A summary of the results from numerous randomized clinical trials in eye care for students and clinicians

Koh, Len V

CommonKnowledge

Pacific University
CommonKnowledge
Faculty Scholarship (COO) College of Optometry
2015
Evidence Based Eye Care
Len V. Koh
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Recommended Citation
https://clinicaltrials.gov
Evidence Based Eye Care
Description
A summary of the results from numerous randomized clinical trials in eye care for students and clinicians.
Keywords
Randomized clinical trials, Optometry, Ophthalmology, Evidence based, Ocular disease
Disciplines
Optometry
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This poster is available at CommonKnowledge: http://commons.pacificu.edu/coofac/31
Evidence Based Eye Care
Amblyopia ATS 1
3‐7yo (VA20/40‐20/100)
1% atropine & daily 
patching >6 h improved 
VA @ 6 months
ATS 2
3‐7yo (VA20/40‐20/80)
Patching
2h = 6h (moderate)
6h = FT (20/100‐20/400)
ATS3
7‐13yo benefit from 
patch/atropine
13‐18yo benefit from 
patch w/o prior Tx
ATS4
<7yo (VA20/40‐20/80)
Daily = Weekend‐only
atropine
ATS5
2h/d X 5 weeks work
ATS6
Near activities does not 
improve VA
ATS7
3‐10yo (bilateral 
refractive amblyopia)
Spectacles improve to 
20/25+ within 1 yr
ATS9
7‐12yo
2h patching = weekend
only atropine
ATS10
Bangerter filters = 
patching
Myopia Control LORIC Study
35 children (7‐12yo)
2 years
AL  0.29 (CRT) vs 
0.54mm
K Reshaping
40 children (8‐11yo)
2 years
AL 0.16mm annually
Dual‐Focus Soft CL
40 children (11‐14yo)
20 months 
+2.00 center distance
Progression  30%
CL  Peripheral 
Hyperopia
45 Children (7‐14yo)
Multifocal CL (CIBA)
33% less AL growth
Multifocal CL
27/40 children (8‐11yo)
2 years 
Proclear MF”D” +2.00
50% less progression
ROMIO Study
78/102 kids (6‐10yo)
2 years
Ortho‐K: 43% less AL 
growth
ATOM 1
364 kids (6‐12 yo) 
2 years OD/OS
1% atropine nightly
‐1.20D vs ‐0.28D
ATOM 2
400 kids (6‐12yo)
2 years atropine qhs OU
0.5% = ‐0.30D
0.1% = ‐0.38D
0.01% = ‐0.49D
Dry Eye
& MGD 
Workshop
DEWS‐Questionaire
OSDI
Mild 13‐22
Moderate 23‐32
Severe 33‐100
DEWS‐Tests
Tearlab ≥ 312 mOsm/L
TBUT ≤ 10 sec
Schirmer Test ≤ 10 mm
Dry Eye Management
Artificial Tears
Eyelid therapy
Anti‐inflammatories
Tetracyclines
Dry Eye Management
Punctal plugs
Secretogogues
Serum
Scleral contact lenses
MGD
Eyelid hygiene
Eyelid warming (>4min 
bid) + firm massage
Artificial Tears
MGD
Topical azithromycin
Tetracyclines
Antiinflammatory
therapy
Ocular TRUST (Tracking Resistance in U.S. Today)
MRSA susceptibility to fluoroquinolones = 15.2%
MRSA: Bactrim/Septa 160/800mg po BID X 10d
Periocular MRSA infections: IV vancomycin
Contact Lens 
Wear
Cornea O2 Requirements
Equivalent O2 % (EOP) > 10% for no K edema
Highest EOP from CL ~ 16% EOP
Dk/t = 24, daily wear w/o K edema
Dk/t = 87, extended wear w 3‐4% edema 
Prevalence of Keratitis
Annual incidence (AI) = 
4.1 per 10,000 dailes
AI = 20/10,000 for EW
Steroids for K Ulcers
1. Vigamox q1h 2d, q2h‐
qid 3wks
2. (+) 1% pred PO4 qid
1wk, bid 1wk, qd 1wk
Same BCVA @ 3 mo
Keratoconus
(CLEK)
CLEK Study
Etiology: freq rub 50%, 
FHx 18%
Associations: Allergies 
(53%), Asthma (15%), 
Atopic dermatitis (8%)
CLEK Study
74% wore RGPs, 64% 
also wore glasses
K scarring: 15% over 5 
years.
CL  risk of K scarring
CLEK Study
10% had unilateral PK in 
8 years.
2.5% had bilateral PK in 
8 years
Herpetic Eye 
Disease Study
(HEDS)
HEDS I
Stromal keratitis: 
Pred + Viroptic
no additional benefit w 
oral acyclovir
HEDS II
Oral acyclovir (400mg 
BID X 1 yr)  recurrence 
