molecularly confirmed AIPL1 mutations and an LCA4 phenotype. Their ages ranged from 6 months to 43 years, and 10 of the patients were younger than age 5. Although good quality, high-resolution optical coherence tomography images could be obtained for only 13 patients, 3 of these 13 demonstrated significant outer retinal structure, with relative preservation of the inner segment ellipsoid layer and outer nuclear layer at the fovea. All 3 patients were 1 year old or younger. The results suggest that a clinical study of gene therapy may be worth considering for patients who have the AIPL1 mutation and are quite young, the researchers said. Aboshiha et al (p. 862) described data collected from 42 patients with Leber's congenital amaurosis (LCA). They found promising evidence that the foveal outer retinal structure was relatively preserved in the youngest patients. The 42 patients described in this report had molecularly confirmed AIPL1 mutations and an LCA4 phenotype. Their ages ranged from 6 months to 43 years, and 10 of the patients were younger than age 5. Although good quality, high-resolution optical coherence tomography images could be obtained for only 13 patients, 3 of these 13 demonstrated significant outer retinal structure, with relative preservation of the inner segment ellipsoid layer and outer nuclear layer at the fovea. All 3 patients were 1 year old or younger. The results suggest that a clinical study of gene therapy may be worth considering for patients who have the AIPL1 mutation and are quite young, the researchers said.