Effect of Funding Source on "Spin" in Studies of Ocriplasmin Therapy for Vitreomacular Traction and Macular Hole

To examine the relationship between industry funding and "spin" in randomized controlled trials (RCTs) and meta-analyses investigating use of ocriplasmin for patients with vitreomacular traction (VMT) and macular hole (MH). In this study, we examined all PubMed and Ovid MEDLINE RCTs and meta-analyses published in journals with impact factor ≥2 investigating effectiveness of ocriplasmin use for VMT and MH. The main outcome measure was correspondence between the studies' main statistical outcome and their abstract conclusion wording. Each article was reviewed by three independent observers and was evaluated for source of funding, industry co-authorship, study methodology, statistical significance of main outcome measure, correspondence between results of main outcome measure and abstract conclusion, and journal impact factor. Funding was determined by public disclosure. Discrepancies were resolved by consensus. Twelve studies met inclusion criteria, of which 11 were industry funded and 1 was non-industry funded; 11 (91.67%) showed correspondence between outcome and abstract conclusion, without difference between industry-funded and non-industry funded publications or between publications in journals with high impact factor (≥3) versus low impact factor (≥2 and <3). In RCTs and meta-analyses of ocriplasmin for VMT and MH, our results suggest that neither industry funding nor journal impact factor affected the rate of "spin" in study conclusions. This study helps physicians understand what challenges they face when learning about a newer, less-established drug

Evaluation of Available Online Information Regarding Treatment for Vitreous Floaters

To assess the quality, content, and readability of information available online on vitreous floater information. Cross-sectional study. Not applicable. Websites were generated using a Google search of "vitreous floaters treatment" and "[State]" and were analyzed using a standardized checklist of 22 questions. Readability was assessed using the Flesch Reading Ease score. Websites met qualification criteria if they represented U.S.-based institutions, if they provided clinical care and addressed vitreous floater treatment on their website. Of the 1,065 websites screened, 456 were included. Of these, 406 (89%) were private institutions, 24 (5.3%) were academic, and 26 (5.7%) were a combination of private and academic. The average readability score correlated to a 10th-12th grade reading level. Vitreous floater treatment was discussed on 283 (62.1%) websites and 63 (21.8%) websites discussed potential side effects. Google rank was inversely correlated with the depth of explanation (r = -0.114, = .016). Observation was the main treatment recommended (55.8%, n = 158), followed by laser treatment (27.6%, n = 78), no specific treatment recommendation (11.3%, n = 32), and vitrectomy (5.3%, n = 15). Centers with vitreoretinal surgeons were 16.43 times more likely to recommend vitrectomy than those without vitreoretinal surgeons ( < .001). Online information about vitreous floater treatment is variable, and the material is at a higher than recommended reading level for health information. While treatment was discussed by nearly two thirds of websites, less than a quarter mentioned possible complications, and treatment recommendations varied significantly depending on physician training

Association Between Early Sjögren Markers and Symptoms and Signs of Dry Eye

Animal models suggest that early markers of Sjögren syndrome (EMS)-antibodies against salivary protein 1, parotid secretory protein, and carbonic anhydrase 6 (CA6)-are more accurate signals of early Sjögren when compared with classic markers (anti-Ro and anti-La). To further understand the relationship between EMS and dry eye (DE), we compared symptoms and signs of DE in subjects who tested positive versus negative for EMS. In this cross-sectional study, patients at the Miami Veterans Affairs Eye Clinic who were tested for EMS underwent a standard ocular surface examination. Indications for EMS testing included DE symptoms in combination with dry mouth symptoms, low tear production, corneal staining, or a Sjögren disease-associated autoimmune disease. Statistical tests performed were the χ test, Fisher exact test, independent sample t test, and Spearman correlation. Seventy-three percent of 44 patients tested positive for 1 or more EMS. CA6 IgG was most frequently elevated, followed by CA6 IgM and parotid secretory protein IgG. EMS-positive versus EMS-negative subjects were more likely to escalate DE treatment past artificial tears to topical cyclosporine (n = 32, 100% vs. n = 9, 75%, P = 0.02). There were no demographic or comorbidity differences between EMS-positive and EMS-negative subjects, and marker levels did not correlate with more severe tear film measures. Most of the individuals with DE tested positive for 1 or more EMS antibodies, including men and Hispanics. Future studies will be needed to understand how to incorporate EMS data into the care of an individual with DE

ISCHEMIC INDEX AND NEOVASCULARIZATION IN CENTRAL RETINAL VEIN OCCLUSION

Purpose: To explore the association of angiographic nonperfusion with anterior segment and posterior segment neovascularization in central retinal vein occlusion (CRVO). Methods: An imaging database at one institution was searched for the diagnosis of central retinal vein occlusion. Ultra wide field fluorescein angiograms were graded for image quality, the presence of retinal neovascularization, and the quantity of nonperfusion; an ischemic index (ISI) was calculated. Charts were reviewed to exclude eyes with previous treatment and to determine which eyes had anterior segment or posterior segment neovascularization on the day of the angiogram. Time from onset to presentation could not accurately be ascertained. Results: In a 39-month period, there were 69 eyes that met inclusion criteria. The mean ISI was 25% (SD, 26%; range, 0-100%), and 15 eyes (21%) with neovascularization had a mean ISI of 75% (range, 47-100%) compared with eyes without neovascularization that had an ISI of 6% (range, 0-43%). Ischemic index significantly correlated to neovascularization, and eyes that had evidence of neovascularization had an ISI >45% (P < 0.0001). Conclusion: Ultra wide field fluorescein angiography provides visualization of nonperfusion in eyes with central retinal vein occlusion. Eyes with neovascularization on the day of the angiogram were found to have significantly larger areas of retinal nonperfusion compared with eyes without neovascularization. A prospective study is indicated to know if early treatment of peripheral retinal nonperfusion in CRVO improves outcomes. RETINA 31:105-110, 201