Week in review: Prenatal diabetic retinopathy screenings, visual impairment and dementia, visual loss risk with anti-VEGF drugs

A weekly roundup of ophthalmic news from around the web.

No diabetic retinopathy in early pregnancy? Later screening may not be needed. To understand more about the need for prenatal diabetic retinopathy (DR) screening, recommended in the UK during both early and late stages of pregnancy, the UK-based Diabetes in Early Pregnancy Study evaluated eye screening data from 4718 pregnant women with either type 1 or type 2 diabetes. Based on fundus photographs, 65.4% of enrollees did not show signs of DR at 13 weeks (early stage); 74.7% of that group did not develop DR at all during pregnancy. Only 14 women who had no DR at 13 weeks progressed to referable DR or maculopathy. The authors suggest that current guidance for DR screening during late-stage pregnancy be revised to only encompass those who have pre-existing DR in early-stage pregnancy. Eye (London)

In older populations, poor vision may exacerbate dementia risk. Data from 2967 enrollees in the 2021 National Health and Aging Trends Study, a representative panel of Medicare recipients aged ≥65 years, were used to explore potential associations between visual impairment (VI) and dementia. Participants with near or distance VI, contrast sensitivity, blindness, or a combination of these ocular conditions were more likely to have dementia than participants with normal vision. The authors conclude that “prioritizing vision health may be key to optimizing both sight and overall health and well-being,” and recommend conducting randomized trials to further investigate whether optimizing vision can truly help to slow cognitive decline and reduce dementia risk. JAMA Ophthalmology

Anti-VEGF therapy for neovascular AMD can sometimes cause sudden visual loss, according to results from the first published real-world study of severe visual acuity (VA) loss following anti-VEGF therapy for neovascular age-related macular degeneration (AMD). Investigators reviewed records of follow-up visits from 1019 eyes that were given anti-VEGF intravitreal injections for neovascular AMD, and found that 229 eyes (15.1%) experienced at least 1 sudden VA loss of ≥15 letters between injections. Forty-seven eyes experienced multiple VA losses. OCT imaging revealed either onset or increases in several biomarkers, including fibrosis, intraretinal fluid, and subretinal fluid. Patients receiving anti-VEGF therapy may therefore need to be monitored closely in the first several months following onset of treatment. Retina

A potential new diagnostic criterion for multiple sclerosis: the optic nerve. Dissemination in space (DIS) is one of the diagnostic criteria for multiple sclerosis (MS). In an Austrian retrospective study, OCT scans were performed on 269 patients seen for a first demyelinating event. Optic nerve involvement (interocular asymmetry) was found in 36% of patients, and per DIS criteria this group was at a higher risk of a second demyelinating event (HR 8.9). Adding optic nerve performance as an additional neurologic region included in the DIS criteria may lead to OCT becoming a routine diagnostic tool for MS. Neurology