Comparing Treatments for Age-related Macular Degeneration: Safety, Effectiveness and Cost

Comparative effectiveness research (CER) has received widespread attention and federal funding because of its potential to inform and improve treatment decisions. Since 2005, patients and their ophthalmologists have faced a dilemma in treating age-related macular degeneration (AMD)—the leading cause of blindness in the United States. Two closely related drugs have produced dramatic improvements in vision; one has been rigorously tested for use in AMD patients, while the other has been rigorously tested for use in cancer patients, but is now widely used to treat AMD. One drug costs 40 times as much as the other. This Issue Brief summarizes a CER study comparing these drugs head-to-head, and provides the most definitive evidence to date about the safety and effectiveness of the two alternatives

Selective β-oxidation of α-sulfanyl amides

A selective β-oxidation of a series of α-sulfanyl amides to the corresponding β-oxo-α-sulfanyl amides is described. This selective efficient oxidation of an unfunctionalised methyl or methylene group occurs under mild conditions, involving three sequential transformations conducted without isolation of the intermediates. Critically neither the sulfur nor the reactive α-CH bond is affected in the overall process

Addition-substitution reactions of 2-thio-3-chloroacrylamides with carbon, nitrogen, oxygen, sulfur and selenium nucleophiles

Synthetically versatile conjugate addition of a range of carbon, nitrogen, oxygen, sulfur and selenium nucleophiles to the highly functionalised 2-thio-3-chloroacrylamides is described. The stereochemical and synthetic features of this transformation are discussed in detail. In most instances, the nucleophile replaces the chloro substituent with retention of stereochemistry. With the oxygen nucleophiles, a second addition can occur leading to acetals, while with the nitrogen nucleophiles, E-Z isomerism occurs in the resulting enamine derivatives. The ratio of the E/Z isomers can be rationalised on the basis of the substituent and the level of oxidation

Effects of Omega-3 Supplementation on Exploratory Outcomes in the Dry Eye Assessment and Management Study.

We report results from a multicenter, randomized clinical trial (N=535) of the effect of ω-3 supplementation, relative to placebo, on exploratory and minimally invasive outcome measures for moderate to severe dry eye disease

Impact of Dry Eye on Visual Acuity and Contrast Sensitivity: Dry Eye Assessment and Management Study.

SIGNIFICANCE:Identification of the association of specific signs of dry eye disease with specific visual function deficits may allow for more targeted approaches to treatment. PURPOSE:The purpose of this study was to explore the association of dry eye signs and symptoms with visual acuity (VA) and contrast sensitivity in the Dry Eye Assessment and Management study. METHODS:Baseline data from participants in the Dry Eye Assessment and Management study were used in this secondary cross-sectional analysis. Standardized procedures were used to obtain results on the Ocular Surface Disease Index (OSDI), high-contrast logMAR VA, contrast sensitivity, tear film debris, tear breakup time (TBUT), corneal fluorescein staining, meibomian gland evaluation, conjunctival lissamine green staining, and Schirmer test scores. Generalized linear models that included age, refractive error status, and cataract status were used to assess the association between VA and contrast sensitivity with OSDI score and each dry eye sign. The Hochberg procedure was used to account for multiple comparisons. RESULTS:Among 487 participants (974 eyes), worse VA was associated with worse mean score on the OSDI vision subscale (39.4 for VA 20/32 or worse vs. 32.4 for VA 20/16 or better; adjusted linear trend, P = .02); scores were not associated with contrast sensitivity. Severe meibomian gland plugging and abnormal secretions were associated with worse mean log contrast sensitivity (1.48 for severe vs. 1.54 for not plugged [P = .04] and 1.49 for obstructed vs. 1.57 for clear [P = .002], respectively). Longer TBUT was associated with better mean log contrast sensitivity (1.57 for TBUT >5 seconds and 1.51 for TBUT ≤2 seconds, P < .0001). CONCLUSIONS:Worse VA rather than worse contrast sensitivity drives vision-related symptoms in dry eye. Greater tear film instability was associated with worse contrast sensitivity

Postinjection Endophthalmitis in the Comparison of Age-Related Macular Degeneration Treatments Trials (CATT)

To describe the incidence and outcomes of endophthalmitis after intravitreal injections of anti-VEGF agents in the Comparison of Age-related Macular Degeneration Treatments Trials (CATT) and to assess the effect of use of prophylactic topical antimicrobials on incidence