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Purpose To study the natural history of optical coherence tomography (OCT) imaging-based findings seen in non-exudative age-related macular degeneration (neAMD) and model their relative likelihood in predicting development of incomplete retinal pigment epithelium and outer retinal atrophy (iRORA), complete retinal pigment epithelium and outer retinal atrophy (cRORA), and neovascular AMD (nAMD). Methods Retrospective chart review was performed at two academic practices. Patients diagnosed with neAMD for whom yearly OCT scans were obtained for at least 4 consecutive years were included. Baseline demographic, visual acuity, AREDS staging, and OCT data were collected. OCTs were assessed for the presence or absence of eleven features previously individually associated with progression of neAMD, both at baseline, and on all subsequent follow-up scans. Likewise, charts were reviewed to assess visual acuity and staging of NEAMD at all follow-up visits. A multivariate regression analysis was constructed to determine predictors of iRORA, cRORA, and nAMD. Results A total of 107 eyes of 88 patients were evaluated. Follow-up included yearly OCTs obtained over at least 4 consecutive years follow-up (range: 50-94 months). During the follow-up period, 17 eyes progressed to iRORA while 25 progressed to cRORA and 16 underwent conversion to nAMD. Predictors of conversion to iRORA and cRORA included integrity of the external limiting membrane (p = 0.02), the ellipsoid zone (p = 0.01), and the cone outer segment line (p = 0.003) and the presence of intraretinal hyporeflective spaces (p = 0.009), drusen ooze (p = 0.05), and drusen collapse (p = 0.001). OCT features predictive of conversion to nAMD included outer nuclear layer (ONL) loss (p = 0.01), presence of intraretinal (p = 0.001) and subretinal (p = 0.005) hyporeflective spaces, and drusen collapse (p = 0.003). Conclusion Of these multiple factors predictive of progression of neAMD, the OCT feature most strongly correlated to progression to iRORA/cRORA was drusen collapse, and the feature most predictive of conversion to nAMD was the presence of intraretinal hyporeflective spaces.

Age-related macular degeneration (AMD) is one of the most common causes of severe vision loss in the developed world. Advanced forms of AMD are seen in primarily 2 types, exudative AMD involving the presence of choroidal neovascularization and nonexudative or dry AMD with geographic atrophy. For the latter, the combination of vitamins and minerals known as the Age-Related Eye Disease Study-2 formulation has been shown to decrease the rate of progression of nonexudative to exudative AMD, as no other treatments are currently approved for nonexudative AMD. This review will highlight upcoming treatments for nonexudative AMD. Six upcoming agents have shown results at least in the 2A phase. This includes intravitreal agents that are inhibitors of integrin (Risuteganib), intravitreal agents that disrupt the complement pathway (Zimura, APL-2), neuroprotective implants (Brimonidine DDS), a subcutaneous injectable (Elamipretide), and photobiomodulation (Valeda Light Delivery System).

Age-related macular degeneration (AMD) is one of the most common causes of vision loss. Advanced forms of AMD are seen in primarily 2 types—neovascular AMD (nAMD) with the presence of choroid neovascularization and nonneovascular AMD (nnAMD) with geographic atrophy. Although there are 4 anti-vascular endothelial growth factor drugs either widely used or approved for the former, there are no current treatments for the latter. This review will highlight upcoming treatments for AMD currently in clinical trials. For nAMD: Abicipar pegol, an intravitreal anti-vascular endothelial growth factor based on designed ankyrin repeat proteins (DARP) in protein, is currently pending approval. Conbercept and Faricimab, 2 intravitreal anti-growth factors, are currently in phase 3. Nine other upcoming agents have at least produced results in the 2A phase including intravitreal injections (KSI-301, OPT-302, RGX-314, ICON-1, and DE-122), depot (GB-102), drug reservoir (PDS), topical drops (PAN-90806), and oral formulations (AKST4290). We summarize all the newer molecules.

Age-related macular degeneration (AMD) is one of the most common causes of severe vision loss in the developed world. Advanced forms of AMD are seen in primarily 2 types, exudative AMD involving the presence of choroidal neovascularization and nonexudative or dry AMD with geographic atrophy. For the latter, the combination of vitamins and minerals known as the Age-Related Eye Disease Study-2 formulation has been shown to decrease the rate of progression of nonexudative to exudative AMD, as no other treatments are currently approved for nonexudative AMD. This review will highlight upcoming treatments for nonexudative AMD. Six upcoming agents have shown results at least in the 2A phase. This includes intravitreal agents that are inhibitors of integrin (Risuteganib), intravitreal agents that disrupt the complement pathway (Zimura, APL-2), neuroprotective implants (Brimonidine DDS), a subcutaneous injectable (Elamipretide), and photobiomodulation (Valeda Light Delivery System).

