Eyeworld

EW RETINA 76 higher probability that the second eye would progress to level 2, he explained. This was in keeping with inves- tigators' expectations. "We were able to quantitate the risk of progression of 1 eye based on the severity of the fellow eye using statistical models." From a clinical perspective, this has important implications, Dr. Klein said. "It enables a physician to tell a patient with some degree of confidence that if 1 eye is progress- ing, there is a high probability of the other following suit," he said, adding that there are exceptions, but this is what is probable. In most cas- es, if 1 eye is progressing, the other will do the same. In addition, it provides a useful model for AMD investigators. "It en- ables people who are studying those with AMD to provide estimates of what the probability of progression is," Dr. Klein said. EW Editors' note: Dr. Klein has no financial interests related to this article. Contact information Klein: kleinr@epi.ophth.wisc.edu by Maxine Lipner EyeWorld Senior Contributing Writer accelerated progression. Meanwhile, if the AMD was mild, the fellow eye tended to have less progres- sion. "The key finding was that the condition was very symmetrical," Dr. Klein said. "Over a period of time, 50% of eyes in individuals were within 1 level and 90% were within 2 or less levels." For exam- ple, if 1 eye began at level 2 while the other was at level 1, there was a Studying the spectrum Most of the information regard- ing risk of progression to date has come from studies examining more severe endpoints, he said. Such studies have, for example, centered on patients with end-stage disease occurring in 1 eye and the chances of doing an intervention to prevent this from happening in the other, Dr. Klein noted. However, there have been no studies done for early stages of disease, he said, adding that prior to this study it remained unclear what the risk of progression was in the fellow eye in such cases. This population-based study was all-inclusive. It was conducted in Beaver Dam, Wis., and at the baseline examination all participants were 43 to 86 years old. Investiga- tors then considered where on the AMD spectrum the participants fell. "We took all of the people based on grading of their fundus photos and categorized the AMD severity using the scale that we developed," Dr. Klein said, adding that there were 5 levels of increasing severity from no AMD to end stage advanced disease. Following baseline exams, partici- pants were measured every 5 years for up to 20 years. "We were able to look at how the AMD progressed in each eye of an individual over time," Dr. Klein said. Symmetrical findings Investigators found that the severity of the condition in 1 eye tended to be mirrored in the other. In cases where there was severe AMD in 1 eye, the fellow eye tended to have Considering implications for disease progression F or a patient with age-related macular degeneration, it's a pressing question with important implications— just what are the chances of the disease progressing in the fellow eye? AMD is the leading cause of legal blindness today, according to Ronald Klein, MD, professor, Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison. New study results can help elu- cidate what the correlation between eyes may be. In a study published in the February 2015 issue of JAMA Ophthalmology, investigators found that when the disease progressed in 1 eye, the other eye tended to prog- ress as well. "What we were looking at was bilaterality—if 1 eye is more ad- vanced, what's the chance of the other eye developing a similar se- verity level of AMD," Dr. Klein said, adding that this is a concern for patients who are already contend- ing with the disease in 1 eye and who understandably want to know what's going to happen to the other. In addition, this can be important for AMD trials. "For clinical trials you need to estimate what the likeli- hood of developing the endpoint are to have enough people in the trial," Dr. Klein explained. Evaluating AMD eye to eye July 2015 Considering what has happened to the patient's fellow eye can offer insight as to whether an eye with early AMD, such as the one on the left, is likely to become one with late AMD, such as the one on the right. Source: National Eye Institute CDC: Poverty level tied to severe vision loss In the news CDC: Poverty level tied to severe vision loss D istinct geographic patterns of severe vision loss prevalence were found at the county level in the U.S., according to a new report from the Centers for Disease Control (CDC, Washington, D.C.). The findings indicate "a significant correlation between severe vision loss and poverty for U.S. counties," the CDC said. Karen A. Kirtland, PhD, and colleagues said the CDC analyzed data from the American Community Survey to estimate county- level prevalence of severe vision loss (SVL) (being blind or having serious difficulty seeing even when wearing glasses) in the United States and to describe its geographic pattern and its association with poverty level. Among the findings: 77.3% of counties in the top SVL prevalence quartile (≥4.2%) were located in the South. SVL was significantly correlated with poverty (r=0.5); 437 counties were in the top quartiles for both SVL and poverty, and 83.1% of those counties were located in southern states. "A better understanding of the underlying barriers and facilitators of access and use of eyecare services at the local level is needed to enable the development of more effective interventions and policies, and to help planners and practitioners serve the growing population with and at risk for vision loss more efficiently," the authors said. EW

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