Ophthalmic Opinion - Vol 6 No 2 - 2023

Introduction

Reflections on current intravitreal therapies

Overall, about 10% of patients in a study in The Netherlands were classified as non-responders to any anti-VEGF therapy. Inadequate response to anti-VEGF therapy is described by the Royal College of Ophthalmology as the presence of fluid in any compartment after a three-month loading phase. In the CATT trial, persistence of intra-retinal fluid at greater than 80% of visits between month 1 and month 12 was deemed an inadequate or sub-optimal (anatomical) treatment response.

• A good visual (functional response) is described as greater than 5 ETDRS letters gain.
• Sub-optimal/partial response is described as 0-5 ETDRS letters gain.
• Poor response is described as 0-4 ETDRS letters loss.
• Non-response is described as greater than 5 ETDRS letter loss. 

Adult strabismus management

Over the last two decades, there has been an upward trend in the incidence of adult strabismus attending strabismus clinics. In children, approximately 1% have strabismus, however, according to the American Academy of Ophthalmology’s recently published Adult Strabismus Preferred Practice Pattern, strabismus is common among adults, with an estimated incidence of 4% in people over the age of 15 years.

Case Study:

Bilateral sequential optic disc swelling evolving to a diagnosis of idiopathic intracranial hypertension

On general examination an elevated body mass index with short stature was noted. Ocular examination was remarkable for a brisk RAPD of her left eye with Snellen best corrected visual acuity (VA) 6/5 in her right eye and 6/60 left eye. Anterior segment examination of both eyes were unremarkable. Fundus exam of her left eye was significant for a grossly swollen optic nerve head, parapapillary oedema and a large star – shaped configuration of exudates radiating from the fovea. There was an associated vasculitis complicated by an inferotemporal vein occlusion with accompanying scattered retinal haemorrhages in the affected sector.