The Top Ophthalmology Research Articles From 2020

Despite the COVID-19 pandemic, ophthalmology research has continued at an exciting pace. It is astonishing to see the number of submissions that are received to the journal Ophthalmic Surgery, Lasers and Imaging Retina, and this year was no exception. To close out this year, I am reviewing the most popular 5 articles from the journal this year as determined by the number of downloads and clicks. And despite the intense competition, please submit your articles to us for consideration in 2021 at

#5 – Pachychoroid disease in Practical Retina, April 2020.

Progression of pachychoroid neovasculopathy to aneurysmal pachychoroid neovasculopathy (polypoidal choroidal vasculopathy) in the left eye of a 65-year-old Asian female. Color photograph (A) shows a central retinal pigment epithelium (RPE) disturbance with scattered drusenoid RPE lesions (pachydrusen). En face swept-source optical coherence tomography (SS-OCT) angiography (B, C) corresponding to the red square in A shows an aneurysmal lesion (white arrow) evolving from a branching vascular network that is composed of type 1 (sub-RPE) macular neovascularization. The magenta lines in the corresponding SS-OCT B-scans (D, E) show the segmentation boundaries used to create B and C. The yellow arrow in E indicates the aneurysmal lesion. The green arrow in A indicates the location and direction of the SS-OCT B-scans.

K. Bailey Freund in the column Practical Retina incorporates the findings from advancements in technology to summarize the latest findings in pachychoroid disease. No single person has done more to advance our understanding of this disease state than Dr. Freund. Briefly summarized, the diagnosis of pachychoroid has been established by the following features:

  1. Increased choroidal thickness co-localizing with areas of fundus abnormalities, which may be focal or diffuse
  2. Clinically visible dilated choroidal vessels or reduced fundus tessellation in eyes with diffuse choroid thickening
  3. Attenuation of the inner choroid in areas of fundus pathology
  4. ICGA choroidal hyperpermeability and reduced inner choroidal flow signal shown with optical coherence tomography angiography
  5. Pachyvessels (dilated veins of Haller’s layer) often co- localizing with overlying disease manifestations
  6. Drusenoid RPE lesions (recently renamed “pachydrusen” by Spaide)

#4 – Private Equity’s Game Plan And Why It Should Matter To Us, August 2020

Veeral Sheth and Dilsher Dhoot in another column of Practical Retina discuss the rapid acquisitions of private equity in ophthalmic and retina practices. While there are advantages to private equity including efficiencies through economies of scale, negotiating better contracts, and standardization of practices, leading to better and more efficient patient care, there is certainly another side to consider. However given the current market forces like COVID-19 and possible most favored nation drug pricing on the horizon, Drs Sheth and Dhoot confirm that the fate of these PE deals in the next 10 years is uncertain. As the first wave of PE firms begin to exit, they predict a shift away from more traditional hospital-physician alignment to alternative types of integration such as the sale of these initial investments to large health care payors.

#3-Long-Term Vision Outcomes in Patients With DME and a Limited Early Anti-VEGF Response, April 2020

I authored the third most popular paper this year in OSLI-Retina examining those with limited early response to Anti-VEGF treatment for diabetic macular edema. A common misconception in retina is that limited early response (within the first three injections) has a poor long-term visual prognosis. This was initially verified with as-needed treatment within Protocol I by the DRCR Retina Network Study. However, we hypothesized that consistent treatment would overcome these limited responders. We retrospectively evaluated the RISE and RIDE data from the pivotal studies on Ranibizumab for DME to evaluate this concept and found while Protocol I had patients who developed “swimming lanes” whereby early limited response predicted long term outcome, RISE and RIDE demonstrated consistent improvement in vision with a mandated treatment approach.

Mean best-corrected visual acuity (BCVA) change over 36 months in patients treated with ranibizumab (RBZ) 0.3 mg in RIDE/RISE (left panels) and RBZ 0.5 mg in Protocol I (right panels) who (A) gained < 5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters from baseline at Month 3; (B) gained 5 to 9 ETDRS letters from baseline at Month 3; and (C) gained ≥ 10 ETDRS letters from baseline at Month 3. RIDE/RISE observed data; sample size varied over time. = Diabetic Retinopathy Clinical Research Network; EARLY = Early Anti- VEGF Response and Long-term Efficacy

#2 – Social Cost of Blindness Due to AMD and Diabetic Retinopathy in the United States in 2020, April 2020

Andrew Moshfeghi, MD estimated the social cost of blindness in the US due to exudative age-related macular degeneration, diabetic macular edema, and proliferative diabetic retinopathy in 2020. This article, also recognized as a top abstract at the Retina World Congress, found the associated costs for these disease states combined translated to a total societal cost of $20 billion in 2020 and it is estimated to triple by 2050. Interestingly while these costs are substantial, a minority of the burden was attributed to the direct healthcare costs like drug charges and insurance fees.

Projected cases of blindness in exudative AMD, DME, and Proliferative Diabetic Retinopathy

#1 – SAFER-ROP: Updated Protocol for Anti-VEGF Injections for Retinopathy of Prematurity, July 2020

And the top article from OSLI-Retina 2020 was the SAFER-ROP protocol for anti-VEGF injections for retinopathy of prematurity. In this article by Beck and colleagues, they propose the acronym SAFER to describe best practices when treating these patients. SAFER stands for (S)hort needle (4-mm length), (A)ntiseptic/ antibiotic (5% to 10% topical betadine), (F)ollow- up (48 to 72 hours post-injection), (E)xtra attention to detail (clean environment, injection site 0.75 mm to 1.0 mm posterior to limbus), and (R)echeck (1 to 2 weeks following injection and until mature vascularization or laser). With the use of this protocol, the authors hope to minimize the complications that can occur with ROP following anti-VEGF treatment.

Wishing you all a happy, healthy, and prosperous new year!

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