of HSK by 41% & 
stromal keratitis by 50%
Beaver DAM Eye Study
5000 (43‐84yo)
Cataracts and AMD link 
to smoking & sun 
exposure (400‐480nm, 
blue) 
Blue Mountain Eye 
Study (BMES)
49‐97yo
Nuclear cataract:
smoking, alcoholics.
BMES
Cortical cataract: 
diabetes, vascular dz
PSC: steroids, smoking, 
sun, diabetes, myopia
BMES
AMD: age, female,
smoking
Glaucoma: age, 
diabetes, fhx,
50% undx glaucoma
Chesapeake Bay 
Watermen Study
Chronic UV‐B exposure 
3.9X  cortical cataract
Salisbury Eye Study
African Americans had 
more cortical cataract.
Caucasians had more 
NSC and PSC.
Glaucoma AGIS
IOP<18, less risk of progression over 7 years
First 1.5yr Tx is the most critical
IOP<15 no VF progression for 15 yrs
16% experienced VFs are artefacts
CNTGS
TP 30% reduction
Tx (+) progression, (+) 
disc heme, (+) migraines
EMGT
45% Tx vs 62% control progress over 6 yrs
Tx  risk of progression by 50%
1mmHg  10% progression
5 pt treated for 1 pt benefit
CIGTS
Drugs  IOP 38%
Filtration  IOP 46%
Drugs first then 
filtration surgery
ICEST
Latanoprost & 
pilocarpine > timolol or 
Cosoft for PXG
LALES
OHTN & glaucoma are 
higher than non‐
Hispanic whites, similar 
to African American
Macular 
Degeneration
AREDS I
4757 (55‐80yo): 500 mg vit C, 400 IU vit E, 
15mg β‐carotene, 80mg Zn, 2mg Cu
Severe AMD: 25% progression &
19% in vision loss
AREDS II
4203(50‐85yo): 10mg lutein, 2mg zeaxanthin
(safer than β‐carotene)
350 mg DHA + 650 mg EPA; lower dose of zn
No further reduction in AMD progression
CATT
Avastin = Lucentis
PRN dosing = Monthly
Avastin is effective and 
more affordable
OHTS
10% of OHTN will develop glaucoma is untreated
19.6 ‘at‐risk’ Tx to prevent 1 ‘at‐risk’ from POAG over 5 yeas
Risk factors: IOP,  vertical C/D, CCT, Ethnicity
https://www.deverseye.org/grc/ (risk calculator)
Diabetic Eye 
Disease
DR Grading Scale
Mild NPDR: >1MA, 5% PDR@ 1yr, f/u 1yr
Moderate NPDR: 12‐27% PDR @ 1yr, f/u 6‐8 mo
Severe NPDR: ‘4‐2‐1’: MA, hemes 4 quad, venous 
beading 2 quad, IRMA 1 quad, 
52% PDE @ 1yr, f/u 3‐4 mo
PDR: NVD, NVE or vitreous hemorrhage
DCCT
1441 DM1 (13‐39yo)
Intensive: A1C < 6
Retinopathy  54‐76%
Neuropathy  60%
Nephropathy  50%
DRS
PRP & focal treatment 
for NVI & NVE
Photocoagulation 
(argon/xenon)  risk of
severe vision loss 
by > 50%
EDTRS
CSME: retinal thickening within 500um (1/3DD) of 
fovea; Hard exudates within 500um  of fovea; 
retinal thickening ≥ 1DD  within 1DD of fovea.
Focal photocoagulation effective in CSME
Consider PRP for severe NPDR & early PDR
Perform PRP for high‐risk PDR
UKPDS
5102 (T2DM)
Tight BS control, 25% 
vascular complications
Tight BP control, 34% 
vascular complications
LALES
4‐year incidences
DR 34%
Worsen DR 38.9%
Better DR 14%
ME 5.4%
CSME 7.2%
Venous 
Occlusions
BVOS
Laser Tx  neovasc & 
vitr hemes
Grid laser, effective for 
macular edema (ME)
CVOS
PRP for NVI
Grid laser for ME
SCORE
Grid laser for BRVO ME
Intravitreal Kenalog
1mg for CRVO ME
BRAVO
0.3 mg and 0.5 mg 
ranibizumab, effective 
for BRVO ME
CRUISE
0.3 mg and 0.5 mg 
ranibizumab, effective 
for CRVO ME
Optic Neuritis ONTT
Oral prednisone, ineffective,  recurrences
IV methylpredx3d, oral predx11d, faster recovery
Oral placebox14d, continual recovery over 1 yr
5‐year recurrence: 28%
https://clinicaltrials.gov Pacific University College of Optometry lenvkoh@pacificu.edu © 2015


Evidence Based Eye Care

http://commons.pacificu.edu/cgi/viewcontent.cgi?article=1031&context=coofac

Evidence Based Eye Care

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