Each year, it is astonishing to see the number of submissions that are received by 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 five articles from the journal as determined by number of downloads and clicks. And despite the intense competition, please submit your articles to us for consideration in 2021
#5 - Pachychoroid disease in Practical Retina, April 2020.
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:
Increased choroidal thickness co-localizing with areas of fundus abnormalities, which may be focal or diffuse;
Clinically visible dilated choroidal vessels or reduced fundus tessellation in eyes with diffuse choroid thickening;Attenuation of the inner choroid in areas of fundus pathology;
ICGA choroidal hyperpermeability and reduced inner choroidal flow signal as shown with optical coherence tomography angiography;
Pachyvessels (dilated veins of Haller's layer) often co-localizing with overlying disease manifestations; and
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, MD, MBA, and Dilsher Dhoot, MD, 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 that lead 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 private equity deals in the next 10 years is uncertain. As the first wave of private equity 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, which examines 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 study by the DRCR Retina Network. 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 that 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.
#2 - Social cost of blindness due to AMD and diabetic retinopathy in the United States in 2020, April 2020
Andrew Moshfeghi, MD, MBA, estimated the social cost of blindness in the U.S. 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 health care costs like drug charges and insurance fees.
#1 - SAFER-ROP: Updated protocol for anti-VEGF injections for retinopathy of prematurityJuly 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 Kinley D. Beck, MD, 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 hours 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.