Introduction Visual acuity (VA) testing is a vital screening tool for the assessment of ocular function. The coronavirus 2019 pandemic has caused an immediate need for synchronous telemedicine in all specialties, including ophthalmology. While a plethora of mobile VA applications exist, there is no consensus as to what technology can accurately and reproducibly measure a patient’s vision at home. Methods A systematic literature search was performed in April 2020 using PubMed, Embase and Medline, identifying English publications from 2010 to 2020 on remote VA tests: 4338 articles were identified and 14 were ultimately included in the review. Results Of those 14, the highest quality studies, best reproducibility and correlation with in-clinic acuities measured were found using the Peek Acuity application. The studies included patients throughout the world aged 3–97, with and without correction, with known ocular pathology. The Peek Acuity studies measured distance vision on a Samsung Galaxy S3 with a mean difference of 0.055 Logarithm of the Minimum Angle of Resolution (LogMAR) for home testing compared with the Early Treatment Diabetic Retinopathy Study (ETDRS). Test–retest variability was ±0.029 LogMAR for 95% confidence interval limits. Discussion There can be one or more lines of variability in vision testing in a clinical setting using reference standard ETDRS and clinical standard Snellen charts. Test–retest reliability is not perfect even on standard clinical charts (variation up to 0.48 LogMAR). Of the technologies reviewed, Peek Acuity home testing had the greatest correlation with ETDRS clinical vision and high test–retest reliability. Peek Acuity performed no worse than Snellen and ETDRS charts.

To evaluate natural history of drusen ooze and its role as a predictor for progression of dry age-related macular degeneration (AMD) longitudinally. Multi-centric retrospective observational case series of 72 eyes (72 patients) with dry AMD with a minimum follow-up of 4 years. Drusen types were identified on volume scans on optical coherence tomography (OCT) and were characterized for occurrence of drusen ooze at baseline until last visit. Drusen ooze was defined as hyperreflective dots overlying a collapsing drusen or pseudodrusen, or hyperreflective RPE above drusen or isoreflective dots at the level of outer nuclear layer. The consequent incidence of incomplete retinal pigment epithelium and outer retinal atrophy (iRORA), complete retinal pigment epithelium and outer retinal atrophy (cRORA), and neovascular AMD (nAMD) were evaluated statistically. In total, 72 eyes with a mean follow-up of 68.89 (± 25.57 months) were studied. At presentation, 11 eyes (15.3%) had a single drusen type, whereas 61 eyes (84.7%) had mixed drusen. Reticular pseudodrusen were most common (84.7%) followed by soft drusen (66.6%). Drusen ooze was seen in 47 eyes (65.2%) at presentation. The presence of drusen ooze at baseline (p < 0.01) and baseline best corrected visual acuity (BCVA) (p = 0.04) significantly correlated with development of iRORA and cRORA. In total, 14 eyes progressed from iRORA to cRORA over a mean follow up of 29.14 (± 24.33) months. Odds of progression to iRORA or cRORA were 20.3 times greater for eyes with drusen ooze at baseline (95% C.I., 4.4–94.2). In dry AMD, drusen ooze is a useful sign for predicting progression to iRORA and cRORA over time.

An important goal of advancements in ocular imaging algorithms and devices has been to improve the image acquisition and resolution of deeper ocular tissues, namely the choroid and its vasculature that are otherwise inaccessible to direct clinical examination. These advancements have contributed to the understanding of the pathophysiology of a number of ocular inflammatory conditions. We focus on the imaging characteristics of clinical conditions where imaging the choroid has improved or radically changed the understanding of the disease, has helped in differentiation of phenotypically similar but distinct lesions, and where imaging features have proven vital for monitoring disease activity. The last two decades have seen some major developments in ocular imaging relevant to uveitis. The current review addresses both the imaging characteristics and their interpretation on conventional modalities such as fundus photography, fluorescein angiography, indocyanine green angiography, and fundus autofluorescence and the recent additions in the armamentarium including optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography.

Introduction More than 400 million people suffer from visual impairment globally, with more than half due to uncorrected refractive error. Autorefraction (AR) is the most common examination performed prior to prescribing glasses. As technology advances, so has the accuracy and number of portable autorefractors available. Portable technology has become acutely important with the coronavirus disease 2019 pandemic and the conversion of in-person clinical evaluations to remote telemedicine encounters. Patients and providers want to do as much as possible remotely. The aim of this study was to conduct a systematic literature review of the accuracy and effectiveness of available portable automated refractors compared to the current standard of care, subjective refraction (SR). Methods A literature search of PubMED, Embase and ClinicalTrials.gov 97 unique publications in English on portable autorefractors. Twelve studies comparing a portable AR device to at least one form of SR were systematically included in this review. Results There were four portable autorefractors (Netra, Quicksee, Retinomax and SVOne) studied against SR. There was high patient acceptance of glasses prescriptions by the Quicksee alone, with 87% subjects seeing the same or better than SR. Quicksee was more accurate than Netra and Retinomax. SVOne was preferred over Netra and outperformed Retinomax in multiple measures, despite Retinomax being the fastest test. Discussion There are numerous portable autorefractors available, but few were compared against SR. Quicksee and SVOne are the most accurate and patient-preferred devices. Quicksee was the most accurate, and it performed clinically the same as SR in some reports.

The viologen N,N′-dicyanomethyl-4,4′-bipyridinium·2PF6 was found to induce an aza-Diels–Alder reaction of N-arylimines with N-vinylpyrrolidinone or N-vinylcarbazole, producing tetrahydroquinoline derivatives with high cis/trans selectivities and yields.

The viologen N,N′-dicyanomethyl-4,4′-bipyridinium·2PF6 was found to induce an aza-Diels–Alder reaction of N-arylimines with N-vinylpyrrolidinone or N-vinylcarbazole, producing tetrahydroquinoline derivatives with high cis/trans selectivities and yields.