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E W NEWS & OPINION 40 Predicting which patients are poised for visual decline I magine being able to identify ahead of time which of your older patients are headed for a more rapid age-related decline in vision due to cataract. Now i t appears that changes in optical quality markers may help do that, according to Darren E. Koenig, OD, PhD, Houston. Results of a study published in the July 2013 issue of Optometry & Vision Science indicated that markers such as entropy of the point spread function, development of posterior subcapsular cataract, a nd greater amounts of trefoil helped to identify those who experienced a greater drop in visual acuity over time. Unlike most prior studies, which were cross-sectional, this one exam- ined longitudinal changes over a four-year span. "These people are coming back to us each year for the four-year period," Dr. Koenig said. "Their vision is changing over that time—or at least for a large number of them it is—and we're trying to predict those who are changing and who are changing the fastest." Raymond A. Applegate, OD, PhD, professor and Borish Chair of Optometry, University of Houston, explained what led the investigators to launch the study initially. "We were interested in finding out how the optical properties of the eye change, particularly in terms of cataract development, and whether such an optical signature could predict those on a fast track to a future acuity loss," he said. Included in the study were any patients over 50 years old, with typical aging changes but no other pathology or retinal disturbances March 2014 by Maxine Lipner EyeWorld Senior Contributing Writer Ophthalmic prestidigitation Future In the future, Dr. Tan said a more varied clinical treatment strategy for use of atropine 0.01% would need to be developed. Questions remain about the use of atropine. They include: "Will atropine continue to be effective if it is used for longer periods of time, and how long?" and "What is the optimal age to start and stop atropine?" and "Could there still be undiscovered longer- term effects?" In addition, the question of whether atropine 0.01% can be brought to the market and into ophthalmic practices is still unan- swered, he said. ATOM continued from page 39 Top row: Slit lamp images with LOCS-III grading scores for nuclear opalescence (NO) and nuclear color (NC) at baseline and four years later. Center row: High order wavefront error map and resulting entropy score (ENT) at baseline and four years later. Bottom row: Retinal image simulations generated using the measured WFE at baseline and four years later. Acuity at baseline in the test eye was –0.13 logMAR or 6/4.5 in metric Snellen equivalent, and four years later acuity was 0.00 logMAR or 6/6 in metric Snellen equivalent. Wavefront error maps and simulations were generated in Visual Optics Laboratory v7.4 (Sarver and Associates Inc., Carbondale, Ill.). Source: Raymond A. Applegate, OD, PhD Those questions might be a good foundation for an ATOM3 study. "We're developing a clinical strategy for Singapore in myopic clinics across several hospitals, and we're working at various clinical algorithms, and perhaps this could be ATOM3," Dr. Tan said. EW Editors' note: Dr. Tan has no financial interests related to this article. Contact information Tan: donald.tan.t.h@snec.com.sg f 18-47 News_EW March 2014-DL2 copy_Layout 1 3/6/14 2:47 PM Page 40