Major Studies 1 Flashcards
HEDS study (Herpetic eye disease study) done in 2 phases. Answers the questions:
- What is the role of topical steroids in treating HSV stromal keratitis
- What is the role of oral acyclovir
- Topical steroids (prednisolone) for stromal keratitis improves recovery/recurrence compared to trifluridiine alone.
- No added benefit to adding oral acyclovir to treat stromal keratitis when patient taking topical antiviral and topical steroid. (however still commonly used, particularly when suspected systemic infection or necrotizing keratitis)
- Oral acyclovir probably benefit for treating HSV iridocyclitis on patients already on topicl steroid and topical antiviral (for prophylaxis) although numbers too small.
- No benefit of adding oral acylcovir to topical antiviral treatment in preventing epithelial keratitis from progressing to stormal/AAU
- Acyclovir 400 bid prevents recurrence by 41% at one year and prevents recurrence/progression to stromal keratitis by 50%.
OHTS (Ocular hypertensive treatment study) Quesiton: Does treatment of OHT prevent POAG?
Findings included:
- Risk Factors: Race, thin CCT, age, high IOP, c/d ratio, PSD in humphrey visual field
- Ocular hypertension may benefit from topical antihypertensives (9.5% of observation developed POAG compared to 4.4% from treatment group at 60 months)
- Risk of developing POAG in treatment vs oberservation diverged in original study but there was no further divergence once the observation group began treatment.
CIGTS (Collaborative initial glaucoma treatment study)
Question: Which is better, medical or filtration surgery on initial diagnosis of POAG?
- Similar long term results between the two
- If more severe POAG on presentation, filtering surgery may be best
- If diabetic, medical therapy may be best
- Aggressive IOP reduction good (38% (medical)-(46% surgery) in this trial)
- Cons to surgery include post-op local eye discomfort/comlipcations, increased risk for cataract surgery
EMGTE (Early manifest glaucoma trial essentials)
Question: What is the difference in OAG progression with initial reduction of IOP vs observation in mild to moderate glaucoma patients?
- Treatment of early glaucoma decreases risk of progression by half
- Risk Factors: higher IOP, age, frequent disc hemorrhages
- each 1mmHG IOP reduction at the first f/u visit reduced risk of progression by 10%
AGIS Essentials (Advanced glaucoma intervention study) Question: For advanced POAG patients which sequence of intervention is best, Laser treatment-trab-trab, or trab-laser-trab? Is there a difference between whites and blacks?
Results:
- Black did better with Laser-trab-trab sequence
- Whites did better with Trab-laser-trab sequence
Diabetic Retinopathy Study
Questions:
- Does laser therapy help in PDR?
- Is Argon or Xenon laser better?
Results:
- . Laser treatment reduces risk of progression to severe visual loss by 50% compared to no laser treatment.
- Both laser treatments were efficacious
- high risk PDR definitely benefited from laser treatment.
Conclusions:
1.. Early PRP is recommended in high risk PDR
Helpful way to rememember DRS is about PDR is that both have 3 letters
COMS (Collaborative Ocular Melanoma Study):
Divided into COMS Large (large melanomas), COMS Medium, and COMS small:
Questions:
- COMS Large: Does enucleation alone or enucleation with external beam radiation before hand have better survival rates?
- COMS Medium: Does enucleation or brachytherapy have improved mortality in medium sized melanomas
- COMS Small: What is the melanoma specific mortality in small melanomas that were observed?
- COMS Large: No difference in enucleation vs enucleation with external radiation therapy before
- No difference in outcomes in enucleation vs brachytherapy in medium sized melanomas
- Mortality rate at 5 years was 1%
AREDS2
Question: to determine if 10mg lutein, 2mg zeaxanthin, and omega-3 have an effect on advancement of AMD. Also to see if reducing zinc to 25 from 80mg has an effect on AMD advancement.
- 10mg lutein and 2mg zeaxanthin reduce the risk of AMD advancement
- Omega-3 have no effect on AMD advancement
- lower dose of zinc (25) is just as effective as 80
ETDRS (Early Treatment Diabetic Retinopathy Study)
Questions:
- Is photocoagulation effective for treating DME?
- Is photocoagulation effective for treating diabetic retinopathy?
- Is ASA effective for preventing DR?
Results:
- Photocoagulation is effective for DME
- Photocoagulation for DR was effective for severe DR with VA
CRUISE (Central Retinal Vein OcclUsIon)
Question: Is ranibizumab efficacious in treatment of ME in CRVO?
Yes, at six months there was improvement in ME and VA over sham
ONTT (Optic Neuritis Treatment Trial)
Objective: To evaluate the role of corticosteroids in the treatment of unilateral optic neuritis
Conclusion:
- IV steroids did not prevent progression to MS (did slow it though) nor did it prevent recurrence (sped recovery though)
- PO steroids had worse recurrence rate
- About 30% rate of progression to MS within 4 years (women and associated neurologic symptoms risk factors)
